Elderly deaf patients' health care experiences.

BACKGROUND: Approximately 10% of the US population has some degree of hearing loss, and 2 million Americans are deaf. Most medical school curricula and major textbooks characterize deafness as pathologic condition only, which is at odds with the movement to understand the Deaf population as a minority group with a unique language and cultural tradition. Physicians might therefore be unprepared to meet the needs of deaf patients effectively and sensitively. This study seeks to understand the health care experiences of elderly Deaf adults in Richmond, Va. METHODS: The authors conducted focus groups of elderly Deaf persons. Real-time voice-interpretation of the sign language communication allowed for tape recording and full transcription. The authors independently analyzed the transcripts using an editing style, and incorporated feedback on their interpretation from participants. RESULTS: Participants experienced many practical barriers to effective health care, including problems with scheduling appointments and communicating with providers. They believed that providers are ill-prepared to care for them and worried that prejudice might be a more subtle obstacle. Participants seemed resigned to these circumstances. CONCLUSIONS: The authors suggest a possible explanation for this perspective, and make specific recommendations for three levels of competency in caring for deaf patients. When the provider and the office staff provide methods to communicate with deaf patients using telephone-assisted communication, qualified interpreters, and some basic knowledge of lipreading or sign language, the care of deaf patients is greatly enhanced and the physician-patient relationship improved.

Choosing a specialty during a generalist initiative: a focus group study.

BACKGROUND: Virginia Commonwealth University (VCU) (as part of a three-school consortium) was 1 of 12 sites awarded a Robert Wood Johnson Generalist Physician Initiative (RWJ-GPI) grant. Given the goals of this initiative--to promote a balanced output of generalists and specialists--program planners wanted to understand how medical students made career decisions in the context of this curriculum change and the larger social environment. METHODS: Seven focus groups (average size: six members each) of second-year and fourth-year students were recruited. Groups were homogeneous with respect to subspecialty or primary care orientation and career trajectory. An experienced moderator conducted all groups. The discussions were taped and transcribed. Analysis proceeded concurrently with data gathering, using a template style and with assistance from the NUD*IST software program. RESULTS: Students from all groups hoped for control of their practice, intellectual challenge, rewarding relationships with their patients and their own families, and fair compensation for effort. They worried about their future prospects, and specialty-oriented students felt that the emphasis on primary care production was being forced on the school. All groups saw managed care as doing more harm than good for patients, and all wished for improved career counseling. DISCUSSION: The RWJ-GPI at VCU became a lightning rod for student worry and resentment at being forced into primary care specialties. The backlash phenomenon was seen at other US medical schools and is one of the postulated reasons for a decline in US student numbers matching in family practice, internal medicine, and internal medicine-pediatrics. Medical school faculty should respond with constructive, pro-student policies and programs.

Desirable features of qualitative research.

Family medicine investigators are beginning to use qualitative approaches to research questions. This paper reviews guidelines for qualitative research from several social sciences, and summarizes discussions of "standards" for qualitative research among health professionals. From these sources, the authors propose desirable characteristics of qualitative research. These include values of empathy, collaboration, service, and moral sensitivity; characteristics of clarity and coherence; techniques of participatory dialogue, triangulation, purposeful sampling, and immersion in context; and outcomes of useful knowledge and behavior effectively shared with readers.

A survey of drinking patterns during medical school.

Several studies have documented the common use of alcohol among medical students and the significant fraction of students (7% to 17%) who show a pattern of alcohol abuse. Many authors have pointed out the implications of physician impairment due to alcoholism, presently estimated at about 10%. We surveyed 263 junior and senior medical students, and our data support earlier surveys of the prevalence of alcohol abuse and indicate that students tend to drink less heavily and less frequently after entering medical school. The clinically proven CAGE questions used in the survey showed statistically significant associations between heavy or frequent drinking before and during medical school, but only 4.2% of respondents indicated that school officials had asked whether they had a drinking or drug abuse problem. Given these findings, we suggest the routine administration of screening instruments to medical students, using education and minimal intervention strategies with individuals at risk.

Naturalistic inquiry: an appropriate model for family medicine.

Family medicine's stated philosophy is consistent with the philosophical basis of naturalistic inquiry, a research paradigm from the social sciences. However, the majority of published family medicine research more nearly resembles traditional biomedical research, here termed rationalistic inquiry. Adding naturalistic inquiry to family medicine's research armamentarium would be consistent with the specialty's stated philosophy and would foster investigation in areas not well addressed by the traditional biomedical approach.