Quality Of Doctor-patient Relationship Research Articles

Understanding experiences of mental health help-seeking in Arab populations around the world: a systematic review and narrative synthesis

BackgroundRacial and ethnic disparities in mental health service utilisation and access is well established. Mental illness is common among Arab populations globally, but most individuals display negative attitudes towards mental health and do not seek professional help. The aim of this systematic review was to determine 1) help-seeking behaviours 2) help-seeking attitudes and 3) help-seeking barriers and facilitators, related to mental health services among Arab adults.MethodA pre-defined search strategy and eligibility criteria allowed for database searching using terms related to: mental health, Arabs, help-seeking, as well as experiences and behaviours. Seventy-four articles were included and analysed through narrative synthesis. Results were reported using the PRISMA guidelines. The review protocol was registered prospectively on PROSPERO (CRD42022319889).ResultsArabs across the world have negative attitudes towards formal help-seeking and are reluctant to seek help, despite the presence of psychological distress. There is little information on factors that influence help-seeking behaviours and rates of service use. Preference for informal help sources such as family and friends were expressed and considered more acceptable. Low mental health literacy, stigma, gender, age, education, religion, acculturation, and immigrant status were the most common factors influencing help-seeking attitudes. Barriers to help-seeking included stigma, privacy and confidentiality, trust, mental health literacy, language, logistics, and culture related barriers. Increasing societal and family awareness, external support and encouragement, shared culture between the client and therapist, quality of doctor patient relationship, and feelings of connectedness with the host country among refugees were mentioned facilitators. Mixed findings for the role of religion, and family and community, in relation to facilitating or hindering help-seeking were reported.ConclusionsThere is an increased likelihood and preference to seek informal sources of psychological support among Arabs. Contextual and cultural factors impeding help-seeking for Arabs are common across the world. Future research should address actual utilisation rates of services to better understand factors that influence help-seeking behaviours and facilitators to help-seeking. Increasing mental health literacy and developing anti stigma campaigns is necessary. Developing culturally informed interventions should inform future efforts to promote help-seeking among this population.

Abstract- Poster

INTRODUCTION:Conversion disorder has one or more symptoms that affect voluntary motor or sensory function suggesting a neurological or other medical condition, but they are inconsistent with known neurological or musculoskeletal pathologies. Individuals with conversion disorder do not intentionally produce or feign their symptoms. Instead, the symptoms are due to an unconscious expression of a psychological conflict or need. There might be associated primary and secondary gains which act as maintaining factors. The disorder is more common in adolescence than in childhood.CASE REPORT:A 17 years old male reported to the Emergency Department alleged history of fall from a 10 feet wall c/o neck pain, inability to move all 4 limbs, diminished sensation below the neck. Cervical immobilization was done and his vitals & routine blood investigations were found to be normal. No signs of any urinary retention or fecal incontinence. Routine neurological examination was performed which revealed hypotonia in all 4 limbs with flaccidity with a power of 0/5 and diminished sensation at the level of C3. Neuro imaging was done. MRI brain with cervical screening revealed no edema, cord compression. MRI CERVICAL SPINE – NORMAL. Stressor: He was convicted under POSCO act for 3 years, 2 days before the incident. Neurosurgeon ruled out the physical cause of the above presentation.Detailed history revealed he was being convicted for 3 years for a marrying a 17 years old girl with her consent under POSCO act 2 days prior to the incident. He was seen distressed after hearing the verdict, had sleep disturbances, remained aloof, not communicating with others. He attempted suicide by jumping from the wall. He had a history of occasional cannabis use for the past 2 years. Family history revealing possession attacks in his mother. He was raised by a single parent as his father left him and his mother when he was 5 years old. He had no episodes of similar illness in the past. His temperament revealed that he had difficulty in adjustment to the situations being impulsive and had self-injurious behavior. Mental status examination revealed that the patient was lying in supine position, not able to move his all 4 limbs with obvious psychomotor retardation decreased talks, sad mood.DISCUSSION:The clinical picture is indicative of Dissociative Motor Disorder F44.4 according to ICD 10. After taking a detailed history, it was clear that he was extremely distressed regarding his punishment under POSCO act as he willfully married a 17 years old girl with her consent which could not stand in the court of law. Patient was started on therapy sessions as well as low-dose diazepam. In the sessions, possible causes of these symptoms were discussed, his family members were also psycho-educated about the psychosomatic nature of the symptoms and advised to encourage him for a symptom-free lifestyle. They were also given an instruction not to pay attention to his complaints of physical nature. Psychotherapy sessions were started in which all her stressors were therapy discussed.CONCLUSION:Conversion disorder, somatoform disorder, and malingering always remain a diagnostic challenge for the clinicians. The prompt history taking, identification of stressors, use of appropriate and validated physical examination manoeuvres, and coordination of care and information exchange between all family members and medical team may facilitate the expeditious care of these patients in a cost-effective manner. Psychogenic symptoms should be treated using suggestions, patience, and reassurance. Early recognition of a conversion disorder will limit unnecessary tests and medications. The quality of doctor-patient relationship can influence outcome. The existing literature supports a multidisciplinary treatment approach, with specific interventions, such as cognitive behaviour therapy for cognitive restructuring and psychodynamic therapy for addressing symptom connections to trauma and dissociation.

Doctor-patient relationship improved during COVID-19 pandemic, but weakness remains

ObjectiveTo assess the quality of the doctor-patient relationship (DPR) in China and possible influencing factors during the COVID-19 period from the patient’s perspective.MethodsAn online survey was carried out nationwide from March 12, 2020 to March 30, 2020 in China via a convenience sampling strategy. Patients who met the inclusion criteria were invited to complete a questionnaire regarding the quality of DPR, including sociodemographic information, the Patient-Doctor Relationship Questionnaire (PDRQ-9), and influencing factors for DPR during the pandemic.ResultsA total of 1903 patients were included. Our result showed that participants had a higher PDRQ-9 score during the COVID-19 pandemic (4.18 ± 0.51) than that before the COVID-19 pandemic (3.86 ± 0.67). Importance-performance analysis (IPA) revealed that doctor-patient communication, patient satisfaction, consultation time, doctor’s attitude, and medical knowledge were specific aspects that needed to be prioritized to improve the DPR. Multiple linear regression analysis suggested that positive media reports, telemedicine, and national policies had a significantly positive effect on the DPR during the pandemic (P < 0.05).ConclusionIn general, the DPR had been improved during the COVID-19 pandemic. Our research found the key points that needed to be prioritized to improve the DPR during the pandemic, which may provide effective suggestions for building a harmonious DPR in the future.

Efficacy, patient-doctor relationship, costs and benefits of utilizing telepsychiatry for the management of post-traumatic stress disorder (PTSD): a systematic review.

Post-traumatic stress disorder (PTSD) is one of the most common psychiatric disorders found among victims of disaster, kidnapping, accidents, sexual assaults and war in Indonesia. However, lacking and unequal distribution of psychiatric medical personnel remains a barrier to its management. This review aims to introduce and evaluate the potential contribution of telepsychiatry to the management of PTSD based on published literature. Original studies were obtained from PubMed, Science Direct, ProQuest, High Wire, and Elsevier Clinical Key databases. A total of 125 articles were found, of which 15 articles (12 randomized controlled trials, 2 open trials and 1 pilot study) fulfilled the inclusion criteria. A total of 991 subjects were found with a follow-up period ranging between 5 weeks and 18 months. Telepsychiatry is an innovative use of technology to aid the delivery of PTSD treatments in areas difficult to reach. The quality of care given by telepsychiatry both through video conferencing as well as web- and application-based is comparable to that of face-to-face therapy. Patient satisfaction, quality of doctor-patient relationship also remains high, with lower costs and shorter therapeutic time when compared to face-to-face therapy. Various studies have shown that telepsychiatry is an effective solution for the management of PTSD. Studies have also reported that the quality of treatment through telepsychiatry is as effective as face-to-face therapy, with greater efficiency. Countries, especially those with a low patient-to-mental health professional ratio, should be encouraged to develop telepsychiatry systems to manage PTSD.

Psychological contract violation and patient’s antisocial behaviour

PurposeThe purpose of this study is to examine the dual effects of the violation of psychological contract on patient’s antisocial behaviour via the mediator of patient trust and the role of doctor-patient communication as a critical contingent variable in the psychological contract violation of patient’s antisocial behaviour relationship.Design/methodology/approachThe data were collected from 483 hospitalized patients distributed in Shanxi province, China by using a self-administered survey.FindingsThe results indicated that psychological contract violation is positively associated with patient antisocial behaviour via patient trust. Moreover, the study found that doctor-patient communication moderates the mediated effects of psychological contract violation on patient’s antisocial behaviour through patient trust; that is, the mediated effect on antisocial behaviour is weaker when both doctor and patients have more communication.Research limitations/implicationsDue to a cross-sectional design in nature, the causal relationship cannot be developed based on the results. Despite the limitation, the present study provides insights for improving doctor-patient relationship by emphasizing the importance of increasing patient trust and doctor-patient communication.Practical implicationsTo improve the quality of doctor-patient relationship, this study addresses the significance of properly showing understandings and care to regain mutual trust and reducing the likelihood of patient’s antisocial behaviour.Social implicationsThe research findings have implications for both the health system and medical schools in China to reinforce the professional ethics and improve their medical humanities as the main concerns to generate a more sustainable doctor–patient relationship.Originality/valueThis study includes patient trust as a mediator and doctor-patient communication as a moderator to investigate the moderated mediation relationship among patients and medical professionals. By further examining the doctor-patient relationship, the results may not only help improve the efficient implementation of medical practices but also support the institutes and develop medical professionals for more positive doctor-patient relationships.

The influence of role-modeling on clinical empathy of medical interns: A qualitative study

Introduction: Clinical empathy ascertains the quality of doctor-patient relationship and entails beneficial outcomes for both parties. Role-modeling is a major factor in promoting clinical empathy skills of medical students. The present study attempted to explain the importance of role-modeling in clinical empathy of medical interns. It was also intended to obtain a better and more profound understanding of the subject based on the experiences of medical interns. Methods:In this qualitative conventional content analysis, semi-structured individual interviews were conducted with 14 medical interns and 6 clinical professors. The participants were selected by purposive sampling. All interviews were recorded, transcribed, and analyzed. Trustworthiness, credibility, and confirmability of the data were confirmed. Results:Data analysis led to the emergence of a theme called role-modeling, and two subcategories: "advertent role-modeling" and "inadvertent role-modeling". Advertent role-modeling included "influenced by the charismatic personality of professors", "critique of faculty members' communicative behaviors with patients", and "observation of the faculty members' performance". Inadvertent role-modeling included "crystallization of human values in communication behaviors" and "compliance with hierarchical behavior". Conclusion:Role-modeling was the main theme of the present study. To improve clinical empathy skills, particular attention should be paid to role-modeling. Informing clinical professors and medical students on role-modeling, strengthening students' empathetic behaviors by role model professors, and recruitment of professors with strong communication skills are among the recommended strategies of this study.

Evaluación de la relación médico paciente (RMP) en una población de San Juan

&lt;p&gt;El objetivo del trabajo fue conocer la calidad de la Relación Médico Paciente (RMP) en pacientes de una localidad de la provincia de San Juan.&lt;/p&gt;&lt;p&gt;Resultados: Más del 70% de los encuestados refirió que su médico lo entiende, que confía en él, que se esfuerza en ayudarlo, que puede hablar él, que está contento con el tratamiento que le ha puesto, que le ayuda, que el tratamiento lo está beneficiando, que está de acuerdo con éste sobre las causas de sus síntomas, que es muy accesible, refieren sentirse mejor gracias a su médico, considera que tiene más información sobre su salud debido a su médico, sostiene que ahora controla mejor los síntomas aunque no vea a su médico.&lt;/p&gt;&lt;p&gt;Discusión: En todos los ítems del cuestionario más del 50% de los encuestados refiere una buena RMP.&lt;/p&gt;

The ethics of mobile health technology

IntroductionMobile health (m-health) technology has been growing rapidly in the last decades. The use of this technology represents an advantage, especially for reaching patients who otherwise would have no access to healthcare. However, many ethical issues arise from the use of m-health. Health equity, privacy policies, adequate informed consent and a competent, safe and high quality healthcare need to be guaranteed; professional standards and quality of doctor-patient relationship in the digital setting should not be lower than those set for in-person practice.AimsTo assess advantages and threats that may arise from the wide use of m-health technologies, in order to guarantee the application of the best medical practices, resulting in the highest quality healthcare.MethodsA literature search has been conducted to highlight the most pressing ethical issues emerging from the spreading of m-health technologies.ResultsFew ethical guidelines on the appropriate use of m-health have been developed to help clinicians adopt a professional conduct within digital settings. They focus on the need for professional associations to define ethical guidelines and for physicians to take care of their education and online behavior when using m-health technologies.ConclusionsThe rapid spreading of m-health technologies urges us to evaluate all ethical issues related to its use. It would be advisable to produce an ethical code for the use of these new technologies, to guarantee health equity, privacy protection, high quality doctor-patient relationships and to ensure that m-health is not chosen over traditional care for merely economic purposes.Disclosure of interestSG received honoraria or Advisory board/consulting fees from the following companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter. All other authors have declared.

What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms

Despite both parties often expressing dissatisfaction with consultations, patients with medically unexplained symptoms (MUS) prefer to consult their general practitioners (GPs) rather than any other health professional. Training GPs to explain how symptoms can relate to psychosocial problems (reattribution) improves the quality of doctor-patient communication, though not necessarily patient health. To examine patient experiences of GPs' attempts to reattribute MUS in order to identify potential barriers to primary care management of MUS and improvement in outcome. Qualitative study. Patients consulting with MUS whose GPs had been trained in reattribution. A secondary sample of patients of control GPs was also interviewed to ascertain if barriers identified were specific to reattribution or common to consultations about MUS in general. Thematic analysis of in-depth interviews. Potential barriers include the complexity of patients' problems and patients' judgements about how to manage their presentation of this complexity. Many did not trust doctors with discussion of emotional aspects of their problems and chose not to present them. The same barriers were seen amongst patients whose GPs were not trained, suggesting the barriers are not particular to reattribution. Improving GP explanation of unexplained symptoms is insufficient to reduce patients' concerns. GPs need to (1) help patients to make sense of the complex nature of their presenting problems, (2) communicate that attention to psychosocial factors will not preclude vigilance to physical disease and (3) ensure a quality of doctor-patient relationship in which patients can perceive psychosocial enquiry as appropriate.

Examining predictive models of HRQOL in a population-based, multiethnic sample of women with breast carcinoma

This study examined health related quality of life (HRQOL) and its predictors among African-, Asian-, Latina-, and European American breast cancer survivors (BCS) using a socio-ecologically and culturally contextual theoretical model of HRQOL. We employed a case-control, cross sectional design with a population-based sample from the California Cancer Registry. Descriptive, bivariate, and multivariate regression analyses were conducted. The sample included 703 BCS: 135 (19%) African-, 206 (29%) Asian-, 183 (26%) Latina-, and 179 (26%) European Americans. Latinas reported the lowest HRQOL (p < 0.0001). The final regression model explained 70% of variance in HRQOL. Years since diagnosis, number of comorbidities, role limitation, emotional wellbeing, quality of doctor-patient relationship, social support, and life stress are significant HRQOL determinants. Exploratory regression analyses indicate ethnic differences in significant predictors for HRQOL. HRQOL among this multiethnic sample ranged from fair to good. Bivariate analysis suggests that ethnic differences in HRQOL exist. However, regression analyses demonstrated that socio-ecological factors in conjunction with medical characteristics are more salient to HRQOL outcomes, and that ethnic group membership may be a proxy for socio-ecological context. Furthermore, the influence of ethnicity, culture, and social-ecology are complex; research with large, population-based samples are necessary to disentangle the impact of contextual factors on HRQOL.

의과대학에서의 윤리교육

The concept of incorporating ethics courses into the medical curriculum has been firmly established in the most medical schools of Western world. Virtually every medical school curriculum in the United States, for example, includes medical ethics, and graduates have generally found these courses to be useful and have favored expansion of the programs. In contrary, however, medical ethics has only recently been included in medical education in Korea. It was early 1980s when one medical school in Seoul first started teaching ethics to the senior medical students, and only half of all 41 medical schools in Korea now are providing some form of ethics education to the medical students. Physicians and curriculum committees have been hesitant to allot time for medical ethics in an already crowded medical curriculum. Their perception that the discipline is soft and nonverifiable when contrasted to more technical subjects is one problem. Another is the fact that ethics rarely offers specific solutions for discrete problems and tends to raise questions rather than provide clear answers. However, as medical practice changes in response to advances in technology, pressures from the community for a different quality of doctor-patient relationship, and political changes in health provision, doctors’ interest in the ethical aspects of their practice continues to grow in Korea too. This paper summarizes the needs of ethics education in medical school in Korea and proposes the hopeful contents and teaching methods based on experiences of medical schools mostly in Western world.

Validation of a new multidimensional health locus of control scale (form c) in asthma research

Abstract This study developed and validated an Asthma Multidimensional Health Locus of Control (AMHLC) scale using 186 asthmatics aged 13 to 55 years recruited from 46 pharmacies in the Hunter Valley, Australia. The construct validity and internal consistency of the scale were demonstrated using principal components factor analysis and Cronbach's alpha respectively. Although correlations were modest, findings indicate that asthmatics with higher “Powerful Others” locus of control perceived they had a better quality of doctor-patient relationship; the opposite was found for those with higher “Chance” scores. Powerful Others orientation was also associated with expectations and valuation of services doctors' provide. Knowledge of asthma was not related in the expected direction with the new scale, nor were clinical indices of asthma severity. Younger asthmatics had higher Chance scores while older asthmatics tended toward higher Powerful Others orientation. Overall, the AMHLC instrument achieved suitable me...

Doctor-patient relationship in the light of patients' experiences

In order to investigate the claims that the quality of doctor-patient relationship has deteriorated, the experiences of 330 ambulatory care patients and of 360 hospitalized patients were collected by means of a mailed questionnaire. The relationships between three groups of variables were studied: background variables describing the doctor and the patient; variables pertaining to certain salient instrumental, communicative, and expressive factors of the doctor-patient relationship, and variables measuring the success of this relationship.