Doctor-patient Rapport Research Articles

Knowledge, perceptions and attitudes of medical doctors toward elderly sexuality in Tunisia

IntroductionThe sexual health of the elderly presents certain particularities to be taken into consideration in the doctor-patient rapport. The aim of our study was to assess physicians’ knowledge and attitudes towards sexuality in the elderly in Tunisia and to determine variables associated with the level of knowledge and the nature of attitudes in this population.ObjectivesThe aim of our study was to assess physicians’ knowledge and attitudes towards sexuality in the elderly in Tunisia and to determine variables associated with the level of knowledge and the nature of attitudes in this population.MethodsA descriptive and analytical study was conducted among specialists and medical residents of all specialties, practicing in Tunisia and recruited anonymously online. We included questions on socio-demographic data, medical specialty and medical training of physicians as well as a French translation of the Aging Sexual Knowlesge and Atttidues Scale (ASKAS). We determined correlations between the socio-demographic and medical training variables and the ASKAS score among participants.ResultsWe included 74 physicians in the study. Sixty-two percent of the doctors surveyed sometimes asked elderly patients about their sexuality (N=46) and the rest of the doctors never mentioned the subject during a medical consultation (N=28). The major obstacles reported when discussing sexuality with the elderly were: a feeling discomfort related to sexuality considered a taboo subject (77%), lack of information and skills (51%) and the duration and setting of the medical consultation considered inadequate (45%). The mean score for the knowledge subcategory of the Aging Sexual Knowledge and Atittudes Scale (ASKAS) was 68.49±5.5 and for the attitudes subcategory was 83.74±4.2. These results indicated a moderate level of knowledge and moderate to negative attitudes.There was a significant and negative correlation between age and the ASKAS knowledge subcategory score (r= -0.75, p=0.026), as well as a significant positive correlation between the knowledge and attitudes subcategories scores and sexology training (p<0.001).The correlation between the knowledge score and the attitudes score was significant, positive, and good (r=0.788, p<0.001): the lower the level of knowledge, the more negative the attitudes regarding elderly sexuality.ConclusionsThere are several gaps in the knowledge and perceptions of Tunisian physicians regarding the sexuality of older subjects. Theoretical teaching and practical anti-ageing training for health professionals are needed.Disclosure of InterestNone Declared

TELE-ANC model in public sector in India: a feasible option to sustain quality antenatal care

Introduction: Prenatal care is one of the most widely used preventive strategies in healthcare. Despite rapid advances in medical practice over a century, obstetric care remains ‘traditional’. It is resource intensive with heavy footfall in public sector antenatal OPD leading to compromise in quality of care. Therefore, hybrid ‘TELE-ANC model’ is a feasible option to sustain quality care in limited resource setting. We assessed feasibility of this model in reducing ‘in-person visits’ in terms of provider, process and recipient and determined barriers and facilitators to implementation and robustness of process in delivering the model. Methods: Single center prospective feasibility study, composed of 50 low-risk women within 20 weeks of pregnancy; recruited from outpatient obstetric department. Model had 5 in-person and 4 virtual visits. During in-person visits; history, general and systemic examination, ANC investigations and ultrasounds were done and clubbed; counseling and treatment were advised. During virtual visit, patients monitored blood pressure, pulse, weight and fetal movements at home. Pictures of prescription were sent on patients’ phones with records maintained by provider. Patients and provider filled detailed Satisfaction Performa after each virtual visit and last antenatal visit which were measured through Likert scale. Results: Each pregnant woman on an average made 5 physical and 5 virtual visits (one extra than proposed 4 in the model). Each patient saved approximately 10 productive hours and 700 Rupees during their antenatal period. Doctor was able to implement services readily. Adequacy to conduct virtual visits, successful decision making, technical issues faced, ease and safety of process and overall improvement in access to healthcare and positive change, demonstrates high levels of Provider satisfaction score of >80% overall. There was high patient satisfaction score of 80 to 90% in areas assessed i.e., satisfaction with the care received, doctor-patient rapport, knowledge about pregnancy, convenience of self-monitoring and ability to contact provider during emergencies. Nearing term, patients had satisfaction score of 85-90% overall in ability to express, continuation of visits post COVID, reduction in overall cost and time, desire for such a model in future and positive change. Minimal technological barriers were identified which did not adversely impact the quality of care. It is ‘Good’ in terms of its robustness. 96% of patients desired hybrid model as mode of future antenatal care. Discussion: Due to rapid increase in use of telehealth during COVID-19 pandemic, we were encouraged to test feasibility of a reduced in-person visit hybrid model; ‘The TELE-ANC model’ in a tertiary care public hospital. It is feasible in delivering an efficient antenatal care with additional advantages of lower cost, greater doctor-patient rapport, increased patient’s productivity, increased patient satisfaction, better continuity of care, better time management and increased provider engagement and satisfaction. It has potential to be standard care model for antenatal services in future leading to a more flexible and patient centered care

Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study

BackgroundDeprescribing can be a challenging and complex process, particularly for early career doctors such as primary care trainees. To date, there is limited data from patients’ and doctors’ perspectives regarding the deprescribing of medications in older persons, particularly from developing countries. This study aimed to explore the necessities and concerns of deprescribing in older persons among older ambulatory patients and primary care trainees.MethodsA qualitative study was conducted among patients and primary care trainees (known henceforth as doctors). Patients aged ≥ 60 years, having ≥ 1 chronic disease and prescribed ≥ 5 medications and could communicate in either English or Malay were recruited. Doctors and patients were purposively sampled based on their stage of training as family medicine specialists and ethnicity, respectively. All interviews were audio-recorded and transcribed verbatim. A thematic approach was used to analyse data.ResultsTwenty-four in-depth interviews (IDIs) with patients and four focus group discussions (FGDs) with 23 doctors were conducted. Four themes emerged: understanding the concept of deprescribing, the necessity to perform deprescribing, concerns regarding deprescribing and factors influencing deprescribing. Patients were receptive to the idea of deprescribing when the term was explained to them, whilst doctors had a good understanding of deprescribing. Both patients and doctors would deprescribe when the necessity outweighed their concerns. Factors that influenced deprescribing were doctor-patient rapport, health literacy among patients, external influences from carers and social media, and system challenges.ConclusionDeprescribing was deemed necessary by both patients and doctors when there was a reason to do so. However, both doctors and patients were afraid to deprescribe as they ‘didn’t want to rock the boat’. Early-career doctors were reluctant to deprescribe as they felt compelled to continue medications that were initiated by another specialist. Doctors requested more training on how to deprescribe medications.

Patient and Physician Satisfaction with Telemedicine in Cancer Care in Saskatchewan: A Cross-Sectional Study.

Background: Telemedicine is a useful tool that connects patients to their care team remotely and improves access to medical care for rural residents. This study aimed to determine the telemedicine experience of both rural patients with cancer and their physicians, and to explore factors associated with a positive patient experience. Methods: In this cross-sectional study, cancer patients and physicians in Saskatchewan completed a paper-based survey composed of 32 items or an electronic survey of 18 items, respectively. Logistic regression analysis was performed to assess patient satisfaction in relation to various sociodemographic and cancer-related factors. Results: Overall, 25 physicians and 165 patients participated in the study. Among the physicians, 94% were confident in their telemedicine assessment, 58% agreed that telemedicine improved clinical efficiency, and 73% agreed that doctor–patient rapport was unimpaired with telemedicine. Of 165 patients, 61% had used telemedicine for the first time, 81% felt that their needs were met, 83% were satisfied with the quality of their care, and 88% had a positive experience. Overall, 83% patients vs. 45% physicians preferred telemedicine to a face-to-face clinic visit (p = 0.005). On univariate analysis, patients ≥ 65 years old had a greater positive telemedicine experience compared to patients < 65 years old (odds ratio 4.1 [1.2–13.8], p = 0.02). Conclusion: Both patients and physicians have a high rate of positive experiences with telemedicine. However, patients have a higher preference for telemedicine over face-to-face visits compared to physicians. In addition, elderly patients have more positive telemedicine experiences compared to younger patients.

Facilitators and barriers to reducing chemotherapy for early-stage breast cancer: a qualitative analysis of interviews with patients and patient advocates

BackgroundAs the combination of systemic and targeted chemotherapies is associated with severe adverse side effects and long-term health complications, there is interest in reducing treatment intensity for patients with early-stage breast cancer (EBC). Clinical trials are needed to determine the feasibility of reducing treatment intensity while maintaining 3-year recurrence-free survival of greater than 92%. To recruit participants for these trials, it is important to understand patient perspectives on reducing chemotherapy.MethodsWe collected qualitative interview data from twenty-four patients with Stage II-III breast cancer and sixteen patient advocates. Interviews explored potential barriers and facilitators to participation in trials testing reduced amounts of chemotherapy. As the COVID-19 pandemic struck during data collection, seventeen participants were asked about the potential impact of COVID-19 on their interest in these trials. Interviews were audio-recorded and transcribed, and researchers used qualitative content analysis to code for dominant themes.ResultsSeventeen participants (42.5%) expressed interest in participating in a trial of reduced chemotherapy. Barriers to reducing chemotherapy included (1) fear of recurrence and inefficacy, (2) preference for aggressive treatment, (3) disinterest in clinical trials, (4) lack of information about expected outcomes, (5) fear of regret, and (6) having young children. Facilitators included (1) avoiding physical toxicity, (2) understanding the scientific rationale of reducing chemotherapy, (3) confidence in providers, (4) consistent monitoring and the option to increase dosage, (5) fewer financial and logistical challenges, and (6) contributing to scientific knowledge. Of those asked, nearly all participants said they would be more motivated to reduce treatment intensity in the context of COVID-19, primarily to avoid exposure to the virus while receiving treatment.ConclusionsAmong individuals with EBC, there is significant interest in alleviating treatment-related toxicity by reducing chemotherapeutic intensity. Patients will be more apt to participate in trials testing reduced amounts of chemotherapy if these are framed in terms of customizing treatment to the individual patient and added benefit—reduced toxicities, higher quality of life during treatment and lower risk of long-term complications—rather than in terms of taking treatments away or doing less than the standard of care. Doctor-patient rapport and provider support will be crucial in this process.

An overview of orthodontic malpractice liability based on a survey and case assessment review.

BackgroundThe purpose of this survey study and case review was to identify 1) the common causes related to filing a malpractice claim against an orthodontist and, 2) the factors mitigating against a potential malpractice claim in the United States (U.S). The objectives of the case review were to examine the current state of orthodontic malpractice litigation from a cause and mitigating point of view. Material and MethodsData for this research was collected and reviewed using the following two methods: 1) A survey questionnaire on aspects of malpractice liability was electronically distributed to 2,241 active U.S. members of the American Association of Orthodontists (AAO). 2) Legal cases were reviewed on the online legal research database Lexis Advance Research, and 35 cases were analyzed. ResultsSurvey questionnaire results and legal case review results are as follows: 1) 77 orthodontists completed the survey. 9.1% of the respondents reported a malpractice claim having been filed against them with periodontal issues accounting for most of the claims. Survey participants reported good doctor-patient communication as being the most relevant contributory factor and most relevant mitigating factor in malpractice claims. 2) Negligence is the main reason patients sue a doctor for clinically related litigation, and failure to obtain a proper informed consent from the patient is the main cause of action for non-clinically related litigation. ConclusionsMost respondents reported doctor-patient communication, periodontal issues, and a lack of informed consent as the main triggering elements of a lawsuit, which is similar to other studies and case review analysis. Good doctor-patient rapport was ranked as being most helpful in mitigating a potential claim, which is also similar to other studies. Another aspect of the survey questionnaire that was evaluated was whether a non-orthodontist can provide expert testimony against an orthodontist, with most respondents reporting that this is not possible. It has been ruled, though, that a general dentist can be an expert witness and provide expert testimony against an orthodontist in a lawsuit depending on the circumstances. Negligence was the most common cause of clinically related orthodontic litigation, and a failure of the practitioner to obtain a proper informed consent from the patient was the most common cause of non-clinically related orthodontic litigation. Key words:Orthodontist, malpractice, legal, lawsuit, liability, medicolegal.

Assessing attitudes of patient-centered care among chiropractic students at a South African university.

Patient-centered care (PCC) is acknowledged globally as a foundation of quality patient care and key to doctor-patient rapport. Student attitudes toward PCC have been assessed in some health professions and some international chiropractic institutions but is lacking in the South African chiropractic student context. This study explores this concept and compares these attitudes to other student groups. A cross-sectional survey was conducted on chiropractic students (years 1, 3, 5, and 6) at a South African institution. The 18-item Patient-Practitioner Orientation Scale (PPOS), with scoring 1-6 on a Likert scale, was used to evaluate the attitude toward PCC by students. Higher scores were representative of more patient-centeredness. Variables were analyzed to assess for associations between variables. Mean PPOS scores were calculated, and reliability and validity were tested using Cronbach α and factor analysis. There were 100 respondents (68% response rate). The PPOS showed unsatisfactory reliability in our sample. The mean scores for the overall PPOS were 3.64 (SD = 0.46), the sharing subscale was 2.99 (SD = 0.61), and the caring subscale was 4.29 (SD = 0.58). There were small but suggestive trends noticed in PPOS scores based on age, sex, and year of study. Chiropractic students from our university showed a general positive tendency toward PCC with no association between age and year of study. Sex showed some suggestive descriptive trends contrary to findings in other studies. The PPOS showed poor reliability in this study, warranting consideration with its use in similar contexts.

Barriers, facilitators, and resources to opioid deprescribing in primary care: experiences of general practitioners in Australia.

Deprescribing is the systematic process of discontinuing drugs when harms outweigh the benefits. We conducted semistructured telephone interviews with 22 general practitioners (GPs) who had prescribed or deprescribed opioids in patients with chronic noncancer pain within the past 6 months to investigate the barriers and facilitators to deprescribing opioid analgesics in patients with chronic noncancer pain. We also explored GPs' perspectives on the available resources to assist them with opioid deprescribing. Interviews were audio-recorded, transcribed verbatim, and then coded using an iterative process until data saturation reached. The thematic analysis process identified themes, first as concepts, and then refined to overarching themes after the merging of similar subthemes. Themes exploring barriers to deprescribing highlighted the difficulties GPs face while considering patient factors and varying prescribing practices within the confines of the health system. Patient motivation and doctor-patient rapport were central factors to facilitate deprescribing and GPs considered the most important deprescribing resource to be a multidisciplinary network of clinicians to support themselves and their patients. Therefore, although GPs emphasised the importance of deprescribing opioid analgesics, they also expressed many barriers relating to managing complex pain conditions, patient factors, and varying prescribing practices between clinicians. Some of these barriers could be mitigated by GPs having time and resources to educate and build rapport with their patients. This suggests the need for further development of multimodal resources and improved support through the public health system to enable GPs to prioritise patient-centred care.

Telehealth and chronic pain management from rapid adaptation to long-term implementation in pain medicine: A narrative review.

The COVID-19 pandemic called for drastic changes to expand and rapidly implement telehealth to prevent breach of care for chronic patients. Responding to the challenge of implementing remote care in chronic pain services, a specialty highly dependent on doctor-patient rapport, physical examination, and frequent follow-up visits requires extensive adaptation involving administrative processes and clinical routines. We present our experience of a successful rapid adaptation to telemedicine paradigm as a response to the COVID-19 pandemic during a time of marked restriction of access to ambulatory hospital services for pediatric and adult chronic pain patients. This narrative review covers current scientific evidence for the use of telehealth for chronic pain management and describes in detail the challenges to implement telemedicine in ambulatory clinics from different perspectives. Best practices for telehealth use are recommended. A proposal for remote physical examination of pain patients is made, based on available evidence in the fields of musculoskeletal medicine and neurology comparing in-person vs remote physical examination. As an internal quality control process, an informal online survey was conducted to assess thoughts and experiences among patients and caregivers using telemedicine consultation services at the pediatric pain clinic. Providing chronic pain management services through telehealth is a viable option for many patients and health care professionals. This is reliant on the availability of appropriate materials and training, with guidelines for both patients and health care workers. With the rapid pace of technological advancements, even further integration of telehealth into routine health care is possible.

Development of Doctors Attire According to Patients Preferences

Background: Doctor-patient rapport can be built in various ways, and it also includes non-verbalcommunication. Medical attire is an example of non-verbal communication that affects the patient’s comfortand perception of a doctor. Medical attire that suits patient’s preferences has a positive effect on the patient’strust and comfort.Objective: This study aims to know about patient’s preference towards doctor attire, so it will be a guide fordoctor building good rapports in doctor-patient communication.Method: This research is an analytical observational study with cross-sectional approach. Using consecutivesampling method, a sum of 6467 Indonesians was taken as samples. The data acquired from questionnairevia google form include age, sex, level of education, and patient’s rate of comfort for doctor apparel. Toanalyze the data, both Independent T test and One Way Anova were conducted.Result: White coat, basic pants, formal shoes, watch, and glasses are male doctors’ garments that patientsfind very comfortable. On female doctors, the pieces of clothing that patients are very comfortable with arewhite coat, basic pants, formal shoes, and hijabs. There is a significant result in comparison at each attire(p<0,05).Conclusion: The attire that patients find very comfortable to be worn by doctors are white coat, basic pants,formal shoes, hijabs (on women), watch, and glasses.

1791P - Patients and physicians’ satisfaction with telemedicine (TM) in cancer care and factors that correlate with a positive patient’s experience

BackgroundTM is a useful tool that improves access to medical care for rural residents. However, factors that correlate with a positive TM experience are not well known. The study aims to determine TM experience in cancer patients and physicians, and to explore clinical and socio-economic factors (CSF) that are associated with a positive TM experience in patients. MethodsIn this cross-sectional study cancer patients on active treatment and physicians in the province of Saskatchewan, Canada completed a paper-based comprised of 32 items or an electronic survey of 18 items, respectively. Six point likert score was used. Logistic regression analysis was done to assess correlation between self-reported CSF and a positive TM experience. We present here preliminary results. ResultsOverall 25 physicians and 165 patients responded to the survey over a period of three months. Among physicians 69% were in practice for ≥10 yrs with M:F of 1.7:1. 94% were confident in their TM assessment, 58% felt that TM improve clinical efficiency, and 74% felt that doctor-patient rapport was unimpaired with TM. Of 165 patients with median age of 67 years (IQR 59-75) and M:F of 1.06:1, 60% were ≥65 yrs, 70% were married, and 82% had a dependent family member. 94% were born in Canada, 77% were Caucasian, 29% were working and 35% had annual income of<40K. 67% had solid tumor, 46% reported having a curable cancer, 31% had surgery, 27% had radiation, and 62% had chemotherapy. 61% used TM first time. 90% felt that their needs were met, 91% felt that TM improved their quality of care, and 91% had a good experience. Overall, 83% patients vs. 45% physicians preferred TM to in-person clinic visit (P=0.005). Only univariate analysis only age ≥65 was strongly associated with a positive TM experience, odd ratio 4.1 (1.2-13.8), p=0.02. No other CSF including marital status, income, working status, dependent family member, and cancer type were significantly correlated with a positive TM experience. ConclusionsThis study supports a higher rate of positive TM experience in cancer patients and physicians. However, high preference of TM was noted among patient compared with physicians. Among various variables examined only older age was associated with a positive TM experience. Legal entity responsible for the studyShahid Ahmed. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Delivery of patient-centered care in complementary medicine: Insights and evidence from the Chinese medical practitioners and patients in primary care consultations in Hong Kong

IntroductionTraditional Chinese Medicine (TCM) has become increasingly popular around the world, and has been accepted by people not only in China and Southeast Asia, but also in Western countries. Despite its historic role in the Chinese society, there has been limited research on exploring the nature of TCM practitioner-patient interactions in the Chinese context. As indicated by a major study regarding the Hong Kong context1, there is a need to investigate the role of TCM practitioner and promote interdisciplinary research to ensure safety and synergy of TCM and Western medicine in primary care. This study aims to address this gap by investigating the nature of TCM consultations and their communication patterns in Hong Kong. MethodsBased on 10 h of conversations (in Cantonese) between TCM practitioners and their patients in the diagnostic interviews, the study explored how the doctor-patient relationship was negotiated in the course of the consultation, while both the TCM practitioners and the patients were constantly trying to manage and maintain common ground. Particular attention had been paid to the identification of specific linguistic and discourse strategies that TCM practitioners had employed to establish doctor-patient rapport, so that a better understanding of patient-centred care in the TCM context could be obtained. The participants were recruited from a local university operated clinic which shared the characteristic of TCM practitioners in Hong Kong. ResultsA range of linguistic strategies that TCM practitioners used to deliver patient-centred care have been identified. These strategies are also helpful in shaping a joint decision-making process that will lead to better patient understanding and compliance with the doctors’ treatments. ConclusionsThis study demonstrates empirically how TCM practitioners utilize a range of linguistic resources and communication strategies to shape the ongoing discourse so that their patients can have a better understanding of their illnesses. For an example, it is found that TCM practitioners and their patients were constantly trying to manage and maintain common ground by using a range of grammatical markers, including sentence-final particles (SFPs) and discourse markers (DMs), to negotiate the epistemic commitment so that the patient would have good compliance with the practitioner’s suggested treatment. It is also observed that various types of interrogatives have been used by the TCM practitioners to elicit information from the patients as well as to encourage them to talk and make a response. Furthermore, it is found that TCM practitioners would deliberately enquire about the patients’ everyday experiences because what they eat, do, and encounter all have an important impact on their body conditions. By exploring into the patients’ daily routines in the social talk, the practitioner can help maintain and promote the overall balance of the patient’s body, and help them monitor and enhance their health conditions by modifying their daily habits and behaviours. With the adoption of these linguistic and communication strategies, the TCM practitioners are shown to have placed the patients’ needs as their top priority. Previous studies in the field have already proved that co-construction of the treatment plan between the doctor and the patient is extremely important, and that a patient-centred approach can largely reduce adverse events leading to avoidable patient harm. The specific strategies identified in the current study can enhance the TCM practitioners’ communication with patients, creating an environment that will surely optimise safety for both patients and clinicians.

Dermatological life quality index in psoriasis out patients: the changing trend

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Psoriasis is a chronic inflammatory disease characterized by remissions and exacerbations, having great impact on social and psychological aspects. From mild plaque psoriasis to more severe pustular and erythrodermic forms with or without joint involvement, is known to have a negative impact on QOL (Quality of Life). Appropriate treatment will improve both disease outcome and QOL in patients. The objective of the study was to assess QOL in psoriasis patient of different age group, type, duration and severity of disease, and their response to this assessment.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross sectional study was done with pretested DLQI questionnaire on 101 psoriasis patients, in a government hospital. Interpretation of score and impact on QOL was done and graded as mild, moderate, considerable, severe and very severe.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, females outnumbered males with male female ratio of 1:1.5. The mean age 39.56±16.029 years. No significant association was noted between grade of affection and demographic variants. Most of them had moderate impact on QOL. QOL was worst affected in patients &amp;lt;5 years of disease duration. 85% of the patients felt happy &amp;amp; 15% felt neutral on being evaluated by this questionnaire.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It is suggested that DLQI is assessed in all new/patients with less than 5 years of disease. Appropriate systemic/photo therapy to be initiated even in mild disease if there is negative impact on the QOL. Assessment of QOL strengthens the doctor-patient rapport and improves better patient adherence to therapy and achieves faster and better control of the disease.&lt;/p&gt;

Assessing the extent of utilization of biopsychosocial model in doctor-patient interaction in public sector hospitals of a developing country.

Background:Biopsychosocial (BPS) model has been a mainstay in the ideal practice of modern medicine. It is attributed to improve patient care, compliance, and satisfaction and to reduce doctor–patient conflict. The study aimed to understand the importance given to BPS model while conducting routine doctor–patient interactions in public sector hospitals of a developing country where health resources are limited. The study was conducted in Rawalpindi, Pakistan.Materials and Methods:The study design is qualitative. Structured interviews were conducted from 44 patients from surgical and medical units of Benazir Bhutto Hospital and Holy Family Hospital. The questions were formulated based on patient-centered interviewing methods by reviewing the literature on BPS model. The analysis was done thematically using the software NVivo 11 for qualitative data.Results:The study revealed four emerging themes: (1) Lack of doctor–patient rapport. (2) Utilization of a paternalistic approach during treatment. (3) Utilization of a reductionist biomedical approach during treatment. (4) Patients’ concern with their improvement in health and doctor's demeanor.Conclusion:The study highlights the fact that BPS is not given considerable importance while taking routine medical history. This process remains doctor centered and paternalistic. However, patients are more concerned with their improvement in health rather than whether or not they are being provided informational care. Sequential studies will have to be conducted to determine whether this significantly affects patient care and compliance and whether BPS is a workable model in the healthcare system in the third world.

Therapeutic Benefit of the Anesthesiologist–Patient Relationship

The psychologic effect of the preoperative visit by an anesthetist has been compared with the effect of pentobarbital for preanesthetic medication. Patients receiving pentobarbital 1 hour before an operation became drowsy but it could not be shown that they became calm. Patients who had received a visit by an anesthetist before operation (informing them about the events which were to occur on the day of operation and about the anesthetic to be administered) were not drowsy but were more likely to be calm on the day of operation. The importance of the preoperative visit probably explains, in part, the difficulties previous investigators have had in showing sedative effects from the barbiturates and narcotics before operation. The tremendous emotional significance to a patient of illness or an operation may explain why physicians are able to exert such influence upon their patients.

A mobile phone application for the assessment and management of youth mental health problems in primary care: health service outcomes from a randomised controlled trial of mobiletype

BackgroundGPs detect at best 50c of mental health problems in young people. Barriers to detecting mental health problems include lack of screening tools, limited appointment times and young people’s reluctance to report mental health symptoms to GPs. The mobiletype program is a mobile phone mental health assessment and management application which monitors mood, stress and everyday activities then transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. The current aims were to examine: (i) mobiletype as a clinical assistance tool, ii) doctor-patient rapport and, iii) pathways to care.MethodsWe conducted a randomised controlled trial in primary care with patients aged 14 to 24 years recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress and daily activities were monitored) or the attention-comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants and researchers were blind to group allocation at randomisation. GPs assessed the mobiletype program as a clinical assistant tool. Doctor-patient rapport was assessed using the General Practice Assessment Questionnaire Communication and Enablement subscales, and the Trust in Physician Scale (TPS). Pathways to care was measured using The Party Project’s Exit Interview.ResultsOf the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention n = 68, attention-comparison n = 46). T-tests showed that the intervention program increased understanding of patient mental health, assisted in decisions about medication/referral and helped in diagnosis when compared to the attention-comparison program. Mixed model analysis showed no differences in GP-patient rapport nor in pathways to care.ConclusionsWe conducted the first RCT of a mobile phone application in the mental health assessment and management of youth mental health in primary care. This study suggests that mobiletype has much to offer GPs in the often difficult and time-consuming task of assessment and management of youth mental health problems in primary care.Trial registrationClinicalTrials.gov NCT00794222

Community‐based study on psychological comorbidity in functional gastrointestinal disorder

Functional gastrointestinal disorder (FGID) is one of the commonest digestive diseases worldwide. Current evidence supports a bio-psycho-social pathophysiological model for FGID, which underscores the importance of psychological and social factors in development of FGID. Concomitant psychological disorders, which include anxiety, depression and somatization, have been shown to be associated with FGID in both specialist and community-based studies. This suggests that the association is genuine rather than biased observation in referral centers. Furthermore, psychological distress such as depression, anxiety and phobia are strongly correlated with severity of FGID symptoms. There are biologically plausible mechanisms that support the causal role of psychological disorders in FGID. Psychological distress, in particular anxiety, can induce aggravation of visceral hyperalgesia as well as hypervigilance in FGID patients. This leads to poorer quality of life and increased utilization of healthcare service in addition to worsening of symptoms. Despite the numerous reports on the potential therapeutic value of psychotropic agents and psychological intervention, the importance of screening for concomitant psychological disorder in FGID patients has not been fully recognized in daily practice. Most FGID patients tend to have very low awareness of their mood symptoms, which lead to delayed diagnosis, deterioration of disease and unnecessary investigations. Many of these patients may be reluctant to accept the diagnosis of concomitant psychological disorders and therefore a good doctor-patient rapport and therapeutic relationship are essential for management of these patients.

Enhancing the quality of antibiotic prescribing in Primary Care: Qualitative evaluation of a blended learning intervention

BackgroundThe Stemming the Tide of Antibiotic Resistance (STAR) Educational Program aims to enhance the quality of antibiotic prescribing and raise awareness about antibiotic resistance among general medical practitioners. It consists of a seven part, theory-based blended learning program that includes online reflection on clinicians' own practice, presentation of research evidence and guidelines, a practice-based seminar focusing on participants' own antibiotic prescribing and resistance rates in urine samples sent from their practice, communication skills training using videos of simulated patients in routine surgeries, and participation in a web forum. Effectiveness was evaluated in a randomised controlled trial in which 244 GPs and Nurse Practitioners and 68 general practices participated. This paper reports part of the process evaluation of that trial.MethodsSemi-structured, digitally recorded, and transcribed telephone interviews with 31 purposively sampled trial participants analysed using thematic content analysis.ResultsThe majority of participants reported increased awareness of antibiotic resistance, greater self-confidence in reducing antibiotic prescribing and at least some change in consultation style and antibiotic prescribing behaviour. Reported practical changes included adopting a practice-wide policy of antibiotic prescription reduction. Many GPs also reported increased insight into patients' expectations, ultimately contributing to improved doctor-patient rapport. The components of the intervention put forward as having the greatest influence on changing clinician behaviour were the up-to-date research evidence resources, simple and effective communication skills presented in on-line videos, and presentation of the practice's own antibiotic prescribing levels combined with an overview of local resistance data.ConclusionParticipants regarded this complex blended learning intervention acceptable and feasible, and reported wide-ranging, positive changes in attitudes and clinical practice as a result of participating in the STAR Educational Program.Trial registrationCurrent Controlled Trials ISRCTN63355948

Opening stages in triadic medical encounters in Taiwan

Opening stages in medical interviews are important because good doctor-patient rapport facilitates the doctor's tasks in later stages, especially in triadic first-visit interviews where doctors are not acquaintances of patients and companions. Given its importance, the research examines opening stages in the Taiwanese context from two perspectives: discourse components of opening stages and discourse mechanisms of presenting non-acquaintances' identities, especially the companions' identities. By examining 30 geriatric triadic encounters collected in a teaching hospital in southern Taiwan, this research concludes that opening-stage interaction patterns in Taiwanese medical interviews differ from Western patterns in the following ways. Under time pressure, Taiwanese doctors tend to open the interview in a fast pattern that hardly allows verbal participation from the patients. The common practice of presenting non-acquaintances' identities in Western conversation openings is rarely observed in the Taiwanese context. As a result, contrary to the professional norms, most companions' identities are not clarified until they talk in the later stages, such as the pedigree stage, which is the most natural context for revealing their identities. This seeming violation of professional norms, however, can be explained by traditional Chinese interaction norms, and can be remedied by following another traditional norm-using a situational greeting. Further recommendations for Taiwanese medical professionals are also proposed to balance these potentially conflicting needs.

Telepsychiatry with Children and Adolescents: Are Patients Comparable to Those Evaluated in Usual Outpatient Care?

Several studies have described successful applications of telepsychiatry with children and adolescents. However, there has been little examination of the populations served by telepsychiatry and the ability to evaluate youth accurately through this medium. In this article, we examined whether telepsychiatry patients are representative of those in usual outpatient care. Participants included 369 patients 3-19 years old evaluated at two clinics. A new telepsychiatry clinic (TPC) developed to provide services to under-served communities, and a child and adolescent psychiatric outpatient clinic (CAPOC) that served youth from predominantly metropolitan areas were included in the study. The telepsychiatry sites were linked using ISDN lines at 384 KB/sec. We examined these two samples regarding demographics, payor status, and diagnostic profiles. Results indicated that youth evaluated through the TPC were broadly comparable to youth evaluated in the CAPOC. Therefore, telepsychiatry appears to serve youth that are representative of those seeking psychiatric care, and it is not restricted to youth with no medical insurance or with selected diagnoses. The similarity of diagnoses further suggests that telepsychiatry provides adequate technical resolution and doctor-patient rapport to detect psychopathology of youths. These findings suggest the need for further systematic investigation of telepsychiatry as a tool for providing psychiatric care to young people.