Taking control of violence against doctors

Violence against healthcare professionals is a serious but understudied global problem and one that lacks evidence‐based solutions. The current research offers a novel explanation and intervention for addressing this issue: We propose that low feelings of control among patients and their family members play an important role in shaping doctor‐patient relationships. To regain a sense of control, we suggest that patients attribute responsibility to doctors for their suffering, which may in turn lead to aggressive behavioural intentions against one's doctors. We conducted three studies to understand whether individuals with low perceived control blame doctors more, and whether threats to their sense of control cause participants to attribute more responsibility to doctors. Study 1 found that feelings of lack of control were an important predictor of attributing responsibility for negative illness‐related incidents to doctors in a manner consistent with blame. Study 2 specified that the chaotic and unpredictable nature of illness, and not just its negative valence, is what drives attributions of increased responsibility to doctors. Study 3, which utilized a field setting in hospitals, found that an experimental intervention to increase feelings of control decreased frustration against (Study 3a/3b) and intention to harm doctors (Study 3b). These findings suggest that increasing feelings of control among patients can improve patient‐doctor relationships. We also discuss the role of control and scapegoating during the COVID‐19 pandemic.

Physician Autonomy at Issue if Patients Demand Ineffective Treatments

The article describes how physician autonomy is at issue if patients demand ineffective treatments as indicated in a Wisconsin Supreme Court case which centers on whether physicians can be legally required to provide ivermectin for COVID-19 if a patient or family requests it, citing the ethical obligations to consider.

"You're Socially Distant and Trying Not to Be Emotionally Distant." Physicians' Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study.

To: 1) characterize how COVID-19-related policies influence patient-clinician communication and relationships in the ICU, with attention to race and ethnicity as factors and 2) identify interventions that may facilitate patient-clinician communication. DESIGN: We conducted a qualitative study between September 2020 and February 2021 that explored facilitators and barriers to patient-clinician communication and the formation of therapeutic relationships. We used thematic analysis to develop findings describing patient-communication and therapeutic relationships within the ICU early in the COVID-19 pandemic. SETTING: We purposively selected hospital dyads from regions in the United States that experienced early and/or large surges of patients hospitalized with COVID-19. SUBJECTS: We recruited a national sample of ICU physicians from Veteran Affairs (VA) Health Care Systems and their associated academic affiliate hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty-four intensivists from seven VA hospitals and six academic-affiliate hospitals participated. Intensivists noted the disproportionate impact of the pandemic on among people holding minoritized racial and ethnic identities, describing how language barriers and restrictive visitation policies exacerbated institutional mistrust and compromised physicians' ability to develop therapeutic relationships. We also identified several perceived influences on patient-clinician communication and the establishment of therapeutic relationships. Barriers included physicians' fear of becoming infected with COVID-19 and use of personal protective equipment, which created obstacles to effective physical and verbal interactions. Facilitators included the presence of on-site interpreters, use of web-based technology to interact with family members outside the ICU, and designation of a care team member or specialist service to provide routine updates to families. CONCLUSIONS: The COVID-19 pandemic has threatened patient-clinician communication and the development of therapeutic relationships in the ICU, particularly among people holding minoritized racial and ethnic identities and their families. We identified several facilitators to improve patient-clinician communication as perceived by intensivists that may help improve trust and foster therapeutic alliances.

Staying Connected During a Global Pandemic: Telephone Support for Vulnerable Populations

This qualitative organisational ethnography explores and analyses the ways in which a local government-provided volunteer telephone support program for vulnerable and older members of the community quickly adapted to continue working during the pandemic. Thematic analysis of data collected through researcher participation in 26 weekly zoom debrief sessions with local government staff and volunteers captures the experience of providing telephone support during a pandemic. Three key themes emerged as integral to the shaping and reshaping of the service: (1) the importance of care and relationships in service provision;(2) the need for flexibility to make service change;and (3) like a beating heart, the regular calls became part of the rhythm of life, providing certainty for staff, volunteers, and those they called. This program offers a model for best practice in low cost, low risk, place-based interventions that can increase social connection for vulnerable community members. IMPLICATIONS Organisational flexibility and a focus on care and relationships underpin best-practice human service delivery—this is emphasised in times of crisis. Volunteer engagement, commitment, and performance are enhanced by positive and caring relationships with paid staff. Befriending schemes can provide a vital means of social support that contributes to maintaining the health and wellbeing of the ageing population.

Trust Takes Two .

Research throughout the COVID-19 pandemic, including investigations of resulting pandemic response strategies, evolving public health recommendations, and vaccine development, has highlighted the role of trust between physicians and patients. The focus, however, has largely been on patient trust in physicians. Although the importance of patient trust in physicians has long been recognized, physician trust in patients remains underappreciated. Physician trust in patients is an important factor in the physician-patient relationship. When physicians trust patients, patients can communicate freely, their experiences are validated, and trust may be engendered through reciprocal trust. Thus, a bidirectional approach to trust is necessary that acknowledges the role of physician trust in patients. We posit that shared trust is the dyadic factor that influences positive patient outcomes and is the foundation of shared decision making. Recognizing shared trust as an important outcome of the physician-patient relationship is a necessary step in evaluating how our practice, research, and education can influence or sow distrust of patients. In this commentary, we discuss the importance of attending to shared trust and physician trust in patients, particularly in family medicine.

Staying Connected During a Global Pandemic: Telephone Support for Vulnerable Populations

This qualitative organisational ethnography explores and analyses the ways in which a local government-provided volunteer telephone support program for vulnerable and older members of the community quickly adapted to continue working during the pandemic. Thematic analysis of data collected through researcher participation in 26 weekly zoom debrief sessions with local government staff and volunteers captures the experience of providing telephone support during a pandemic. Three key themes emerged as integral to the shaping and reshaping of the service: (1) the importance of care and relationships in service provision;(2) the need for flexibility to make service change;and (3) like a beating heart, the regular calls became part of the rhythm of life, providing certainty for staff, volunteers, and those they called. This program offers a model for best practice in low cost, low risk, place-based interventions that can increase social connection for vulnerable community members. IMPLICATIONS Organisational flexibility and a focus on care and relationships underpin best-practice human service delivery—this is emphasised in times of crisis. Volunteer engagement, commitment, and performance are enhanced by positive and caring relationships with paid staff. Befriending schemes can provide a vital means of social support that contributes to maintaining the health and wellbeing of the ageing population.

Face-to-Face and Tele-Consults: A Study of the Effects on Diagnostic Activity and Patient Demand in Primary Healthcare.

Primary healthcare services have changed from face-to-face to tele-consults during the two COVID-19 years. We examined trends before and during the COVID-19 pandemic years based on groups of professionals, patient ages, and the associations with the diagnostic registry. We analyzed proportions for both periods, and ratios of the type of consults in 2017-2019 and 2020-2021 were calculated. The COVID-19 period was examined using monthly linear time trends. The results showed that consults in 2020-2021 increased by 24%. General practitioners saw significant falls in face-to-face consults compared with 2017-2019 (ratio 0.44; 95% CI: 0.44 to 0.45), but the increase was not proportional across age groups; patients aged 15-44 years had 45.8% more tele-consults, and those aged >74 years had 18.2% more. Trends in linear regression models of face-to-face consults with general practitioners and monthly diagnostic activity were positive, while the tele-consult trend was inverse to the trend of the diagnostic registry and face-to-face consults. Tele-consults did not resolve the increased demand for primary healthcare services caused by COVID-19. General practitioners, nurses and primary healthcare professionals require better-adapted tele-consult tools for an effective diagnostic registry to maintain equity of access and answer older patients' needs and priorities in primary healthcare.

Crisis, Feminism, and Existentialism: Re-reading El-Saadawi's Memoirs of a Woman Doctor in COVID -19 times

In her Memoirs of a Woman Doctor , Dr. Nawal El-Saadawi, an Egyptian physician, writer and feminist, describes the development of her existential questions as a human being and a doctor throughout her life changes and the interaction with her socio-cultural patriarchal context. Following a crisis in her professional identity, Dr. El-Saadawi questions the meaning of doctoring, the doctor-patient relationship, and life as well as the absurdity of death and alienation. A young woman died while giving birth to her first child, and Dr. El-Saadawi's failure to save the woman's life changed her self-positioning in relation to medicine and the sanctity of science. This experience caused her to sanctify human beings and the humanity of doctors, rather than sanctifying their knowledge only, and created an acute awareness of the link between her body, mind and soul. She writes "The focus of the struggle inside me widened out from masculinity and femininity to embrace humankind as a whole. Human beings appeared to be insignificant creatures in spite of their muscles, their brain cells and the complexity of their arterial and nervous systems. A small microbe, invisible to the naked eye, could be breathed in through the nose and eat away at the cells of the lungs. An unidentifiable virus could strike at random and make the cells of the liver or spleen or any other part of the body multiply at a crazy rate and devour everything around them [...] I found my feet taking me in a completely new direction." (p. 21). In the end, she finds relief for her soul in her love for a musician and attributes music to rescuing her from darkness. Drawing on content-thematic analysis of the memoirs, in this presentation I make an analogy between the crisis that Dr. El-Saadawi experienced, and the potential crises that health care providers (HCPs) faced during their work in the first stages of the COVID-19 pandemic. Through the existential and philosophical questions suggested by Dr. El-Saadawi, in this presentation, I suggest that we look behind the scenes of the ICU and think in-depth about healthcare providers' existential experiences during the COVID-19 outbreak - a global crisis that can be very personal for the HCPs. We will discuss how the crisis and facing death on daily basis could influence healthcare providers' existential and philosophical perceptions, when they are unable to control a virus and save lives. [ FROM AUTHOR] Copyright of QScience Connect is the property of Hamad bin Khalifa University Press (HBKU Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Experiences of interaction between people with cancer and their healthcare professionals: A systematic review and meta-synthesis of qualitative studies.

PURPOSE: This study investigates patients' experiences of interaction with their healthcare professionals (HCPs) during cancer treatment and identifies elements that HCPs can utilize to improve cancer care provision. METHODS: PubMed, CINAHL, PsycINFO, SCOPUS, and Embase were systematically searched for relevant studies published from January 2010 until February 2022. Qualitative studies investigating adult patients' perspectives on their interaction with HCPs during cancer treatment were included. Studies conducted during the diagnosis or end-of-life treatment phase were excluded. Duplicate removal, screening, and quality appraisal were independently performed by four reviewers using Covidence.org. We performed a thematic meta-synthesis of qualitative data extracted from studies meeting the quality criteria in three stages: excerpts coding, codes categorization, and theme identification by merging similar categories. RESULTS: Eighty-eight studies were included for quality appraisal, of which 50 papers met the quality inclusion criteria. Three themes were identified as essential to positively perceived patient-HCP interaction: "Support, respect and agency", "Quantity, timing, and clarity of information", and "Confidence, honesty, and expertise". Overall, patients experienced positive interaction with HCPs when the approach was person-centered and when HCPs possessed strong interpersonal skills. However, patients expressed negative experiences when their preferences regarding communication and the type of personal support needed were ignored. CONCLUSIONS: This meta-synthesis emphasizes the importance for HCPs to recognize all patients' needs, including communication and personal support preferences, to provide high-quality care. Consequently, healthcare professionals should continuously train their verbal and non-verbal communication, empathy, active listening, and collaboration skills during their undergraduate and continuing education.

Patients' and physicians' experiences with remote consultations in primary care during the COVID-19 pandemic: a multi-method rapid review of the literature.

BACKGROUND: During the COVID-19 pandemic, many countries implemented remote consultations in primary care to protect patients and staff from infection. AIM: The aim of this review was to synthesise the literature exploring patients' and physicians' experiences with remote consultations in primary care during the pandemic, with the further aim of informing their future delivery. DESIGN & SETTING: Rapid literature review. METHOD: PubMed and PsychInfo were searched for studies that explored patients' and physicians' experiences with remote consultations in primary care. To determine the eligibility of studies, their titles and abstracts were reviewed, before the full article. Qualitative and quantitative data were then extracted from those that were eligible, and the data synthesised using thematic and descriptive synthesis. RESULTS: A total of 24 studies were eligible for inclusion in the review. Most were performed in the US (n = 6, 25%) or Europe (n = 7, 29%). Patient and physician experiences were categorised into perceived 'advantages' and 'issues'. Key advantages experienced by patients and physicians included 'reduced risk of COVID-19' and 'increased convenience', while key issues included 'a lack of confidence in or access to required technology' and a 'loss of non-verbal communication' which degraded clinical decision-making. CONCLUSION: This review identified a number of advantages and issues experienced by patients and physicians using remote consultations in primary care. The results suggest that, while remote consultations are more convenient and protect patients and staff against COVID-19, they result in the loss of valuable non-verbal communication, and are not accessible to all.

The "CONNECT" Protocol: Delivering Bad News by Phone or Video Call.

The COVID-19 pandemic has changed the principles of communication within the health-care setting. Communication skills as developed for use in the context of a direct and personal encounter have become insufficient. As a result, numerous health professionals came to believe they were not sufficiently prepared to deliver bad news in relation to medical care. The CONNECT protocol is a tool designed to help health-care professionals in the delivery of such messages. The name of the protocol is an acronym derived from C - context, O - organization, NN - near and niceties, E - emotions, C - counseling, T - taking care. The objective of the protocol is to improve the effectiveness of the delivery of bad news in relation to medical care by ensuring proper organization of the key elements of the encounter with the patient and/or their family.

Psychosocial Implications of COVID-19 on Head and Neck Cancer.

The COVID-19 pandemic has fundamentally changed healthcare access, delivery, and treatment paradigms throughout oncology. Patients with head and neck cancer comprise an especially vulnerable population due to the nature of their disease and the transmission mechanism of the SARS-CoV-2 virus. The consequences of triage decisions and delays in care have serious psychosocial implications for patients. The development of structured psychosocial support programs, coupled with clear and consistent communication from treating physicians, can help mitigate perceptions of abandonment and distress that may accompany delays in care. As the unpredictability of the pandemic's course continues to burden both providers and patients, we must be proactive in addressing the psychosocial implications of these delays in care.

Telemedicine for Hip Preservation Patients: Access, Ability and Preference

BACKGROUND: Recent events have resulted in rapid rises in the use of telemedicine in orthopaedic surgery, despite limited evidence regarding patient preferences or concerns. The purpose of this study is to determine access to and, ability to use telemedicine technology in an adult hip preservation patient population, as well as determine associations with patient characteristics. Additionally, we seek to understand patients' perceived benefits, risks and preferences of telemedicine. METHODS: We performed a cross-sectional survey administered on patients scheduled to undergo joint preservation surgery by one of three surgeons at a single academic institution. Both preoperative and postoperative established patients were included and called for a telephone administered survey if a date of surgery was scheduled between October 1, 2019 and March 30, 2020 and were 18 years or older. The survey had seven sections with 45 questions relating to demographics, technology access, videoconferencing capability, confidence using technology, telehealth experiences, perceptions. RESULTS: 101 patients completed the survey (48% response rate, 101/212). Overall, 99% of participants reported using the internet, 94% reporting owning a device capable of videoconferencing, and 86% of patients had participated in a video call in the past year. When asked for their preferred method for a physician visit: 79% ranked in-person as their first choice and 16% ranked a videoconference visit as their first choice. Perceived benefits of telemedicine visits included reduced travel to appointments (97% agree) and reduced cost of attending appointments (69% agree). However, patients were concerned that they would not establish the same patient-physician connection (51% agree) and would not receive the same level of care (38% agree) through telemedicine visits versus in person visits. CONCLUSION: The majority of hip preservation patients have access to and are capable of using the technology required for telemedicine visits. However, patients still prefer to have in person visits over concerns that they will not establish the same patient-physician connection and will not receive the same level of care. Telemedicine visits in hip preservation patients may be most attractive to return patients with an established doctor-patient relationship, particularly those with concerns for long distances of travel and associated costs.Level of Evidence: III.

Patients Contributing to Visit Notes: Mixed Methods Evaluation of OurNotes.

BACKGROUND: Secure patient portals are widely available, and patients use them to view their electronic health records, including their clinical notes. We conducted experiments asking them to cogenerate notes with their clinicians, an intervention called OurNotes. OBJECTIVE: This study aims to assess patient and provider experiences and attitudes after 12 months of a pilot intervention. METHODS: Before scheduled primary care visits, patients were asked to submit a word-constrained, unstructured interval history and an agenda for what they would like to discuss at the visit. Using site-specific methods, their providers were invited to incorporate the submissions into notes documenting the visits. Sites served urban, suburban, and rural patients in primary care practices in 4 academic health centers in Boston (Massachusetts), Lebanon (New Hampshire), Denver (Colorado), and Seattle (Washington). Each practice offered electronic access to visit notes (open notes) to its patients for several years. A mixed methods evaluation used tracking data and electronic survey responses from patients and clinicians. Participants were 174 providers and 1962 patients who submitted at least 1 previsit form. We asked providers about the usefulness of the submissions, effects on workflow, and ideas for the future. We asked patients about difficulties and benefits of providing the requested information and ideas for future improvements. RESULTS: Forms were submitted before 9.15% (5365/58,652) eligible visits, and 43.7% (76/174) providers and 26.76% (525/1962) patients responded to the postintervention evaluation surveys; 74 providers and 321 patients remembered receiving and completing the forms and answered the survey questions. Most clinicians thought interim patient histories (69/74, 93%) and patient agendas (72/74, 97%) as good ideas, 70% (52/74) usually or always incorporated them into visit notes, 54% (40/74) reported no change in visit length, and 35% (26/74) thought they saved time. Their most common suggestions related to improving notifications when patient forms were received, making it easier to find the form and insert it into the note, and educating patients about how best to prepare their submissions. Patient respondents were generally well educated, most found the history (259/321, 80.7%) and agenda (286/321, 89.1%) questions not difficult to answer; more than 92.2% (296/321) thought sending answers before the visit a good idea; 68.8% (221/321) thought the questions helped them prepare for the visit. Common suggestions by patients included learning to write better answers and wanting to know that their submissions were read by their clinicians. At the end of the pilot, all participating providers chose to continue the OurNotes previsit form, and sites considered expanding the intervention to more clinicians and adapting it for telemedicine visits. CONCLUSIONS: OurNotes interests patients, and providers experience it as a positive intervention. Participation by patients, care partners, clinicians, and electronic health record experts will facilitate further development.

A qualitative study of abortion care providers' perspectives on telemedicine medical abortion provision in the context of COVID-19.

BACKGROUND: Telemedicine for medical abortion care was rapidly introduced in Great Britain in response to the COVID-19 pandemic. A growing body of literature demonstrates that telemedicine abortion care is safe, effective and highly acceptable to patients. Less is known about the perspectives of abortion care providers (ACPs). METHODS: Qualitative research within the telemedicine abortion service in Lothian (Edinburgh and surrounding region), UK. We conducted qualitative in-depth interviews with ACPs between May and July 2020 (doctors, n=6; nurses, n=10) and analysed the data thematically. RESULTS: We present three themes from our qualitative analysis: (1) Selective use of ultrasound - the move away from routine ultrasound for determination of gestational age was generally viewed positively. Initial anxiety about non-detection of ectopic pregnancy and later gestations was expressed by some ACPs, but concerns were addressed through clinical practice and support structures within the clinic. (2) Identifying safeguarding issues - in the absence of visual cues some ACPs reported concerns about their ability to identify safeguarding issues, specifically domestic violence. Conversely it was acknowledged that teleconsultations may improve detection of this in some situations. (3) Provision of information during the consultation - telephone consultations were considered more focused than in-person consultations and formed only part of the overall 'package' of information provided to patients, supplemented by online and written information. CONCLUSIONS: ACPs providing telemedicine abortion care value this option for patients and believe it should remain beyond the COVID-19 pandemic. Safeguarding patients and the selective use of ultrasound can be initially challenging; however, with experience, staff confidence improves.

Stigma, guilt and motherhood: Experiences of pregnant women with COVID-19 in Brazil.

BACKGROUND: The COVID-19 pandemic raises health issues worldwide. Infected pregnant women may have negative mental health outcomes, but little is known about their emotional experiences. AIM: We aimed to understand the experience of women infected with COVID-19 during pregnancy, regarding their feelings, their relationships, and the influence of social media. METHODS: We conducted a qualitative study among 22 women infected with COVID-19 during pregnancy, from a tertiary hospital during the first wave of the pandemic in Brazil (May-August 2020). We applied semi-directed interviews, sociodemographic and health data sheets, and field diaries. We built the sample purposefully. Interviews were audio-recorded and transcribed verbatim. We used thematic analysis and discussed data considering the health psychology framework. RESULTS: We created five categories following a timeline perspective, from before infection to the experience after recovering. Pregnant women were resistant to believing the diagnosis. They described a fear of serious symptoms or death, concerns about the fetus, sorrow from being isolated, and worries about stigma. Family relationships were ambiguous, generating either support or tension. The attachment to the health team through telemedicine or support during hospitalization produced a feeling of security. CONCLUSIONS: Participants psychologically denied the COVID-19 diagnosis and did not accomplish isolation properly, even upon medical recommendations. The illness may produce a traumatic experience, regardless of mild or severe symptoms, but family/friend support and contact with the health team helped them to cope. We offer important insights for the clinical approach and future research, emphasizing that infected pregnant women require emotional support.