Offering welcome in the kingdom of the sick: A physician guide to hospitality.

RATIONALE, AIMS AND OBJECTIVES: The onset of acute illness may be accompanied by a profound sense of disorientation for patients. Addressing this vulnerability is a key part of a physician's purview, yet well-intended efforts to do so may be impeded by myriad competing tasks in clinical practice. Resolving this dilemma goes beyond appealing to altruism, as its limitless demands may lead to physician burnout, disillusionment, and a narrowed focus on the biomedical aspects of care in the interest of self-preservation. The authors propose an ethic of hospitality that may better guide physicians in attending to the comprehensive needs of patients that have entered "the kingdom of the sick." METHODS: Using philosophical methods, the authors explore what compels people to present to emergent medical attention and why altruism may not offer physicians a sustainable way to address the vulnerabilities that occur in such situations. They then present the concept of hospitality from a Derridean perspective and use it to interpret a narrative case of an on-call paediatrician caring for an infant with bronchiolitis to demonstrate how this approach may be practically implemented in the acute care hospital context. RESULTS: Hospitality allows physicians to acknowledge that clinical presentations that are routine in their world may be disorienting and frightening to patients experiencing them acutely. Further, it recognizes that the vulnerability that accompanies acute illness may be compounded by the unfamiliarity of the hospital environment in which patients have sought support. CONCLUSION(S): While it is unlikely that anything physicians do will make the hospital a place where patients and caregivers will desire to be, hospitality may focus their efforts upon making it less unwelcoming. Specifically, it offers an orientation that supports patients in navigating the disorienting and unfamiliar terrains of acute illness, the hospital setting in which help is sought, and engagement with the health care system writ large.

The Big D(eal): professional identity through discursive constructions of 'patient'.

CONTEXT: Professional identity formation has become a key focus for medical education. Who one becomes as a physician is contingent upon learning to conceptualise who the other is as a patient, yet, at a time when influential ideologies such as patient-centred care have become espoused values, there has been little empirical investigation into assumptions of 'patient' that trainees take up as they progress through their training. METHODS: Our team employed a critical discourse analysis approach to transcripts originally produced from a micro-ethnography of medical student learning on an acute care in-patient paediatric ward. The dataset included 20 case presentations and 14 sign-over rounds taken from a 3-week observation period. We paid specific attention to how trainees used language to talk about, refer to and categorise patients. RESULTS: Identified discourses included patient-as-disease-category, patient-as-educational-commodity and patient-as-marginalised-actor. These discourses conceptualise 'patient' as an entity that is principally biomedical, useful for clinical learning and spoken for and about. Medical student participation in these discourses contributes to an identity that allows them to move further into the professional medical world they are joining. CONCLUSIONS: We contend that as learners participate in these discourses, they are also performatively produced by them. By making these discourses visible, we can consider how to minimise unintended effects such discourses may cause. Our findings, although limited, offer a glimpse of the effects that those assumptions may have as we look to align better the formation of professional medical identity with the ideals of patient-centred care and socially responsible health care systems.

"How to do things with words" in health professions education.

This paper reports on a qualitative study of journal entries written by students in six health professions participating in the Interprofessional Health Mentors program at the University of British Columbia, Canada. The study examined (1) what health professions students learn about professional language and communication when given the opportunity, in an interprofessional group with a patient or client, to explore the uses, meanings, and effects of common health care terms, and (2) how health professional students write about their experience of discussing common health care terms, and what this reveals about how students see their development of professional discourse and participation in a professional discourse community. Using qualitative thematic analysis to address the first question, the study found that discussion of these health care terms provoked learning and reflection on how words commonly used in one health profession can be understood quite differently in other health professions, as well as on how health professionals' language choices may be perceived by patients and clients. Using discourse analysis to address the second question, the study further found that many of the students emphasized accuracy and certainty in language through clear definitions and intersubjective agreement. However, when prompted by the discussion they were willing to consider other functions and effects of language.