A critical ethnography of doctor–patient interaction in southern Iran.

Doctor–patient interaction is a subject with ethical ramifications, besides being an important issue in medical sociology. The main goal of this critical study is to explore the interactional experience of hospital admitted patients. For this reason, the study, carried out in an educational hospital in southern Iran, entailed 156 recorded clinical consultations, 920 hours of participant observation, and six focus groups consisting of patients and their families. The research method used is Critical Ethnography, which was introduced by PF Carspecken. The results showed that negative interactional experience was common among the participants. Six related themes were: doctors’ inattentiveness; weak interaction; violation of patients’ privacy; unjustified pain; long waiting period and ambiguity; and faceless physicians. According to the participants’ observations, poor interaction with doctors has led to these negative experiences. The findings showed that doctors were inconsiderate about patients’ concerns and due to this, patients were dissatisfied. Theoretically, this form of fragmented collaboration has deep roots in the framework of modern medicine, but in the context of this study, the intensity of the fragmentation between doctors and patients was observed to be intolerable. To solve this problem, models of patient-centredness and narrative medicine are recommended. In addition, the health system should monitor and evaluate the observance of ethics by physicians.

Acute mesenteric ischemia: causes and mortality rates over sixteen years in southern Iran.

Acute mesenteric ischemia (AMI) is a catastrophic disorder of the gastrointestinal tract with high mortality. Few data on the characteristics of this disease in Iran are available. Patient records of public and private hospitals in Shiraz, southern Iran, with impression of acute abdomen, bowel gangrene or abdominal pain, and patients with risk factors for this disease, who were admitted between March 1989 and March 2005, were reviewed. Among the 10,000 patient records studied, 105 patients (mean age 57 years) with AMI were identified. The mortality rate was 50.4%. The most common symptom was abdominal pain (98.1%). Heart diseases were seen in 44.7% of cases. The mortality rate was lower in patients undergoing mesenteric angiography (p=0.014). In those patients in whom the site of lesion was identified, venous thrombosis was the most common type (41.9%). AMI is a common cause of acute abdomen especially in elderly patients, with venous thrombosis being the most common type.

Analysis of patients listed for liver transplantation in Shiraz, Iran.

AIM: To analyze records of patients listed for liver transplantation (LT) at our hospital, the first and the largest LT center in Iran. METHODS: We analyzed medical records of patients aged 14 years or older, who were listed for LT for chronic liver disease between 1994 and 2004. Outcome was determined from records or follow-up data. RESULTS: Among the 480 patients (mean age 39 [SD 13] years; 327 [68.1%] men) listed for LT, common causes of cirrhosis were cryptogenic (143; 29.9%) and hepatitis B (127; 26.5%). Child-Turcott-Pugh (CTP) class distribution of these patients was: A - 37 (7.7%), B - 258 (53.7%) and C - 185 (38.6%). Mean (SD) follow-up duration was 11.4 (11.8) months (range 1-108). One hundred and four (21.7%) patients received LT and 173 (36%) died while awaiting LT. CTP class influenced 1-year (90%, 73% and 55% in class A, B and C, respectively) and 2-year (84%, 48% and 25%, respectively) survival rates. MELD score also influenced survival. Survival was better in patients who underwent LT than in those who continued on the waiting list (p< 0.01). CONCLUSION: Only about one-fifth of patients listed for LT in Iran received LT and a large proportion died without LT.