Descriptive study of cooperative language in primary care consultations by male and female doctors.
OBJECTIVE: To compare the use of some of the characteristics of male and female language by male and female primary care practitioners during consultations. DESIGN: Doctors' use of the language of dominance and support was explored by using concordancing software. Three areas were examined: mean number of words per consultation; relative frequency of question tags; and use of mitigated directives. The analysis of language associated with cooperative talk examines relevant words or phrases and their immediate context. SUBJECTS: 26 male and 14 female doctors in general practice, in a total of 373 consecutive consultations. SETTING: West Midlands. RESULTS: Doctors spoke significantly more words than patients, but the number of words spoken by male and female doctors did not differ significantly. Question tags were used far more frequently by doctors (P<0.001) than by patients or companions. Frequency of use was similar in male and female doctors, and the speech styles in consultation were similar. CONCLUSIONS: These data show that male and female doctors use a speech style which is not gender specific, contrary to findings elsewhere; doctors consulted in an overtly non-directive, negotiated style, which is realised through suggestions and affective comments. This mode of communication is the core teaching of communication skills courses. These results suggest that men have more to learn to achieve competence as professional communicators. (+info)
Sending parents outpatient letters about their children: parents' and general practitioners' views.
Parents' cooperation is essential to ensuring implementation of effective healthcare management of children, and complete openness should exist between paediatricians and parents. One method of achieving this is to send parents a copy of the outpatient letter to the general practitioner (GP) after the child's outpatient consultation. To determine the views of parents and GPs a pilot survey was conducted in two general children's outpatient clinics in hospitals in Newcastle upon Tyne. In March and April 1991 a postal questionnaire was sent to 57 parents of children attending the clinics, and a similar questionnaire to their GPs to elicit, respectively, parents' understanding of the letter and perception of its helpfulness, and GPs' views on the value of sending the letters to parents. Completed questionnaires were received from 34(60%) parents and 47(82%) GPs; 26(45%) respondents were matched pairs. 27(79%) parents said they understood all of the letter, 19(56%) that it helped their understanding, 32(94%) felt it was a good idea, and 31(91%) made positive comments. In all, 29(61%) GPs favoured the idea and six (13%) did not. Eleven (23%) said they would be concerned if this became routine practice, and 20(74%) of the 27 providing comments were doubtful or negative; several considered that they should communicate information to parents. The views in the matched pairs were dissimilar: parents were universally in favour whereas many GPs had reservations. The authors concluded that sending the letters improved parents' satisfaction with communication, and they recommend that paediatricians consider adopting this practice. (+info)
AIDS-related policies, legislation and programme implementation in India.
This paper traces the evolution of AIDS-related policy and legislation in India from an initial response characterized by conservatism and discrimination to the development of a coherent national programme which aims to prevent the transmission of HIV and to develop support structures for people with HIV and AIDS. Examining the strategies, achievements and problems of specific components of the National AIDS Control Programme (NACP), the paper finds that the very progressive approach of national-level policy makers has been countered by conservative forces at the state and local levels. Little progress has been made, moreover, in incorporating HIV/AIDS prevention efforts into broader development and empowerment strategies. The paper concludes by considering the wider social context of AIDS in India and the role of more far-reaching policy measures. (+info)
The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies.
Private pharmacies are an important source of health care in developing countries. A number of studies have documented deficiencies in treatment, but little has been done to improve practices. We conducted two controlled trials to determine the efficacy of face-to-face educational outreach in improving communication and product sales for cases of diarrhoea in children in 194 private pharmacies in two developing countries. A training guide was developed to enable a national diarrhoea control programme to identify problems and their causes in pharmacies, using quantitative and qualitative research methods. The guide also facilitates the design, implementation, and evaluation of an educational intervention, which includes brief one-on-one meetings between diarrhoea programme educators and pharmacists/owners, followed by one small group training session with all counter attendants working in the pharmacies. We evaluated the short-term impact of this intervention using a before-and-after comparison group design in Kenya, and a randomized controlled design in Indonesia, with the pharmacy as unit of analysis in both countries (n = 107 pharmacies in Kenya; n = 87 in Indonesia). Using trained surrogate patients posing as mothers of a child under five with diarrhoea, we measured sales of oral rehydration salts (ORS); sales of antidiarrhoeal agents; and history-taking and advice to continue fluids and food. We also measured knowledge about dehydration and drugs to treat diarrhoea among Kenyan pharmacy employees after training. Major discrepancies were found at baseline between reported and observed behaviour. For example, 66% of pharmacy attendants in Kenya, and 53% in Indonesia, reported selling ORS for the previous case of child diarrhoea, but in only 33% and 5% of surrogate patient visits was ORS actually sold for such cases. After training, there was a significant increase in knowledge about diarrhoea and its treatment among counter attendants in Kenya, where these changes were measured. Sales of ORS in intervention pharmacies increased by an average of 30% in Kenya (almost a two-fold increase) and 21% in Indonesia compared to controls (p < 0.05); antidiarrhoeal sales declined by an average of 15% in Kenya and 20% in Indonesia compared to controls (p < 0.05). There was a trend toward increased communication in both countries, and in Kenya we observed significant increases in discussion of dehydration during pharmacy visits (p < 0.05). We conclude that face-to-face training of pharmacy attendants which targets deficits in knowledge and specific problem behaviours can result in significant short-term improvements in product sales and communication with customers. The positive effects and cost-effectiveness of such programmes need to be tested over a longer period for other health problems and in other countries. (+info)
What health plans should know about clinical practice guidelines--round-table discussion.
Quality is the watchword for health plans that wish to survive to see the new century, and accreditation by the National Committee for Quality Assurance is becoming quality's indispensable stamp. Practice guidelines are an imperative for that accreditation. Here's what seven managed care leaders had to say about guidelines in a recent round-table discussion. (+info)
Reducing malpractice risk through more effective communication.
This activity is designed for physicians, health plan administrators, and other providers. GOAL: To help physicians, health plan administrators, and other providers learn more about the relationship between provider communication behaviors and subsequent negligence litigation and learn how to reduce malpractice risk through improving communication behaviors. OBJECTIVES: 1. To describe research findings concerning the relationship between provider communication behaviors and subsequent claims of negligence. 2. To describe the major interviewing deficiencies that have been identified as precipitants of malpractice litigation. 3. To describe three functions of effective interviewing. 4. To describe training and learning methods that can improve provider-patient relationships, leading to improved clinical outcomes and decreased malpractice risk. (+info)
Patients' experience of surgical accidents.
OBJECTIVE: To examine the psychological impact of surgical accidents and assess the adequacy of explanations given to the patients involved. DESIGN: Postal questionnaire survey. SETTING: Subjects were selected from files held Action for Victims of Medical Accidents. PATIENTS: 154 surgical patients who had been injured by their treatment, who considered that their treatment had fallen below acceptable standards. MAIN MEASURES: Adequacy of explanations given to patients and responses to standard questionnaires assessing pain, distress, psychiatric morbidity, and psychosocial adjustment (general health questionnaire, impact of events scale, McGill pain questionnaire, and psychosocial adjustment to illness scale). RESULTS: 101 patients completed the questionnaires (69 women, 32 men; mean age 44 (median 41.5) years. Mean scores on the questionnaires indicated that these injured patients were more distressed than people who had suffered serious accidents or bereavements; their levels of pain were comparable, over a year after surgery, to untreated postoperative pain; and their psychosocial adjustment was considerably worse than in patients with serious illnesses. They were extremely unsatisfied with the explanations given about their accident, which they perceived as lacking in information, unclear, inaccurate, and given unsympathetically. Poor explanations were associated with higher levels of disturbing memories and poorer adjustment. CONCLUSIONS: Surgical accidents have a major adverse psychological impact on patients, and poor communication after the accident may increase patients' distress. IMPLICATIONS: Communication skills in dealing with such patients should be improved to ensure the clear and comprehensive explanations that they need. Many patients will also require psychological treatment to help their recovery. (+info)
A multiple case study of implementation in 10 local Project ASSIST coalitions in North Carolina.
Community health promotion relies heavily on coalitions to address a multitude of public health issues. In spite of their widespread use, there have been very few studies of coalitions at various stages of coalition development. The purpose of this study was to identify factors that facilitated or impeded coalition effectiveness in the implementation stage of coalition development. The research design was a multiple case study with cross-case comparisons. Each of the 10 local North Carolina Project ASSIST coalitions constituted a case. Data collection included: semi-structured interviews, observation, document review, and surveys of members and staff. Some of the major factors that facilitated implementation included: the ability of the coalition to provide its own vision, staff with the skills and time to work with the coalition, frequent and productive communication, cohesion or a sense of belonging on the coalition, and complexity of the coalition structure during the intervention phase. Barriers to effective implementation included: staff turnover and staff lacking community organization skills, dependence on the state-level staff during the planning phase and lack of member input into the action plan. Conflict contributed to staff turnover, reluctance to conduct certain activities and difficulty in recruiting members, all of which had implications for implementation. (+info)