Doctor-Patient Interaction

U zdravstvu je proteklih decenija veliki značaj dat dobrim interpersonalnim i komunikacionim veštinama kao jednim od ključnih osobina zdravstvenih radnika. Brojna istraživanja empirijskog karaktera su pratila uticaj koji interpersonalna komunikacija ima na ponašanje pacijenata, ishod lečenja i zadovoljstvo uslugom. Cilj ovog rada je bio da se prikaže zdravstvena komunikacija, kroz kratak osvrt na istraživanja usmerena na neverbalnu komunikaciju, u interakciji između lekara, kao zdravstvenog radnika i pacijenta, kao korisnika zdravstvenih usluga. Na osnovu uvida u dostupnu literaturu dat je pregled istraživanja usmerenih na neverbalnu komunikaciju u interakciji između lekara i pacijenta. Karakteristike neverbalnog ponašanja u interakciji,  kao profesionalnom kontaktu između lekara i pacijenta, sagledane su sa aspekta zdravstvene komunikacije. Rezultati su potvrdili da je interpersonalna komunikacija lekara i pacijenta složena, dinamična i pod višestrukim uticajem čitavog spektra različitih faktora. Veštine neverbalne komunikacije lekara su povezane sa mnoštvom pozitivnih rezultata ishoda, kao što su zadovoljstvo pacijenta i lekara, viši nivoi pridržavanja terapijskih preporuka, poboljšani fiziološki pokazatelji i kontrola bolesti, poboljšanje fizičkog i mentalnog zdravlja i funkcionalnog statusa. Razumevanjem interpersonalne komunikacije u okviru dijade lekar–pacijent stvara se dobra osnova za unapređenje efektivnosti i podizanje kvaliteta zdravstvenih usluga.
Ključne reči: ponašanje; neverbalna komunikacija; medjuljudski odnosi; odnosi lekar-pacijent; zdravstveni radnici.

Although oncology is a major site for clinician‒patient treatment negotiation requiring a careful balance of potentially competing viewpoints, little is known about how clinicians promote their treatment recommendations to patients and what the manner of promotion tells us about the oncologist‒patient relationship. Utilizing an already-established schema of coding treatment recommendations, I draw on 61 treatment recommendations to examine treatment decision-making in oncology. This paper inves- tigates how physicians balance asserting their authority while at the same time attending to patient agency and involvement in decision-making. Taking this one step further, this paper explores how physicians negotiate decision-making with patients given that they occupy a liminal state between obligations to policy imperatives and commitments to their professional knowledge and technical expertise. How do they do this, and what accounts for this? To answer these questions, this paper analyzes the ways in which physicians present treatment recommendations and the treatment contexts in which they are made.

This study draws from Grice's conversational implicatures and uses Discourse analysis to explore interactions of doctors and patients during consultations in private clinics. It advances the claim that effective use of communication strategies facilitates common ground as participants get involved in mutual discussion of treatment options, goals, and roles in health management. Extracts from eight transcripts of the audio-recorded interactions serve as data. Results show that communicative strategies of doctors include instances of bureaucratic negotiation and casual inserts, frequent repetitions and explanations, and codeswitching while patients preferred brief answers, asking for confirmation, and giving more information than requested. These strategies promote effective doctor-patient interaction and communication central to doctors' clinical competence and patients' health status, satisfaction, and health care.

This paper examines opening question designs in seventy transcribed audio recordings of doctors' conversations with HIV-positive patients in Southwestern Nigeria, using the methodology of conversation analysis (CA). Results show that in the opening phases of the conversations, doctors adopt Wh questions and polar questions to initiate interactional tasks. These task-talks, which investigate patients' adherence to medical recommendations, are further contextualised by medical history-taking sequences and two social actions: reading patients' medical records and refuting patients' adherence claims. Consequently, opening question designs set interactional agendas and provoke social distance and institutional roles between the doctors and patients. This paper argues that task-based opening question designs offer a perspective on understanding the problem of compliance in doctor/patient conversations at least, within the specific medical context of chronic-routine HIV patients' visits in Southwestern Nigeria.

The public has questioned many of the previously accepted medical treatments. One of the factors highlighted is the uprising of social demands influenced by religious-centred ideation. Even though medical practitioners are regarded as one of the noble professions in society, their professional opinions are started to be questioned. To complement this social phenomenon, we reviewed and construct models of doctor-patient relationships from the religious perspective, Islamic jurisprudence in particular. Most discussions related to doctor-patient relationship focused on codes of conducts such as medical ethics, professionalism, and confidentiality. In this brief review, we would like to highlight more on the models of doctor-patient relationship and the Islamic rulings related to it. The rulings were reviewed from various aspects pertaining to the patient who seeks for treatments, the doctor who provides the medical services or treatment, involvement of a third party, and the form of agreement involving all related parties. The rulings were derived from the five basic rules pertaining to the actions and interactions of a person (al-ahkam al-taklifiyyah). Relationship models were classified based on the profitability of the service rendered, types of contract involved, as well as the related Islamic rulings. The obligation of becoming a medical practitioner varies depending on various factors. Similarly, the rulings on patients seeking for treatment for medical illnesses remain debatable among religious scholars. Models of doctor-patient relationship can be summarized into four models; Model A-Charitable Work, Model B-Profit-based, Model C-Civil Servant, and Model D-Private Employee. Providing medical services is indeed a noble obligation. However, it involves certain requirements and principles in relation to the religious rulings that may differ from what are commonly practiced. © 2014 AENSI Publisher All rights reserved. To Cite This Article: Mohd Ariff Sharifudin, Wan Rumaizi Wan Husin, Mai Nurul Ashikin Taib, Religious Perspective of Doctor-Patient Relationship Models in Complementing Uprising Social Phenomenal Demands. Aust. J. Basic & Appl. Sci., 8(8): 34-37, 2014

Dr. Miles Shore seems to take the shortsighted view in his commentary entitled “Patient or Client” in the December, 1988 issue. Citing Webster, Dr. Shore claims that a patient “is a sick individual, eps. when awaiting or under the care and treatment of a physician or a surgeon” and a client is “a person who engages the professional service or services of another…[esp in] a social agency or public institution.” So henceforth “patients” with chronic mental illness are more properly “clients” except during the relatively brief times when they are acutely ill, although Dr. Shore also grants that “they may continue to need medical monitoring of symptoms and medication and thus be patients as well.”

But let us return to the dictionary for another look. Skeat’s “Etymological Dictionary” traces both “client” and “patient” back to Roman antiquity and earlier.  According to Skeat, “client” is derived originally from the Indo-Germanic root “kleu,” to hear, and takes independent form as the Latin “clientum,” “a dependent on a patron.” On the other hand, “patient” is traced back to the Latin “pati,” to suffer, as in “bearing pain, enduring long suffering.” Skeat also relates “patient” to “passion,” defined as “strong agitation of the mind, suffering,” and further relates it to “com-passion.”

These critical distinctions persist in modern times. For example, the authoritative Oxford English Dictionary defines “client” as “1. Rom. Antig. A plebian under the patronage of a patrician…… 2. One who is under the protection of patronage of another, a dependent …… a ‘hanger-on’ ….. vassals or retainers ..... an adherent of follower of a master. 3. One who employs the services of a legal advisor in matters of law. 4. A person who employs the services of a professional or business man in any branch of business, or for whom the latter acts in his professional capacity; a customer".

On the other hand, the Oxford Dictionary defines patient as “A.1. Bearing of enduring (pain, affliction, trouble, or evil of any kind) with composure ….. long suffering, forebearing …. 2. Enduring or able to endure …. 3. Undergoing the action of another…… B.1. A sufferer … esp. One who suffers from bodily disease; a sick person. 2. One who is under medical treatment for the cure of some disease or wound; one of the sick persons whom a medical man attends…

Digital technologies are increasingly embedded in clinical encounters, reconfiguring the basis on which health care is delivered. Thereby, the delivery of care shifts from territorial locations in clinics and temporal modes of co-presence towards digital platforms. Drawing on a sociotechnical evaluation of digitised patient follow-up in HIV care, this paper argues that the forms of interactivity practised in platform encounters cannot be adequately understood through traditional interaction frameworks such as Erving Goffman's interaction order. To conceptualise the new in-formational space and temporal mode of 'response pres-ence' within which platform encounters are conducted, the paper draws on theoretical advances made by Karin Knorr Cetina who further developed Goffman's interaction order to describe interactions augmented by 'scopic media'. A comprehensive framework is presented to elaborate the distinct qualities of interactions occurring in face-to-face, tele-interaction and platform encounters and to analyse their affordances based on doctor and patient experiences. This framework is intended to stimulate further research on how new interactional forms between doctors and patients will reconfigure roles and responsibilities as well as wider structures of digital society. Furthermore, it can also support practical guidance of when and how different forms of clinical encounters may be integrated in care pathways.

This study draws from Grice’s conversational implicatures and uses Discourse Analysis to explore interactions of doctors and patients during consultations in private clinics. It advances the claim that effective use of communication strategies facilitates common ground as participants get involved in mutual discussion of treatment options, goals, and roles in health management. Extracts from eight transcripts of the audio-recorded interactions serve as data. Results show that communicative strategies of doctors include instances of bureaucratic negotiation and casual inserts, frequent repetitions and explanations, and codeswitching while patients preferred brief answers, asking for confirmation, and giving more information than requested. These strategies promote effective doctor-patient interaction and communication— central to doctors’ clinical competence and patients’ health status, satisfaction and health care.

In this article, we contribute to understanding the interactional aspects of making clinical diagnosis in mental health care. We observe that therapists, during the “problem presentation” sequence in clinical encounters, often use a specific form of diagnostic formulations to elicit more diagnostically relevant information. By doing so, they often substitute one type of verb with another, following a diagnostic hypothesis. Specifically, in interviews that arrive at a diagnosis of neurosis, therapists formulate with behavioral verbal processes; in interviews that arrive at a diagnosis of psychosis, they do so with material ones. Such formulations often prove useful to define clinical diagnoses. They can, however, also be dangerous in that they may favor the therapist’s agenda over the patient’s. Our analysis helps therapists not only better understand the diagnostic process but also reflect upon their own use of diagnostic formulations and become aware of the clinical effects of their interactional performance.

Neste artigo, apresenta-se o fenômeno interacional da
formulação, inicialmente descrito por Garfinkel e Sacks (1970) e posteriormente elaborado por Heritage e Watson (1979, 1980), que pode ser entendido como uma prática utilizada por interagentes para demonstrar explicitamente sua compreensão de partes de uma conversa ou de ações realizadas nessa conversa. Discutem-se as características principais da formulação e a importância do fenômeno no trabalho organizacional da conversa. Em seguida, apresentam-se um estudo comparativo realizado por Drew (2003), que identifica as diferentes tarefas interacionais realizadas por formulações em contextos institucionais diversos. Finalmente, são analisadas interações gravadas e transcritas provenientes de consultas ginecológicas e obstétricas em um posto do Sistema Único de Saúde que se apresenta como tendo aderido à Política de Humanização do SUS (HumanizaSUS). Por meio da análise, especula-se sobre a possível relação entre a política de humanização (nível macro) e a prática interacional de formular (nível micro). Ou seja, propõe-se a possibilidade de se pensar
os objetivos da política de humanização do SUS como traduzíveis em práticas interacionais específicas – nesse caso, a de formular.