Demanding patient or demanding encounter?: A case study of a cancer clinic

Department of Sociology, Kent State University, OH 44242-0001, United States.
Social Science [?] Medicine (Impact Factor: 2.89). 08/2009; 69(5):729-37. DOI: 10.1016/j.socscimed.2009.06.032
Source: PubMed


This paper explores the sociological relevance of demanding encounters between doctors and patients. Borrowing from Potter and McKinlay's [(2005). From a relationship to encounter: an examination of longitudinal and lateral dimensions in the doctor-patient relationship. Social Science & Medicine, 61, 465-479] reconceptualization of the doctor-patient relationship, we suggest an analytic shift away from 'demanding patients' toward 'demanding encounters'. Such a shift places provider-patient conflict within a broader socio-cultural context, emphasizing constraints facing both doctor and patient as they interact in a clinical setting. Specifically, through an ethnographic study of doctor-patient interactions at the oncology clinic of a US University Hospital, we examine the respective influences of new information technologies and patient consumerism in the production of demanding encounters in oncology. Findings suggest that these interconnected socio-cultural realities, in tandem with patient tendencies to challenge physician judgment or expertise, play a role in demanding encounters. We conclude by considering the implications of demanding encounters for doctors, patients and healthcare organizations.

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    • "Research shows that relationships between patients and physicians have become less hierarchical, and more client-provider oriented (Timmermans and Oh 2010; Boyer and Lutfey 2010). At the same time, there are extensive cultural messages surrounding the need for patients to take an active role in their own health care, be an advocate for themselves, and participate in health care decisions (Stacey et al 2009). This focus on the empowered patient is also fuelled by the increased information available to patients, largely through the Internet (Boyer and Lutfey 2010). "
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    ABSTRACT: There is a growing interest in understanding the effect that online information-seeking has on patients' experiences, empowerment and interactions with healthcare providers. This mixed-methods study combines surveys and in-depth interviews with 41 parents of paediatric cancer patients in the USA to examine how parents think about, evaluate, access and use the internet to seek information related to their child's cancer. We find that, during the acute crisis of a child being diagnosed with cancer, parents preferred to receive information related to their child's diagnosis, prognosis and treatment options from a trusted healthcare provider rather than through the internet. We find that access to medically related cancer information through the internet was deemed to be untrustworthy and frightening. Parents' reasons for avoiding online information-seeking included fear of what they might find out, uncertainty about the accuracy of information online, being overloaded by the volume of information online and having been told not to go online by oncologists. Some parents also had logistical barriers to accessing the internet. While most parents did not turn to the internet as a source of health-related information, many did use it to connect with sources of social support throughout their child's illness.
    Sociology of Health & Illness 08/2011; 34(3):444-58. DOI:10.1111/j.1467-9566.2011.01386.x · 1.88 Impact Factor
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    • "High users of medical services, these patients are generally unsatisfied with the care they receive [2-6] and may evoke strong negative emotions in clinicians [1,7]. Although clearly a subjective and imprecise term, the perception of patients as 'difficult' may result in worse care for patients involved [8,9] and increased stress and burn-out among professionals [10,11]. In the scarce empiric research into patients perceived as difficult in psychiatric services, incidence varies between 6 and 28%[12,13]. "
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    ABSTRACT: Little is known about the perspectives of psychiatric patients who are perceived as 'difficult' by clinicians. The aim of this paper is to improve understanding of the connections between patients and professionals from patients' point of view. A Grounded Theory study using interviews with 21 patients from 12 outpatient departments of three mental health care facilities. Patients reported on their own difficult behaviours and their difficulties with clinicians and services. Explanations varied but could be summarized as a perceived lack of recognition. Recognition referred to being seen as a patient and a person - not just as completely 'ill' or as completely 'healthy'. Also, we found that patients and professionals have very different expectations of one another, which may culminate in a difficult or ambivalent connection. In order to explicate patient's expectations, the patient-clinician contact was described by a stage model that differentiates between three stages of contact development, and three stages of substantial treatment. According to patients, in each stage there is a therapeutic window of optimal clinician behaviour and two wider spaces below and above that may be qualified as 'toxic' behaviour. Possible changes in clinicians' responses to 'difficult' patients were described using this model. The incongruence of patients' and professionals' expectations may result in power struggles that may make professionals perceive patients as 'difficult'. Explication of mutual expectations may be useful in such cases. The presented model gives some directions to clinicians how to do this.
    BMC Psychiatry 11/2010; 10(1):96. DOI:10.1186/1471-244X-10-96 · 2.21 Impact Factor
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    • "Patients perceived as 'difficult' may be labelled as such in services, and subsequently be at increased risk to be treated less respectfully, less effectively, and to be excluded from health services because of their failure to comply with its implicit and explicit rules for 'proper' patienthood [8-10]. Professionals working with these patients report more stress and burn-out [11,12]. "
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    ABSTRACT: Health clinicians perceive certain patients as 'difficult' across all settings, including mental health care. In this area, patients with non-psychotic disorders that become long-term care users may be perceived as obstructing their own recovery or seeking secondary gain. This negative perception of patients results in ineffective responses and low-quality care by health clinicians. Using the concept of illness behaviour, this paper describes the development, implementation, and planned evaluation of a structured intervention aimed at prevention and management of ineffective behaviours by long-term non-psychotic patients and their treating clinicians. The principles of Intervention Mapping were applied to guide the development, implementation, and planned evaluation of the intervention. Qualitative (individual and group interviews), quantitative (survey), and mixed methods (Delphi-procedure) research was used to gain a broad perspective of the problem. Empirical findings, theoretical models, and existing evidence were combined to construct a program tailored to the needs of the target groups. A structured program to increase effective illness behaviour in long-term non-psychotic patients and effective professional behaviour in their treating clinicians was developed, consisting of three subsequent stages and four substantial components, that is described in detail. Implementation took place and evaluation of the intervention is being carried out. Intervention Mapping proved to be a suitable method to develop a structured intervention for a multi-faceted problem in mental health care.
    BMC Health Services Research 10/2010; 10(1):293. DOI:10.1186/1472-6963-10-293 · 1.71 Impact Factor
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