Patient-centered communication, patient satisfaction, and retention in care in assisted reproductive technology visits.

PURPOSE: To explore the association between patient-centered communication, patients' satisfaction, and retention in care in assisted reproductive technology (ART) visits. METHODS: ART visits at eight Italian clinics were videotaped and coded using the Roter Interaction Analysis System, which includes a Patient-Centered Index (PCI), a summary "patient-centered communication" ratio. After the visit, patients completed a satisfaction questionnaire (SATQ). After 3 months, patients were asked about their retention in care. Spearman correlations and Mann-Whitney tests were used to test associations between the study variables; the open-ended item of SATQ was analyzed through content analysis. RESULTS: Eighty-five visits were videotaped (involving 28 gynecologists and 160 patients). PCI score (µ = 0.51 ± 0.28) revealed a more disease-oriented communication during the visit. Patients reported high levels of satisfaction with the visit and identified in the information provision or in the doctor's humanity or kindness the main reasons of satisfaction. At the follow-up, the majority of the couples declared to have followed the clinicians' recommendations and to have remained related to the ART center. No associations were found among the study variables, except for a lower male satisfaction among couples who declared to have changed ART clinic. CONCLUSIONS: Contrary to what was expected, the style of physician-patient communication was not found to be associated with patient satisfaction and retention in care. However, patients were highly satisfied and engaged. The actual meaning of a communication that is "patient-centered" in the ART context might be wider, including the couples' need for information, as suggested by qualitative findings.

Doctor-couple communication during assisted reproductive technology visits.

STUDY QUESTION: What are the characteristics of doctor-couple communication content during actual ART visits? SUMMARY ANSWER: Physicians were mainly focused on providing biomedical information, while communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. WHAT IS KNOWN ALREADY: Communication aspects in ART seem crucial for clinical decision-making, retention in care and critical conversations with couples due to low treatment success rates. However, no studies have been carried out on the actual interaction between the doctor and the couple in this context. STUDY DESIGN, SIZE, DURATION: This observational study involved 28 clinicians and 160 patients referred to eight Italian ART clinics during a one-year recruitment period. PARTICIPANTS/MATERIALS, SETTING, METHODS: ART visits at eight Italian clinics were videotaped. The visits were coded using the Roter Interaction Analysis System (RIAS), particularly focusing on RIAS composite categories, verbal dominance and patient-centeredness score. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 85 visits were eligible for analysis (62% acceptance rate), involving 28 clinicians and 160 patients (including 75 couples). The average visit duration was 37 ± 17.7 min. The mean verbal dominance was 1.9 ± 0.86 (range: 0.72-5.74). Physicians mainly focused on providing biomedical information. Communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. The mean of patient centeredness index (PCI) was 0.51 (SD = 0.28; range 0.08-1.77); visits in which the doctor was a woman or the treatment indication was for heterologous fertilization showed higher PCI scores. Overall, females accounted for 67% of all patient talk. Taking this imbalance into account as expected frequencies for each composite category, males reported significantly more utterances in almost all of the socioemotional categories. LIMITATIONS, REASONS FOR CAUTION: These results are preliminary and observational and only regard Italy. Communication during visits may have been biased since the professionals who agreed to participate showed an interest in communication issues. Another limitation is a possible Hawthorne effect due to the fact that participants were aware of being videotaped. WIDER IMPLICATIONS OF THE FINDINGS: Our study showed that ART physicians mainly adopted an informative model of communication and a more disease-oriented approach. Findings revealed the complexity of communication content during ART consultations, given its triadic characteristic in which the third party is also a patient; clinicians should be aware of this complex aspect and of the specific male and female perspectives to be taken into account. The results could be useful for training ART professionals. STUDY FUNDING/COMPETING INTEREST(S): This study was possible thanks to an unconditional grant from Ferring Spa to the Department of Health Sciences, University of Milan. There are no competing interests to declare. TRIAL REGISTRATION NUMBER: N/A.

Psychological factors associated with failure of detoxification treatment in chronic headache associated with medication overuse.

AIM: The aim of this study was to evaluate the psychological factors associated with a negative outcome following detoxification in a 2-month follow-up in medication-overuse headache. METHODS: All consecutive patients entering the detoxification program were analysed in a prospective, non-randomised fashion. Psychiatric conditions and personality characteristics were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I) and the Minnesota Multiphasic Personality Inventory (MMPI)-2. χ2 tests, one-way analyses of variance, and odds ratios (ORs) were used. RESULTS: A total of 248 patients completed the follow-up: 156 stopped overuse and their headaches reverted to an episodic pattern (Group A); 23 kept overusing without any benefit on headache frequency (Group B); and 51 stopped overuse without any benefit on headache frequency (Group C). The prognostic factors for the outcome of Group B were higher scores on the correction (OR 1.128; p = 0.036), depression (OR 1.071; p = 0.05), hysteria (OR 1.106; p = 0.023), and overcontrolled hostility (OR 1.182; p = 0.04) MMPI-2 scales, whereas those for Group C were psychiatric comorbidities (OR 1.502; p = 0.021) and higher scores on the hysteria scale (OR 1.125; p = 0.004). CONCLUSIONS: The outcome of detoxification is influenced by psychological factors that should be considered when considering treatment strategies.

Adjustment to cancer: exploring patients' experiences of participating in a psychodramatic group intervention.

The main purpose of the present study was to understand the subjective experience of patients adjusting to cancer by focusing on how that experience might be affected by participating in a psychodramatic group intervention. In-depth interviews using an interpretative-phenomenological approach were conducted with eight cancer patients involved in a psychodrama group. Four key themes were identified: (1) outside and inside relationships; (2) identities: nurturing other selves; (3) a feelings' gym: performing the internal world; and (4) many ends: mourning death and dying. Participation in cancer group using a psychodramatic approach provided positive results. In detail, the group setting: (1) favoured relationships in which it was possible to freely express oneself and (2) empowered patients in their feelings of being able to give and receive help; the psychodramatic approach: (1) supported the physical mobilisation of sense of agency and (2) permitted to deal with the grieving process. Cancer healthcare pathways would benefit from psychotherapeutic programmes using a similar approach, since psychodrama by actively involving body seems to works on areas that are often underwhelmed by other approaches, such as (i.e., physical mobilisation, body engagement, grieving adjustment). Psychodrama supports patients to achieve insights into their own possibilities to actively participate in their own life situations despite having cancer and undergoing treatment for it.

Factors influencing illness representations and perceived adherence in haemophilic patients: a pilot study.

Illness representations of chronic patients are important to explain adherence and preventive behaviours. However, it is unclear if the patient's objective health status may influence illness representations and perceived adherence. This study explored if health status and socio-demographic characteristics influence illness representations and perceived adherence in haemophilic patients. Fifty patients (25 on-demand and 25 on prophylaxis) ageing from 13-73, completed the Illness Perceptions Questionnaire-Revised and the Morisky Medication Adherence Scale. Patients' cognitive illness representations were influenced by type of treatment, haemophilia severity, presence of inhibitor and co-morbidity. Perceived chronicity was influenced by patient's age (P = 0.021). Perceived adherence was not influenced by the health status, but was affected by the relationship status (P = 0.048). Perceived adherence was predicted by perceived chronicity (ß = 0.412; P = 0.003) and by emotions (ß = -0.308; P = 0.023). Patient's health status seems to affect cognitive illness representations but not perceived adherence. Perceived chronicity and negative emotions, which affected perceived adherence, were not influenced by the health status. Physician-patient communication addressing perceived chronicity and emotions rather than patients' health status may influence patient's adherence. Psycho-educational groups could be offered to promote patient's well-being and adjustment to haemophilia, and improve adherence.

Parental experience of end-of life care in the pediatric intensive care unit.

BACKGROUND: There is a considerable variability among European countries regarding the management of end-of-life (EOL) care in the pediatric critical care setting. In Italy, recommendations on these issues are available but no study has investigated the parents' experience. The aim of this study was to explore parents' experience of EOL care in a Pediatric Intensive Care Unit (PICU) in Italy. METHODS: The study was conducted in a 6-bed PICU of a university affiliated hospital in Milan. Parents of children who died between 2007-2010 after a stay of at least 24 hours were eligible to participate. Through semi-structured interviews, parents were asked to describe the story of their child's stay in the PICU, including his/her final moments. The interviews were audio-recorded, transcribed verbatim and analyzed according to the hermeneutic-phenomenology approach. RESULTS: Twelve parents of 8 children were interviewed. Four themes emerged that described the parents' experience: 1) loss of parental role; 2) lack of physical intimacy with their child; 3) ambivalence about end-of-life decisions; and 4) reclaiming the dying process. CONCLUSION: Our findings suggest that in order to improve pediatric EOL care we need to better integrate medical and parental priorities, in a shared process that allows parents to preserve their role and relationship with their child. The most critical aspect for parents was not related to the involvement (or not) in EOL decisions, but rather to the possibility of staying connected with their child during the hospitalization and at the time of death.

How individuals with phenylketonuria experience their illness: an age-related qualitative study.

BACKGROUND: The aim of the study was to explore the illness experience of individuals affected by phenylketonuria (PKU) and its differences in different patient age groups. METHODS: A qualitative-interpretative methodology was used through in-depth interviews. Textual data were explored using the principles of grounded theory. RESULTS: Forty-seven patients participated in the study, aged from 10 to >25 years old. The results suggested the age-related PKU experience: (1) a paradox, either to feel normal but isolated from the social context, or to be different while participating in the convivial aspects of the social being; and (2) the need for education about the disease tailored to the individual and growing needs. Specific themes seem to characterize each age range. CONCLUSIONS: This study constitutes a first attempt at understanding PKU from a non-medical-biological perspective.

Comparação entre as variações respiratórias da amplitude de onda pletismográfica da oximetria de pulso e do pulso arterial em pacientes com e sem uso de norepinefrina / Comparison between respiratory pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure variations among patients with and without norepinephrine use

OBJETIVOS: A variação respiratória da pressão arterial é um bom preditor da resposta a fluidos em pacientes ventilados. Foi recentemente demonstrado que a variação respiratória na pressão arterial de pulso se correlaciona com a variação da amplitude da onda pletismográfica da oximetria de pulso. Nossa intenção foi avaliar a correlação entre a variação respiratória da pressão arterial de pulso e a variação respiratória na amplitude da onda pletismográfica da oximetria de pulso, e determinar se esta correlação foi influenciada pela administração de norepinefrina. MÉTODOS: Estudo prospectivo de sessenta pacientes com ritmo sinusal normal sob ventilação mecânica, profundamente sedados e hemodinamicamente estáveis. Foram monitorados o índice de oxigenação e pressão arterial invasiva. A variação respiratória da pressão do pulso e a variação respiratória da amplitude da onda pletismográfica na oximetria de pulso foram registradas simultaneamente batimento a batimento, e foram comparadas utilizando o coeficiente de concordância de Pearson e regressão linear. RESULTADOS: Trinta pacientes (50 por cento) necessitaram de norepinefrina. Ocorreu uma correlação significante (K=0,66; p<0,001) entre a variação respiratória na pressão arterial de pulso e a variação respiratória na amplitude de onda pletismográfica na oximetria de pulso. A área sob a curva ROC foi de 0,88 (variando de 0,79-0,97) com melhor valor de corte de 14 por cento para prever uma variação respiratória na pressão arterial de pulso de 13. O uso de norepinefrina não influenciou esta correlação (K=0,63; p=0,001, respectivamente). CONCLUSÕES: Uma variação respiratória na pressão do pulso arterial acima de 13 por cento pode ser prevista com precisão por meio de uma variação respiratória da amplitude de onda pletismográfica na oximetria de pulso de 14 por cento. O uso de norepinefrina não modifica este relacionamento.

OBJECTIVES: Arterial pulse pressure respiratory variation is a good predictor of fluid response in ventilated patients. Recently, it was shown that respiratory variation in arterial pulse pressure correlates with variation in pulse oximetry plethysmographic waveform amplitude. We wanted to evaluate the correlation between respiratory variation in arterial pulse pressure and respiratory variation in pulse oximetry plethysmographic waveform amplitude, and to determine whether this correlation was influenced by norepinephrine administration. METHODS: Prospective study of sixty patients with normal sinus rhythm on mechanical ventilation, profoundly sedated and with stable hemodynamics. Oxygenation index and invasive arterial pressure were monitored. Respiratory variation in arterial pulse pressure and respiratory variation in pulse oximetry plethysmographic waveform amplitude were recorded simultaneously in a beat-to-beat evaluation, and were compared using the Pearson coefficient of agreement and linear regression. RESULTS: Thirty patients (50 percent) required norepinephrine. There was a significant correlation (K = 0.66; p < 0.001) between respiratory variation in arterial pulse pressure and respiratory variation in pulse oximetry plethysmographic waveform amplitude. Area under the ROC curve was 0.88 (range, 0.79 - 0.97), with a best cutoff value of 14 percent to predict a respiratory variation in arterial pulse pressure of 13. The use of norepinephrine did not influence the correlation (K = 0.63, p = 0.001, respectively). CONCLUSIONS: Respiratory variation in arterial pulse pressure above 13 percent can be accurately predicted by a respiratory variation in pulse oximetry plethysmographic waveform amplitude of 14 percent. The use of norepinephrine does not alter this relationship.

Fatores preditores precoces de reinternação em unidade de terapia intensiva / Early predictive factors for intensive care unit readmission

OBJETIVOS: Prever reinternação na unidade de terapia intensiva, analisando as primeiras 24 horas de pacientes após admissão em unidade de terapia intensiva. MÉTODOS: A primeira internação de pacientes de janeiro a maio de 2009 em UTI geral foi estudada. Considerou-se reinternação em unidade de terapia intensiva na mesma permanência hospitalar ou retorno em até 3 meses após alta da unidade. Pacientes que faleceram na 1ª admissão foram excluídos. Fatores demográficos, uso de assistência ventilatória e permanência na unidade de terapia intensiva por mais de 3 dias foram analisadas de forma uni e multivariada de acordo com desfecho reinternação. RESULTADOS: Quinhentos e setenta e sete pacientes foram incluídos (33 óbitos excluídos). O grupo de reinternação foi 59 pacientes, e 518 não reinternados. O tempo entre admissão índice e reinternação foi 9 (3-28) dias (18 foram readmitidos com menos de 3 dias) e 10 faleceram. Os pacientes reinternados pelo menos 1 vez na unidade de terapia intensiva apresentaram as seguintes diferenças em relação ao grupo controle: maior idade: 75 (67-81) versus 67 (56-78) anos, p<0,01; admissão por insuficiência respiratória e/ou sepse: 33 versus 13 por cento, p<0,01; admissão clínica: 49 versus 32 por cento, p<0,05; maior SAPS II: 27 (21-35) versus 23 (18-29) pontos, p<0,01; Charlson: 2 (1-2) versus 1 (0-2) pontos, p<0,01 e permanência maior que 3 dias na unidade de terapia intensiva na 1ª admissão (35 versus 23 por cento, p<0,01). Após regressão logística, idade, índice de Charlson e admissão por causas respiratórias ou sepse foram independentemente associados às reinternações em unidade de terapia intensiva. CONCLUSÃO: Idade, comorbidades e admissão por insuficiência respiratória e/ou sepse estão precocemente associadas a maior risco de reinternações na unidade de terapia intensiva estudada.

OBJECTIVE: To predict readmission in intensive care unit analyzing the first 24 hours data after intensive care unit admission. METHODS: The first intensive care unit admission of patients was analyzed from January to May 2009 in a mixed unit. Readmission to the unit was considered those during the same hospital stay or within 3 months after intensive care unit discharge. Deaths during the first admission were excluded. Demographic data, use of mechanical ventilation, and report of stay longer than 3 days were submitted to uni and multivariate analysis for readmission. RESULTS: Five hundred seventy-seven patients were included (33 excluded deaths). The readmission group had 59 patients, while 518 patients were not readmitted. The lead time between the index admission and readmission was 9 (3-28) days (18 were readmitted in less than 3 days), and 10 died. Patients readmitted at least once to the intensive care unit had the differences below in comparison to the control group: older age: 75 (67-81) versus 67 (56-78) years, P<0.01; admission for respiratory insufficiency or sepsis: 33 versus 13 percent, P<0.01; medical admission: 49 versus 32 percent, P<0.05; higher SAPS II score: 27 (21-35) versus 23 (18-29) points, P<0.01; Charlson index: 2 (1-2) versus 1 (0-2) points, P<0.01; first ICU stay longer than 3 days: 35 versus 23 percent, P<0.01. After logistic regression, higher age, Charlson index and admission for respiratory and sepsis were independently associated to readmissions in intensive care unit. CONCLUSION: Age, comorbidities and respiratory- and/or sepsis-related admission are associated with increased readmission risk in the studied sample.

Comparison between respiratory pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure variations among patients with and without norepinephrine use. / Comparação entre as variações respiratórias da amplitude de onda pletismográfica da oximetria de pulso e do pulso arterial em pacientes com e sem uso de norepinefrina.

OBJECTIVES: Arterial pulse pressure respiratory variation is a good predictor of fluid response in ventilated patients. Recently, it was shown that respiratory variation in arterial pulse pressure correlates with variation in pulse oximetry plethysmographic waveform amplitude. We wanted to evaluate the correlation between respiratory variation in arterial pulse pressure and respiratory variation in pulse oximetry plethysmographic waveform amplitude, and to determine whether this correlation was influenced by norepinephrine administration. METHODS: Prospective study of sixty patients with normal sinus rhythm on mechanical ventilation, profoundly sedated and with stable hemodynamics. Oxygenation index and invasive arterial pressure were monitored. Respiratory variation in arterial pulse pressure and respiratory variation in pulse oximetry plethysmographic waveform amplitude were recorded simultaneously in a beat-to-beat evaluation, and were compared using the Pearson coefficient of agreement and linear regression. RESULTS: Thirty patients (50%) required norepinephrine. There was a significant correlation (K = 0.66; p < 0.001) between respiratory variation in arterial pulse pressure and respiratory variation in pulse oximetry plethysmographic waveform amplitude. Area under the ROC curve was 0.88 (range, 0.79 - 0.97), with a best cutoff value of 14% to predict a respiratory variation in arterial pulse pressure of 13. The use of norepinephrine did not influence the correlation (K = 0.63, p = 0.001, respectively). CONCLUSIONS: Respiratory variation in arterial pulse pressure above 13% can be accurately predicted by a respiratory variation in pulse oximetry plethysmographic waveform amplitude of 14%. The use of norepinephrine does not alter this relationship.

Early predictive factors for intensive care unit readmission. / Fatores preditores precoces de reinternação em unidade de terapia intensiva.

OBJECTIVE: To predict readmission in intensive care unit analyzing the first 24 hours data after intensive care unit admission. METHODS: The first intensive care unit admission of patients was analyzed from January to May 2009 in a mixed unit. Readmission to the unit was considered those during the same hospital stay or within 3 months after intensive care unit discharge. Deaths during the first admission were excluded. Demographic data, use of mechanical ventilation, and report of stay longer than 3 days were submitted to uni and multivariate analysis for readmission. RESULTS: Five hundred seventy-seven patients were included (33 excluded deaths). The readmission group had 59 patients, while 518 patients were not readmitted. The lead time between the index admission and readmission was 9 (3-28) days (18 were readmitted in less than 3 days), and 10 died. Patients readmitted at least once to the intensive care unit had the differences below in comparison to the control group: older age: 75 (67-81) versus 67 (56-78) years, P<0.01; admission for respiratory insufficiency or sepsis: 33 versus 13%, P<0.01; medical admission: 49 versus 32%, P<0.05; higher SAPS II score: 27 (21-35) versus 23 (18-29) points, P<0.01; Charlson index: 2 (1-2) versus 1 (0-2) points, P<0.01; first ICU stay longer than 3 days: 35 versus 23%, P<0.01. After logistic regression, higher age, Charlson index and admission for respiratory and sepsis were independently associated to readmissions in intensive care unit. CONCLUSION: Age, comorbidities and respiratory- and/or sepsis-related admission are associated with increased readmission risk in the studied sample.

"All the rest is normal". A pilot study on the communication between physician and patient in prenatal diagnosis.

The aim of the study was to verify in the context of prenatal diagnosis if the communicative style in consultations is modified in relation to the seriousness of the diagnosis. Videoed consultations after executing amniocentesis and ultra-sound scanning of II level were included in the study with the consent of participants. Only visits with Italian speaking couples without psychiatric problems were analyzed for the study. Selected visits were grouped into "low" (L, minor anomalies) and "high" (H, serious anomalies) visits. A modified version of the RIAS tailored for the specific context was used in the analysis. 27 visits, respectively 13 H and 14 L, were studied. Analysis of the communicative structure of the consultations did not show significant differences between the two groups. The communication during the consultation seems to be mostly influenced by a highly disease-centered model that is not dependent on the content of the consultation itself. Only emotional exchanges showed a marginally significant decrease in the H visits (t = 1.995, p = 0.057), suggesting the probable difficulty of the disease-centered model to manage emotional items during a highly dramatic consultation. Due to the exploratory nature of the study, further research is needed to test the preliminary results.

Stories from doctors of patients with pain. A qualitative research on the physicians' perspective.

GOAL OF WORK: The aim of this study was to explore the physicians' internal representation of the doctor-patient relationship in the dramatic field of the patient with pain. METHODS: Using an open narrative format, 151 physicians were asked to "Tell us about an episode during your professional experience in which you found yourself in difficulty whilst confronting a patient who was in pain". The narrations were examined in accordance with a clinical-interpretive method. MAIN RESULTS: Three "perspectives of observation" were identified, namely: the biological perspective, the professional perspective, and the personal perspective. The biological perspective is about the biological model and the "depersonalization" of pain. In the professional perspective, the narrative concerns the patient as a "person" and the reattribution of the pain to the suffering person. The personal perspective is about the emotional-relational explosion within the meeting between the doctor as human being and the patient as human being. Most of the narrations did not strictly connect to one or another of the perspectives, but each story seemed a journey without peace back and forth among the perspectives. CONCLUSIONS: The professional perspective seemed to be the only place in which physicians could "stop", a space not extreme in which they seemed to express the need for education about the management of the professional relationship with the other person.

Improving patient-centred medicine: a preliminary experience for teaching communication skills to Italian general practitioners.

INTRODUCTION: A key concept for general practice nowadays is that of patient-centred medicine. In this model the physician's aim is to integrate the patient's experience of illness with the conventional understanding of disease, trying to reconcile the patient's agenda with his/her own. This paper describes a preliminary experience of a CME course on patient-centred medicine in Italy. AIM AND METHODS: The article focuses on a 7 hour course for teaching patient-centred medicine to Italian general practitioners. Assessment of the course was done both in terms of learner satisfaction and efficacy. Learner satisfaction was evaluated by a questionnaire with a 6-point Likert scale and course efficacy by a pre/post-paper-and-pencil test. FINDINGS AND DISCUSSION: The pilot course on patient-centred medicine seems to obtain high satisfaction in participants. Furthermore, an increase in competence with regards to patient-centeredness resulted after the course. The pilot study represents the first Italian CME seminar on patient-centered medicine. Results obtained both in terms of satisfaction and efficacy suggest that the CME course is a valid educational tool. The opportunity to extend the experience to a higher number of participants is therefore recommended.

Giving bad news: a GPs' narrative perspective.

The purpose of this study was to explore GPs' perspectives on giving bad news during consultations. To this end, 168 GPs were asked to recall, and record on the first page of a questionnaire, an occasion when they had given medically related bad news to a patient. The stories were analysed with a qualitative and interpretative approach. Two axes, each with a semantic polarity, were identified: a relational axis (semantic polarity: escape vs accompanying) and an ethical axis (semantic polarity: the doctor's choice vs the patient's choice). Furthermore, two main topics appeared to be common to almost all the narratives: the need to reassure the patient and the account of the doctor's emotions. Two different relational patterns appear to be described by doctors. A substantial number of GPs implicitly describe a disease- or doctor-centred consultation: in these cases the physicians refer to signs and symptoms, diagnosis and treatments; they decide for themselves whether to tell the truth or not. On the other hand, a smaller number describe consultations that could be defined as patient centred: these doctors consider that their duty of care for the individual ill person is paramount and try to respect the patient's right to decide. In both these relational patterns, GPs feel it is a fundamental professional duty to reassure the patient; furthermore, they feel the most difficult aspect is managing their own emotional responses.

[The video recording of medical visits for the study of physician-patient rapport in general medicine. An experimental experience in Italy]. / Videoregistrazione di visite mediche per lo studio del rapporto medico-paziente in Medicina Generale. Un'esperienza sperimentale in Italia.

The communication and relationship between doctors and patients has been given increased attention in recent years. There are many different methods by which to collect data on doctor-patient communication and relationship: of these, videorecording seems to have the most advantages. The objective of this article is to describe the method we used to make videorecorded consultations in General Medical Practice in Italy. In particular, the article addresses: 1) the technical feasibility of videorecording consultations; 2) a possible answer to the problem of informed consent both from doctors and from patients. At present, the archives collect 258 videotaped consultations of 14 General Practitioners: about three patients in four (75.9%) did consent to have their consultation recorded; a high range of videorecorded consultations (94.2%) does not present technical problems. In line with published surveys, these recording consultations are an increasingly important method of studying communication and doctor-patient relationship, and of teaching/learning these aspects of medical practice.

[Patient-centered medicine]. / La medicina centrata sul paziente.

The dominant model in medical practice today has been defined as the "disease-centered" model. In the past few years, it has been attacked for oversimplifying the problems of illness because it assumes disease to be fully accounted for by deviations from the norm of measurable biological variables. This article describes a patient-centered model that integrates the traditional understanding of disease with each patient's experience of illness. The transformed clinical method involves three major changes: 1) new tasks for the consultation: the patient-centered method focuses on disease and on four principal dimensions of the patients, i.e., their ideas about the illness, their feelings and fears, the impact of their problems on their lives, their expectations about what should be done; 2) new strategies to obtain these objectives: new interviewing skills and communication techniques, e.g., attentive listening; open questions; 3) new modes of teaching and learning, e.g., the use of role-playing and videotaping. Research has shown that patient-centered medicine enables better clinical results to be obtained and is associated with increased patient and physician satisfaction.