Actual Encounters Research Articles

I Can't Hear You—There Is a Banana in My Ear

Dr Wolff is a board-certified family physician in private practice in Cornelius, North Carolina. He finished his family practice residency in 1997. He has graciously consented to share stories from the trenches of primary care. While his practice diary is taken from actual patient encounters, the reader should be aware that some medication references may represent off-label uses. Identifying details have been changed to protect patient confidentiality. We at the Companion are certain that these vignettes will inform, entertain, challenge, and stimulate our readers in their effort to address behavioral issues in the everyday practice of medicine.

Communication with parents in child welfare: skills, language and interaction

ABSTRACTThis paper reviews the literature on communication between professionals and parents/carers in health and social care. It notes that there is considerable research on doctor–patient communication and counselling, but much less on professionals who visit families in their homes. While there is a large literature on good practice and communication skills, there is little research on the actual encounters themselves. What counts as ‘communication’ in such publications is explored. The paper suggests that there is much to be gained by considering research in discourse analysis and sociolinguistics on professional–client encounters. Examples of some of the key concepts are discussed and an engagement with this literature is recommended.

Video Analysis of Athletic Training Student Performance: Changing Educational Competency into Clinical Proficiency

Context: Assessing clinical proficiency and documenting learning over time is quite challenging. Educators must look for unique ways to effectively examine students' performance and archive evidence of their academic progress. Objective: To discuss the use of video analysis to bridge the gap from educational competency to clinical proficiency, and describe its use in the assessment of clinical proficiency of the athletic training student Background: A consistent challenge in curricular development for any athletic training education program (ATEP) is transforming formal classroom and psychomotor skill learning to the appropriate clinical proficiencies required by the standards for accreditation. Thus, we developed a method to address this challenge that incorporates the use of digital video technology. Description: We describe the use of video in the form of a digital video disc (DVD) as the means to evaluate and assess the student's achievement of specific clinical proficiencies. Additionally we give specific examples of the aspects of video analysis that we have addressed in actual encounters. We present this method as a means to perpetuate the concept of “learning over time.” Clinical Advantage(s): The use of video to analyze student performance during a clinical injury evaluation provides the means of (1) evaluating an athletic training student's clinical proficiency, (2) allowing student input into their psychomotor performance, and (3) developing archival data of student performance for re-evaluation and documentation of learning overtime. Conclusion(s): The use of video analysis represents an effective pedagogical method to educate athletic training students.

The emergence of selection rules and their encounter with group theory, 1913–1927

In today's quantum mechanics and quantum field theory, the observable signature of a symmetry is often sought in the form of a selection rule: a missing radiation frequency, a particle that does not decay in another one, a scattering process which fails to take place. The connection between selection rules and symmetries is effected thanks to the mathematical discipline of group theory. In the present paper, I will offer an overview of how the productive synergy between selection rules and group theory came to be. The first half of the work will be devoted to the emergence of the idea of spectroscopic selection rules in the context of the old quantum theory, showing how this notion was linked with an interpretive scheme of theoretical nature which, once combined with group theory, would bear many fruits. In the second part of the paper, I will focus on the actual encounter between selection rules and group theory, and on the person largely responsible for it: Eugene Wigner. I will attempt to reconstruct the path which led Wigner, of all people, to be the agent effecting this connection.

Antipredator Behavior of the Freshwater MicroturbellarianStenostomum sphagnetorumAgainst the Predatory CiliateDileptus margaritifer

This study investigated defensive behavior by the microturbellarian Stenostomum sphagnetorum against the predatory ciliate Dileptus margaritifer. When S. sphagnetorum was attacked by D. margaritifer, the microturbellarian released a mass of mucous material from the site of attack and swam away, while D. margaritifer ingested the released material. If the attack was repeated, S. sphagnetorum was killed and eaten by the predator. Observations on the predator-prey interactions between these two organisms suggest that the discharge of mucous material by S. sphagnetorum is the main component of defensive behavior. The following findings support this hypothesis: 1) individuals of S. sphagnetorum artificially deprived of glandular secretions through lysozyme treatment were more vulnerable to D. margaritifer and were more sensitive to the predator's toxin than were untreated animals, while they were indistinguishable from intact S. sphagnetorum in external morphology and in the capacity to grow; 2) supernatant containing the D. margaritifer toxin induced in S. sphagnetorum the same behavioral reactions observed in actual encounters with D. margaritifer.

Physician as partner or salesman? Shared decision-making in real-time encounters

The results of recent research have led to the increased advocacy of shared decision-making regarding medical treatment. Nonetheless, only a limited number of studies have focused on the process of decision-making in real-time encounters. The present paper aims to document and analyze this process. Specifically, we assess whether these decisions are the result of partnership or of persuasive tactics based on power and hierarchical relationships. We will describe and analyze different strategies used by pediatric gastroenterologists in breaking bad news encounters, as well as their consequences. The analysis is based on a multi-method, multi-participant phenomenological study on breaking bad news to adolescents and their families regarding a chronic illness. It included 17 units of analysis (actual encounters and 52 interviews with physicians, parents and adolescents). Data were collected from three hospitals in Northern Israel using observations and audiotapes of diagnosis disclosure encounters and audio-taped interviews with all participants. The analysis identified eight different presentation tactics used in actual encounters during which physicians made various use of language, syntax and different sources of power to persuade patients to agree with their preferred treatment choice. The tactics included various ways of presenting the illness, treatment and side effects; providing examples from other success or failure stories; sharing the decision only concerning technicalities; and using plurals and authority. The findings suggest that shared decision-making may be advocated as a philosophical tenet or a value, but it is not necessarily implemented in actual communication with patients. Rather, treatment decisions tend to be unilaterally made, and a variety of persuasive approaches are used to ensure agreement with the physician's recommendation. The discussion is focused on the complexity of sharing a decision, especially in the initial bad news encounter; and the potentially harmful implications on building a trusting relationship between the physician and the family when a decision is not shared.

Assessing Medical Studentsʼ Skills in Working With Interpreters During Patient Encounters: A Validation Study of the Interpreter Scale

Interpreted patient encounters require distinct communication skills. The absence of available reliable, valid, and practical measures hinders the assessment of these skills; therefore, the authors aimed to construct and validate the Interpreter Scale (IS). The authors constructed the IS based on expert consensus and prior studies. They administered the IS to two classes (n = 182) in an interpreted standardized patient (SP) case setting. Standardized interpreters in the examination room assessed, using the IS, students' communication skills. Concurrently, SPs, using the validated Patient-Physician Interaction scale (PPI) and the Interpreter Impact Rating Scale (IIRS), also assessed students' skills. Trained observers watched DVDs and used the Faculty Observer Rating Scale (FORS) to assess student performance. A prior study documented the qualities of the IIRS and FORS. The authors determined the internal consistency reliability and examined construct validity of IS scores through factor analysis and concordance with other measures' scores. IS reliability analysis yielded Cronbach alpha = 0.77. Factor analysis demonstrated two IS dimensions. Nine items, "managing the encounter," and four items, "setting the stage," explained 76% and 15% of score variance, respectively. IS and FORS scores significantly correlated (r = 0.385; P < .0001). IS factor 1 scores significantly correlated (all P < .0001) with FORS (r = 0.402), IIRS (r = 0.277), and PPI (r = 0.332) scores. The IS has reasonable internal consistency reliability and construct validity to warrant use for formatively measuring student communication skills in interpreted SP encounters, and it needs testing in actual patient encounters.

Filipino Children’s Social Construction of Socioeconomic Differences: Everyday Realities of Street Children and Private School Children

Starting with the author's encounter with a stone-throwing incident, which involved different socioeconomic groups of children - street children and private school children - at Katipunan Avenue, this article seeks to understand the processes by which these two groups of children come to know about socioeconomic differences in their everyday lives. It first describes the avenue as an interface situation where encounters between street children and private school children are likely to happen. It subsequently clarifies the modes and the contents of children's knowledge construction of the other at the interface situation. Three findings are drawn from data gathered through key informant interviews and observations. One, children construct their common-sense knowledge of the other as they adjust to or reconcile with their own socioeconomic positions. Two, the ongoing process of knowledge construction involves the reinforcement of their understanding through actual encounters between the two groups and under the influence of other people and elements that are directly and inderectly related to interface encounters. Ultimately, the children themselves actively maintain social reality of socioeconomic differences.

Embodied Anticipation: A Neurodevelopmental Interpretation

This article proposes an approach to the brain's role in communication that treats the brain as the vehicle of a multi-scale embodiment of anticipation. Instead of conceptualizing anticipation as something a brain is able to do when circumstances seem to require it, this study proposes that anticipation is continuous and ongoing because to anticipate is an inherent design characteristic of the brain. Correspondingly, there is no anticipation module in the brain, and no focal lesion selectively abolishes the brain's propensity to anticipate. Anticipation is a wager based on previous experience. It readies a response to an event that has yet to occur. First, the anticipation is “embrained” in terms of covert neural representations, and then it is embodied in terms of rudiments of the embrained actions and expressions of feeling. This study applies this concept to conversation and shows that nested anticipations precede the dynamics of the actual encounter and continue at each turn as long as the conversation lasts.

Byron and Andrić in Sintra: Searching for a Moment of Fervor and Forgetfulness

Byron and Andrić in Sintra:1Searching for a Moment of Fervor and Forgetfulness Dušan Pajin Oh! let that eye, which, wild as the gazelle's,Now brightly bold or beautifully shy,Wins as it wanders, dazzles where it dwells,Glance o'er this page, nor to my verse denyThat smile for which my breast might vainly sigh,Could I to thee be ever more than friend:This much, dear maid, accord; nor question whyTo one so young my strain I would commend,But bid me with my wreath one matchless lily blend.2 Ivo Andrić (1892-1975—Nobel Prize for literature, 1961), wrote some short stories, one of these being "Byron in Sintra." Andrić started the story with the fact that Byron visited Sintra in July 1809. On July 2, Byron embarked at Falmouth and sailed for Lisbon with John Cam Hobhouse. After Portugal, they crossed Spain, and via Gibraltar and Malta, reached Greece. In Greece Byron began Childe Harolde's Pilgrimage, which he continued in Athens. In March 1810, he sailed with Hobhouse for Istanbul, visited the site of Troy, and swam the Hellespont (following Leander, who swam the same route)—evening after evening—to meet his beloved hero. Byron's journey made a lasting impression on him. First the Portuguese and Spanish, and then the Greeks' free and open frankness, contrasted strongly with English manners of his class in those times. He delighted in the sunshine and the moral tolerance of the people. Byron was back in London by July 1811. [End Page 41] When I first read Andrić's story "Byron in Sintra" in the early 1980s, I knew nothing about these details from Byron's biography. I thought that the whole story was fiction—including the name of the place "Sintra." What was important for me, however, was the story itself, and specifically, the encounter between Byron and the "Little creature"—an anonymous Portuguese girl, whom he met by chance, walking through a park in Sintra.3 In this story Andrić explains that only Byron used to call the girl he met near Sintra "Little creature" (Serbian: Malo stvorenje), as no one else knew of the episode. He did not know her name, and it was his way to keep the sweet memory of her alive, for a year, or so; after that time, the "Little creature" started to fade "like a dream in the morning." The encounter of Byron and the "Little creature" happened when Byron went with his company from Lisbon to Sintra, and left them to go to a big park for a long walk by himself. Suddenly, on one of the paths, he met a girl who was standing beside a stone object. She was in a white dress, with a semi-African face, and with clever eyes, full of health and joy. They exchanged greetings. She was smiling and looking him straight in the eyes which, along with her lips, fascinated him. Suddenly he realized that he was ablaze from inside, and felt that on this green peak he had found all that he was ever seeking. Byron felt that in those moments he had all that our dreams promise, but actual life always denies it. While he was walking around her he was fascinated by her eyes, by the smell of her body, by her hair, and by her dress. He felt as if his senses were operating with great intensity, and at the same time enriching and nullifying him as a person. Now he could say what self-transcendence is. Suddenly, he heard the voices of his companions coming closer to the area, and he left the girl—who was a bit puzzled—without a good-bye. After a short walk, he joined his company and went back to Lisbon. He kept the memory to himself for about a year's time, with the scene coming back to him in certain moments when he felt the full sensual fever that he experienced in the actual encounter. And then, the Little creature started to fade away just like a dream as we reach morning. For Byron, ordinary life came back with its encounters, and animosities, as...

THE ART OF WAR: IMAGERY OF THE UPPER TEMPLE OF THE JAGUARS, CHICHEN ITZA

AbstractThis paper reexamines the art and architecture of the Upper Temple of the Jaguars, Chichen Itza, in light of new unpublished digital images of Adela Breton's copies of the murals. Following discussion of the construction date of the building and previous interpretations of the murals, examination of costume, setting, and house form suggests that rather than depicting mythic or symbolic episodes, these murals illustrate actual military encounters between Chichen and its enemies. The occasion for their production seems to be the utilization of the Upper Temple of the Jaguars by a specific sector of Chichen Itza's military, perhaps for rites of investiture. This sector is argued to have been associated with the Cloud Serpent, either as the title of its leader or as a patron deity, and the structure itself is perhaps related to later Nahua buildings associated with penitential rites involving warfare and investiture.

The D&amp;T Report

The D&amp;T Report

Mood Follows the Market

Editor's Note Dr. Wolff is a board-certified family physician in private practice in Cornelius, North Carolina. He finished his family practice residency in 1997. He has graciously consented to share stories from the trenches of primary care. While his practice diary is taken from actual patient encounters, the reader should be aware that some medication references may represent off-label uses. Identifying details have been changed to protect patient confidentiality. We at the Companion are certain that these vignettes will inform, entertain, challenge, and stimulate our readers in their effort to address behavioral issues in the everyday practice of medicine.

THE PHILOSOPHER AND THE TWO PLAYWRIGHTS: SOCRATES, AGATHON, AND ARISTOPHANES IN PLATO'S SYMPOSIUM

This article reflects my current research, exploring the complex interactions between the discursive practices of theatre and performance on the one hand and philosophy on the other. Instead of beginning by trying to formulate the general principles for such an interaction, I examine actual encounters: direct face-to-face meetings and actual dialogues between philosophers and representatives of the Thespian professions. The earliest recorded encounter of this kind is in Plato's Symposium depicting the banquet in Agathon's house, celebrating his victory at the Lenaean theatre festival in 416 b.c., during which the celebrants spent the whole night eulogizing Eros. On this occasion Socrates and the two playwrights, Agathon and Aristophanes, interacted directly on several occasions.

The Importance of Simulation: Preventing Hand-off Mistakes

ries a high risk of adverse events is the hand off—the point at which the patient is transferred, either physically to a different part of the hospital or administratively when a new member of the care team takes responsibility. This is a period of great risk to the patient, because hand offs often occur in a chaotic environment where much is happening at once and opportunities to impart critical information, which may not be reflected on the medical chart, can be limited. The communication and teamwork failures associated with hand offs may be among the most important contributors to preventable adverse events in health care. Nurses, particularly perioperative nurses, end up shouldering a great deal of responsibility for hand offs—and taking an unfair amount of blame when things go wrong. This is because nurses contribute most strongly to the care process when they work as team members on behalf of the patient. Unfor tunately, educational silos, authority gradients, role specialization, and incentives that favor individual rather than team performances pose structural barriers that underlie ineffective communication. As a crucial component of safe care, effective communication among clinicians—including between physicians and nurses at the bedside—is starting to receive the attention it deserves. Because hand offs in particular can be so dangerous, the Agency for Health care Research and Quality (AHRQ) is devoting attention and resources to study how they can be made safer. This effort includes funding simulation re search to analyze real-life medical situations, which are recreated so that health care providers can practice new procedures and techniques before performing them on patients. Simulation is important because, in a variety of clinical settings, it allows health care practitioners and teams to acquire valuable experience safely without placing patients at risk. In addition to gaining this experience, simulation allows researchers to analyze processes that tend to be practiced by rote in order to discover opportunities for improvement that may not be easily detectable during an actual patient encounter. In 2006, AHRQ awarded nearly $5 million for 19 new projects that focus on assessing and evaluating the roles that medical simulation can play to improve the safety and quality of health care delivery. It is hoped that these projects will inform providers, health educators, payers, policymakers, patients, and the public about the effective use of simulation in improving patient safety.

From “Distance” to “Friction”: Substituting Metaphors and Redirecting Intercultural Research

The cultural distance metaphor dominates international management research, promoting a sterile, detached view where static antecedents in the form of artificially constructed differences serve as the dominant lens through which culture is viewed and its impact assessed. We examine culture and its positivist treatment in the foreign direct investment literature using the theoretical and real-world lenses. Adopting a social constructionist approach, we propose cultural friction as a substitute metaphor centered on the actual encounter of cultural systems within a context of power relations and potential conflict between a multinational enterprise and its host country constituencies.

Risky business? Asking tourists what hazards they actually encountered in Thailand

Studies of tourist hazards usually cover only standard ones such as accidents and crimes and often rely on official statistics and media reports, which may underestimate actual encounters. This paper argues for a broader concept of tourist hazard and reports a study in which 616 tourists were asked what challenging experiences they actually had in Thailand, which has many standard and special hazards. Around 40% reported at least one “serious challenging experience/s”, often a scam, constant overcharging, and dual pricing. Around 7% had been a crime victim, usually of theft, but some were mugged or drugged and robbed. Some complained of increasingly unfriendly locals in tourism areas, some about the other tourists, and some reported a negative life-changing experience. Most were satisfied with their visit and planned to return, although those reporting problems were less likely to say so. Thailand might consider broader consular travel warnings and eliminating some particularly disliked official practices.

The service recovery paradox: true but overrated?

PurposeThe paper's aim is to test the existence of the service recovery paradox.Design/methodology/approachTo date, much of the literature exploring the service recovery paradox has generated mixed results. The paper argues that a service recovery paradox is a rare event, which makes its measurement difficult, since the “treatment group” sample size is usually too small to produce significant results. For that reason, the existence of the service recovery paradox in a banking context with more than 11,000 customer interviews based on actual customer encounters is tested.FindingsOverall, the survey findings support the argument that a service recovery paradox is a rare event, and the hypothesized mean differences are, albeit significant, not very large, which diminishes their managerial relevance to some degree.Research limitations/implicationsBecause of the required extremely large sample size, no multi‐item measures were collected. Furthermore, privacy concerns restricted us from a longitudinal study and from linking the survey results to behavioural data. Both limitations are inherent in the chosen setting.Practical implicationsWhile a service failure offers an opportunity to create an excellent recovery, the likelihood of a service paradox is very low. The implications of verifying a service recovery paradox do not suggest that ineffective service followed by an outstanding service recovery is a viable strategy.Originality/valueTo the authors' knowledge, this is the first empirical study testing not only the existence of the service recovery paradox, but also exploring its magnitude and frequency. This is crucial because the paradox is a very rare event, which, in turn, limits its managerial relevance.

Construction of the client in physiotherapy student's practical learning sessions: a discourse analytic study

AbstractIn recent years, there has been a tendency to stress the active role and equal partnership of clients in social and healthcare. Moreover, research in the role of clients has attracted growing interest. Clinical education has been seen as an excellent arena for learning the distinctiveness of the interaction between the client and the professional physiotherapist by giving students the chance to participate in actual healthcare encounters. This study focuses on examining the construction of various client roles through interactions between participants in practical learning sessions that physiotherapy students took part in. These sessions were real professional physiotherapy encounters. Qualitative discourse analysis was applied to 12 videotaped practical learning sessions and four constructions of the client were identified. These interpretative repertoires were named according to the client's role in the interaction as ‘receiver’, ‘executer’, ‘participator’ and ‘fellow’. The identified repertoires represented the multi‐dimensionality and contradictory construction of the client during sessions where two professionals differing in knowledge and skills worked together. Although the professional appeared to play a dominant role in constructing the client role, the client's eagerness to participate was also significant. Extrapolating from the study, we suggest that in aiming to enhance student understanding and practice of patient‐centred physiotherapy, clinical educators should be aware of the interactional practices through which the participation of the client can be supported.

Sources of Uncertainty in Project Management: A “Real Life” Account

Although the studies of IT project management abound, they rarely present in one study the perspective of both the customers and the providers. The very relation between customers and provides has been rather rarely explored (Latusek and Jemielniak, 2007). It may be partially due to the fact that usually neither clients, nor providers, are willing to let outsiders into the details of the project. Through this paper we want to take advantage of our unique research setting in which we were allowed to interview representatives of both parties. Through presenting their stories we wish to cast light on the actual practices of organizing in the project work. At the starting point, we assume the equality of both parties: namely we see both parties, the suppliers and the client, as active and equal actors in their relationships. We see their relationships as interactional processes, created and re-created over time by all parties involved (Berger and Luckmann, 1966/83). In interpreting their stories we would like to draw upon the concept of translation (Callon, 1986; Latour, 1987; Law and Hassard, 1999) that, as we believe, may provide an insightful viewpoint on how relationships between suppliers and customers in IT project work develop. It should be also taken into consideration that the high-tech environment is quite often regarded as very stressful and uncertain (Kunda, 1992; Jemielniak, 2005). On the other hand, uncertainty has also been recognized in management and organization literature as an important factor shaping relationships between providers and customers. It is being consciously played out, especially by consultants in the field of IT (e.g. Sturdy, 1997). Apt management of uncertainty maximization and mitigation helps consultants exert control over the bonds with their customers. We would like to graft the theoretical perspective developed in existing studies onto our empirical research, to see the sources of uncertainty in actual project supplier client encounters.