From 1990 through 1997 the working schedules for staff surgeons underwent gradual changes. The aim was to comply with patient demands to receive care from few surgeons during hospital care. To evaluate the effect, four controlled or cross sectional studies were conducted. Quality of care was assessed by surgical audit. Patient and surgeon satisfaction was examined with questionnaires and interviews. Changes in costs were evaluated by administrative data. The number of different specialists providing care was reduced by 50%, initially during inpatient care and later also during outpatient care. The patients experienced this change as very satisfying. Hospital stay was reduced, as was time used by specialists on out-of-hours duty. The quality of care did not change neither did the use of diagnostic tests. The specialists appraised the increased individual responsibility in patient care as satisfying. Initiatives should be taken to examine whether other ways of organising work for hospital employed doctors have similar effect.
Increased knowledge of how patients express their experiences may help physicians to capture their patients' perceptions and agenda. The aim of the present study was to examine words and language used by patients when describing specific primary care consultation experiences. Six focus group sessions with a total of 31 patients were conducted shortly after a general practice consultation. All group sessions were audiotaped and analysed by qualitative ethnographic methodology. Seven distinct grammatical and verbal characteristics were found: The consultations were recited in the first person with little recollection of the doctors' talk or actions. Subjectivity was constantly underlined by the verbs "feel" or "think". When expressing negative emotions, the personal pronoun constantly was changed from the personal singular to the impersonal or plural form. Language tended to be evasive in connection with possible criticism. Negative emotions were diminished by the use of limiting expressions and modest wording. Non-committal expressions, with a wide range of possible meanings, were frequent, and were possible to decipher only by close attention to non-verbal cues. We conclude that doctors may capture more of their patients' hidden emotional messages in the consultation by increased awareness of specific verbal characteristics and non-verbal cues.
To investigate attitudes and experiences among general practitioners (GPs) taking part in an experiment with a list patient system in four municipalities in Norway.
A questionnaire distributed to all 160 GPs in the four municipalities after 3 years' trial of the system.
Primary health care in Norway.
The opinions of physicians on a list patient system after 3 years of trial.
Most of the physicians held that the list patient system imposed more obligations than they were used to. However, the majority also held that the system enhanced preconditions for doing a good professional job; 68% wanted the system on a permanent basis, while 14% rejected it.
Positive aspects outweigh negative aspects in the attitude of GPs to a list patient system.
As development organizations undertake the task of improving the public health in former socialist states, their interventions are shaped by a particular cultural logic and predetermined frame of possible action. In the context of local encounters, however, they often confront competing interpretations of a society's prevailing needs. How they manage such differences may not only explain the outcomes of a given project, but may also reveal the capacities and limitations of development agencies to engineer post-socialist change. This article examines a recent WHO project in St. Petersburg, Russia, which defined women's "social well-being" as a local health concern. While the project employed a discourse of "democracy" to promote women's empowerment in the clinic, its parameters of intervention neither incorporated local knowledge nor addressed the structural relations underlying clinic-level conflicts. Two kinds of results ensued: the ideology of democracy was rejected, while WHO's recommendations were partially appropriated as profit-making strategies.
This article addresses the importance of language, speech, and communication accommodations between the physician and the patient with dementia. Following a brief summary of common profiles of speech, language, and communication in several different types of dementia, the authors discuss key elements based on a comprehensive model of communication enhancement for individuals with dementia. The primary emphasis of this article is that physicians must select individually tailored communication strategies drawn from a sound knowledge of patients' skills. More importantly, the article stresses that communication is not just the exchange of information, but communication includes components that help establish mutual respect and maintain patients' self-identity and autonomy.
Effective patient-physician communication significantly influences health outcomes of older patients. For example, concordance between patient and physician expectations and patient participation in the decision-making process affects older patients. Communication is also linked to patient recall, adherence, and satisfaction. Furthermore, communication impacts emotional and physical outcomes of older patients, although evidence of improved physical outcomes remains under-investigated in this population. Dimensions of communication, such as continuity of relationship, seem to be important in decreasing hospitalization of older patients. This article explores the link between communication and health care outcomes in the older population.
The purpose of this study was to describe the sociodemographic patterns, consultations and the nature of problems of frequent attenders (FAs) at general practitioners at a primary health care centre. The design was a comparative study of FAs (> or = 5 consultations during 1991) (n = 179) and a contrast group of patients (CPs) matched by age and sex (1-4 consultations during 1991, n = 179). Data from medical records, appointment system, mortality and marital status were recorded. FAs comprised 1.7% of the inhabitants. Boys, middle-aged females, retired males and females and especially very old females were more frequent among FAs than their sections of the population would imply. FAs accounted for 15% and CPs for 4% of the consultations, 6.3 and 1.7 consultations on average, respectively. The average booked time for consultations during 1991 was 140 minutes for FAs and 35 minutes for CPs. Continuity was higher among older than younger FAs. Contacts other than medical consultations comprised a substantial part of the work with FAs, especially among middle-aged and elderly FAs. Problems arising from the musculoskeletal system, psychological and social problems were most common among FAs, often in combination, while chronic diseases such as cardiovascular diseases and diabetes were not crucial for frequent attending. Few FAs consulted as frequently in the preceding years and the following year, as in 1991, but still they accounted for more consultations than CPs during these years. More female FAs than males and CPs were divorced. The study indicates that FAs require a long-term strategy where continuity and accessibility are often important. They might also have profited by more time. However, FAs were a heterogeneous group of patients and follow-up studies and individual studies of FAs would be of interest.
The article discusses the effects that video conferencing in psychotherapy (distant therapy) may have upon the interaction between client and therapist. Experiences from distant therapy in North Norway, as well as earlier studies, are discussed in relation to factors such as client power and control, regulation of intimacy, and verbalization. The experiences indicate that physical presence--which is intuitively perceived as the ideal in relation to which the distant therapy settings are assessed--should be treated instead as a variable which can have positive and/or negative effects on a given therapeutic process.