Examination of an Audiologist's Response to Patient's Expression of Symptoms: A Pilot Study

This pilot study explores audiologist-patient interactions during initial evaluations or consultations. In particular, an audiologist's response to patient symptoms is examined. Conversations between audiologist and patients were recorded using a digital recorder, which were transcribed, and analyzed using the Codes for Human Analysis of Transcripts and Child Language Analysis computer programs. Mean length of turn and frequency of utterances related to explicit discussion or description of symptoms or the patient's interpretation of symptoms was determined. Study sample: six audiologist-patient interactions were recorded and transcribed. A single audiologist was used for this pilot investigation. Results suggest that during the initial audiological consultations related to hearing difficulties the audiologist produced more utterances related to explicit description of the symptoms, whereas when during the sessions about complex disorder and hearing aid consultation the audiologist produced more utterances related to the patient's interpretation of the symptoms. Also, a more equitable distribution of words and utterances per turn are observed during the initial consultation about hearing difficulties when compared to complex disorders and hearing aid consultation sessions where the audiologist was dominant within the interaction. This preliminary study reveals unique insights to audiologist's communication behavior during audiology consultation session. Efforts are needed to educate and promote appropriate communication between audiologists' and patients, which could result in increased patient satisfaction.

Preferences to Patient-Centeredness in Pre-Service Speech and Hearing Sciences Students: A Cross-Sectional Study

BACKGROUND AND OBJECTIVES: Patient-centeredness is a critical approach to rehabilitation in allied health professions and is an imperative component of evidence-based practice. However, it is unknown if patient-centeredness is valued by students enrolled in allied health. This study was aimed at determining preferences to patient-centeredness in pre-service speech and hearing students in the field of speech and hearing sciences. SUBJECTS AND METHODS: Pre-service speech and hearing students (n=93) completed the Patient-Practitioner Orientation Scale (PPOS) and were grouped according to low, medium, or high exposure to curriculum content. RESULTS: Across exposure levels, students exhibited high preference to patient centeredness with a mean PPOS score of 4.13 (standard deviation–0.5). A pairedsample t-test revealed a significant difference (p≤0.0001) between the caring and sharing subscales of the PPOS with lower mean scores on the caring subscale. No significant differences were noted across levels of exposure for sharing subscale, caring subscale, or PPOS full-scale. CONCLUSIONS: Results suggest a need for curriculum enhancement focused on improved caring and empathy.

Physicians' Perspectives Toward Shared Decision Making in Developing Countries.

Aims: To evaluate Iranian physicians’ perspectives on shared decision making by validating and translating the physician version of a shared decision making questionnaire (SDM-Q-DOC). Place and Duration: Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran, from June 2012 to July 2013. Methods: The physician version of a shared decision making questionnaire (SDM-QDOC) was translated and validated through a pilot study among urologists in one of the hospitals of Tabriz University of Medical Sciences. A validated questionnaire was handed out among Iranian physicians in three main hospitals of Urmia. The results were analyzed using factorial analysis SPSS 16 software. To assess reliability, Cronbach’s alpha coefficient was calculated. Pearson correlation coefficient was used to assess testretest value. Results: The Persian version of the questionnaire showed an acceptable level of reliability (Cronbach alpha=0.901). In the implementation phase, Iranian physicians were generally in favor of the SDM process ( mean score=74.4%) but their perspective on different phases of SDM were different, with 93% answering questions evaluating physicians’ clinical explanations to their patients and only 68% agreeing with questions evaluating physicians’ attitudes regarding involving patients in the last treatment option. Conclusion: The physician version of SDM-Q-DOC is a valid and reliable questionnaire assessing physicians’ attitudes toward the SDM process. In this study, Iranian physicians showed a positive view to SDM.

Shared Decision-Making and Its Correlation with Demographic Characteristics of Iranian Patients.

Aims: To evaluate relationship between patient age, location and their preference toward partnership in clinical decision making Place and Duration: A university-based clinic, Tabriz University of medical sciences, Tabriz, Iran from March to September Methods: In a cross-sectional study, 200 patients were randomly selected for the study. Patients’ demographic indicators and attitude toward partnership with their doctor was assessed by the use of an author-developed questionnaire containing 12 questions. Validity of this questionnaire was previously confirmed. The data was finally collected and analyzed. Results: Fifty three percent (53%) of patients were male and 47% was female. Mean age was 33.88 (SD=11.35). Of the 200 patients, 66% had tendency toward shared decision making (SDM). There was a positive correlation between higher level of education and SDM in Iranian patients. Conclusion: We found a trend toward shared decision making among patients. We conclude that raising literacy could change the culture of patient-physician relationship within the country.

Differences in Attitude Toward Patient-centeredness in Patients and Physicians / 한국의학교육

PURPOSE: There have been studies on the patient-centeredness of medical students and physicians in South Korea, but no result has presented the patient-centered attitude of patients and doctors. So, this study intended to compare the attitudes of patients and doctors toward the roles that patients and physicians should play in the health care process. METHODS: One hundred and fifteen doctors and 264 patients participated in this survey using a structured questionnaire, including sociodemographic data and Patient Practitioner Orientation Scale (PPOS). The PPOS comprises sharing (sharing information, take part in decision making) and caring (respecting one's feelings, interpersonal relationships) subscales. RESULTS: The PPOS scores of the doctors and patient were 3.02 and 3.20. In detail, the doctors' sharing and caring scores were and 3.02 and 3.48, and the those of patients were 3.14 and 3.12, respectively. This results are enough to demonstrate that patients are likely to be patient-centered with regard to sharing and that doctors tend to be patient-centered in terms of caring. CONCLUSION: The patients' desire to obtain medical information and take part in decision making (sharing) are greater than those of doctors. Doctors had more patient-centered attitude than patients in terms of respects for one's feelings and interpersonal relationships (caring).

Patient safety and healthcare standard

Recently patient safety has become overwhelming issue in Korean healthcare societies. Since ancient period, it has been essential principle of medicine. But the word of patient safety was recently emerged. It is more patient-centered concept than error, malpractice, and iatrogenesis, which are focused on healthcare providers. Main domains of healthcare quality are patient safety, effectiveness, timeliness, and patient-centeredness. Patient safety is not only the core of healthcare quality but also the principle of other qualities. It became standard of care, standard of accreditation, standard of medical device quality, and so on. It also works as driving forces of health industry, health information technology, and simulation-based medical education. Nowadays safe health technologies are most competitive in healthcare. The era of patient safety was just begun. Improving patient safety is a big challenge to us. Action plans at the level of whole Korean healthcare societies are urgently needed and innovative solutions should be sought.

Medical Students' Attitudes Toward the Patient-Doctor Relationship / 한국의학교육

PURPOSE: This study investigated the attitudes of medical students toward physicians and the roles which the doctors and patients should play in the health care process. METHODS: Attitudes toward the patient-doctor relationship of 436 medical students of the K university in Seoul were measured using the Patient-Practitioner Orientation Scale(PPOS), a validated instruments designed to measure individual preferences toward various aspects of the patient-doctor relationship. The PPOS was composed of Sharing(sharing information, take part in decision making) and Caring(respect one's feelings, interpersonal relationship) subscale. Total PPOS scores can range from patient-centered(egalitarian, whole person oriented) to disease- or doctor-centered(paternalistic, less attuned to psychosocial issues). Socio-demographic data including gender, age, school year, marital status, undergraduate major, student's and her/his family medical background and specialty choice were collected and it was investigated the possible impact of socio-demographic factors on students' attitudes. RESULTS: The PPOS score was 3.82. The Sharing and Caring scores were 3.74 and 3.90, respectively. Female gender and students of graduate entry program were significantly associated with patient-centered attitudes. Age, school year, marital status, academic background, student's and her/his family medical background, and specialty choice did not show significant associations with PPOS scores. CONCLUSION: Female and graduate students showed more patient-centered attitudes than male and undergraduate students, respectively. Given the emphasis placed on patient-centered care in the current medical environment, our results suggest further research to explore the dynamics in medical education that may foster or inhibit student attitudes toward patient-centered care.

Patient-Centeredness Associated with Personality Traits of Medical Students / 한국의학교육

PURPOSE: The patient-centered attitude is an effort to understand patients themselves as well as their disease. The doctor-oriented approach has been shifting to one where patients and participate in the deciding of medical service. We performed this study to investigate the patient-centeredness and influencing variables associated with personality traits. METHODS: We recruited 94 medical students before their psychiatric clinical clerkship, and all subjects were assessed by a structured questionnaire including socio-demographic data, Minnesota Multiphasic Personality Inventory(MMPI), Meyers-Briggs type indicator(MBTI), the patient-practitioner Orientation Scale(PPOS), and the Authoritarian Personality scale(AP), The AP and PPOS questionnaires were repeated after the psychiatric clinical clerkship. RESULTS: After the psychiatric clinical clerkship, the AP scores were significantly lower than before, and the PPOS significantly higher than before. The change in the AP scores were related to MBTI, correlated with MMPI subscales, however, inversely correlated with the changes in PPOS after the clinical clerkship. CONCLUSION: The authoritarian personality trait was related to, not only the personality trait including MBTI and MMPI subscales, but also to patient-centeredness in medical students.

The Study on Patient-Centeredness and Influencing Variables in Medical Students / 신경정신의학

INTRODUCTION: The practicing of patient-centered medical services means a change in the pattern of the nature of doctor-patient relationship. The doctor oriented relationship is now moving to the pattern that patients resolve problems autonomously and participate in the decision-making in medical services. Authors performed this study to investigate the patient centeredness and influencing variables in medical students. METHODS: Authors recruited 94 medical students before psychiatric clinical clerkship and all subjects were assessed by structured questionales including socio-demographic data, frequency of receiving doctor-patient relationship lectures, Minnesota multiphasic personality inventory (MMPI), Meyers-Briggs type indicator (MBTI), the authoritarian personality scale (AP), job satisfaction scale (JS), patient practitioner orientation scale (PPOS), problem-solving decision-making scale (PSDM), and Beisecker locus of authority in decision-making scale (BLAS), and the questionnaire of JS, PPOS, PSDM, and BLAS were rechecked after psychiatric clinical clerkship. RESULTS: After psychiatric clinical clerkship, the score of JS, PPOS were higher than before. The group who had a good memory for taking a doctor-patient relationship lecture showed higher scores of the BLAS and PSDM than unexposed group. The AP was related with MBTI, correlated with the subscale of MMPI, however, inversely correlated with PPOS after psychiatric clinical clerkship. CONCLUSION: The authoritarian personality trait was related not only with other personality trait including introversion and psychopathic deviation (Pd) but also with patient-centeredness. Taking a lecture in doctor-patient relationship is positively related to the patient-centeredness.

Patient-Centeredness in Faculties, Residents and Medical Students / 신경정신의학

INTRODUCTION: The nature of doctor-patient relationship has changed. We performed this study to investigate the patient centeredness and influencing variables in medical faculties, residents and medical students. METHOD: The subjects were 56 medical students, 62 residents and 103 faculties in university and general hospitals. The sociodemographic data, frequency of receiving doctor-patient relationship lectures, the job satisfaction scale (JS), the patient practitioner orientation scale (PPOS), the authoritarian personality scale (AP) were items assessed. RESULT: The AP were inversely correlated with total scores of the PPOS in medical students, residents, and faculties. The scores of JS were correlated with total scores, and the care subscale of the PPOS in medical students. The group received doctor-patient relationship lecture showed higher scores of the PPOS than unexposed group. Female faculties showed higher scores of the care subscale of the PPOS than male counterparts. The scores of care subscale of the PPOS of the women doctors who have children were higher than those who do not have children. CONCLUSION: The authoritarian personality trait is correlated with the doctor/disease centeredness in medical students and doctors. The experience of learning about doctor-patient relationship is positively related to the patient centeredness. The job satisfaction, sex, and children bearing may be correlated with the patient centeredness under the certain circumstances.