ABSTRACT
To explore the ways in which biomedical culture responds to the new curricular addition of communication skills training, we observed activities related to the communication skills training of a class of 70 first-year medical students in an Israeli medical school during 2002-3. In addition, focus groups were conducted with medical students (n = 210) during 1998-2001. A gap was found between the rhetoric of "patient-centered communication" and "empathy" and the traditional concerns of medical authority, efficiency, and scientism. Communication skills and empathy training were appropriated into medical socialization by being reconstructed as clinical competence. Findings are further discussed in the context of medical professionalism, Israeli culture, service acting and service roles, and organizational learning.
Subject(s)
Communication , Education, Medical , Physician-Patient Relations , Adolescent , Adult , Education , Empathy , Female , Humans , Israel , Male , Professional CompetenceABSTRACT
A variety of reasons can explain the paternalistic relationship between doctor and patient that prevailed for centuries. Undoubtedly, the exclusive control exercised by doctors over medical knowledge, constitutes a primary reason for the perpetuation of this relationship. However, in the past few generations, substantial changes have evolved in the nature of the physician-patient encounter. For example, the concept of "informed consent", introduced by social and legal changes, has subsequently led to the empowerment of the patient. Furthermore, the current information revolution might well bring about even more substantial changes in the doctor-patient relationship. In this article we will discuss the principal changes that have occurred in the doctor-patient relationship due to the information revolution, and explore future trends which might be expected in view of these changes.
Subject(s)
Physician-Patient Relations , Physicians , Humans , Informed Consent , KnowledgeABSTRACT
OBJECTIVES: To discuss the problems encountered teaching interviewing skills to first year medical students and describe their responses to a structured workshop in interviewing skills. METHODS: Focus groups and a short evaluation questionnaire filled in by 56 first year medical students before and after a workshop in interviewing skills were used. RESULTS: All students evaluated their skills very highly prior to the workshop. After participating in the workshop, students evaluated their skills as lower than before. DISCUSSION: When communication skills are taught in an informal, unstructured manner, medical students might view this knowledge as unspecialized, repetitive, and even boring. It is suggested that employing a structured model for teaching doctor-patient communication skills awards psycho-social issues the status of formal knowledge. This can lead to students viewing communication skills as a relevant and consistent body of knowledge. Introducing a structured model can overcome two kinds of problems: over-confident students are formally introduced to unique aspects of medical interviewing, whilst those who lack confidence are offered a lifeline in the form of a structured model. Identifying possible sources of resistance to communications training has important implications for medical education as it allows for appropriate course planning and follow up.
Subject(s)
Education, Medical, Undergraduate/methods , Physician-Patient Relations , Teaching/methods , Focus Groups , Humans , Interviews as Topic , Surveys and QuestionnairesABSTRACT
In recent years, non-conventional medicine (NCM) has grown tremendously in popularity and economic importance. This paper explores a relatively unresearched phenomenon: patients' dissatisfaction with non-conventional medical treatment they have received. 16 out of 20 patients who had severed their contact with a large, hospital-adjacent multi-modality NCM clinic in Israel were interviewed. Two of these patients had severed their relationship with the clinic right after being referred to a certain practitioner and 18 did not keep their next appointment while in the process of treatment. The narratives through which participants understand and communicate their experience regarding dissatisfaction with NCM are organized around three main topics: independence versus paternalism, foreign versus familiar, and care versus cure. Findings illustrate the patients' views concerning the desirable doctor-patient relationship and their expectations of non-familiar treatments. Patients are characterized as "smart consumers" who place utmost importance on outcome and do not hesitate to discontinue treatment. Findings are further discussed in the context of domestication and the minimizing of cultural difference through the integration of NCM into a biomedical setting.
