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Abstract

Determining the patient's major reasons for seeking care is of critical importance in a successful medical encounter. To study the physician's role in soliciting and developing the patient's concerns at the outset of a clinical encounter, 74 office visits were recorded. In only 17 (23%) of the visits was the patient provided the opportunity to complete his or her opening statement of concerns. In 51 (69%) of the visits the physician interrupted the patient's statement and directed questions toward a specific concern; in only 1 of these 51 visits was the patient afforded the opportunity to complete the opening statement. In six (8%) return visits, no solicitation whatever was made. Physicians play an active role in regulating the quantity of information elicited at the beginning of the clinical encounter, and use closed-ended questioning to control the discourse. The consequence of this controlled style is the premature interruption of patients, resulting in the potential loss of relevant information.
... Cette attitude renvoie à un manque d'écoute des patients de la part de l'équipe médicale. Beckman et Marvel concluaient dans les années 1990 que la durée moyenne d'écoute d'un soignant avant de couper un patient exposant son motif de consultation, n'était que d'une vingtaine de secondes (chiffre repris en 2016 par Revah-Levy), ce qui ne semble pas suffisant pour construire les prémices d'une relation de qualité [4][5][6]. ...
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Lien de partage : https://authors.elsevier.com/a/1gStq6HQtUL7e7 Objectif La relation soigné-soignant anime la réflexion éthique depuis toujours et d’autant plus depuis la promulgation de la loi Kouchner, au regard de son implication majeure dans la qualité de la prise en charge délivrée aux patients. La place que tient le discours du soignant, élément fondateur de cette relation, questionne toujours depuis plus de 20 ans. Matériel et méthode Une revue de la littérature a été menée sur les dix dernières années afin de mettre en évidence l’impact du discours des soignants chez les patients, notamment en termes de vécu de la maladie et d’engagement dans la démarche thérapeutique. Résultats Sur les 1292 articles, 15 ont été inclus dans la revue. Ces derniers ont permis de souligner des attitudes de soin très variées allant d’une relation autoritaire souvent associée à un manque d’informations fournies aux patients, à la coopération thérapeutique. Conclusion Cette synthèse souligne que certains comportements paternalistes sont contre-productifs. À l’inverse une approche centrée sur le patient contribue à développer l’alliance thérapeutique et à favoriser l’empowerment chez ces derniers. Le discours du soignant apparaît ainsi comme un levier indispensable pour promouvoir la santé des patients.
... 19 İyi iletişim, hasta öyküsü ile daha fazla ve daha doğru bilgi almayı sağlar, tanı doğruluğunu ve karar verme becerisini geliştirir. [20][21][22] Ayrıca, hasta ve diş hekimi arasındaki olumlu iletişim hastanın ağız sağlığının önemi hakkındaki farkındalığını geliştirir. Dolayısıyla, toplumun ağız sağlığını iyileştirmenin ilk adımı olarak iyileştirilmiş hasta-diş hekimi iletişimine ihtiyaç vardır. ...
... Despite this, patients often report that they feel the clinicians are not listening to them, or at least, not hearing their full story. Classic observational studies demonstrated that, on average, clinicians interrupted the patients' narrative about their main concerns after around 18-23 s [14,15]. Although more in-depth analysis indicated that not all interruptions are intrusive, and some aim at clarification, or rapport building [16], it remains concerning that physiotherapists have been shown to spend twice as long as patients talking in the first consultation [17], and that the most experienced practitioners were significantly more likely to talk over their patients [18]. ...
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Consultations between practitioners and patients are more than a hypothesis-chasing exploration, especially when uncertainty about etiology and prognosis are high. In this article we describe a single individual's account of their lived experience of pain and long journey of consultations. This personal account includes challenges as well as opportunities, and ultimately led to self-awareness, clarity, and living well with pain. We follow each section of this narrative with a short description of the emerging scientific evidence informing on specific aspects of the consultation. Using this novel structure, we portray a framework for understanding consultations for persistent musculoskeletal pain from a position of patient-centered research to inform practice.
... 5 A study was done by Beckman and Frankel reported that most patients struggle with expressing their concerns and only 23% of them were able to openly talk. 6 In a narrative published in 2015 in respect with the medical history, the finding indicated that it assists in reaching an accurate diagnosis, a treatment plan modification, and a treatment prognosis because of the detailed information obtained. 5 It has also a substantial effect on building patient rapport, providing information, education, and management. ...
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Objective: To evaluate the patient's willingness to declare their medical history to their dentists against demographic and medical information. Methods: A self-administered structured questionnaire regarding common chronic condition and pregnancy awareness and attitude toward medical information disclosure to their dentists was designed employing a five-point Likert-type scale. The questionnaire was distributed to among sample of adults. Data were collected and statistically analyzed using descriptive statistics, t-tests, ANOVA, and P values. Results: A total of 573 questionnaires were completed. Only 61.3% were willing to share their medical history with the dentist and 76.1% will disclose previous complications of their condition in the dental office. Two third 71.9%of the sample will disclose about medications and 76.1% will disclose pregnancy month. There was lack of education regarding health conditions, 73.3% did not receive any information about their medications. While 72.8% did not receive any information regarding complications of their disease and 76.3% were not told what to do if complication arises. Conclusion: The population's willingness to reveal their medical information in the dental office is crucial. Though was within acceptable limit but still deficient. Age, education, occupation and marital status have a significant effect on disclosing and awareness. Educating patients and raising their awareness may aid in reducing emergencies, errors, and legal issues in the dental office.
... If IIB is discussed or brought up by the patient, then that would help identify a need for initiating or modifying treatment. For instance, in a study of doctor-patient interactions, the investigators found that "characteristically, after a brief period of time (mean, 18 s), and most often after the expression of a single stated concern, the physicians in our study took control of the visit by asking increasingly specific, closed-ended questions that effectively halted the spontaneous flow of information from the patient" (42). This is unfortunate because migraine is a condition in which providerpatient communication is paramount especially since the clinical and/or neurological examinations of patients with migraine are typically normal and providers are unable to rely upon biomarkers to aid in diagnosis or tracking of disease progression. ...
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Migraine is a highly prevalent neurological disease of varying attack frequency. Headache attacks that are accompanied by a combination of impact on daily activities, photophobia and/or nausea are most commonly migraine. The headache phase of a migraine attack has attracted more research, assessment tools and treatment goals than any other feature, characteristic, or phase of migraine. However, the migraine attack may encompass up to 4 phases: the prodrome, aura, headache phase and postdrome. There is growing recognition that the burden of migraine, including symptoms associated with the headache phase of the attack, may persist between migraine attacks, sometimes referred to as the “interictal phase.” These include allodynia, hypersensitivity, photophobia, phonophobia, osmophobia, visual/vestibular disturbances and motion sickness. Subtle interictal clinical manifestations and a patient's trepidation to make plans or commitments due to the unpredictability of migraine attacks may contribute to poorer quality of life. However, there are only a few tools available to assess the interictal burden. Herein, we examine the recent advances in the recognition, description, and assessment of the interictal burden of migraine. We also highlight the value in patients feeling comfortable discussing the symptoms and overall burden of migraine when discussing migraine treatment needs with their provider.
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Drawing on conversation analysis, this study examines primary-concern solicitation in Mandarin-speaking medical encounters in China. Based on the observation of naturally occurring solicitation sequences, we identify the major question formats and problem-solicitation patterns in China’s mainland. It is found that Chinese medical openings feature both the dominance of generic solicitation in primary-concern solicitation and the recurrence of phase-skipping business-specific solicitation. Chinese primary-concern solicitation tends to be both more permissive and restrictive than its English counterpart, driven by the same concern of consultation efficiency. The study contributes to a cross-cultural comparison of the medical activity and enriches the understanding of culture and language’s influence on performing social actions in medical encounters.
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* We wish to acknowledge the help, through discussion and/or through bringing relevant data to our attention, of Jo Ann Goldberg, Anita Pomerantz, and Alene Terasaki at the University of California, Irvine, and of Françoise Brun-Cottan, Irene Daden, and Louise Kerr at the University of California, Los Angeles. Harvey Sacks was killed in an automobile accident while this paper was undergoing final revision. 1. Bolinger ([1953] 1965:248) writes: 'What speakers avoid doing is as important as what they do. Self-correction of speech and writing, and the correction of others in conversation ("I can't understand what you say"), in classrooms, and over editorial desks is an unending business, one that determines the outlines of our speech just as acceptances determine its mass. Correction, the border beyond which we say "no" to an expression, is to language what a seacoast is to a map. Up to now, linguistic scientists have ignored it because they could see in it nothing more than the hankerings of pedants after a standard that is arbitrary, prejudiced and personal. But it goes deeper. Its motive is intelligibility, and in spite of the occasional aberrations that have distracted investigators from the central facts, it is systematic enough to be scientifically described.' Not much has been made of the distinction—in part, perhaps, because the disciplines have used it to divide up their work, self-correction being occasionally discussed by linguists (since it regularly occurs within the sentence?), e.g. Hockett...
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The purpose of this study was to investigate the effectiveness, dynamics, and consequences of a health education intervention designed to increase patient question asking during the patient's medical visit. Data were collected at a Baltimore family and community health center which provides outpatient services to a low income, predominantly black and female population. The majority of the study participants were, in addition, elderly and chronically ill. A total of 294 patients and 3 providers took part in the study. The study design included random assignment of patients to experimental and placebo groups with two non-equivalent (non-randomized) control groups. Findings included: (1) The experimental group patients asked more direct questions and fewer indirect questions than did placebo group patients. (2) The experimental group patient-provider interaction was characterized by negative affect, anxiety, and anger, while the placebo group patient-provider interaction was characterized as mutually sympathetic. (3) The experimental group patients were less satisfied with care received in the clinic on the day of their visit than were placebo patients. (4) The experimental group patients demonstrated higher appointment-keeping ratios (an average number of appointments kept divided by an average number of appointments made) during a four-month prospective monitoring period.
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In observing more than 300 clinical interviews, we have seen a high frequency of physician-engendered defects. Most of the defective examples can be classified as one or a combination of five syndromes: the therapeutic lack; inattention to primary data (symptoms); a high control style; an incomplete data base usually omitting patient-centered data and active problems other than the present illness; and a thoughtless interview in which the physician fails to formulate needed working hypotheses. Proper diagnosis of these defects allows for better prescription of educational correction.
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The relationship between the presenting complaint and the principal problem identified during 103 new patient visits was assessed in an academic primary care setting. Complaints and problems were classified by content as somatic, psychosocial, or health maintenance and compared by category. The presenting complaint correctly identified the category in 76 percent of somatic but only 6 percent of psychosocial principal problems (sensitivity of 76 percent and 6 percent, respectively). The likelihood of a same-category principal problem (positive predictive value) ranged from 53 percent for somatic to 100 percent for psychosocial presenting complaints. A specific underlying motivation for the visit other than the presenting complaint was noted by the primary provider in 42 percent of the encounters and was most frequent in those encounters characterized by a lack of concordance between complaint and problem. The presenting complaint introduces the clinical encounter, but its value is limited in specifically identifying the principal problem.
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The communication skills of house officers in medical clinic were studied. Ten communication skills were identified as being central to the doctor-patient relationship. Twenty interns and residents were observed in 60 clinic visits. Skills well-demonstrated by the house officers related to listening, history taking, assessing patient compliance, examining the patient, and prescribing therapy. Underdeveloped skills were those that involved obtaining the patient's understanding of his illness, social history, and emotional response and the doctor's explanation of the illness. To enhance performance of these skills, changes are recommended in four areas of ambulatory teaching: liaison psychiatry, faculty development, medical precepting, and the relationship between faculty and house officers.
National Ambulatory Medical Survey Maryland: National Center for Health Sta-tistics, 1983; DHHS publication no. (PHS) 83-1250. (Advance data from Vital and Health Statistics
  • Lawrence L Mclemore
LAWRENCE L, MCLEMORE T. National Ambulatory Medical Survey, 1981 Summary. Hyattsville, Maryland: National Center for Health Sta-tistics, 1983; DHHS publication no. (PHS) 83-1250. (Advance data from Vital and Health Statistics; March 16, 1983; no. 88).
C : Center for Applied Linguistics
  • D Washington
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