The complaints that patients bring to their doctors often have roots in social issues that involve work, family life, gender roles and sexuality, aging, substance use; or other problems of nonmedical origin. In this book, physician/sociologist Howard Waitzkin examines interactions between patients and doctors to show how physicians' focus on physical complaints often fails to address patients' underlying concerns and also reinforces the societal problems that cause or aggravate these maladies. A progressive doctor-patient relationship, Waitzkin argues, fosters social change. Waitzkin provides a pathbreaking analysis of medical encounters, applying perspectives from structuralism, post-structuralism, and critical literary theory to transcripts of recorded conversations between doctors and patients. He demonstrates how doctors unintentionally maintain dominance in their dealings with patients, encourage conforming social behavior and attitudes, and marginalize patients' concerns with social problems. Waitzkin urges physicians to attend to the social as well as the medical problems that emerge from patients' narratives and suggests ways to restructure the manner in which patients and doctors communicate with each other. Physicians and patients, for example, should work together to demystify medical discourse, should refrain from medicalizing social problems through medications or reassurances that dull socially caused pain, and should be prepared to call on advocacy organizations seeking to change the social conditions that create personal distress. This book will influence and challenge physicians scholars, and students in the social sciences and humanities, as well as anyone concerned about the present problems and future direction of medicine.

"Kelly Wisecup examines how European settlers, Native Americans, and New World Africans communicated medical knowledge in early America, and how the colonists represented what they learned in their literatures."--Book cover.

Kananoja demonstrates how medical interaction in early modern Atlantic Africa was characterised by continuous knowledge exchange between Africans and Europeans.

Primary care medicine is the new frontier in medicine. Every nation in the world has recognized the necessity to deliver personal and primary care to its people. This includes first-contact care, care based in a posi tive and caring personal relationship, care by a single healthcare pro vider for the majority of the patient's problems, coordination of all care by the patient's personal provider, advocacy for the patient by the pro vider, the provision of preventive care and psychosocial care, as well as care for episodes of acute and chronic illness. These facets of care work most effectively when they are embedded in a coherent integrated approach. The support for primary care derives from several significant trends. First, technologically based care costs have rocketed beyond reason or availability, occurring in the face of exploding populations and diminish ing real resources in many parts of the world, even in the wealthier nations. Simultaneously, the primary care disciplines-general internal medicine and pediatrics and family medicine-have matured significantly.

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

This innovative volume provides fresh perspectives on how medical students and patients construct identities in relation to each other, using stories of their clinical encounters. It explores how paying attention to medical students’ and patients’ stories in clinical teaching encounters can encourage empathy and the formation of professional identities that embody desirable values such as integrity and respect. Written by an experienced clinician and based on original, rigorous research combining ethnography and dialogic narrative analysis, Storytelling Encounters as Medical Education: Crafting Relational Identity includes patient stories alongside those of students and clinical teachers. This is an important contribution for all those interested in medical education, narrative medicine, person-centred care and identity formation in healthcare. It will also be of value to scholars in a range of other disciplines, who are using a dialogic approach.

This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.

Are patients passive, or merely deferent? How does gender affect questioning and topic control in medical encounters? What does it sound like when physician and patient co-construct a diagnosis through storytelling? Nancy Ainsworth-Vaughn, a sociolinguist, ethnographer, and cancer survivor, answers questions such as these in a study of 100 medical encounters, with balanced numbers of men and women among physicians as well as patients. Ainsworth-Vaughn draws upon linguistics and medical ethics to develop a comprehensive theory of types of power. She engages critical problems in discourse theory, expanding our understanding of topic transitions, questions, ambiguity, and co-construction.

Global migration continues to increase, and with it comes increasing linguistic diversity. This presents obvious challenges for both healthcare provider and patient, and the chapters in this volume represent a range of international perspectives on language barriers in health care. A variety of factors influence the best ways of approaching and overcoming these language barriers, including cultural, geographical, political and practical considerations, and as a result a range of approaches and solutions are suggested and discussed. The authors in this volume discuss a wide range of countries and languages, and cover issues that will be familiar to all healthcare practitioners, including the role of informal interpreters, interpreting in a clinical setting, bilingual healthcare practitioners and working with languages with comparatively small numbers of speakers.

When Bill Moyers visited China to explore the mysteries, and the healing potential, of Chinese medicine for his acclaimed PBS series "Healing and the Mind," he sought out David Eisenberg as his guide. For every reader fascinated by the seemingly fantastical aspects of Chinese medicine, from acupuncture addiction to Qi Gong martial arts, this captivating book offers deeper and more detailed encounters with the physicians and patients, the mystics and the martial artists, who were featured on television. Here is a sympathetic, yet objective appraisal of the concept of Qi (chee), the vital energy which is the unifying principle of Chinese medicine. Here are Chinese sages from the Yellow Emperor of 2700 B.C. to the very modern Dr. Fang, who remarks, "Acupuncture without Qi is only as effective as one man's sticking needles in another." And here are Chinese people from all walks of life as they seek relief, through a rebalancing of their Qi, their vital energy, for ailments from colds to cancer.