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1
Claridge, S. "Educational psychologists' and teachers' perceptions of consultation : an analysis of initial consultations." Thesis, University College London (University of London), 2005. http://discovery.ucl.ac.uk/1444580/.
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This research took a qualitative approach, focusing on the perceptions and experience of consultants and consultees. The rationale is explored in the light of previous research, which concentrates on a quantitative approach and does not explore consultation from the participants' perspective. This research adds to the research base because it investigates the experience of participants in consultations from a number of perspectives. 46 questionnaires were sent to educational psychologists to gain their understanding of the pertinent elements of consultations and to aid reflection on the language of consultation. The return rate was 40%. The resultant data was used to formulate a semi-structured questionnaire, which was used to interview eight educational psychologists about their experiences of consultation in perceived successful and unsuccessful circumstances. 16 consultees were interviewed: one from each of the perceived successful and unsuccessful situations. Finally transcriptions were made from recordings of 'live' consultations of each of the original consultants. An iterative qualitative analysis was undertaken using grounded theory and focused feedback with the participants. A critique of the methodology focused on the strengths and limitations of the design adopted. The results showed significant variation in the conceptualisation and practice between consultants, with little shared understanding of the role and practice of consultation either across consultants or between consultants and consultees. The espoused practice of consultants differed from their actual practice and from the experience of consultees. Differences were found in the use of theoretical principles, power stances, the process of problem analysis and intervention strategy development. Although most participants acknowledged the importance of evaluation, in practice no time was allocated to this activity. This research considered a small sample of consultants and consultees, all of whom worked in the same county. Any generalisations drawn must be tentative. Nonetheless, the variance found within the relative homogeneity of the group of psychologists does suggest the variance would only increase within a larger sample with less homogeneity. The discussion and summary considers the implications for educational psychology practice of consultation and future research.
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Kim, Byoungju. "The British parliamentary e-consultation system : a case study of e-consultations." Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/341939/.
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Democracy is being challenged by low public participation in the democratic process. This has resulted in low voter turnout and is therefore called a crisis of representative democracy. As a means of increasing citizens’ engagement with their representative bodies, Information Communication Technologies (ICTs) have been implemented to encourage public online participation. In particular, the British Parliament has adopted an e-consultation system, available on its website since 2007, as an electronic tool for online participation. As e-consultation is the only system which truly enables the public to engage the legislative process, it is worth assessing this system in order to determine its effectiveness and impact. To do this, it is necessary to conduct an analysis through case studies on past econsultations. Through this analysis, an aim of this thesis is to seek new methods by which to maximise the efficiency of the e-consultation system through the consideration and application of specific research questions. Answers to specific questions were sought by means of employing empirical studies on two e-consultation cases to determine levels of public participation: the successful topic of ‘Domestic Violence’ and the less popular topic of ‘e-Petitions.’ Analysis of the two e-consultation cases reveals that e-consultation provides the public with valuable opportunity to connect with its representatives and to engage the legislative process. However, in order to maximise the efficiency of the e-consultation system, several modifications are suggested including: adequate preparation and publicity on behalf of the organising body, a high rate of MP participation, active consideration of any contributions by the committee in charge, and the establishment of a parliamentary division unit specifically for the conduction of e-consultations.
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Arnet, Hayley Ruth. "The rituals of medicine : exploring the General Practice Consultation using simulated consultations." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/716.
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The consultation is a distinguishing feature of general practice compared to other medical disciplines. The relationship between the doctor and patient is crucial to the successful outcome of the consultation. Despite suggestions in the literature that interruptions to the consultation are detrimental to this relationship, there is a lack of research to support this claim.The overall aim of this study was to explore the consulting style of General Practitioners (GPs) and the impact of interruptions to the consultation to further understand GP behaviour and the doctor-patient relationship during the consultation. The implication of the study was to raise awareness for GPs of their consulting style and interaction with patients, potentially leading to changes in behaviour, resulting in better outcomes from consultations.This research involved six GPs consulting six actor-patients during two video recorded simulated consultation workshops. This research consisted of three studies. The first involved observation of GP behaviour during the simulated consultations, and the impact of interruptions to the consultation; the second involved GP and patient perceptions of behaviour during the consultations, and the impact of the interruptions; and the third involved obtaining GP and patient perspectives of behaviour and interruptions to the consultations, prompted by video footage from the consultations.In Study 1, evidence was found to support a GP consultation style whereby individual GPs showed similar behaviours during each consultation despite consulting a variety of patients. Variability in GPs ability to cope with interruptions to the consultation, and the little time spent by GPs establishing a relationship with patients regardless of the consultation being interrupted was highlighted. The findings of Study 2 supported previous reports of the frequent occurrence of interruptions to the consultation. Differences between GPs beliefs and patient perceptions of the impact of interruptions to the consultation to the doctor-patient relationship were highlighted. In Study 3, the opening sequence of the consultation was found to be of importance to the doctor-patient relationship and the outcome of the consultation.Overall, the findings of this study showed GPs inability to describe their behaviour, and a lack of awareness of their behaviour during the consultation. As a result, GPs may be missing vital cues from patients during the consultation regarding their thoughts and concerns, which may have negative consequences for the doctor-patient relationship. These implications, however, require further research. This study concluded that reflection, and mindfulness could be applied to GP consultation behaviour, using video techniques, in order to raise GP self- awareness of behaviour, improve communication, and the way that GPs relate to patients, and to improve outcomes of general practice consultations.
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Bakekolo-Nganga, Francis. "Les juridictions internationales et les fonctions consultatives." Paris 12, 1998. http://www.theses.fr/1998PA122016.
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Andén, Annika. "Outcomes from GPs' Consultations." Doctoral thesis, Linköpings universitet, Allmänmedicin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-18483.
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Background and aims. Patients’ consultations with GPs can deal with a wide range of conditions and problems. Generally, consultation outcomes have been considered in evaluations but outcome has a meaning for elaboration of care beyond the graduating role of quality and other evaluation instruments. Knowledge about outcomes is needed for understanding and development. The aim of this thesis was to investigate outcomes of GPs’ consultations as directly experienced by patients and GPs and to investigate connections between clinical strategies and presumed patient outcomes. Methods. First, concepts describing outcomes from patients’ and GPs’ viewpoints were developed from interviews in groups and individually. Secondly, based on this, questionnaires about the consultation outcomes were formulated. Then, patients and GPs answered questionnaires regarding the same recent consultation. The numbers of the different outcomes were counted and the experiences of outcomes from the same consultations were compared. Finally, another questionnaire including both the GP outcome questions and questions about the clinical situation and decisions made was answered by GPs. Results. Concepts describing consultation outcomes were brought forward. Cure/symptom relief, reassurance, patient understanding and satisfaction were used by both patients and GPs to describe outcome of consultations. Only patients described as outcomes a confirmation of their ideas and a change in self-perception. GPs, but not patients, described the patient outcomes in terms of check-up and coping. Besides this, GPs also described other outcomes that concerned relationship-building, a change of surgery routines and self-evaluation. Selfevaluation was related to a perceived collegial consensus about right and wrong. The concordance between GPs and patients assessing the same consultations was high for satisfaction, intermediate for patient understanding and low for belief in cure/symptom relief. Clinical strategies were linked to outcomes. Immediate problem solving was registered in about half the consultations. When immediate problem solving was registered the patients were supposed to be more reassured, satisfied and coped better than after gradual problem solving. With increasing psychosocial content of the consultation the GPs registered more dissatisfaction both for themselves and their patients. Conclusions. Change in self- perception was a prominent patient outcome. GPs’ self-evaluations ought to have the inherent possibility to serve as a basis for development of general practice. The entire map of the encountered outcome concepts can serve as a basis for further research and development. The mapping of concepts can be of help when prioritising. Knowledge about the total picture of consultation outcomes can help the GP to understand the patients’ worlds better. It can also contribute to a realistic picture of possible consultation outcomes. The GPs seemed to adjust their problem solving (immediate or gradual) to the registered problem and furthermore adjust the immediate problem solving, focusing either on the problem or on the patient as a person.
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Juslin, Emil. "Consulting with the Citizens : An Introductory Study on Citizen Participation in the European Commission ́s Online Consultations." Thesis, Uppsala universitet, Statsvetenskapliga institutionen, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-374005.
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For a long time the citizen participation in the European Commission Online Consultations have been low and quite insignificant. This came to an abrupt change during 2018, with the consultation on Summertime arrangements bringing out over four million citizens to participate and it is now clear that the citizen impact on consultations are not something to overlook. So, who participates in the online consultations? It is assumed that biases generated through the voluntarily participation of the Online Consultations (OC) will provide discrepancies between the participants in OC:s compared to the EU population in general. The aim of the study is to examine how individual participation in OC:s differs based on the complexity of the topic and the Member State affiliation of the citizen. The study is tested based on four hypotheses predicting how possible biases might take place. The hypotheses are tested by an quantitative study of the EU online consultations published on the “Your voice in Europe” website. The results indicate that participation differs between different regions, with the eastern Member States participating to a lower degree. Furthermore, the study indicates that it exists a negative covariance between positive EU policy opinions and participation per Member State. This is believed to be caused by a difference in diversity of the sample that participates. The study also examines how the technical complexity of the consultations affects political participation among citizens. This part of the study did not generate any clear results.
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Olsson, Pia. "Antenatal midwifery consultations : a qualitative study." Doctoral thesis, Umeå universitet, Institutionen för omvårdnad, 2000. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-96903.
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Rosario, Pacahuala Emilio Augusto, Pimentel Janett Isabel Sanchez, and Gamero Aldo Rafael Medina. "Soft skills in cardiology telemedicine consultations." Ediciones Doyma, S.L, 2021. http://hdl.handle.net/10757/655879.
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Saut, Dominique. "Consultations psychiatriques d'adolescents à l'hôpital général." Montpellier 1, 1988. http://www.theses.fr/1988MON11010.
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Lejeune, Thierry. "Consultations de genetique medicale en vaucluse." Aix-Marseille 2, 1992. http://www.theses.fr/1992AIX20046.
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Leydon, Geraldine Marie-Claire. "Communication in UK outpatient oncology consultations." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.429092.
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Bard, Etienne. "Faire bon poids, bonne figure : Sociologie des suivis diététiques en libéral." Thesis, Paris 13, 2019. http://www.theses.fr/2019PA131024.
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Ce travail de thèse est consacré aux suivis diététiques en libéral. Il repose sur une enquête qualitative qui associe entretiens, avec des praticiens et des patients, et observations de consultations diététiques. Nous nous attachons dans un premier temps à caractériser les trajectoires, positions sociales et conditions de travail des enquêtés diététiciennes et diététiciens. Dans un second temps, la thèse analyse le déroulement des consultations et des suivis, du point de vue des praticiens et de leurs patients. Alors qu’ils sont principalement formés à l’administration de régimes thérapeutiques ou de rations équilibrées, les praticiens libéraux, confrontés à des patients sains désirant maigrir, doivent adapter leurs recommandations aux attentes de leurs patients. Dans le cadre d’un marché diététique sur lequel les prix mais également les normes et les représentations, notamment, régulent la rencontre entre les offreurs et les demandeurs de services d’accompagnement à l’amaigrissement, nous observons comment les diététiciennes et diététiciens font valoir leurs différences pour accroître ou préserver la taille de leur patientèle. Ces derniers sont cependant confrontés à un impératif de résultats. La perte de poids effective, mesurée lors de chaque consultation à l’occasion de «la pesée», apparaît comme le principal critère d’évaluation auquel recourent les patients. Or, le recours aux régimes amaigrissants est stigmatisé et pensé comme inefficace. Les praticiens libéraux mettent donc en oeuvre des méthodes alternatives. Ces dernières, sous couvert d’une efficacité naturelle et universelle, s’avèrent cependant situées socialement et potentiellement inefficaces pour les patients appartenant aux classes populaires. Les diététiciennes et diététiciens rencontrés doivent alors composer avec les propriétés sociales, parfois hétérogènes, de leurs patientes et patientsThis Ph.D. Thesis focuses on self-employed dietitians, the aftercare they provide and their patients. It is based on the result of a qualitative investigation which combines interviews with dietitians and patients and observations of consultations. Firstly, we attempt to characterize career paths, social positions and working conditions of the dietitians that we met. Secondly, the thesis focuses on the progress of consultations and the follow-up procedure, from both the point of view of dietitians and their patients. They have to bear in mind when dealing with healthy patients who simply desire to lose weight, that they have to adjust their recommendations according to the expectations of their patients. In the context of a dietetic market in which prices but also social norms and representations regulate the encounter between suppliers and seekers of weight-loss follow-up services, I have observed how dietitians highlight their variations in order to develop their patient base. However, self-employed dietitians have to deal with an outcome obligation. Effective weight-loss, determined during each consultation on the occasion of « la pesée » (the weigh in),appears to be the main way through which patients evaluate the effectiveness of their aftercare. This investigation shows that going on a diet is currently stigmatized and considered as ineffective. Therefore , self-employed dietitians have to use alternative methods. These methods pretend to be naturally and universally effective. In fact, they would appear to be socially situated and thus potentially counter-effective for patients who belong to working class.The dietitians encountered on the fields have to take into account the social properties of the patients, which are sometimes quite diverse and heterogeneous
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Dodson, Christopher James. "The role of public consultation in the formation of Canadian immigration policy, the 1989-1990 immigration consultations." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/mq30466.pdf.
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Sterno, Imren. "A study of patient-psychiatrist consultations using conversation analysis : how is risk assessment conducted in psychiatric outpatient consultations?" Thesis, Queen Mary, University of London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.516713.
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Dia, Alassane. "Le principe de consultation en droit public comparé : l’exemple de la France et du Sénégal." Thesis, Toulouse 1, 2016. http://www.theses.fr/2016TOU10021/document.
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Le principe de consultation est un concept qui se veut novateur parce qu’il est entendu ici de façon extensive désignant aussi bien les consultations décisionnelles que les consultations propositionnelles. En raison de sa portée universelle, il fait l’objet de la présente étude pour tenter d’ouvrir des pistes de solutions à la crise de la représentation tout en réclamant l’adaptation de la norme juridique aux réalités historico-sociales de chaque pays. D’où l’adoption d’une approche comparative avec notamment l’exemple de la France et du Sénégal. Les consultations décisionnelles renvoient à l’élection et au référendum. L’élection parait indispensable dans son objectif d’établissement de la démocratie représentative mais déficient dans son effet générateur de la concentration du pouvoir entre les mains de l’Exécutif. Cette concentration est susceptible d’aboutir à l’adoption de décisions publiques entachées d’inefficacité et d’illégitimité. Quant au référendum, il parait nécessaire dans son objectif de rationalisation du système représentatif mais redouté dans ses effets néfastes sur les droits et libertés des individus et sur la séparation des pouvoirs. Les consultations propositionnelles sont destinées à remédier à la crise d’efficacité et de légitimité de la décision publique en exigeant une obligation de consultation technique, juridique et publique avec l’utilisation des méthodes institutionnelles et électroniques. Toutefois, pour rationaliser le système représentatif sans porter atteinte à son existence, l’obligation de prise en compte des avis en serait un élément complémentaire qui devrait, néanmoins, pouvoir être supplantée par l’obligation de motivation sauf en période de circonstances exceptionnelles. Par conséquent, tel qu’il est étudié ici à la lumière du droit public comparé, le principe de consultation, a permis de comprendre que dans le processus d’adoption des décisions publiques majeures, ni l’autorité publique ni l’expert et encore moins le public ne semblent inspirer la confiance absolue. Il serait alors nécessaire d’établir une juste collaboration entre ces différents acteurs afin que la norme juridique ne souffre de contestation majeure susceptible de mettre en péril les relations entre gouvernants et gouvernés et, par voie de conséquence, les libertés et droits individuels et politiquesThe principle of consultation is a concept that claims to be innovative because it is understood here in a wide view referring not only to decision-making consultations but also to propositional ones. On account of its universal scope, it is the subject of this study. The idea is to attempt to ponder on likely solutions to the representation crisis while insisting on the adoption of the legal norm to the social and historical realities of every country. This explains the adoption of a comparative approach of the topic which includes the example of France and Senegal. Decision-making consultations are related to the election and referendum. The election appears to be compulsory in its target to set up representative democracy but is defective in its effect generating the concentration of the power in the hands of the executive. This concentration is likely to lead to the adoption of illegitimate and inefficient public decisions. As for the referendum, it seems necessary in its aim to rationalise the representative system. But the referendum is redoubted in its harmful effects on individuals’ rights and liberties and on the separation of powers. Propositional consultations are supposed to solve the legitimate and efficient crisis of public decisions in requiring a public, legal and technical obligation of consultation with the use of electronic and institutional methods. However, to rationalise the representative system, without breaking its existence, the obligation of taking into account point of views would be an additional element which should be, nevertheless, superseded by the obligation to motivate except for the period of exceptional circumstances. Consequently, as studied in the light of this compared public law, the principle of consultation enables us to understand that as far as the adoption process of major public decisions is concerned, either the public authority or the expert even less the public seem to inspire absolute confidence. So, it would be necessary to establish a fair collaboration between those different actors so that the legal norm could not suffer from major questioning likely to imperil the relation between rulers and citizens, and as a result, imperil as well civil liberties, and political and individual rights
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Kidd, Jane Margaret. "Patient and doctor satisfaction with medical consultations." Thesis, King's College London (University of London), 1998. https://kclpure.kcl.ac.uk/portal/en/theses/patient-and-doctor-satisfaction-with-medical-consultations(f0db6225-b073-4f17-859f-0b9fe7b5920b).html.
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Collins, Sarah Frances. "Communication and strategy in health care consultations." Thesis, University of York, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.431649.
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Johnson, David John. "The doctor-patient relationship : an analysis of framing in general practice." Thesis, Loughborough University, 1986. https://dspace.lboro.ac.uk/2134/31913.
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Utilizing a research technique involving semi-structured interviews and video-recordings of doctor patient consultations within British general practice, an empirically based 'ideal type' is created. This ideal type is seen to rest upon questionable assumptions, and although actors have expectations for behaviour which are consistent with the ideal type, deeper analysis of patient expectations shows them to be aware of the inapplicability of the ideal type in certain consultations. From this perspective one would expect change to be occurring. However using the concept of frames, a detailed analysis of the interaction between doctor and patient illustrates the social constraints and power structure of the consultation as playing a significant role in the maintenance of the status quo.
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DESPLATS, BERTRAND. "Consultations dans un service de neurologie du c. H. U. De lille : etude d'activite a partir de 485 consultations successives." Lille 2, 1990. http://www.theses.fr/1990LIL2M046.
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Weijts, Louisa Bernarda Maria. "Patient participation in gynaecological consultations: studying interactional patterns." Maastricht : Maastricht : Rijksuniversiteit Limburg ; University Library, Maastricht University [Host], 1993. http://arno.unimaas.nl/show.cgi?fid=5938.
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Webb, Helena. "Doctor-patient interactions during medical consultations about obesity." Thesis, University of Nottingham, 2009. http://eprints.nottingham.ac.uk/10818/.
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The current “obesity epidemic” is a global concern for governments and healthcare organisations. Obesity is seen as a medical problem of excess body weight which can be resolved through interventions to encourage weight loss, most particularly diet and exercise regimes. Much existing sociological work focuses on moral understandings of obesity as a perceived symbol of individual greed and laziness in a culture that prioritises self-control and effort. This neglects the ways in which the condition is actively discussed and managed in relevant settings such as medical encounters. This thesis addresses this research gap by analysing talk during obesity-related medical consultations. Talk is central to all medical encounters and has particular resonance in treatments for obesity where most interventions are carried out by the patient away from the medical gaze. Patients must report on their treatment behaviours in ways that enable practitioners to evaluate them and offer further relevant advice. Talk is not only a means through which treatment is delivered but a form of treatment itself. Fieldwork took place in two UK NHS outpatient clinics specialising in weight loss treatment for obese patients. A sample of 18 patients and 1 doctor consented to have their consultations video-recorded over a period of 9 months. This resulted in 39 recorded interactions which were analysed according to the principles of Conversation Analysis (CA) to identify recurring patterns of interaction. The thesis describes how talk between doctor and patient functions to achieve certain tasks. In particular, it analyses how the specific institutional setting shapes and is shaped by talk. A dominant theme is that clinic interactions frequently invoke normative issues concerning knowledge, responsibility and effort. These issues are consistent with moral dynamics perceived to surround the condition of obesity and patient responsibilities. Doctor and patient collaboratively construct obesity as a moral issue. This has consequences for the conduct of the consultation. The findings extend existing CA knowledge on medical interactions and demonstrate the utility of an interactional approach to the sociological study of obesity. They also have relevance to healthcare policy and practice.
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Cape, John Donald. "General practice consultations with patients with psychological problems." Thesis, King's College London (University of London), 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.309361.
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Alshammari, Adel H. N. A. "Improving community pharmacy consultations for people with depression." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14480.
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Aims The aims of this study were to increase community pharmacists’ willingness and confidence to provide consultations for people with depression, and to enhance patients’ awareness of the pharmacists’ developing role. Research Design To observe pharmacist-patient consultations, the researcher developed a patient scenario. Pharmacist knowledge and attitude questionnaires were adapted, and a skills observation checklist was developed. Assessments of patient satisfaction levels took place before and after pharmacist training, which included a simulated consultation and action planning. The consultations were both video recorded and observed. Participants undertook a short interview with the researcher and each pharmacist developed his/her own plan for continuing professional development (CPD). An exploration of the interview transcripts was undertaken qualitatively. A University Ethics Panel approved the project. Results There were twenty-two pharmacists who took part in the study, comprising eighteen males and four females. MPharm students comprised one female and two males, and community pharmacists made up three females and sixteen males. The quantitative results: It was found that pharmacists possessed appropriate knowledge (the mean score was 75%, which showed that the pharmacists were aware of the safety and action of anti-depressants). The mean score for attitude was 54%, which tends towards the positive. When observing the simulated consultations, the mean score for initiating a consultation session was recorded at 28%. This indicates that the pharmacists were not very interested in initiating rapport with patients. However, the highest mean score calculated was 61%, which corresponded with closing a consultation. For data collection and action, the mean scores were 42% and 35%, respectively, and this indicates the need for improvement in these areas. The qualitative findings: The pharmacists demonstrated good knowledge about anti-depressants and held positive attitudes towards people with depression. However, the pharmacists were not very willing to exercise the responsibilities of their extended role or provide additional services for patients. The pharmacists lacked certain skills and opportunities to be able to enhance the patients’ satisfaction. The pharmacists in this study needed to improve their soft skills in some areas and engage in mutual discussion with patients in order to enhance patients’ expectations with the service provided. Conclusion/discussion The knowledge and attitude of pharmacists were good, but their consultation skills could be improved. Although simulated consultation allowed pharmacists to review their skills and practice the apparent impact on patient care was limited. This study has enable greater understanding of pharmacist strategies when consulting people with depression, and the findings could be used by those developing training programmes for enhancing pharmacists skills.
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Castro, SÃrgio Bastos de. "Effects of smoking in demand for medical consultations." Universidade Federal do CearÃ, 2012. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=9514.
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Secretaria do Planejamento e GestÃoSecretaria do Planejamento e GestÃoThis study aims to evaluate the effects of smoking on the medical appointments demand, it was used the data of Household Sample Survey - PNAD 2008 by the Brazilian Institute of Geography and Statistics - IBGE. In this work, subjects were separated into different categories: smokers (which were separated in two subcategories: intensive and non-intensive), former smokers and never smokers. It was investigated the relationship between tobacco consumption and the number of medical appointments in one year. It was used the number of medical consultations as dependent variable and variable of socioeconomic kind, health related outcomes associated with smoking and other independents. It was noted by analysis and Zero-Inflated Negative Binomial count model that was not found significant difference between smokers and never smokers on the number of medical appointments. In relation to former smokers, it was observed that these require more medical visits than those who never smoked. In addition, it was analyzed the influence of other factors in the number of queries.
Este estudo tem como objetivo avaliar os efeitos do tabagismo na demanda por consultas mÃdicas. Foram utilizados os dados da Pesquisa Nacional por Amostra de DomicÃlios â PNAD de 2008 realizada pelo Instituto Brasileiro de Geografia e EstatÃstica â IBGE. No presente trabalho, os indivÃduos foram separados em categorias: fumantes (estes, em duas subcategorias: intensivos e nÃo intensivos), ex-fumantes e nunca fumantes, buscando-se investigar a relaÃÃo entre consumo de tabaco e a quantidade de consultas mÃdicas realizadas no perÃodo de um ano. Foi utilizado o nÃmero de consultas mÃdicas realizadas como variÃvel dependente e variÃveis de natureza socioeconÃmicas, variÃveis relacionadas à saÃde e outras associadas ao tabagismo como independentes. Foi possÃvel verificar pela anÃlise descritiva e pelo modelo de contagem Binomial Negativo Inflacionado de Zeros que nÃo houve diferenÃa significativa entre fumantes e nunca fumantes quanto ao nÃmero de consultas mÃdicas demandadas e que, em relaÃÃo aos ex-fumantes, observou-se que estes demandam mais consultas mÃdicas do que aqueles que nunca fumaram. AlÃm disso, foi analisada a influÃncia de outros fatores no nÃmero de consultas.
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Wu, Kaihang. "Multimodal Approaches for Detecting Mimicry in medicalvideo consultations." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21391.
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Excellent nonverbal communications between doctors and patients are essential for having an effective medical consultation. Current studies usually work on face-to-face doctor-patient communications and manually measure the nonverbal behaviors for doctors or students; however, the main challenge of those methods is to automatize the detection method. In the past decade, new technologies, such as video conferencing, transformed medical communication. Therefore, it is better to do nonverbal behavior analyses via computer vision technologies, which can benefit the video-conferencing medical consultations. This thesis presents a system consisting of detectors to recognize medical student’s nonverbal behaviors automatically. The system implemented the new technologies, including computer vision (CV) and affective computing, to enable automatic detections for video-conferencing communication between medical students (from UNSW) and volunteers who acted as Simulated Patients (SP). The results of the detected medical students’ behaviors have been analyzed and showed that nonverbal behavior mimicry has an impact on their communication performance. In addition, how students’ nonverbal behaviors influence the quality of the teleconsultations has been studied. Communication skills can be vital to many professions, not just medical education. The potential application of nonverbal behavior mimicry detector and the findings of this thesis are not limited. Many professionals, such as employee-employer communication, could be benefited from using detectors for communication skills training.
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Berkman-Smith, Emma Louise. "Experiences of disclosing sexual orientation in healthcare consultations." Thesis, University of Leeds, 2011. http://etheses.whiterose.ac.uk/1982/.
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This study focused on experiences of healthcare consultations for lesbian, gay and bisexual (LGB) people, particularly their disclosure of sexual orientation. LGB people are more at risk of certain healthcare conditions than heterosexual people; disclosing sexual orientation allows healthcare professionals to consider the most appropriate approach to treat the concerns of LGB people. Previous literature suggests that lesbians use techniques to assess the safety of a healthcare environment before choosing to disclose their sexual orientation (Hitchcock & Wilson,1992). No previous study to the author’s knowledge has explored British LGB people’s experiences of healthcare consultations. Six students between the ages of 18 and 25 from the University of Leeds were interviewed using semi-structured interviews. These were analysed using interpretative phenomenological analysis (IPA). Individual analyses are presented followed by a group analysis detailing master themes occurring across participants. These are: somewhere safe to be free, discomfort defining sexual orientation, searching for acceptance and anticipation and fear of punishment. A process of participants’ approach to healthcare consultations and disclosure of sexual orientation is presented. A combination of participants’ search for acceptance of self and anticipation and fear of punishment seemed to shape their expectations of professionals and how they approached consultations. The interactions between professionals and participants then appeared to influence the participants’ perception of the consultations and their approach future consultations. Clinical implications of this study include: increased training for healthcare professionals around lesbian, gay and bisexual issues, so that they are better able to pick up cues from LGB patients, making it easier for them to disclose sexual orientation if they so choose. By providing the conditions for LGB people to disclose, healthcare professionals are helping to ensure that their LGB patients receive the most appropriate healthcare.
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Thompson, K. J. "The effect of a consultation charge on the patterns, types and outcomes of consultations with a general practitioner in Ireland." Thesis, Queen's University Belfast, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.426908.
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Weller, Julian. "Democratic legitimacy? : the online consultations of the European Commission." Thesis, University of Portsmouth, 2012. https://researchportal.port.ac.uk/portal/en/theses/democratic-legitimacy(c6f45c24-0c89-44e9-841f-78d0cae5f434).html.
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The central research puzzle of this thesis relates to new opportunities for political organisations due to technological change and non-electoral forms of creating democratic legitimacy. In particular, the thesis asks if new Information and communication technologies can address democratic legitimacy issues of the European Union. Without doubt, the European Union already has mechanisms for creating democratic legitimacy. However, does political participation based on new information and communication technologies offer an avenue for enhancing democratic legitimacy besides elections for the European Parliament and indirect democratic legitimacy provided by national governments in the European Council and the Council of Ministers? If we accept the assumption that technology offers new opportunities for the development of democratic legitimacy providing institutions then what are these new opportunities for the European Union? The methods used for this thesis are based on a qualitative case study design. The first case study is an online consultations for the directive on 'Harmonisation of legislation on industrial products', the second consultation is for the 'Community Action Plan on the Protection and Welfare of Animals 2006- 2010'. The main phenomenon, around which the research is built, is the input legitimacy potential of the Commission's online consultation regime. The unit of analysis are two online consultations of the Commission. The thesis uses three hypotheses to examine the input legitimacy potential dealing with accessibility of the participation arena, the meaningful transformation of inputs and participation patterns of participants. The gathered original data comes from four primary sources, semi-structured interviews with Commission officials directly related to case studies, semi structured interviews with consultation participants, interviews with so-called case study outsiders and a document analysis concerning the EU's communication strategies in connection with participation in policy-making. The key finding of this study is that the input legitimacy potential of the Commission's online consultation in its current form is negligible. Input legitimacy is not a prime concern, either for the citizens or for the Commission. There is no culture of inclusive participation aimed at individual citizens from within the Commission.
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O'Keefe, Maree Frances. "Maternal perspectives of child health consultations by medical students." Title page, contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09PH/09pho4121.pdf.
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"June 2002" Errata inside back cover. Bibliography: leaves 244-256. The first aim of this thesis was to determine the relationship between medical student clinical competence and patient-centredness, and maternal satisfaction and subsequent recall of information in child health consultations. The second aim was to test the application of this knowledge in medical student teaching programmes. The study demonstrated the ability of mothers to assess the clinical competence and patient-centredness of medical students in videotaped consultations. Applications in medical student learning were also developed and evaluated.
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Hajat, Shakoor. "Effects of air pollution on daily general practitioner consultations." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252350.
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MacKinnon, Rhona I. "Practising power : parent-teacher consultations in early years settings." Thesis, University of Stirling, 2013. http://hdl.handle.net/1893/19849.
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This research explores parent-teacher consultations in a range of early years settings. Data were collected from eighteen audio-recorded parent-teacher consultations from six different settings and from follow up interviews with parents and teachers. The data related to the consultations and participants’ direct experience of these and revealed the practices of power within these consultations. Using a Foucauldian approach to analysis, the exercise of power and its impact on the parent-teacher relationship was explored. The analysis revealed the ways in which surveillance, normalising judgements and the ‘examination’ of all involved in the reporting process to parents, constitutes an exercise of power. Within the consultation parents, teachers and children are positioned as subjects who are homogenised and judged accordingly. Conversely, the presentation of observations and assessment information leads to the individualisation of children, allowing classifications and comparisons to be made in relation to a particular set of ‘truths’ about what it is to be a child, a parent and a teacher. Throughout the consultations parents and teachers assert and defend their positions and in doing so, attempts at resistance are evident. The findings of the research open up new possibilities for challenging existing modes of practice in parent-teacher consultations. These include implications for initial teacher education and CPD programmes, in order to develop awareness of the way in which power is exercised through parent-teacher interactions and the effects it can have. The need for policy makers to take greater account of the exercise of power when developing policies in relation to partnership with parents, and indeed in evaluating the impact of existing policy is also identified.
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Ortiz, Nathalie. "La place du père dans les consultations thérapeutiques précoces." Montpellier 1, 1995. http://www.theses.fr/1995MON11103.
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Laidsaar-Powell, Rebekah C. "Exploring family involvement in cancer consultations and decision-making." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13924.
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Introduction Family members (FM) often attend cancer consultations with patients and may be involved in medical decision-making (DM). However, limited research, theory, and practical strategies include the family. This thesis aimed to examine the existing evidence base, explore health professional (HP), patient, and family experiences of, and actual behaviours in cancer consultations involving family. It aimed to utilise this research to propose an initial conceptual framework and draft physician communication strategies. Method A systematic review of 52 triadic consultation studies was conducted. Interviews with 10 nurses, 11 oncologists, 30 patients, and 34 FMs examined their attitudes and experiences. An interaction analysis coding system capturing family-relevant behaviours was developed and applied to 72 audiotaped cancer consultations. An initial conceptual framework of triadic DM and communication strategies were developed. Results HPs, patients, and FMs held positive attitudes towards family involvement. However, challenges such as conflicting patient-family wishes were reported. HPs reported inclusive behaviours, however consultation analyses revealed HPs rarely initiated interaction with FMs and regularly interrupted them. In light of study results, practical strategies for HPs to manage and enhance family involvement were proposed. Additionally, triadic (physician-patient-family) DM may rest on a spectrum from passive to dominant, is variable and dynamic, and may be influenced by a number of clinical and contextual factors. An initial conceptual framework was proposed, using a triangle to graphically represent triadic dynamics. Conclusion This thesis improves our understanding of patient, FM, and HP experiences of, and actual behaviours in, cancer consultations and raises a number of conceptual, ethical, and practical issues regarding the accommodation of family. Continued refinement of the framework and strategies will follow completion of this thesis.
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Williams, Susan Margaret. "Doctor-patient communication : a study of input, process and outcome in General Practice." Thesis, King's College London (University of London), 1998. https://kclpure.kcl.ac.uk/portal/en/theses/doctorpatient-communication--a-study-of-input-process-and-outcome-in-general-practice(c7bad17a-3b54-4178-bed6-1fbd37438d25).html.
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Innes, Michael Anthony. "Determining the process of telephone consultations in primary care: development of a standard measure for the process of telephone consultations in primary care." Thesis, University of Birmingham, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487506.
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AIM To develop and validate a method of measuring elements ofthe process of telephone consultations in primary care. BACKGROUND There is an unrecognised confusion about telephone consultations in healthcare. There is virtually no research that has considered the difference between consulting on the telephone and consulting face-to-face. Work on face-to-face consultations points the way forward, suggesting the need to develop a tool to measure process in telephone consultations. METHODS Qualitative approaches were used: a narrative analysis ofextant instruments for face-to-face consultations and Discourse Analysis for the telephone consultations. Using this combined knowledge, a new instrument was designed. Brief reliability testing was undertaken. RESULTS There were no instruments for face-to-face consulting that were sufficient for use with telephone consultations. Several important features were identified that informed design of a new instrument. Discourse Analysis of the 43 telephone consultations from primary care, revealed newly described elements of linguistic structure: 'Advise' and 'Request' exchanges and highlighting structure in narrative passages. From this the Instrument for Measurement of Telephone Process (IMoTeP) was developed. Argument was made for its construct and face validity. Reliability testing was limited to two people with eight consultations. This highlighted promising perfonnance, though there is need for further testing. CONCLUSION It has proved possible to develop an instrument to measure process in telephone consultations based on sound theory and real life observations. Further work should consolidate the reliability and validity while also looking for attributes oftelephone consultations that lead to positive outcomes.
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Clifford, Julie Veronica. "Computers in general practice consultations : impact on doctor-patient relationships /." Title page, contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09MPM/09mpmc637.pdf.
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Greenhill, Nicola H. "An exploration of pharmacist-patient communication in clinic-style consultations." Thesis, University of Nottingham, 2010. http://eprints.nottingham.ac.uk/11659/.
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The importance of communication skills for pharmacists has been widely acknowledged. Research has shown that the use of good communication skills can improve patient health outcomes but little research has focussed on communication within new consultation based roles of pharmacists. This study aimed to explore the communication between pharmacists and patients in clinic style consultations and to investigate participant perceptions of communication and consultations. Eleven pharmacists were recruited to the study and were responsible for the recruitment of patients from their own practice; five pharmacists recruited a total of 18 patients. A semi-structured interview was conducted with each pharmacist and with each patient before and after their consultation. Consultations were audio-recorded and observed and all recordings were transcribed verbatim. Thematic analysis based on the principles of grounded theory was conducted. Consultations were additionally coded according to the Calgary–Cambridge guide. NHS Ethics and local research and development approvals were obtained. The data show that patient reports of communication skills during consultations can lack detail, indicating that actual consultation data is required in order to assess communication skills. Pharmacists reported a lack of communication skills training and stated that additional training would need to be focussed on specific, relevant skills and should involve underpinning theory combined with observation of practice and personalised feedback. Pharmacists observed in this study used of a variety of methods for structuring consultations including official computerised or paper based forms, rehearsed segments of speech, and mental checklists. Some difficulties in using computers in a way that did not interfere with communication were identified. Further training may help pharmacists to more effectively structure their consultations. The participants reported that location has important effects on the communication within consultations. Both pharmacists and patients valued privacy in enabling open and honest consultations, particularly in community pharmacy. While it was reported that infrequent use of consultation rooms can lead to stigma being associated with private consultations, the data suggest that having a dedicated space for pharmacist-patient consultations is important. Application of the Calgary-Cambridge guide to recorded consultations showed good usage of many of the skills by the study pharmacists but skills linked to creating a patient centred consultation were under-represented. Some data did not correspond to a specific skill within the guide. Analysis showed the key theme of social conversation, which is essential for relationship building, was present in the non-coded data. Building up a relationship was reported by both pharmacists and patients as important in facilitating communication and that trust in particular played an important part in achieving successful consultations. The study methods enabled collection of rich data about pharmacist-patient communication. The data show that many factors can influence communication within consultations including pharmacist training, location, relationships, structure and use of computers. Pharmacists may need to think widely when aiming to achieve effective consultations. The data suggest that pharmacists made good use of communication skills during consultations but could improve use of the skills that create patient-centred consultations. The Calgary-Cambridge guide could be used to focus both training and research in this area.
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Kumarapeli, Pushpa. "Modelling the computerised clinical consultations : a multi-channel video study." Thesis, Kingston University, 2011. http://eprints.kingston.ac.uk/22364/.
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This study aims to understand the use of a computer during GP consultations and to enable the development of EPR systems which are easier to review, enter data into, use to take action, and is more sensitive to the clinical context. This thesis reports the development of a multi-channel video and data capture toolkit, the ALFA (Activity Log File Aggregation) because existing observation techniques have limitations. None of the existing tools are designed to assess human-computer interaction in the context of the clinical consultation, where the social interaction is the prime focus. The ALFA tool-kit has been used to observe and study 163 live primary care consultations supported by computer systems with four different designs. A detailed analysis of consultation interactions was then performed focusing on doctor-patient communication and the integration of the computer into the consultation workflow. The data collection elements of the ALFA supported recording of consultation activities by providing rating techniques attuned with the characteristics of those interactions. The Log File Aggregation (LFA) component of the ALFA toolkit aggregated those multitudes of data files into a single navigable output that can be studied both quantitatively and qualitatively. A set of Unified Modelling Language (UML) sequence diagrams were then created as they could be used by software engineers to develop better systems. This research proposes a framework with three elements to analyse the computerised clinical consultation; (1) the overview of the context within which the consultation was carried out, (2) time taken to perform key consultation tasks and (3) the process used. Traditional analysis with its emphasis on the technology often misses crucial features of the complex work environments in which the technology is implemented. Direct observation could inform software designers in developing systems that are more readily integrated into clinical workflow. Direct observation of the consultation, using the ALFA toolkit is acceptable to patients; captures the context of the consultation the precise timing and duration of key tasks; and produces an output a software engineer can understand. ALFA offers a range of possibilities for research in the consulting room. The computer should be considered as an active element of the consultation; room layout and consultation models should let the computer in, while software engineers take in the capacity to sustain patient centred social interactions as a core facet of their design agenda.
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Johnson, Clair Louise. "Systemic consultations in intellectual disability services : experiences of care staff." Thesis, University of Hertfordshire, 2017. http://hdl.handle.net/2299/17960.
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This research used interviews and Interpretative Phenomenological Analysis (IPA) methodology to explore the experiences of care staff who attended systemic consultations within an Intellectual Disability (ID) service. A systematic literature review revealed limited research in the area of systemic approaches used with people with IDs and their networks. Research questions encompassed 'How do care staff experience systemic consultations that they have attended in ID services'?, 'What do care staff find helpful in systemic consultations'?, and, 'What do care staff find unhelpful in systemic consultations'?. Seven participants were interviewed, and interview data was transcribed and analysed using IPA. Five superordinate themes emerged; 'Not knowing what to expect; it was something different', 'Our relationships improved', 'An outside person shone a new light enabling us to think and work differently', 'Making sense of what we have achieved', and 'They made us feel validated'. The research findings highlighted important clinical implications. These included a need for the context to be 'warmed' and relational reflexivity (Bunham, 2005) to be applied in order to help care staff prepare for systemic consultations and feel supported. Future research directions are also discussed in order to develop the evidence-base for systemic approaches within ID services.
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Li, Shuangyu. "Understanding interactions in interpreted triadic medical consultations in primary care." Thesis, University of Leeds, 2011. http://etheses.whiterose.ac.uk/2109/.
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Communication is one of the core clinical skills and has been taught at medical schools in many countries for some 30 years. However, the use of ad hoc and professional interpreters in medical consultations has imposed new challenges on the medical professionals’ communication skills and medical education. Traditional communication models have not provided guidance for working with different types of interpreters. Researchers and educators have been striving to develop new communication models to guide education and practice. However, these models are limited in many ways. This research points out that more research is needed to provide a better understanding of interpreted medical consultations, especially of people’s verbal behaviour in talk-in-interaction. Based on this, a more effective communication model can be developed to remedy the limitations the current models have. Therefore, the research has two goals: namely, to develop a better understanding of the interpreted medical consultation and to develop communication skills for work with interpreters. Using conversation analysis (CA) the research investigated 7 naturally recorded GP consultations involving either ad hoc or professional interpreters. Three languages, Slovak, Mirpuri Punjabi and Urdu, were included. GP interviews and focus groups were conducted for member checking and enhancing the validity of the research results. The research has investigated the turn-taking and turn-design of the interpreted medical consultations and established two theoretical frameworks which provide a generic understanding of the participants’ verbal behaviour in the interaction. Based on the frameworks this research has developed 12 communication strategies orienting to behavioural change of the doctor so as to improve the overall communication. The strategies are useful not only for the training of GPs but also other medical professionals and professional interpreters.
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Serré, Sylvain. "Les consultations préconciliaires des laïcs au Québec entre 1959 et 1962." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape15/PQDD_0027/MQ38190.pdf.
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Andersson, Sven-Olof. "Time and general practice consultations : aspects of length, attendance and quality." Doctoral thesis, Umeå universitet, Allmänmedicin, 1995. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-100583.
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The consultation is the GP’s form of work. How long a consultation should be, and what short/long consultations imply with regard to the satisfaction of patient and doctor has been much debated. The aim of this thesis was to study consultations with regard to content and time consumption in a short term and long term perspective. Three studies were carried out. 1. Consultations with the members of a group of GPs were investigated, where patients and doctors separately assessed different aspects of the consultation, and their ratings were related to the real length of the consultations. The following questions were posed: Was there time enough? Could the patient tell the doctor about her/his problems? Were the problems physical or psychological? 2. Nurses at the primary care health centres were interviewed about their considerations in booking short or long appointments for the patients. 3. Patients who frequently attended one health centre during one year and consumed much time were studied. Quantitative and qualitative methods were used. The results of the first study (Papers I-III) show that the average length of the consultations was 21 minutes; there was considerable variation (ranging from 3 to 60 minutes). (About 600 consultations with 7 male doctors were registered in two batches). The doctors’ mean consultation length also varied widely, from 13-28 minutes. Consultations dealing with psychological problems were longer than those dealing with physical problems. Older patients had longer consultations than younger patients, and female patients had somewhat longer consultations than male patients. The patients were generally more satisfied with the consultations than the doctors were, and there were no clear affinities between long consultations and high satisfaction. Male patients and patients with physical problems mainly received short consultations, whereas patients with ”mixed" problems and older patients received long consultations. The single factors most decisive for the length of a consultation were ‘the doctor factor’, the character of the problem and the age of the patient. "Good” consultations (operational definition) were associated primarily with ‘the doctor factor’, and the real length of the consultations was less important. The interviews with ten experienced primary care nurses (Paper IV) showed that the nurses worked in two perspectives: in the ”immediate” perspective, appointments were booked according to rules which directly impacted the length of the visit, and in the "reflective" perspective, appointments were booked with a view to the quality of the work at the health centre and the long-term time consumption. Other factors of importance were the patient’s age and problem(s), the doctor’s experience and working style, and the current situation at the health centre. Frequent attenders (FAs) at one health centre (Paper V) were compared with a contrast group of matched patients (CPs). The FAs represented 1.7% of the population of the catchment area and made 15% of the visits. The FAs were a heterogeneous group where small boys, women of working age and pensioners of both sexes were overrepresented. The FAs had higher consultation frequency than the CPs during the year of investigation, but few remained FAs for longer periods. The FAs had more problems and more complex problems than the CPs. Complaints regarding the musculo-skeletal organs, and psychosocial problems were common among these patients, often in combination. The present work thus shows that longer consultations do not naturally imply higher patient satisfaction. Other factors than the time factor, in particular ‘the doctor factor’ seem to be more important. ‘The doctor factor’, the characteristics of the patients, the type of problem and the situation at the health centre also have a bearing on consultation length and time consumption in a short-term as well as long-term perspective. The implications of these factors and their relative importance are discussed, but further studies of certain issues, such as ‘the doctor factor’, are necessary.Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 5 uppsatser.
digitalisering@umu
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Tawab, Rauja Abdel. "Development and psychometric validation of a framework for medication-related consultations." Thesis, University of Brighton, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.413088.
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This research set out to develop a framework to evaluate the consultation skills of healthcare practitioners undertaking medication-related consultations. A medication-related consultation framework would facilitate the teaching and evaluation of consultation skills and provide a structured format for feedback. Furthermore, it would allow to identify practitioners' learning needs in order to target areas for improvement. The aims of this research were (i) to develop a standardised framework outlining key competencies that should be undertaken in a medicationrelated consultation, (ii) to assess the framework's psychometric properties (validity, reliability), and (iii) to produce guidelines to accompany the framework to facilitate its use and educational impact. To achieve these aims the research was divided into three parts. The first was concerned with the generation of the framework competencies. A critical review of relevant healthcare consultation literature identified key components of patient-centred consultations. The second part involved the testing of the framework's psychometric properties. Face and content validity were explored using a systematic approach to gain views of experts in the field of practitionerpatient consultations, student pharmacists, 'expert patients' and a framework development panel. Discriminant validity, inter and intra-assessor reliability and internal consistency were investigated using data obtained from 150 assessments following the application of the framework by ten assessors to fifteen video-taped simulated consultations of varying quality (good, satisfactory, poor). Any issues which arose as a result of the assessors' use of the framework were collated and addressed in the guidelines developed in part three of the study. The final consultation framework consisted of forty-six key competencies divided into five main sections. These were (A) Introduction (6 items), (B) Data Collection & Problem Identification (15 items), (C) Actions & Solutions (8 items), (D) Closing (3 items), and (E) Consultation Behaviours (14 items). Appropriate adjustments were made following the initial systematic review to improve its face and content validity. Use of the framework resulted in the assessment of the quality of a consultation on three levels; a rating for each individual competency (1 =not at all to 4=very good), a global rating for each section (5-point scale with the middle and extreme points anchored by explicit descriptors) and an overall rating for the entire conSUltation (5-point scale, 1 =poor to 5=very good). Additional space for qualitative comments was provided. The framework was found to discriminate between the rating of consultations at the overall level, i.e. between good, satisfactory and poor (Kruskal Wallis Chi-square=12.5; df=2; p<0.01) and to have moderate to high inter-assessor reliability at this level (rho=0.49 to 0.76). Inter-assessor reliability was low to moderate on the global assessment level (rho=0.26 to 0.68) and consistently low on the individual competency level (rhosO.39). Intra-assessor reliability was found to be generally higher than inter-assessor reliability with high agreements on the overall level (rho=0.59-0.95) and moderate to high on the global level (rho=0.42 to 0.94). The agreements on the individual competency level were inconsistent and ranged from low to high (rhosO.39 to ;::0.70). The framework's internal consistency was found to be acceptable for each section as indicated by moderate to high positive correlations between individual competencies and the corresponding global rating (rho=0.40 to 0.94) and by satisfactory Cronbach's alpha coefficients (ranging from a=0.58 to 0.97). This framework meets key criteria necessary for a formative assessment instrument in that it possesses good face, content and discriminant validity. Whilst the framework demonstrated acceptable inter-assessor and intra-assessor (test-retest) reliability on the overall assessment level and moderate agreement on the global assessment level, this was not the case on the individual competency level. This is acceptable for instruments used for formative assessments where the emphasis is placed on the identification of a practitioner's relative strengths and weaknesses and where specific strategies for improvement are to be fed back to the practitioner. However, in summative assessments where 'pass' or 'fail' decisions about a candidate's performance are made, the possession of high validity and reliability at all assessment levels is important. Further work is needed to test whether the use of the specific guidelines developed to support the framework and additional assessor training improves the framework's reliability when used by multiple assessors. Additionally, further validation studies need to be undertaken.
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Alayyash, Maha. "Three-party medical consultations in Saudi Arabia : a mixed-methods study." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/25977.
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One of the cultural traditions in Saudi Arabia is that the Saudi female patient has to be accompanied by a third-party on her medical visits, thus giving rise to consultations between three parties. By third-party, I mean a chaperone or a family member who can be a patient’s spouse, parent, adult child, sibling, or relative. This person shares responsibility for the patient’s health and the patient relies on them to support them generally with assistance in terms of their health care needs and especially for medical visits. In this research, I focus on the presence of a third party in medical consultations with reference to patient satisfaction, how patients perceive the role of their chaperones during the medical visit and the nature of three-party medical interactions. To investigate these aspects, a convergent parallel mixed method design was used in order to develop a better understanding of doctor-patient-three party interactions, as no mixed method study has been conducted on these issues in medical consultations in Saudi Arabia. Hence, this study addresses this gap in literature by focusing on the interaction between the Saudi female patients, their male physicians and their chaperones. I have concentrated on the Saudi female patients (from different age groups, i.e. 19-75) for religious and cultural reasons. Therefore, the overall aim of this thesis is to understand the phenomenon of three-party consultations in Saudi Arabia through a variety of aspects including patient satisfaction, patients’ perceptions, and what actually happens in three-party medical interactions (e.g., alignment and epistemic asymmetry). The data for this study included quantitative (i.e. questionnaires) and qualitative (i.e. four open-ended questions and observational and audio-recorded) data collected in one phase from 20 clinics in 3 hospitals in Jeddah in Saudi Arabia (two private and one governmental). A total of 117 female patients along with their chaperones were recruited. Statistical analysis of the questionnaire ratings showed that only patient’s education has a positive effect on patient satisfaction with chaperone involvement. Findings from thematic analysis of the open-ended questions data revealed that patients described three supportive roles of the chaperones, namely emotional, informational and logistical support. The patients’ perceptions regarding their chaperones’ supportive roles are re-evaluated in a real-life context by observing the chaperone’s facilitative role in three-party consultations. Therefore, conversation analysis of the audio-recorded data showed three main patterns of alignment: (1) doctor-patient, (2) chaperone-patient (and patient-chaperone), and (3) chaperone-doctor (and chaperone-patient) alignments. All these actions indicate that the participants were collaboratively involved in the positive interaction and this enhanced patient participation. However, in analysing three exceptional cases from the Chemotherapy and Haematology clinics, it was found that the presence of a chaperone dominates as well as complicates doctor-patient interaction and thus can significantly override or ostracise the patient who does not know her illness. For example, by using the Conversation Analysis approach, various epistemic resources used by the interlocutors (i.e. the oncologist and chaperones) are displayed by which the patient’s epistemic primacy is usurped and her epistemic access is controlled in terms of participation and the amount of information given. In comparing the mixed methods used in this study, congruent and discrepant results are found between the quantitative and qualitative data. In terms of congruent results, overall, the findings of this study concurred on the importance of having a supportive chaperone during a female patient’s medical appointment. Chaperones’ supportive roles appear to differently influence female patients’ symptoms, diagnosis or treatment plan. Chaperones in the current study have provided a useful contribution to the doctor-patient interactions. However, in terms of discrepancy, findings yielded by the conversation analysis (in Chapters 6 and 7) showed a discrepancy between what patients reported (see Chapter 5) about their chaperones’ supportive roles and what their chaperones did in the consultation. For example, the thematic analysis of the open-ended questions found that both genders were equally likely to be active in speaking for the patient. However, the conversation analysis of observational data adds and clarifies to what patients reported about their chaperones speaking on their behalf. The conversation analysis has given a good picture of the chaperone’s supportive role during medical visits in orienting towards patients as being the actual owners of their bodies and illness (see Chapter 6). Therefore, patients were given the chance to present their problem. Chaperones, in working collaboratively with patients and physicians, support the patient and facilitate the physician’s understanding. However, in only two exceptional cases (see Chapter 7) of actual medical interactions, the chaperone acts as a surrogate patient and restricts the patient’s own knowledge of their illness. Therefore, the current study contributes to three important areas, namely: (1) the literature of three-party interactions, (2) three-party interactions in Saudi Arabia, and (3) clinical practices in Saudi Arabia.
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Gelcich, Sarah. "Exploring risk, resistance and closing talk in chronic diabetes routine consultations." Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/19167/.
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Qualitative research is widely recognised as making a valuable contribution to healthcare practice and policy. One area of study that has noticeably relied on qualitative research is doctor-patient communication, due to the fact that practitioner-patient interaction is inherently dependent on talk. One methodology that has proven very useful in order to analyse practitioner-patient interaction is Conversation Analysis (CA). Little seems to have been done in terms of analysing practitioner-patient talk within chronic routine consultations. Routine consultations are especially important in the treatment of long-term conditions such as type 2 diabetes. This study analyses the talk between type 2 diabetic patients and a practice nurse during their routine consultations. The study will address four main points. Firstly, it will determine the differences between diabetic chronic routine consultations and acute primary care visits. Secondly, based on these differences, it will address the closing phase of these visits. Thirdly, it will establish how communication of risk takes place during these consultations and lastly it will demonstrate how disagreement takes place during these visits. Analysing these elements within chronic routine consultations can potentially inform best practice when it comes to closing a visit, communicating risk and identifying patient disagreement. The analysis and presentation of significant differences between chronic and acute visits could have an effect on patients presenting new concerns and in turn could affect their long-term care.
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Ford, Joseph. "Empathy in doctor-patient palliative care consultations : a conversation-analytic approach." Thesis, Loughborough University, 2017. https://dspace.lboro.ac.uk/2134/27661.
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This thesis analyses doctors empathising with patients in palliative care interactions. Historically, palliative care has treated not only patients physical pain but their emotional pain, as well. Although the importance of empathy (defined for the purposes of this thesis as The doctor s expressed understanding of the patient s emotional experience ) has been emphasised in this environment, however, there has been no prior research showing how palliative care doctors actually empathise with their patients in practice. Drawing upon 37 recordings of doctor-patient consultations collected in a UK hospice, this thesis addresses this omission by using conversation analysis (CA) to analyse several facets of empathy in this environment. The analysis begins in chapter four by considering the ways in which doctors can empathise with patients. It shows how doctors can empathise semantically, either by reworking what the patient has themselves said or by showing understanding on a normative basis. It also considers non-semantic ways of displaying empathy (e.g. response cries), showing how these are fundamentally different to the semantic type of empathic display. Overall, this chapter shows that empathy is not restricted to particular formats but, rather, is dependent upon the content of the doctor s turn. The analysis then moves on consider the wider context of doctors empathic responses. Chapter five, first of all, analyses cases where patients emotions become the topic of the interaction, either because the doctor asks about them directly or because the patient raises an emotionally-implicative topic. The emphasis here is on how palliative care doctors can talk to patients about, and empathise with, their emotions without necessarily having to do anything about those emotions. Chapter six then focuses on cases where patients emotions are discussed alongside the more task-driven aspects of the consultation, either because the patient s physical condition has had an emotional impact on them or because their presenting problem is inherently emotional. In contrast to chapter five, then, the source of the patient s emotions here can be treated by the doctor without the emotions being topicalised. The final two chapters of the analysis focus on doctors empathising with patients not in response to something that the patient has said but in the service of some task. Chapter seven shows how doctors can empathically bridge the gap between their medical and the patient s experiential perspectives at moments where it becomes clear that there is a disparity between the two. These include moments where the patient expresses expectations that go beyond what can realistically be provided, moments where the patient might take offence at the doctor s advice and moments where the doctor must reassure patients about their symptoms without seeming to criticise their emotional responses to those symptoms. Chapter eight, meanwhile, shows how doctors can empathically demonstrate that their practice is being driven by a due consideration of the patient s feelings. Specifically, it shows how doctors can draw upon patients feelings in helping them come to a decision about a treatment, cite those feelings when accounting for a treatment that they have recommended and frame a difficult topic as an outgrowth of sentiments that the patient has already expressed. In conclusion, this thesis shows how empathy is not clearly demarcated in palliative care. While there are cases where patients emotions are discussed and empathised with for the sake of discussing and empathising with them, more commonly, empathy and emotion are interwoven alongside and into the task-driven aspects of consultations. This thesis thus shows the interactional manifestation of palliative care s underlying philosophy, with patients emotional pain addressed alongside their physical pain in an integrated, holistic way.
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Radosteva, Alesya. "Cultural Consultations in Criminal Forensic Psychology:A Thematic Analysis of the Literature." Antioch University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1536856667462656.
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Wu, Yifan. "Healthcare professionals’ experiences using video consultations at Akademiska Sjukhuset in Uppsala." Thesis, Uppsala universitet, Människa-datorinteraktion, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-447302.
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McGuire, Lindsay Kellogg. "Pediatric consultations to child protective services the role of expert opinions /." [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12092008-143351/.
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Liu, Chunfeng. "EQClinic: an online platform for learning communication skills in clinical consultations." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/18701.
Full textAbstract:
Doctors’ communication skills have an impact on patients’ health outcomes, so it is important for medical students to develop these skills. Current communication skills training normally provides face-to-face practice consultations and manually analysed feedback of verbal and nonverbal communication for students, however the main challenge of these methods is the extensive needs of human and financial resources. In the past two decades, we have witnessed a dramatic improvement in technologies such as video conferencing, computer vision and affective computing, and these new technologies provide solutions to deal with the challenges on the training of clinical communication skills. This thesis presents an online training platform EQClinic to improve medical students’ clinical communication skills. EQClinic utilises the new technologies to enable medical students and simulated patients to have video conferencing consultations, and provide human assessment and feedback, and computer-generated nonverbal behaviour feedback for students to reflect on. EQClinic has been evaluated through different user studies reported in this thesis. The important evaluation results showed that medical students’ overall communication skills were improved through using EQClinic. EQClinic has been successfully incorporated into the communication skills teaching curriculum of two Australian Universities. In addition, medical students’ nonverbal behaviour is analysed to investigate the influences of the culture background and gender differences in video consultations. Communication skills are essential to many professions, not just medicine. The potential impact of EQClinic and the findings of this thesis are not limited to medical education. Many professionals, who need communication skills training, could be benefited from using of EQClinic.