Engaging student analysis of the practitioner-patient relationship assessed with reflective outcomes.

The representations and beliefs of both patient and practitioner influence the relationship that develops between them. We developed an innovative, interactive teaching tool in two stages (1- interviews with the patient or healthcare practitioner and 2- a session with sharing of the patient's and practitioner's perspective) whose objectives are to recognize the basic characteristics of PPR and identify how it can be influenced by expectations, beliefs and emotions. This pedagogical device was particularly appreciated by the students, as it enabled them to identify the importance of the patient's point of view and to reflect on their future professional identity.

Where the joy comes from: a qualitative exploration of deep GP-patient relationships.

BACKGROUND: Relationship-based, whole person care is foundational to quality general practice. Previous research has identified several characteristics of deep General Practitioner (GP)-patient relationships and their association with improved patient concordance, satisfaction and perceived health outcomes. Psychological attachment theory has been used to understand therapeutic relationships, but has only been explored to a limited extent in the general practice context. Additionally, evolving changes in sociocultural and commercial practice contexts may threaten relationship-based care. In view of this, we aimed to explore the nature and experience of deep GP-patient relationships, as identified by patients, from GP and patient perspectives. METHODS: Semi-structured interview design. An initial survey assessed patients' perceived depth of their relationship with their GP, using the Health Care Provider Attachment Figure Survey and Patient-Doctor Depth of Relationship Scale. Patients who reported a deep relationship, and their GPs, were purposively selected for individual interviews exploring their experience of these relationships. A post-interview survey assessed interviewees' attachment styles, using the Modified and Brief Experiences in Close Relationships Scale. Patient interviewees also rated the patient-centredness of their GP's clinic using the Person-Centred Primary Care Measure. Transcripts were analysed using thematic analysis. RESULTS: Thirteen patients and five GPs were interviewed. Four themes characterised deep relationships: the 'professional'; human connection; trust; and 'above and beyond'. Patient, GP and practice team all contributed to their cultivation. CONCLUSIONS: We present a revised conceptual framework of deep GP-patient relationships. Deep relationships come to the fore in times of patient trouble. Like attachment relationships, they provide a sense of safety, caring and support for patients experiencing vulnerability. They can stretch GP boundaries and capacity for self-care, but also provide joy and vocational satisfaction. Patients may not always desire or need deep relationships with their GP. However, findings highlight the importance of enabling and cultivating these for times of patient hardship, and challenges of doing so within current healthcare climates.

Cultivating Cultural Humility to Address the Healthcare Burnout Epidemic-Why It Matters.

Physician burnout is a major problem that has long been facing our healthcare system. The COVID-19 pandemic has unfortunately deepened this problem and shed the light on the multiple structural shortcomings of our healthcare system that need immediate attention. Demoralization is one of the core features of "physician burnout," which results from a breakdown of genuine physician-patient interaction. A healthcare system that embraces cultural humility, where we find ourselves rewarded for supporting, uplifting, and respecting our patients' diverse voices could pave the way for battling burnout. Unlike cultural competency, which suggests that one should know everything about another's culture (an unfeasible task), cultural humility is a continuum of self-reflection and critique that aims to foster a deep connection between the physician and patient; a connection that sits at the core of the humanistic and multicultural experience of medicine.

Women's Experiences of Childbirth in Serbian Public Healthcare Institutions: a Qualitative Study.

PURPOSE: The aim of the present study was to explore how women, users of public maternity healthcare services in Serbia, experience birth and what the most problematic relational aspects of institutional context associated with negative or even traumatic aspects of birth experiences are, as described by the women themselves. METHOD: An exploratory qualitative study was undertaken using semi-structured interviews with 15 primiparous women aged 26 to 49 who have recently given birth in different public healthcare institutions in Belgrade. The basic framework for the analysis of interview transcripts was the interpretative phenomenological analysis (IPA). RESULTS: Through the analysis, four relatively broad and partly interrelated themes emerged: (a) feelings of isolation and abandonment, (b) lack of communication, (c) lack of a caring relationship, and (d) lack of control and agency. The aspects of institutional environment that were considered particularly distressing in most of the childbirth experiences are related to distant and cold relationship with healthcare providers which adds to the feelings of isolation and abandonment, in addition to the lack of insight into and control over the process of birth that is managed in the hospital context without relying on women's subjective involvement in any relevant way. CONCLUSION: The present study emphasized a supportive and caring relationship with medical practitioners, as well as allowing women to be more involved into their birthing process, as crucial for positive experience of birth, which might have profound and long-lasting psychosocial consequences. Recommendations for policy makers and future research are offered.

'She believed in me'. What patients with depression value in their relationship with practitioners. A secondary analysis of multiple qualitative data sets.

BACKGROUND: Clinical guidance promotes the practitioner-patient relationship as integral to good quality person-centred care for patients with depression. However, patients can struggle to engage with practitioners and practitioners have indicated that they want more guidance on how to establish effective relationships with their patients. OBJECTIVE: To identify what practitioner attributes patients with depression particularly value or find problematic. METHOD: A secondary analysis of data collected during four qualitative studies, all of which entailed interviewing patients diagnosed with depression about their treatment experiences. Patients in the four studies had received different treatments. These included antidepressants, cognitive behaviour therapy, facilitated physical activity and listening visits. We thematically analysed 32 patient accounts. RESULTS: We identified two complimentary sets of important practitioner attributes: the first based on the practitioner's bearing; the second based on the practitioner's enabling role. We found that patients value practitioners who consider their individual manner, share relevant personal information, show interest and acceptance, communicate clearly and listen carefully, collaborate on manageable goals and sanction greater patient self-care and self-compassion. It was also evident that patients receiving different treatments value the same practitioner attributes and that when these key practitioner qualities were not evident, patients were liable not to re-attend or comply with treatment. CONCLUSION: The practitioner attributes that patients with depression most value have a positive impact on their engagement with treatment. Patients emphasise the importance of a practitioner's demeanour and encouragement, rather than the amount of time or specific treatment a practitioner is able to provide.

Aspectos Éticos da Percepção de Pacientes em Atendimento Odontológico / Ethical Aspects of Patient Perception in Dental Care

Para que o ensino da Odontologia se efetive, é necessária a realização de uma fase clínica que ocorre mediante o atendimento de pacientes em clínicas integradas ou setorizadas. O objetivo deste trabalho foi avaliar qual a percepção de pacientes atendidos em uma Instituição de Ensino Superior de Odontologia sobre o atendimento oferecido, visando ressaltar alguns aspectos éticos envolvidos no atendimento. Dessa forma, foi realizada uma avaliação qualitativa, que permite o estudo de comportamentos, atitudes, crenças e valores, por meio da realização de entrevistas semi-estruturadas com 42 pacientes atendidos em uma Instituição de Ensino de Odontologia. Foram investigados: informações recebidas, expectativas com o tratamento, seu custo, orientação recebida pelo aluno, relacionamento entre professores, alunos e pacientes, satisfação com o tratamento e queixas e sugestões dos pacientes. Esses itens constituíram-se em categorias de análise. A interpretação dos discursos dos entrevistados permitiu concluir que: a percepção dos pacientes atendidos na IES pode ser mais bem explorada e incluída no modelo de atendimento; é necessário enfatizar, no processo ensinoaprendizagem, o processo de comunicação entre professor, aluno e paciente, a fim de tornar mais ético o atendimento; o modelo de exercício profissional é adquirido durante a graduação, por isso as atitudes éticas devem ser exercitadas durante o atendimento realizado nas IES.(AU)

For a greater effectiveness of Dental Care teaching, it is necessary to promote a clinical stage, caring for patients in integrated or sectored clinics. This work's objective was to evaluate the perception of patients treated at a Dental Care Superior Education Institution, about the service offered, with the goal of stressing some ethical aspects connected to the treatment. Therefore, a quality evaluation was done to permit the study of behaviors, attitudes, beliefs and values, through the application of semi-structured interviews with 42 patients treated at a Dental Care Educational Institution. The following were investigated: information received, expectations about the treatment, its cost, orientation received by the student, relationship among teachers, students and patients, satisfaction with the treatment, complaints and suggestions from the patients. These items formed themselves into analysis categories. The interpretation of the discourse of those who were interviewed allowed us to conclude that: the perception of the patients treated in the SEI may be better explored and included in the treatment model; we need to give emphasis, in the teaching-learning process, to the process of communication between teacher, student and patient, so as to make the treatment more ethical; the model for practitioner conduct is acquired during the graduation, therefore the ethical attitudes must be exercised during the treatment done at the SEI.(AU)