Encounters Between Patients And Doctors

The complaints that patients bring to their doctors often have roots in social issues that involve work, family life, gender roles and sexuality, aging, substance use; or other problems of nonmedical origin. In this book, physician/sociologist Howard Waitzkin examines interactions between patients and doctors to show how physicians' focus on physical complaints often fails to address patients' underlying concerns and also reinforces the societal problems that cause or aggravate these maladies. A progressive doctor-patient relationship, Waitzkin argues, fosters social change. Waitzkin provides a pathbreaking analysis of medical encounters, applying perspectives from structuralism, post-structuralism, and critical literary theory to transcripts of recorded conversations between doctors and patients. He demonstrates how doctors unintentionally maintain dominance in their dealings with patients, encourage conforming social behavior and attitudes, and marginalize patients' concerns with social problems. Waitzkin urges physicians to attend to the social as well as the medical problems that emerge from patients' narratives and suggests ways to restructure the manner in which patients and doctors communicate with each other. Physicians and patients, for example, should work together to demystify medical discourse, should refrain from medicalizing social problems through medications or reassurances that dull socially caused pain, and should be prepared to call on advocacy organizations seeking to change the social conditions that create personal distress. This book will influence and challenge physicians scholars, and students in the social sciences and humanities, as well as anyone concerned about the present problems and future direction of medicine.

This 2006 volume provides a comprehensive discussion of communication between doctors and patients in primary care consultations. It brings together a team of leading contributors from the fields of linguistics, sociology and medicine to describe each phase of the primary care consultation, identifying the distinctive tasks, goals and activities that make up each phase of primary care as social interaction. Using conversation analysis techniques, the authors analyze the sequential unfolding of a visit, and describe the dilemmas and conflicts faced by physicians and patients as they work through each of these activities. The result is a view of the medical encounter that takes the perspective of both physicians and patients in a way that is both rigorous and humane. Clear and comprehensive, this book will be essential reading for students and researchers in sociolinguistics, communication studies, sociology, and medicine.

This book of readings offers compelling evidence that even in this age of advanced medical technology and large-scale bureaucracy, the essence of diagnosis, therapy, and management of illness continues to reside in the doctor-patient relationship. It brings together 17 articles published from 1927 to 1978 dealing with the sociological and cultural aspects of clinical and bedside medicine. The articles are grouped into five parts. These cover the ground rules for the doctor-patient relationship, the dynamics of the interchange, the nature of the communication, barriers to communication, case studies, and visions of what the ideal relationship might be. The editor has added an extensive introduction that situates the articles and reviews in the current state of research in the field.AuthorsEmily M. Ahern, Arlene K. Daniels, Milton S. Davis, Sherman Eisenthal, Joan P. Emerson, Vida Francis, Arlene Frank, Eliot Freidson, L. J. Henderson, Marc H. Hollender, Arthur Kleinman, Barbara M. Korsch, Aaron Lazare, John B. McKinlay, Marie J. Morris, Talcott Parsons, Francis W Peabody, Thomas J. Scheff, Thomas S. Szasz, Howard Waitzkin, Harry A. Wilmer, and Irving Kenneth Zola

The encounter between patient and physician may be characterized as the focus of medicine. As such, the patient-physician relationship, or more accurately the conduct of patients and physicians, has been the subject of considerable comment, inquiry, and debate throughout the centuries. The issues and concerns discussed, apart from those more specifically related to medical theory and therapy, range from matters of etiquette to profound questions of philosophical and moral interest. This discourse is impressive with respect both to its duration and content. Contemporary scholars and laypeople have made their contribution to these long-standing discussions. In addition, they have actively addressed those distinctively modern issues that have arisen as a result of increased medical knowledge, improved technology, and changing cultural and moral expectation. The concept of the patient-physician rela tionship that supposedly provides a framework for the conduct of patients and physicians seemingly has taken on a life of its own, inviolable, and subject to norms particular to it. The essays in this volume elucidate the nature of the patient-physician relationship, its character, and moral norms appropriate to it. The purpose of the collection is to enhance our understanding of that context, which many consider to be the focus of the entire medical enterprise. The con tributors have not engaged in apologetics, polemics, homiletics, or em piricism.

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

This title was first published in 2001. A classic ethnographic study of the interactions between paediatricians and parents of children thought to be neurologically handicapped. Strong used this work to systematize the often chaotic ideas of Erving Goffman, to explore the connections between micro and macro analysis in sociology and to reflect on the nature of medical practice in modern liberal societies. The book stands as a testament to Strong's pursuit of methodological rigour in qualitative sociology.

The effect of encounters between medical gatekeepers and patients on the doctor-patient relationship.

Primary care medicine is the new frontier in medicine. Every nation in the world has recognized the necessity to deliver personal and primary care to its people. This includes first-contact care, care based in a posi tive and caring personal relationship, care by a single healthcare pro vider for the majority of the patient's problems, coordination of all care by the patient's personal provider, advocacy for the patient by the pro vider, the provision of preventive care and psychosocial care, as well as care for episodes of acute and chronic illness. These facets of care work most effectively when they are embedded in a coherent integrated approach. The support for primary care derives from several significant trends. First, technologically based care costs have rocketed beyond reason or availability, occurring in the face of exploding populations and diminish ing real resources in many parts of the world, even in the wealthier nations. Simultaneously, the primary care disciplines-general internal medicine and pediatrics and family medicine-have matured significantly.

In a page-turning collection of vignettes, doctor, poet, and frequent NPR commentator David Watts captures with great humanity and wit the complicated relationship between the sick and the well.

Discusses how to avoid harmful medical mistakes, offering advice on such topics as working with a busy doctor, communicating the full story of an illness, evaluating test risks, and obtaining a working diagnosis.