Medical students’ views of power in doctor–patient interactions: the value of teacher–learner relationships

Medical Education 2010: 44 : 187–196 Context This paper aims to contribute to the important, and relatively underexplored, area of medical education research that seeks to illuminate the value and meaning of relationships in the undergraduate education of doctors. Here I present new empirical material in which I ground my reflections on some ways in which teacher–learner relationships can help address medical students’ often uncritical views of professional practice. The views I illustrate are of particular significance as they contrast sharply with the participative models of practice promoted by current policy, professional and educational discourses. Methods My reflections stem from the analysis of data I generated for a larger, broadly ethnographic study exploring students’ approaches to their future role as practitioners in one UK medical school. I draw upon this larger body of data and focus here on two examples in particular of the more general uncritical readings of medical professionalism I encountered at Sundown Medical School (an invented name), namely: students’ often reductive views of medical power, and their simplistic formulations of patient education. Discussion I argue for the need to foster richer and more critical understandings of professional power and knowledge among students and educators, and suggest here that teacher–learner interactions could have an important role in fostering such richer understandings. I argue that teacher–learner relationships can model some of the dynamics of the practitioner–patient interaction and thus provide useful opportunities for closer and more critical analysis of power, education and knowledge in the medical school classroom as well as in the consultation room. Conclusions I suggest that effective integration of participative and critical pedagogical strategies in medical curricula and more structured involvement of patients in the role of teachers may represent valuable strategies for the development of learning relationships that better promote reflexive and collaborative forms of professionalism.     

The influence of medical cost controls implemented by Taiwan's national health insurance program on doctor–patient relationships

To prevent medical costs from rising, the National Health Insurance administration implemented the global budget system for financial reform, effective 1 July 2004. Since the implementation of this system, patients have been required to pay for some medicines to limit costs to the system. More recently, as they have faced constant increases in health insurance fees and also faced an increase in the number of medical expenses they must pay during an economic recession and a rise in unemployment, would the economic burden on the people of Taiwan not be increased? Even though National Health Insurance is a form of social insurance, does it guarantee social equality? The value of the healthcare industry is irreplaceable, so the most critical concern is whether worsening doctor–patient relationships will worsen healthcare quality. In short, while the global budget system saves on National Health Insurance costs, whether its implementation has affected healthcare quality is also worth exploring. This commentary also hopes to serve as a reference for the implementation of national health insurance in the United States. Copyright © 2014 John Wiley & Sons, Ltd.     

Contextual dynamics in clinical workplaces: learning from doctor–doctor consultations

Medical Education 2013: 47 : 463–475 CONTEXT Some studies have explored the role of learning context in clerkships and in clinical teams. Very little is known, however, about the relationship between context and competence development in more loosely framed, day‐to‐day practices such as doctor–doctor consultations, although such interactions are frequent and typical in clinical work. METHODS To address this gap in the literature, a study was conducted using semi‐structured interviews in four different hospitals and participant observation at one site. Inductive content analysis was used to develop a framework. Special reference was made to the principles of situated cognition. RESULTS The framework illustrates how different situational, personal and organisational factors interact in every learning situation. The interplay manifests in three different roles that doctors assume in highly dynamic ways: doctors learn as ‘actors’ (being responsible), as ‘participants’ (being involved) and as ‘students’ (being taught); contextual influences also impact on the quality of learning within these roles. CONCLUSIONS The findings add to the current literature on clinical workplace learning and to the conceptualisation of context in the field of education. The practical contribution of the research lies in disentangling the complex dynamics of learning in clinical environments and in helping doctors and medical educators to increase their responsiveness to contextual factors.     

Boundary‐making in the medico‐legal context: examining doctor–nurse dynamics in post‐sexual assault forensic medical intervention

A key dimension of the institutional response to sexual assault is the forensic medical examination of a victim's body conducted for purpose of documenting, collecting and testifying to corroborative evidence. Drawing upon in‐depth interviews with forensic examiners and forensic nurse practitioners in one region of England, this study addresses a gap in the existing research on medico‐legal processes, and critically examines the nature and dynamics of the relationship between doctors and nurses involved in this intervention. Using an analytic framework based on Thomas Gieryn's notion of ‘boundary‐work’, we explore how this historically gendered dyadic relationship is experienced and understood in a context influenced by both medicine and law. We demonstrate very clear boundaries demarcating (i) physicians as experts and nurses as non‐experts in the collection and representation of medical evidence, and, (ii) physicians as equated with technical competence and nurses with ‘caring’ duties. We conclude by positing implications that may stem from these professional relations with respect to sexual assault evidence, professionals and victims.     

浅谈护患语言沟通的技巧

目的探讨护患语言沟通的技巧。方法根据护患沟通中存在的问题,如:语言表达不当,缺乏沟通的技巧,沟通能力差等问题,采取恰当的护理措施,合理运用语言,加强护患沟通,强化护士素质,掌握好护患沟通的技巧,加强心理护理,充实语言交流的内涵。结果通过有效的护患沟通,取得了患者的信任,缩短了护患之间的距离。了解患者的心理状态,并实施了心理护理,使患者消除了紧张情绪,调整了心态,积极配合治疗和护理。结论护患语言沟通的技巧在临床护理工作中起着至关重要的作用。     

Memorial Hermann creates standalone patient communications system

This standalone patient communications system can be customized by individual clinics. It also offers patients a series of message types, each of which can be routed to a different person at the clinics. And, though it required a security infrastructure, it didn't have to be integrated with backend systems.