Medicine and Health Sciences Commons^™

Prescription Drug Abuse Communication: A Qualitative Analysis Of Prescriber And Pharmacist Perceptions And Behaviors, Nicholas E. Hagemeier, Fred Tudiver, Scott Brewster, Elizabeth J. Hagy, Angela Hagaman, Robert P. Pack

Angela M. Hagaman

Background: Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and pharmacist health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research on HCP PDA communication behavioral engagement and factors that influence it is limited. Objectives This study quantitatively examined communication behaviors and trait-level communication metrics, and qualitatively described prescription drug abuse-related communication perceptions and behaviors among primary care prescribers and community pharmacists. Methods: Five focus groups (N = 35) were conducted within the Appalachian Research Network (AppNET), a rural primary care practice-based research network (PBRN) in South Central …

Prescription Drug Abuse Communication: A Qualitative Analysis Of Prescriber And Pharmacist Perceptions And Behaviors, Nicholas E. Hagemeier, Fred Tudiver, Scott Brewster, Elizabeth J. Hagy, Angela Hagaman, Robert P. Pack

Nicholas E. Hagemeier

Background: Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and pharmacist health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research on HCP PDA communication behavioral engagement and factors that influence it is limited. Objectives This study quantitatively examined communication behaviors and trait-level communication metrics, and qualitatively described prescription drug abuse-related communication perceptions and behaviors among primary care prescribers and community pharmacists. Methods: Five focus groups (N = 35) were conducted within the Appalachian Research Network (AppNET), a rural primary care practice-based research network (PBRN) in South Central …

Challenges Of Refugee Health Care: Perspectives Of Medical Interpreters, Case Managers, And Pharmacists, Fabiana Kotovicz, Anne Getzin, Thy Vo

Fabiana Kotovicz, MD

Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin. Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. …

An Exploration Of Patients' Trust In Physicians In Training, Denise Bonds, Kristie Foley, Elizabeth Dugan, Mark Hall, Pam Extrom

Elizabeth Dugan

Several characteristics associated with patient trust are identified. To determine the level of trust patients from disadvantaged circumstances have in their primary care resident physician, and to determine patient and physician characteristics that predict trust, we administered a survey to randomly selected primary care patients of an academic medical center staffed by internal medicine residents after a visit to their primary care provider. Participants were adults. The group was racially diverse (50% non-white), English-speaking, and from lower socioeconomic groups. The 10-page survey consisted of 7 sections (Physician Trust Scale, Patient Demographics, Patient Health and Well-Being, Patient-Physician Relationship Characteristics, Global Doctor …

Medical Malpractice Reform: A Societal Crisis Or Fear Marketing?, Phil Rutsohn, Andrew Sikula Sr.

Andrew Sikula, Sr.

This paper explores the primary issues surrounding the malpractice crisis currently facing the healthcare system and asks the question ‘is it truly a crisis or is it an effective marketing campaign waged by interested parties?’ The authors discuss the primary issues presented by both the supporters of tort reform and the opposition to tort reform. As is true for many issues in healthcare, final analysis suggests that tort reform is needed or not needed depends on the analysts' role in the system. The authors argue that the evidence suggests malpractice reform will produce desired results if the goal is to …

Patient Education About Anticoagulant Medication: Is Narrative Evidence Or Statistical Evidence More Effective?, Kathleen Mazor, Joann Baril, Elizabeth Dugan, Frederick Spencer, Pamela Burgwinkle, Jerry Gurwitz

Elizabeth Dugan

OBJECTIVE: To determine the relative impact of incorporating narrative evidence, statistical evidence or both into patient education about warfarin, a widely used oral anticoagulant medication.

METHODS: 600 patients receiving anticoagulant therapy were randomly assigned to view one of three versions of a video depicting a physician-patient encounter where anticoagulation treatment was discussed, or usual care (no video). The videos differed in whether the physician used narrative evidence (patient anecdotes), statistical evidence, or both to highlight key information. 317 patients completed both the baseline and post-test questionnaires. Questions assessed knowledge, beliefs and adherence to medication and laboratory monitoring regimens.

RESULTS: All …

Pulling Together And Pushing Apart: Tides Of Tension In The Icu Team, Laura Hawryluck, Sherry Espin, Kim Garwood, Cathy Evans, Lorelei Lingard

Lorelei Lingard

No abstract provided.

What Do We Mean By "Relevance"? A Clinical And Rhetorical Definition With Implications For Teaching And Learning The Case-Presentation Format, Lorelei Lingard, R. Haber

Lorelei Lingard

No abstract provided.

Tensions Influencing Operating Room Team Function: Does Institutional Context Make A Difference?, Lorelei Lingard, Stacey Garwood, Dan Poenaru

Lorelei Lingard

BACKGROUND: A recent study of operating room (OR) team communication in a large, urban hospital described recurrent tension catalysts and a preliminary theory of team members' interpretive processes. To determine to what extent these findings were transferable to other institutional contexts, we conducted a validation study in 2 small, academic hospitals in a mid-size city. METHODS: Eight focus groups and 8 interviews were conducted with 6 general surgeons, 22 OR nurses, 5 anaesthesiologists and 10 trainees. Observations of 10 surgeons and their team members were conducted over 4 months. Data were analysed by applying thematic codes derived from previous research …

A Qualitative Study Examining Tensions In Interdoctor Telephone Consultations, Anupma Wadhwa, Lorelei Lingard

Lorelei Lingard

OBJECTIVE: Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor-patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight. The interdoctor telephone consultation is a common health care setting in which health professional communication skills are exercised. Breakdowns in this communication commonly occur and, surprisingly, this skill is not formally addressed in medical training. This study sought to clarify the communication issues that can occur during interdoctor telephone consultations in order to inform future educational initiatives in this domain. METHODS: Data …

Context, Conflict, And Resolution: A New Conceptual Framework For Evaluating Professionalism, Shiphra Ginsburg, Glenn Regehr, Rose Hatala, Nancy Mcnaughton, Alice Frohna, Brian Hodges, Lorelei Lingard, David Stern

Lorelei Lingard

No abstract provided.

Team Communications In The Operating Room: Talk Patterns, Sites Of Tension, And Implications For Novices, Lorelei Lingard, Richard Reznick, Sherry Espin, Glenn Regehr, Isabella Devito

Lorelei Lingard

PURPOSE: Although the communication that occurs within health care teams is important to both team function and the socialization of novices, the nature of team communication and its educational influence are not well documented. This study explored the nature of communications among operating room (OR) team members from surgery, nursing, and anesthesia to identify common communicative patterns, sites of tension, and their impact on novices.

METHOD: Paired researchers observed 128 hours of OR interactions during 35 procedures from four surgical divisions at one teaching hospital. Brief, unstructured interviews were conducted following each observation. Field notes were independently read by each …

Towards Safer Interprofessional Communication: Constructing A Model Of "Utility" From Preoperative Team Briefings, Lorelei Lingard, Sarah Whyte, Sherry Espin, G. Baker, Beverley Orser, Diane Doran

Lorelei Lingard

"Improved team communication" is broadly advocated in the discourse on safety but rarely supported by a precise understanding of the relationship between specific communication practices and concrete improvements in collaborative work processes. We sought to improve such understanding by analyzing the discourse arising from structured preoperative team briefings among surgeons, nurses, and anesthesiologists prior to general surgery procedures. Analysis of observers' fieldnotes from 302 briefings yielded a two-part model of communicative "utility", defined as the visible impact of communication on team awareness and behavior. "Informational utility" occurred when team awareness or knowledge was improved by provision of new information, explicit …

Learning Oral Presentation Skills A Rhetorical Analysis With Pedagogical And Professional Implications, Richard Haber, Lorelei Lingard

Lorelei Lingard

OBJECTIVE: Oral presentation skills are central to physician-physician communication; however, little is known about how these skills are learned. Rhetoric is a social science which studies communication in terms of context and explores the action of language on knowledge, attitudes, and values. It has not previously been applied to medical discourse. We used rhetorical principles to qualitatively study how students learn oral presentation skills and what professional values are communicated in this process. DESIGN: Descriptive study. SETTING: Inpatient general medicine service in a university-affiliated public hospital. PARTICIPANTS: Twelve third-year medical students during their internal medicine clerkship and 14 teachers. MEASUREMENTS: …

Time As A Catalyst For Tension In Nurse-Surgeon Communication, Sherry Espin, Lorelei Lingard

Lorelei Lingard

Carefully studying communication patterns between nurses and surgeons questions popular stereotypes about OR discourse and expands educators' understanding of the factors that motivate team communication, patterns that are habitual among team members, and issues that act as catalysts for tension. This study examines the nature of communication between perioperative nurses and surgeons and identifies patterns and sites of tension. Researchers observed 128 hours of interaction between nurses and surgeons in four surgical divisions at one teaching hospital in Ontario, Canada. Field notes were read, coded, and analyzed independently. Results showed that higher tension in nurse-surgeon communication clusters around particular themes, …

Perceptions Of Operating Room Tension Across Professions: Building Generalizable Evidence And Educational Resources, Lorelei Lingard, Glenn Regehr, Sherry Espin, Isabella Devito, Sarah Whyte, Douglas Buller, Bohdan Sadovy, David Rogers, Richard Reznick

Lorelei Lingard

BACKGROUND: Effective team communication is critical in health care, yet no curriculum exists to teach it. Naturalistic research has revealed systematic patterns of tension and profession-specific interpretation of operating room team communication. Replication of these naturalistic findings in a controlled, video-based format could provide a basis for formal curricula. METHOD: Seventy-two surgeons, nurses, and anesthesiologists independently rated three video-based scenarios for the three professions' level of tension, responsibility for creating tension and responsibility for resolution. Data were analyzed using three-way, mixed-design analyses of variance. RESULTS: The three professions rated tension levels of the various scenarios similarly (F=1.19, ns), but rated …

Teaching And Learning Communication In Medicine: A Rhetorical Approach, Lorelei Lingard, R. Haber

Lorelei Lingard

The language people use both makes possible and constrains the thoughts they can have. More than just a vehicle for ideas, language shapes ideas--and the practices that follow from them. Thus, in medical education, teaching students how to talk about medical cases also teaches them how to think about patients and medical work, and how to define their relationships to both. Without a theoretical model, however, teaching efforts in this domain tend to be implicit and ad hoc, which can lead to serious problems. Rhetoric is one science that can deepen understanding of communication and improve teaching of this clinical …

Getting Teams To Talk: Development And Pilot Implementation Of A Checklist To Promote Interprofessional Communication In The Or, Lorelei Lingard, S. Espin, B. Rubin, S. Whyte, M. Colmenares, G. Baker, D. Doran, E. Grober, B. Orser, J. Bohnen, R. Reznick

Lorelei Lingard

BACKGROUND: Pilot studies of complex interventions such as a team checklist are an essential precursor to evaluating how these interventions affect quality and safety of care. We conducted a pilot implementation of a preoperative team communication checklist. The objectives of the study were to assess the feasibility of the checklist (that is, team members' willingness and ability to incorporate it into their work processes); to describe how the checklist tool was used by operating room (OR) teams; and to describe perceived functions of the checklist discussions.

METHODS: A checklist prototype was developed and OR team members were asked to implement …

The Rhetorical 'Turn' In Medical Education: What Have We Learned And Where Are We Going?, Lorelei Lingard

Lorelei Lingard

This paper presents a critical reflection on the contributions and challenges associated with one rhetorical approach to studying teaching and learning communication in health professions education. A rhetorical approach treats language as a social act, and attends to the role of language in establishing professional identities and relationships. The research has produced insights into the use of standard communication formats to teach novices, the nature of socialization on clinical teams, and the relationship between communication patterns and patient safety. Challenges and emerging questions include the problem of accounting for the material dimensions of communication in a rhetorical model, grappling with …

Routine And Adaptive Expert Strategies For Resolving Ict Mediated Communication Problems In The Team Setting, Lara Varpio, Catherine F Schryer, Lorelei Lingard

Lorelei Lingard

CONTEXT: The use of information and communication technologies (ICTs) for supporting interprofessional communication is becoming increasingly common in health care. However, little research has explored how ICTs affect interprofessional communication, or how novices are trained to be effective interprofessional ICT users. This study explores the interprofessional communication strategies of nurses and doctors (trainees and experts) when their communications were mediated by a specific ICT: an electronic patient record (EPR).

METHODS: A total of 72 doctors and nurses participated in this 8-month study on a paediatric in-patient ward. Eighty hours of non-participant observations and 20 semi-structured interviews were conducted. All data …

What's So Great About Rehabilitation Teams? An Ethnographic Study Of Interprofessional Collaboration In A Rehabilitation Unit, Lynne Sinclair, Lorelei Lingard, Ravindra Mohabeer

Lorelei Lingard

OBJECTIVE: To explore team structures, team relationships, and organizational culture constituting interprofessional collaboration (IPC) in a particular rehabilitation setting; to develop a description of IPC practice that may be translated, adapted, and operationalized in other clinical environments.

DESIGN: An ethnographic study involving: Field observations: 40 hours, over 4 weeks, daily activities, 7 interprofessional meetings, 3 care planning meetings, 1 business meeting, and 3 family meetings; Individual observations: a physiotherapist, an occupational therapist, and a social worker individually observed for 45 minutes to an hour; and Interviews: 19 participants, 11 professions, 27 informal, 5 formal interviews. Data analysis consisted of an …

Communication Channels In General Internal Medicine: A Description Of Baseline Patterns For Improved Interprofessional Collaboration, Lesley Gotlib Conn, Lorelei Lingard, Scott Reeves, Karen-Lee Miller, Ann Russell, Merrick Zwarenstein

Lorelei Lingard

General internal medicine (GIM) is a communicatively complex specialty because of its diverse patient population and the number and diversity of health care providers working on a medicine ward. Effective interprofessional communication in such information-intensive environments is critical to achieving optimal patient care. Few empirical studies have explored the ways in which health professionals exchange patient information and the implications of their chosen communication forms. In this article, we report on an ethnographic study of health professionals' communication in two GIM wards through the lens of communication genre theory. We categorize and explore communication in GIM into two genre sets-synchronous …

The Impact Of Space And Time On Interprofessional Teamwork In Canadian Primary Health Care Settings: Implications For Health Care Reform, Ivy Oandasan, Lesley Gotlib Conn, Lorelei Lingard, Allia Karim, Difat Jakubovicz, Cynthia Whitehead, Karen-Lee Miller, Natalie Kennie, Scott Reeves

Lorelei Lingard

Aim: This paper explores the impact of space and time on interprofessional teamwork in three primary health care centres and the implications for Canadian and other primary health care reform.

Background: Primary health care reform in Canada has emphasized the creation of interprofessional teams for the delivery of collaborative patient-centred care. This involves the expansion and transformation of existing primary health care centres into interprofessional family health teams (FHT) promising to provide patients better access, more comprehensive care, and improved utilization of individual health professionals. Benefits for providers include improved workplace satisfaction and organizational efficiencies. Currently, there is little evidence …

Point-Of-Care Assessment Of Medical Trainee Competence For Independent Clinical Work, Tara Kennedy, Glenn Regehr, G. Baker, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Clinical supervisors make frequent assessments of medical trainees' competence so they can provide appropriate opportunities for trainees to experience clinical independence. This study explored context-specific assessments of trainees' competence for independent clinical work.

METHOD: In Phase One, 88 teaching team members from internal and emergency medicine were observed during clinical activities (216 hours), and 65 participants completed brief interviews. In Phase Two, 36 in-depth interviews were conducted using video vignettes. Data collection and analysis employed grounded theory methodology.

RESULTS: Supervisors' assessments of trainee trustworthiness for independent clinical work involved consideration of four dimensions: knowledge/skill, discernment of limitations, truthfulness, and …

Interprofessional Information Work: Innovations In The Use Of The Chart On Internal Medicine Teams, Lorelei Lingard, Lesley Conn, Ann Russell, Scott Reeves, Karen-Lee Miller, Chris Kenaszchuk, Merrick Zwarenstein

Lorelei Lingard

An abundance of evidence suggests that communication in interprofessional healthcare teams is a complex endeavour. Even relatively simple communication processes involving information work - the gathering, storage, retrieval and discussion of patient information - may be fraught with pitfalls, and yet teams manage to conduct their daily information work, often with a high degree of effectiveness. In this article, we explore one commonplace dimension of information work - the use of patient charts to foster collaborative decision-making and care enactment - towards building an elaborated understanding of how teams innovate in the face of daily complexities in their information work …