Outpatients’ Perspective of Clinical Communication Skills

Outpatients’ Perspective of Clinical Communication Skills Research Paper Title: Outpatients’ Perspective of Clinical Communication Skills of Doctors in Private Practice in Goa Abstract Clinical communication entails a dialogue between doctor and patient, and has been clearly demonstrated to affect many aspects of patient care, including health outcomes. Ideally, doctors are expected to play a dual role – as a source of patient healing as well as a source of reassurance and encouragement (Baker et al, 2011). This study was aimed at assessing the basic clinical communication behaviours of doctors in outpatient private practice in Goa, based on the reports of their patients. Good clinical communication skills include facilitation of the patient’s expression of feelings and expectations related to his/her health care, conveyance of clear information to the patient, and provision of empathy and encouragement. The participants of the study were chosen using purposive sampling. Internationally standardized questionnaires HPQ (Four Habits Patient Questionnaire), consisting of 15 Likert-scale items, and CAHPS (Consumer Assessment of Healthcare Providers and S ystems) was employed to understand the patients’ perception of ‘their’ doctor’s communication. Results were analyzed using total scores obtained. Individual behaviours were also analyzed using frequencies and percentages indicating doctors’ competence in one or more habits over others. Introduction The health outcome of a patient is greatly affected by the manner in which doctors communicate with their patients (Baker et al, 2011). The key to diagnosis and treatment is exchanging information, and communication plays a vital role in building a trusting relationship between doctor and patient that encourages better information-giving and information-getting, both of which are particularly important to enable positive healthcare. Furthermore, communication and trust may influence patient satisfaction, compliance, and coping (Desjarlais-deKlerk and Wallace, 2013). Recognizing the onus on the doctor to ensure satisfied and healthy patients by way of the former’s ability to communicate with the latter, this study attempted to determine the communication abilities of doctors in Goa as reported by their outpatients. Objectives To determine the medical communication skills of outpatient doctors To ascertain the relationship between doctors’ gender and communication abilities To establish a connection between the proficiency in communication of doctors’ support staff and ratings of doctors Method Sample and Sampling Method The study included 90 respondents (67 females and 23 males) chosen by purposive sampling from across the state of Goa. The respondents ranged in age from 20 to 70 years, with an almost equal number being below (n=47) and above (n=43) 40 years. Sixty percent of the respondents possessed a graduate or higher degree and nearly half (49%) the respondents answered the questionnaire based on their personal experiences with a General Practitioner. The perceived age of the doctors, as reported by the respondents, ranged from 26 to 70 years, with 63.3% being reported to be in the age range of 40 to 60 years. Measurement Internationally standardized questionnaires (4 HPQ – Four Habits Patient Questionnaire) (Bard, 2011), consisting of 15 Likert-scale items, and CAHPS (Consumer Assessment of Healthcare Providers and Systems, 2012) were employed to understand the patients’ perception of ‘their’ doctor’s communication. Results and Discussion Communication abilities of doctors’ support staff Effective communication between doctor and patient is a central clinical function that cannot be delegated (Simpson et al, 1991). The competency of support staff such as nurses and receptionists often influences the quality of health care (Marcinowiczi, 2010) as they are the first point of contact between doctor and patient. Their behaviour can, therefore, influence a patients’ rating of his doctor. Using CAHPS, it was observed that only 40% of the respondents were â€Å"definitely happy† with the help received by their doctors’ receptionist (see Fig.1), although more than half (51%) were â€Å"definitely happy† with the courtesy and respect accorded to them (see Fig.1). Figure 1. Receptionists’ Behaviour with Patients Analyzing a total score of receptionists’ behaviour, only 45.5% of the respondents reported â€Å"definite happiness† with the former’s conduct, thus suggesting that support staff ought to improve their communication skills so as to meet patients’ expectations of the healthcare system. Getting care quickly The availability of immediate healthcare is an important determinant of quality in the primary care setting. Availability refers to the ease with which a person may receive care (Marcinowiczi, 2010), and can include factors such as speed of providing an appointment, time spent by the patient in the waiting room (>15 minutes past appointment time), and doctor’s willingness to provide telephonic answers. An analysis of these factors, using CAHPS, revealed that a majority of respondents were quite happy with the rapidity of obtaining an appointment (44%) and obtaining answers to their telephonic queries (46%) (see Fig. 2). However, a moderate percentage (33%) reported having to wait for more than 15 minutes past their appointment time (see Fig. 2). A long waiting time, which can be interpreted as a mode of non-verbal communication, can be quite irksome, and underlines the need for doctors to improve their time management skills. Figure 2. Clinic Experiences of Patients Respondents’ rating of their doctor A health system can deliver truly patient-centered care only when patient ratings are elicited, integrated, and honoured. A 10-point scale (from CAHPS) used to measure the respondents’ rating of their doctor revealed that a majority (52.2%) rated their doctor as â€Å"Average† (see Fig. 3). This indicates outpatients’ perception that there exists scope for improvement in their doctors’ ability to provide quality healthcare. Figure 3. Respondents’ rating of their doctor Correlation between various parameters and rating of doctor Assuming that the longer the period of doctor-patient acquaintance, the better the rating obtained by the doctor, a correlation between the two was done but yielded no significant result (r = 0.15, p Analysis revealed that a majority of the respondents (78.9%) visited a male doctor, and literature suggests that females score over males in communication skills. A correlation was thus attempted between the gender of the doctors and the respondents rating of them. However, no significant correlation was obtained between the two variables in this study (r = 0.11, p Research suggests that education of respondents also affects ratings, with more educated individuals giving lower ratings to doctors (Instructions for Analyzing Data from CAHPS ® Surveys; 2012). However, the converse was noted in this study as a significant positive correlation was obtained (r = 0.244, p=0.05), indicating that the higher the educational qualifications of the respondents, the more accepting they were of their doctor’s communication abilities. It is a known paradox in medical literature that ‘patients can be satisfied with care that is not high quality and can be dissatisfied with high-quality care’ (Makoul, 2001). Willingness to recommend doctor Seventy six percent of the respondents expressed their willingness to refer their doctor to others (see Fig. 4). This suggests that despite scoring their doctors â€Å"average† in parameters such as clinic experiences and rating, the respondents had satisfactory overall experiences with their doctor. Figure 4. Respondents’ willingness to recommend their doctor to others Analysis of 4 HPQ In 1996, Frankel and Stein structured the principles of good, clinical communication into a teaching model for didactic purposes: â€Å"The Four Habits model – an approach to effective clinical communication†. The habits are: invest in the beginning of the encounter to create rapport and set an agenda (Habit I), elicit the patient’s perspective (Habit II), demonstrate empathy to provide opportunity for patients to express emotional concerns (Habit III), and invest in the end to provide information and closure (Habit IV) (Bard, 2011). The 4 HPQ, consisting of 15 questions divided into sets of 4, was formulated based on these well-researched habits. Analysis revealed that the respondents rated their doctors well in Habits I, II, and III (see Table 1). However, the doctors were scored low on Habit IV, thus suggesting that they require to further hone their skills in summarizing the consultation by checking the patients understanding and negotiating a treatment or follow-up plan (see Table 1). Table 1. Scores obtained on each HABIT Minimum Maximum Mean + SD HABIT I 8 16 14.34 + 1.76 HABIT II 3 8 6.52 + 1.27 HABIT III 3 12 9.82 + 2.18 HABIT IV 12 24 19.99 + 3.52 Conclusion Good medical communication includes building a relationship, exploring the patient’s perspective, displaying empathy, checking for understanding, reaching agreements on problems and plans, and providing closure (Makoul, 1991). Increasing public dissatisfaction with the medical profession is, in good part, related to deficiencies in clinical communication (Simpson, 1991). This study found that outpatients rated their doctors satisfactorily despite indicating certain communication habits that required improvement. Respondents also indicated that communication skills of receptionists in doctors’ clinics could be improved so as to provide a better healthcare environment. Shifting focus from patient satisfaction to patient experiences will enable doctors to be better communicators, thereby helping to bring about a radical shift in total healthcare experiences. References Bard J. Hospital Doctors Communication Skills: A randomized controlled trial investigating the effect of a short course and the usefulness of a patient questionnaire. British Medical Journal. 2011. Desjarlais-deKlerk K and Wallace J. Instrumental and socio-emotional communications in doctor-patient interactions in urban and rural clinics. BMC Health Services Research 2013, 13:261 http://www.biomedcentral.com/1472-6963/13/261 Instructions for Analyzing Data from CAHPS ® Surveys: Using the CAHPS Analysis Program Version 4.1 Document No. 2015 Updated 4/2/12 Makoul M. 2001 Marcinowicz L, Rybaczuk M, et al. International Journal for Quality in Health Care web site (Internet). Poland: 2010; Volume 22, Number 4: pp. 294–301 (cited 2014 January 15) Simpson M, Buckman R, et al. Doctor-patient communication: the Toronto consensus statement. British Medical Journal. 1991; 303:1385-7. 1

Interviews Guidelines :: Interviewing

Interviews Guidelines Hi friendz today I am gonna tell you some of the questions the interviewers’ will ask you generally. Please note that these questions are for general purpose only and meant for mainly those interviews which judge the overall personality of man/woman. 1.  Ã‚  Ã‚  Ã‚  Ã‚  OK Mr./Ms. XYZ tell me something about yourself? Hint: the interviewer is going through u’r c.v. and wants some time. He may not be looking at u’r face. Just speak on continuously and don hesitate. The most important things which should be included are: Salutation; Your name; schooling; college; work experience; why u wanna join and how u’r qualification and experience would relate to the post vacant. 2.  Ã‚  Ã‚  Ã‚  Ã‚  What are your hobbies? Hint: Don’t write those hobbies in which u don’t know in detail. Suppose u tell u’r hobby as cricket but u may not show him any award won in that! 3.  Ã‚  Ã‚  Ã‚  Ã‚  Why Do you want to join this organization? How can u help us? 4.  Ã‚  Ã‚  Ã‚  Ã‚  What is u’r ambition in life? Hint: this is a remarkable question; If u r going for a marketing kind of job and tell that u r not after money but recognition first; u may not be selected; as marketing can be done only by those who r after money only as their priority as their main source of income is their commissions. 5.  Ã‚  Ã‚  Ã‚  Ã‚  What is u’r expected salary? Hint: Don’t under – estimate u’r self. U would be surprised to know that some applications are rejected only because they are ready to work for a very lesser amount ! They argue that we don take the cheap variety. Get Branded; see what is the salary generally accepted in u’r field and demand in proportion to that. 6.  Ã‚  Ã‚  Ã‚  Ã‚  Well Mr./Ms. XYZ Tell me where do u see u’r self after 2 years from now? Hint: Be Specific, Don tell u r going 2 be the BILL GATES. In 2 years. They’ll tell u that they cant’ hire a bill gates and cant’ promote u at that level within 2 years. 7.  Ã‚  Ã‚  Ã‚  Ã‚  You told that u wanna be†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. ,; what are u doing to achieve that? 8.  Ã‚  Ã‚  Ã‚  Ã‚  What are u’r strengths? 9.  Ã‚  Ã‚  Ã‚  Ã‚  What are u’r weaknesses? Hint: Be sure u r not caught; You can tell that I am emotional; etc. 10.  Ã‚  Ã‚  Ã‚  Ã‚  When did u see u’r strength as u described above helped u overcome a situation? And the weakness u had suffer from? 11.  Ã‚  Ã‚  Ã‚  Ã‚  Tell me which are u’r favourite subjects? Hint: Hey don study only one subject. Sometimes it has happened that they ask another question; And the second favorite?

Landscape Urbanism

This modern period, architecture gives attention not only on creating new designs on buildings and structures but on reinventing the environment as well by taming the nature and aestheticizing them for man’s use and pleasure.   Architects understand arts and environmental care which they formed together to reflect a culture and history in the midst of modernization and industrialization.   This is because people begun to reject the complexity of urban life and the consequence of global capitalism.Landscape urbanism is one area of architecture which becomes significant in the overall formation of a building’s construction.   Wikipedia, the online encyclopedia, defined landscape urbanism as a â€Å"theory of urbanism arguing that landscape †¦ is more capable of organizing the city and enhancing the urban experience.†Ã‚   Its purpose is to create an environment for human to enjoy, live and work; thus making the city or urban distinct from rural areas. Thi s concept was elaborated by Charles Waldheim in his book in which he stated that landscape urbanism is the union of landscape with urbanism which â€Å"promises new relational and systematic workings across territories of vast scale and scope, situating the parts in relation to the whole† (p. 33).   In his explanation, he emphasized that the concept lies on â€Å"mobilizing the new ecologies of our future metropolitan regions† (p. 33).   Ad Graafland, Leslie Jaye Kavanaugh and George Baird on the other ha  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   nd, described the term as a strategy that â€Å"the overlaying of ecological and urban strategies can offer a means by which projects may create new systems of interconnected networks that complement the existing structures† (p. 585).Thus, landscape urbanism is integration in the architectural design of the evocative power of landscape and the principles of ecology; it is a celebration of diversity or urban life by discovering an d articulating the aesthetic appreciation and expression of urban life. It is indeed sustainability that is taking place in a city in a technical way by giving it a character in between buildings and public places.Why Landscape Urbanism Emerged in ArchitectureThe discipline of landscape urbanism according to Charles Waldheim has emerged from landscape architecture but with greater consideration of â€Å"cultural and historical as well as natural and ecological† (p. 127).     Waldheim strongly pointed out that it has emerged from architecture because, the concept of landscape urbanism lies strongly on one function of architecture as a device in urban transformation (p. 127).Landscape urbanism has come out from the very idea of landscape architecture according to Richard Weller is â€Å"relatively ineffectual in reshaping the world†¦ and seems nonetheless theoretically correct and worthy in its aspiration† (p. 71), because of the influence of capitalism and trad itional hegemony of engineering and architecture.   In the same way, Weller believed that landscape urbanism alone could â€Å"prepare and practically capable of collapsing the divide between planning and design† (p. 71).Igor Marjanovic, Lesley Naa Norle Lokko clearly pointed out that landscape urbanism is distinct from landscape architecture in a way that the former is not traditional and it even â€Å"looks at the contemporary city and its problems and tries to define the possible contributions that architects†¦ can make† (p. 24).   Urbanism looks at the city and responds to aspect of popular culture while architecture proposes big structures derived from everyday consumer culture; these two work hand in hand for one goal which, the emphasis is on aesthetic and position of public places within community for human comfort that feed human spirit.Comparison and Contrast between the Park de la Villette and Downsview ParkThe two considered great models in terms o f landscape urbanism are the Park de la Villette by Bernard Tschumi and Downsview Park by Bruce Mau.Heather Stimmier-Hall narrated that La Villette was built in an abandoned quarrysite or dump area and at the same time slaughterhouses.  Ã‚   The park which was designed by Bernard Tschumi, was redeveloped and opened in 1986 as a modern city park in Paris â€Å"dedicated to science, arts and entertainment† (p. 96).   In the description made by Stimmier-Hall, Parc de la Villette does not have gates or walls; it has mini-forests, bamboo groves and vast lawn in its seventy acres of land.   In that vast of land, it has numerous museums, concert halls and whimsical playground.   At the entrance of the science and technology museum was the sphere La Geode Cinema that mirrors the green grass and blue skies. The author added that Parc de la Villette has â€Å"all there is to see and do† (p. 96).Downsview Park on the other hand, is a former Canadian military base at the n orth end of Toronto, Canada since 1929; and in 1996, it was closed for renovation.   Downsview Park is approximately 586 acres or 237 hectares that is underutilized tract of land.   With the initiative of its parent company, it became very important place in the heart of Toronto.   It is committed to sustain education and community development and awareness by offering venues for backyard birds, eco-footprints, butterfly landing, tree city, natural habitats and wildlife, history and walking tours.   Both children and adults are accommodated in this place for special civic activities (Parc Downsview Park).   Downsview Park is committed as a â€Å"unique recreational greenspace, a safe and peaceful place, developed according to the principles of environmental, economic and social sustainability, for Canadian to enjoy in all seasons (Parc Downsview Park).These two great and beautiful parks were both renovated from once unproductive and underutilized ground.   Both won the awards for being the largest park that give emphasis on green open space for appreciation of nature though domesticated.   These two parks serve same purposes which are to house special and big events from cultural to sports.   Both have museums and landscape designs.On the other hand, they differ in many ways.   (1) First, they differ in emphasis in aesthetical concept.   Downsview Park promotes the social and natural histories that supports natural ecology; it does not intent to change the site but simply to inaugurate the transformation of it (Van Alen Institute).   Parc de la Villette’s design suggests the conventional conception of a park designed to â€Å"express the fact that it is artificial and domesticated† (Berman, 1999), meaning it has a lot of man-made design to make it beautiful.   (2) Downsview Park retains the old military buildings which are kept for special uses such as for cultural, recreational and community; while Park de la Villette is a total renovation of a place in which the relics of the old place cannot be seen in the place. (3) Park de la Villette is completely constructed and Downsview Park is set for further development which will last after many more years. (4)Lastly, Park de la Villette is privately owned while Downsview Park is government owned and controlled yet self-supporting.Work CitedBerman, Jay 1999.   Le Parc de la Villette, Paris. http://www.galinsky.com/buildings/villette/Downsview Park International Design Competition,’ Van Alen Institute.   http://www.vanalen.org/exhibits/downsview.htmGraafland, A., Jaye Kayanaugh, L. and Baird, G. 2006.   Crossover: Architecture, Urbanism, Technology.   Netherlands:   010 Publishers.Gauzin-Muller, Dominique, 2004.   Sustainable Architecture and Urbanism: Concepts, Technologies, Examples.‘Landscape Urbanism.’ Wikipedia, the Free Encyclopedia. http://en.wikipedia.org/wiki/Landscape_urbanismMarjanovic, I. and Norle Lokko, L. 200 3.   The Portfolio: An Architecture Student’s Handbook.   Elsevier Ltd.Stimmer-Hall, Heather, 2004.   Adventure Guide. England: Hunter Publishing, Inc. Waldheim, Charles, 2006.   The Landscape Urbanism Reader.   USA: Princeton Architectural Press ‘Making it a Reality.’ Parc Downsview Park Inc. (PDP). Canada, 2005/http://www.yorku.ca/mclaughlin/documents/downsviewpark.pdf

Killer Angels Essay - 1856 Words

History 1301 1. Were soldiers religious? What did they think about God? What sorts of religious viewpoints do we see in this book? 2. Why did soldiers fight? Did the motivations of men on the two sides differ? What enabled men to fight in the face of death? 3. What thesis does the author argue as to why the Confederacy was defeated at Gettysburg? What evidence does he present to make his point? Do you agree or disagree with him? Trevor Jenke Professor Lockwood History 1301: M-W 12:30 2 December, 2013 Killer Angels Book Review 1. During the Civil War, there were two sides, the Confederate Army and the Union Army. While the Confederates fought for slavery, the Union fought for their freedom. While the†¦show more content†¦They believed that slavery could not co-exist in a country that was founded on the ideology of freedom. However, they eventually found themselves fighting to help free the slaves rather than fighting for each other. The Confederate Army was fighting to maintain its grip on slavery as it was ever so important to their economy and way of life. They depended on it so greatly that they would be willing to risk their lives on order to hold on to it. Col. Chamberlain talks about his view on the war, and what it meant to him as he was trying to convince the imprisoned troops from the 2nd Maine Division to fight with him. He believed that this war was far different than any other war ever waged in the history of mankind. He believed that what we were fighting for was the value of man, t hat they were fighting for each other. â€Å"This is free ground. All the way from here to the Pacific Ocean . . . . Here we judge you by what you do, not by what your father was . . . . .What we’re all fighting for, in the end, is each other.† (Pg. 32 / 33 - Killer Angels, Michael Shaara) However, there were still men in the Union who were fighting for themselves rather than the idea of a free nation. In personal discussion, Kilrain says that the reason he, personally, is fighting is to prove Im a better man than many (Pg. 188). He says, Its the aristocracy Im after (Pg. 189). He wants to be treated fairly, as he deserves, no matter what his father deserved.Show MoreRelatedEssay On Killer Angels1776 Words   |  8 PagesKiller Angels is a 1974 historical novel by Michael Shaara. The book tells the story of the Battle of Gettysburg in the American Civil War. The novel is told through the voices of both Union army and Confederate Army of Northern Virginia leaders who were in battle there. The novel is laid out in days and each new chapter for the day gives a number and the name of the man who is the focus of the chapter. 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It follows up with four sections and within each section there are chapters that are written in chronological order, covering the events between Monday, June 29, 1863 and Friday, July 3Read MoreThe Killer Angels By Michael Shaara1947 Words   |  8 Pagesthe dueling North and South together to the small town of Gettysburg and on the threshold of splitting the Union. Gettysburg was as close as the United States got to Armageddon and The Killer Angels gives this full day-to-day account of the battle that shaped America’s future. Michael Shaara author of â€Å"The Killer Angels,† tells the story of the Battle of Gettysburg through the eyes of generals Robe rt E. Lee, Joshua Chamberlain, James Longstreet, and John Buford, and the other men involved in the action