Healthcare and Listening: A Relationship for Caring

The optimal relationship between healthcare provider and patient is one of trust. This therapeutic relationship is dependent on the ability of the healthcare provider to communicate effectively with the patient. Research indicates that when healthcare providers listen to patients, there is more compliance with medical regimens, patient satisfaction is increased, and physicians are less vulnerable to malpractice lawsuits. Within the last few decades, the relationship between physician and patient has been reconceptualized from a paternalistic relationship to a partnership between provider and patient. This change is demanding a shift in how healthcare providers communicate and, in particular, listen to patients. To address this need, medical organizations such as the Accreditation Council for Graduate Medical Education has emphasized improved training and competence in communication skills of physicians. Effective communication and listening also is critical to the ethical treatment of patients and their families. This paper will discuss the critical component of listening within the healthcare context.     

Medicaid physician fees and the quality of medical care of Medicaid patients in the USA

When enacted in 1965, the original Medicaid legislation sought to finance access to mainstream medical care for the poor. I use data on visits to office-based physicians from the National Ambulatory Medical Care Survey in four years—1989, 1993, 1998 and 2003—to test the extent to which this goal has been achieved. Specifically, I test whether this goal has been achieved more in states that pay higher fees to physicians who treat Medicaid patients compared to states that pay lower fees. By comparing the treatment of Medicaid patients to that of privately-insured patients and by using state fixed effects, I am able to estimate the effects of changes in the generosity of Medicaid physician payment within a state on changes in access to care for Medicaid patients, therefore separating Medicaid’s effect on access to health care from any correlation between the Medicaid fee and other attributes of the state in which a patient lives. Using this method, I examine the effect of Medicaid fees on whether or not an office-based physician accepts Medicaid patients, on the fraction of a physician’s practice that is accounted for by Medicaid, and on the length of visit times with physicians. Results imply that higher Medicaid fees increase the number of private physicians, especially in medical and surgical specialties, who see Medicaid patients. Higher fees also lead to visit times with physicians that are more comparable to visit times with private pay patients.

Empathy,sympathy, and tax compliance

This paper examines the effect of “empathy” and “sympathy” on tax compliance. We run a series of laboratory experiments in which we observe the subjects’ decisions in a series of one-shot Tax Compliance Games presented at once and with no immediate feedback. Importantly, we employ methods to identify subjects’ sympathy, such as the Davis Empathic Concern Scale and questions about frequency of prosocial behaviors; we also use priming in order to promote subjects’ empathy. Our results suggest that the presence of sympathy in most cases encourages more tax compliance. Our results also suggest that priming to elicit empathy also has a positive impact on tax compliance. These results support the inclusion of noneconomic factors in the analysis of tax compliance behavior.     

When people become patients: fluctuations in trust from the cancer patient’s perspective

This study explores the trust relationships between cancer patients and their physicians by discussing the concept of trust and the collection of patients’ medical experiences before and after being diagnosed with cancer. The purpose of the study is to determine changes in patients’ trust during this process. This ethnographic study was conducted from 2009 to 2014 on doctor–patient relationships under the coverage of the National Health Insurance (NHI) in Taiwan. Under the NHI, patients may access physicians and acquire treatment at low cost. In this study, the sample comprised 12 female cancer patients. Data were collected in in-depth interviews with six patients. With the bloggers’ consent, data were collected from six blogs. These data were analyzed to determine how these cancer patients constructed and altered their opinions during their diagnosis and treatment. The results are discussed according to the calculative trust that was constructed based on information collected and/or impressions developed during their initial visits. The findings showed that relational trust was developed and (dis)evolved through interactions and experiences with medical staff. In addition, calculative trust was generated based on the following: eliminating institutions or physicians with which the patients had negative experiences; feeling and perceiving caring and professional competence; yielding to cancer and respecting professional reputations. Relational trust was derived from the following: the doctors’ ability to sooth patients’ anxieties and explain uncertainties; the compatibility of expectations in information sharing between physicians and patients. The results showed that in the early stage of developing a doctor–patient relationship, calculative and relational trusts were intertwined. As the doctor–patient relationship developed, the patients’ relational trust increased. The findings of this study contribute to the knowledge concerning the co-construction of patients’ trust in physicians in medical systems through communication between patients and medical staff.     

NEW TRENDS IN THE DOCTOR-PATIENT RELATIONSHIP: IMPACTS OF MANAGED CARE ON THE GROWTH OF A CONSUMER PROTECTIONS MODEL

Managed care is prompting a large revision not only in the ways doctors are employed and paid but also in the essence of the relationship between doctors and patients. In medical sociology, a discipline with a long-standing focus on scrutinizing the role of both the physician and the patient, there has already been discussion of a shift from the doctor as more all knowing to a less dominant position vis-a-vis both the patient and delivery of care. Patients are aware of shifts that place physicians in an environment characterized by new roles and responsibilities, such as acting as a gatekeeper. Limitations on health care coverage and the rethinking of roles have led to a depiction of the patient as the consumer of care and the managed care plan's becoming the commercial enterprise from which a service is obtained. The model of the patient as consumer of medically related goods and services appears to be growing, as does a model of the physician as one who contracts for a specified range of services for specific patients. In this article, trends in and problems with contemporary managed care are raised. Calls for patients' rights legislation may be among the health trends of the new millennium.     

HIV/AIDS stigma manifestations during clinical interactions with MSM in Puerto Rico

HIV/AIDS stigma can have detrimental effects on physician/patient interactions when manifested by health professionals. Unfortunately, HIV/AIDS stigma is usually manifested in an intersectional manner with other preexisting stigmas, including stigma toward men who have sex with men (MSM). Therefore, our study aimed to examine the behavioral manifestations of HIV/AIDS stigma among physicians in training during simulated clinical interactions with MSM, and explore the interrelation between HIV/AIDS stigma attitudes and behaviors. We implemented an experimental design using Standardized Patient simulations with a sample of 100 physicians in training in Puerto Rico. Results show a significant difference in the two groups’ means (p?<?.001), with a higher number of stigma behaviors in the HIV MSM patient condition (M?=?6.39) than the common cold control condition (M?=?5.20). Results evidence that stigma manifestations toward MSM with HIV may continue to be an obstacle for public health in Puerto Rico, and that medical training to prevent stigma is still needed.     

Domains of medical practice: physicians' assessment of the role of physician extenders

The relationship between physicians and physician extender occupations is considered in light of the stratification of medical care workers. Professional dominance between various medical occupations and professional competition among physicians are considered. Data from a national sample of physicians taken in 1981 are used to determine 1) under what conditions physicians are likely to consider the employment of physician extenders helpful for improving quality of care and 2) which characteristics and available resources are associated with the belief that the employment of physician extenders will improve medical care. Of four different service populations considered, physicians are most likely to think that the use of physician extenders to care for the urban poor will aid care and are least likely to think that their employment will improve care for obstetrics and pediatrics cases. The results indicate that physicians' beliefs regarding the employment of physician extenders are dependent on the clientele as well as on the relative position of the two occupational groups in the hierarchy of medical care occupations.     

Is doctor-patient race concordance associated with greater satisfaction with care?

We examined a national sample of African American, white, Hispanic, and Asian American respondents to test the hypothesis that doctor-patient race concordance is predictive of patient satisfaction. Our analysis examined racial/ethnic differences in patient satisfaction among patients in multiple combinations of doctor-patient race/ethnicity pairs. Additionally, we outline the determinants of doctor-patient race concordance. The analysis used the 1994 Commonwealth Fund Minority Health Survey to construct a series of multivariate models. We found that for respondents in each race/ethnic group, patients who had a choice in the selection of their physician were more likely to be race concordant. Whites were more likely to be race concordant with their physician compared to African American, Hispanic, and Asian American respondents. Among each race/ethnic group, respondents who were race concordant reported greater satisfaction with their physician compared with respondents who were not race concordant. These findings suggest support for the continuation of efforts to increase the number of minority physicians, while placing greater emphasis on improving the ability of physicians to interact with patients who are not of their own race.     

Considering social ergonomics: the effects of HIT on interpersonal relationships between patients and clinicians

This study explored physicians' interactions with EHRs to understand the qualities that contribute to patient satisfaction with their use of the technologies and patient satisfaction with physician. Video-taped observations of 100 medical consultations were used to distinguish interaction patterns between physicians and EHRs. Quantified observational methods were used to contribute to ecological validity. Ten primary care physicians and 100 patients from five clinics participated in the study. Visits were videotaped and coded using an objective coding methodology to understand how physicians interacted with electronic health records. Results indicate, a variety of EHR interaction styles may be effective in providing patient-centered care.     

The Effects of Student Satisfaction and Attitudes on Staffing and Policy Decisions: A Case Study and Empirical Support

Abstract

Increased interest in the University of Mississippi (U.M.) Student Health Service (S.H.S.) indicated dissatisfaction among its users. Complaints about the service in general and one physician in particular suggested an evaluation to identify the causes of the complaints and areas where improvements could be made. Because patient satisfaction can exert a strong influence on factors such as utilization of services, compliance with treatment regimens, and recovery and wellness, a study of user satisfaction was conducted.

A 16-statement patient satisfaction questionnaire was constructed and administered to students reporting a visit to the health service during the semester the study was conducted. The physician conducting the examination was identified at the end of the questionnaire. Simple frequency analyses for the physicians identified specific elements of dissatisfaction, and comparisons showed a distinctly greater amount of dissatisfaction with one physician.

A report to the university administration brought a promise of improvements without an indication of what they would be. Several months later the physician in question resigned. Even though appointments were suspended and waiting time increased with the loss of the physician, comparisons of utilization with the previous period showed little change.     

Hard and Soft Commitments to Human Rights Treaties, 1966–20001

What factors determine whether and how deeply countries will commit to the international human rights regime? Using data for up to 142 countries between 1966 and 2000, this article analyzes patterns of membership to the International Human Rights Covenants. The analysis produced two main conclusions. First, the potential costs associated with joining a treaty, rather than its substantive content, motivates the decision to join. Treaties that protect different rights but establish comparable implementation mechanisms exhibit similar patterns of membership, whereas treaties that protect identical rights but establish different implementation provisions exhibit dissimilar patterns of membership. Second, rates of treaty membership differ by level of commitment. Countries that sign human rights treaties differ from countries that ratify. Results are interpreted with respect to four theories of commitment and compliance: realism, liberalism, constructivism, and sociological institutionalism. Theories that emphasize the importance of a treaty’s costs (realism and institutionalism) fare better than theories that prioritize a treaty’s content (liberalism and constructivism).     

Can strategic uncertainty help deter tax evasion? An experiment on auditing rules

This paper adds to the economic-psychological research on tax compliance by experimentally testing a simple auditing rule that induces strategic uncertainty among taxpayers. Under this rule, termed the bounded rule, taxpayers are informed of the maximum number of audits by a tax authority, so that the audit probability depends on the joint decisions among the taxpayers. We compare the bounded rule to the widely studied flat-rate rule, where taxpayers are informed that they will be audited with a constant probability. The experimental evidence shows that, as theoretically predicted, the bounded rule induces the same level of compliance as the flat-rate rule when strategic uncertainty is low, and a higher level of compliance when strategic uncertainty is high. The bounded rule also induces distinctive tax evasion dynamics compared to the flat-rate rule. The results suggest that increasing the level of strategic uncertainty among taxpayers could be an effective device to deter tax evasion.     

Social norms and tax compliance: Framing the decision to pay tax

Observed levels of tax compliance are higher than predicted levels (when predictions are based on Allingham and Sandmo's neoclassical model of tax evasion). They are higher if social norms recognise the importance of compliance. But how do social norms frame decisions to pay tax? Can prospect theory be applied to shed insight into the way that social norms exert their influence? An analysis of questionnaire responses (from Italy and from the UK) suggests that they exert their influence by changing the reference points that individuals use when they code changes as ‘gains’, or ‘losses’. The evidence suggests that social norms frame the decision to pay tax by changing individuals’ perceptions of their entitlement to income. This consideration is important when designing policy to deter evasion.     

The role of empathy in crisis communication: Providing a deeper understanding of how organizational crises and crisis communication affect reputation

This study advances our theoretical knowledge of how organizational crises and crisis communication affect reputation. Prior research solely emphasizes the importance of organizational crisis responsibility in this process. Three experiments show that stakeholders’ empathy toward the organization provides a second explanation. The first two experiments demonstrate that victim crises not only inflict less reputational damage than preventable crises because stakeholders consider the organization less responsible for the events, but also because they are more likely to empathize with the company. The third study shows that empathy can also explain the outcomes of crisis communication. An apology arouses empathy among stakeholders and subsequently increases reputation repair, unlike denial. The role of empathy in the crisis communication process has implications for both theory and practice.     

PHYSICIAN PAYMENT AND PRENATAL CARE ACCESS FOR HETEROGENEOUS PATIENTS

Changes in prospective payments to reimburse physicians for serving Medicaid patients have been rising in many States. Policy makers anticipate that higher fees will increase access to services. This paper explores whether physicians respond to the increased payment by increasing access differentially by patient type. Physicians may gain from serving only those patients expected to be of low medical risk and cost. Empirical tests using Medicaid data from 1988 to 1991 for prenatal care provision in Washington State show fees are significant in improving access to care for the average patient with significantly greater improvement for Hispanics and single patients. ( JEL I11, I18)     

Medically speaking: Mandative adjective extraposition in physician speech

Clinical recommendations are central features of physician‐patient interaction. Mandative adjective extraposition (MAE; e.g. it's important to …) is one of many linguistic forms used by physicians in providing recommendations. This study decomposes MAE, a relatively unexplored sociolinguistic variable, into features that contribute to its deontic interpretation. It establishes that MAE's component features convey different degrees of illocutionary force, whereby some forms are perceived to be more compelling (i.e. stronger) than others. It further suggests that said forms index confidence in physician speech. Utilizing a large U.S.‐wide corpus of medical consultations, it demonstrates that physicians use stronger MAE forms as they gain professional experience. Within specific practice settings, physicians' use of strong MAE forms is additionally constrained by patients' medical severity. Collectively, this evidence points to socialization into medical practice as the major social force impacting MAE variation across physicians' professional lifespans, pushing physicians towards authoritative‐sounding variants despite interactional pressures favoring indirectness.     

Psychiatry in the age of neuroscience: the impact on clinical practice and lives of patients

Due to the progress being made in the neurosciences, higher expectations for the use of medication, even against the patient’s will, are arising in mental hospitals. In this article, we will discuss whether the neurosciences and new psychopharmacological solutions really support patients who suffer from mental illnesses. To answer this question, we will focus on the perspective of patients and their experiences with psychiatric (coercive) treatments. The analysis of one person’s story shows that other issues besides appropriate medication are important for recovery from a mental illness. In daily life, issues such as coping, rehabilitation and social support are of major importance for a patient suffering from psychiatric disease. Thus, although progress in the neurosciences is a positive development for clinical practice, it does not mean that (coercive) medication alone will carry a patient into recovery. A patient’s recovery is dependent, not only upon the process of finding the appropriate medication and trust between the psychiatrist and the patient, but also upon relational aspects, such as being recognised as a person, belonging, accepting responsibilities, developing friendships and trusting others. These findings lead to the conclusion that dealing with psychiatric diseases is more complex than what the biomedical model of neuroscience suggests and that one should include the social context of the patient in the recovery process.     

Physician's perceptions of the suit-prone patient

The medical profession is experiencing tremendous increases in the number of malpractice claims and suits. The individual physician is confronted with the question of whether he has patients who are prone to sue him. This paper examines physicians' tendencies to label certain patients as suit-prone and identifies the social characteristics of those labeled as such. The findings suggest that physicians may be labeling the wrong patients. Further, the characterization of the suit-prone patient appears to be a stereotype that merely reflects the physician's political and social attitudes. The moral, ethical, and practical consequences of labeling and of mislabeling are discussed.     

Physician’s Listening and Adherence to Medical Recommendations among Persons with Diabetes

Every year, millions of people die of diabetes-related complications. Despite this risk, patients’ nonadherence to lifesaving medical recommendations remains a persistent crisis. One factor that could increase adherence is the formation of an alliance with the medical staff. This alliance, in turn, may increase when the patient perceives that the health care staff is willing to listen. To test this model, we asked people with diabetes, N = 76, to report (a) perceptions of listening by their nurse and physician, (b) their working alliance with the medical-staff members, and (c) several indicators of adherence with medical recommendations. The results suggested that listening is highly correlated with working alliance, r = .84, both with the nurse and the physician. Furthermore, both listening by the physician, r = .27, and alliance with the physician, r = .44, were associated with medication adherence. Listening by the physician, and alliance with the physician were not associated with adherence to life-style recommendations, but hinted at possible associations with glycemic control, r’s = .19, and .22, respectively. Our findings suggest that listening is an important facet of a working alliance, which in turn appears to positively affect the health of patients with diabetes.     

Citizenship and power in an agent-based model of tax compliance with public expenditure

In this paper we present a model of tax compliance with heterogeneous agents who maximize their individual utility based on income and the conjectured level of per capita public expenditure. We formally include psychological drivers in this model. These drivers affect individual behavior, such as risk aversion, together with appreciation of public expenditure, expectations about peers’ compliance and a natural inclination to comply, all of which we summarize in a quality termed “citizenship”. The enforcement system, based on random inspections, is standard and only partially known to agents.The agent-based model is simulated under a variety of settings, representing different “societies”. We use the artificial data produced by the model to estimate the effects of taxpayers’ traits on personal tax behavior and to build a compliance societal slippery slope. At the individual level, we find a positive dependence of compliance on all variables, with the significant exception of the tax rate, which has a negative impact. As far as societies are concerned, we show how aggregate tax compliance depends on composite indices of citizenship and power, and we find that the former is more important than the latter.