Constructing the digital patient: Patient organizations and the development of health websites

In order to understand the constraints and challenges of realizing the democratic potentials of the Internet, this paper focuses on the attempts of three Dutch patient organizations to develop health websites. The authors describe how these patient organizations had to overcome specific barriers to develop their digital services. All three organizations faced certain constraints that had negative consequences for the plans they wanted to realize. Lack of financial resources and manpower were the main reasons why these patient organizations could not develop interactive parts of their website or provide personal advice services. Other barriers the patient organizations had to overcome were getting access to digital expertise to build the websites. The paper shows that the development of a website is a very demanding task, even for patient organizations that have in-house expertise with computers and Internet. Moreover, the paper shows that patient organizations do not consider the involvement of patients as crucial for the design of health websites. This research thus confirms previous research findings that users, in this case patients, are largely absent from the design process of information and communication technologies Finally, the paper shows how patient organizations' websites contribute to a redefinition of the patient from being a passive actor towards one who is an active participant in his or her care.     

A comparison of objective and subjective measures of clinical competence

The purpose of this study was to determine if objective performance measures from a simulated patient practical examination were related to faculty subjective assessments of surgery students' performance. Another purpose was to determine if those students performing well on a simulated patient practical examination were the same students awarded honor ratings by faculty. Faculty ratings of students (n = 72) on history taking ability, physical exam skills, problem identification, use of investigations, problem integration, patient management, and patient relations skills were correlated with objective measures on these same criteria achieved on a practical exam employing three simulated patient cases. Correlations were also calculated to study the relationship between practical exam scores and honor rating recipients. Results indicated significant relationships between faculty subjective ratings and practical exam outcomes on all practical examination skills except physical exam skills and patient management skills. Findings also indicated the performance of honor students on the practical examination was significantly better than non-honor students on two skills: history-taking and patient relations. The implications of these research findings are discussed.     

Psychiatric triage: a cost-effective approach to quality management in mental health.

As seen from this trial program, psychiatric triage in the ED is potentially a very effective tool for improving the quality of mental health patient care. For a minimal investment in personnel, there is a potential for a major improvement in patient care, patient record documentation, interdepartmental relations, and financial reimbursement to the institution.     

Semantics of patient choice: how the UK national guideline for depression silences patients

Several stakeholders, including the National Survivor User Network and the British Psychological Society, have called for the National Institute for Health and Care Excellence (NICE) to include an up-to-date review of patient experience research in the new depression guideline. In response, the Guideline Committee (GC) postponed publication, the guideline now due in February 2020. Yet the GC also stated it will not review patient experience research. Instead, it will incorporate a new element of ‘patient choice’, without elaborating what this entails. Here, we attempt to untangle a number of similar sounding terms including ‘patient choice’, ‘patient preference’, ‘patient experience research’ and ‘service user involvement’ in terms of how they relate to the NICE depression guideline. We argue that by conflating these concepts and implying that one will serve the purpose of another equally well, NICE risks leaving patients without a real voice, their perspectives buried in semantically void rhetorical jargon.     

Mental illness,partial hospitalization,and the family

Summary When illness is socially defined, the task of therapy is to enable the patient to move from a sick role to one of maximal social functioning. In a day hospital setting, methods are explored to involve a patient with his family both directly and indirectly. Thus the patient is supported both in the treatment milieu and when he is at home. Not only the patient, but the family, is vulnerable at this time and each must be helped to make parallel and complementary shifts in interpersonal behavior. To view the family solely as a resource for the support of the ill member and his treatment is to fail to accept the need of the family as a whole for reorganization and strengthening.     

Patient satisfaction in primary health care: a literature review and analysis.

This paper reviews the literature on patient satisfaction in primary health care settings. Definitions and models of satisfaction are considered first. Attention is given to the conceptualization of satisfaction by investigators concerned about consumers in general as well as by researchers focusing on consumers of medical services. Research findings are discussed and used to develop a model of patient satisfaction. The measurement of patient satisfaction and the findings of empirical studies are then reviewed, including summaries of effect sizes. It is concluded that patient satisfaction information can provide a dependent measure of service quality and serves as a predictor of health-related behavior. Issues deserving further investigation and recommendations regarding research strategies are presented.     

Metacommunications. A missed opportunity?

1. The process of communication is a multilevel phenomenon. Certain levels may be transparent or hidden. 2. Human communication dictates that people not only communicate, but also that they communicate about their communication. In essence, humans metacommunicate. 3. "Meta" instructions provided by the patient are interpreted by the therapist during therapeutic discourse. These interpretations allow the therapist to shape the relationship with the patient. 4. A complementary interactional communication approach allows the patient and therapist to maximize their inequalities to the therapeutic benefit of the patient.     

Becoming/Being a Cosmetic Surgery Patient: Semantic Instability and the Intersubjective Self

Against approaches that center the subject—the cosmetic surgery patient—as the primary site of inquiry regarding the “truth” of cosmetic surgery, I argue that we must rethink the positioning of the subject in considering cosmetic surgery's meanings. Here I offer a brief discussion of various feminist theories of the cosmetic surgery patient, as well as an account of my own experience of cosmetic surgery, to explore how the cosmetic surgery patient is semantically unstable, named and identified through a variety of discourses and social relations. This semantic instability suggests a need to examine the ongoing processes by which cosmetic surgery comes to have meaning and by which the subjectivity of the cosmetic surgery patient is produced.     

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.     

Disorganizing Paralysis of the Clinician’s Mind as a Property of a System of Treatment

This paper addresses the phenomenon of “psychic numbing” in the clinician, which interfered with the clinician’s capacity to understand and respond to the patient’s highly turbulent reaction to a personal crisis of the clinician. Through gaining an understanding of the meanings of the retraumatizations for both the patient and the clinician, the clinician became able to recapture the functioning of her mind, respond differently to the patient, and thus facilitate the calming of the turbulence of the treatment. The clinician’s understanding included her recognition of her own thwarted twinship longings with the patient.     

A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. Conclusions: (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.     

Time and Timelessness in the Psychoanalysis of an Adult With Severe Childhood Trauma

This article is an exploration of the phenomenological experiences of temporality in the psychoanalytic treatment of a patient who suffered severe dissociation. The writer tracked exchanges with an adult analysand who repeatedly suffered childhood attachment losses and sexual and physical traumata. During treatment sessions the patient enacted dissociated alter personality states each with distinct memories. Loewald (1980) contrasted the experience of time as eternity to the fragmented temporality of trauma. Tracking his experience during key sessions, the writer/analyst infers that by repeatedly going back and forth between experiences of sequential time and timelessness, the analyst helped the patient link previously dissociated experiences. This in turn allowed the patient to realize increased coherence and stability of identity and affectivity. The case material is used to consider how multiple temporalities are represented by the patient and the implications of temporality for understanding trauma and deep dissociation.     

“If You Knew Who I Really Am …”

This paper describes the work of a White lesbian analyst with her White gay male patient who carries a secret feminine self of which he is mortifyingly ashamed. Together they discover this feminine self as the site of childhood gender trauma—for years the patient was violently and persistently bullied for not being a masculine-enough boy. To enable this patient to address his shame and find an internal space to develop an authentic gender identity, analyst and patient must take account of and process the field of the treatment room as it exists within the larger social/political field of Trump’s America, in which the forces of misogyny, homophobia, gender rigidity, and racism combine to collapse any breathable space for this dyad’s multiple “deviant” identities.     

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.     

Patient compliance,physician empathy and financial incentives within a principal-agent framework

Compliance with medication regimens among patients with chronic conditions in the U.S. and other developed countries averages only 50%. Numerous studies have attributed poor compliance to physicians’ failure to exhibit sufficient empathy with patients’ problems. Can financial incentives help modify physicians’ empathic behavior? In view of contradicting evidence in the health psychology literature, the present paper addresses this question from a rational-choice perspective, introducing a principal-agent model of physician empathy and patient compliance. The model allows the physician to exhibit empathy with the patient, to which the patient responds by choosing his desired level of compliance, which the physician takes into account when determining the level of empathy she exhibits. The model is first applied to rationally substantiate the evidence that patient compliance rises with physician empathy, and subsequently to examining the relationship between physician empathy and the physician's fee. The analysis reveals that the physician will exhibit less empathy in response to a higher fee, implying that the higher the fee the less compliant her patient will be.     

Can healthcare providers at a university health clinic predict patient satisfaction?

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

The Attachment Function of Acute and Chronic Suicidal Illness in the Psychotherapy of an Adult Female Incest Survivor

This paper presents the attachment-focused psychotherapy of a suicidal adult woman with a history of paternal incest, paternal suicide, and maternal death; the latter provoked the patient’s near lethal overdose. Psychotherapy with this patient posed formidable clinical challenges because killing herself represented the internalization of profound incest-related shame and pathological beliefs about herself and mother that permeated her whole way of being. By focusing on the patient’s multiple working models of attachment associated with the incest and father’s suicide, I illustrate the intergenerational transmission of unresolved trauma underlying her suicidal illness. The implications for practice emphasize how understanding and utilizing the intersubjective disorganized attachment dynamics facilitated the patient’s internalization of more adaptive and life-affirming views of self and surrounding conditions.     

Strengthening implementation success using large-scale consensus decision-making - A new approach to creating medical practice guidelines

A study involving over 2000 stoma care nurses in the development of best practice guidelines for the assessment of peristomal body profiles, patient engagement and patient follow-up was conducted in 2018. The study was designed to develop guidelines for stoma care treatment and product selection and to decrease the evidence to implementation gap. The project built on research evidence from a literature review of 77 articles. The results of the literature review were then used to inform a series of Delphi surveys sent out to stoma care nurses through Association and industry list-serves in 11 languages. The Delphi surveys were followed by a face2face professionally facilitated discussions among nurse-research experts. The project concluded with a facilitated consensus dialogue among 960 stoma care nurses from 25 countries, resulting in an implementation plan to ensure the guidelines become a normal part of routine patient care. The study resulted in a set of medical practice guidelines for stoma care nurses, designed to improve patient outcomes and patient quality of life, that were accepted and adopted into routine medical practice across 25 countries. This article describes the study and how the process used, coined the ‘Modified Delphi Process’ by the process designer, led to faster implementation than is generally experienced in the medical community.