Different terms used to describe "red tides"

An event characterized by sudden increase in phytoplankton population, in the sea or aqueous environment, is often designated by different Spanish terms that attempt to describe the nature, aspect, characteristics, and/or properties of such phenomena. In this communication, we discuss the convenience of reaching an agreement among the Spanish-speaking scientific community to use a simple Spanish term that could be much more informative and accurate when referring to Harmful Algal Blooms (HABs), in general. Summarizing the different Spanish terms historically employed to describe the proliferation of noxious phytoplankton in the sea, we propose "Proliferación Microalgal Nociva" (PMN = HAB) as a term that, on the basis of its etymological meaning could be considered correct. Its use could help to avoid the prevailing confusion in our language caused by different misleading terms now employed when referring to a Harmful Algal Bloom event.     

Translation is not enough. Interpreting in a medical setting.

Unique obstacles must be overcome when providing medical care to patients who have an incomplete command of the English language. Serious barriers to effective communication may arise at the exact point where our health care system must succeed or fail. Miscommunication, differences in attitudes about health care, and various other misunderstandings interfere with or frustrate good health care for these patients and their families. Such difficulties are best overcome by the use of a professional interpreter who can ensure good communication between patients and health care professionals. My daily experiences as a professional medical interpreter and translator in Spanish provide insights into the complexities of bilingual and bicultural communication in the hospital setting. Although the examples given relate to Hispanic patients, the lessons learned can be extended to other foreign language patients as well.     

Making secular ‘French’ medical ethics: transcendent morality and patient subjectivities in southern French hospitals

Drawing on ethnographic fieldwork with physicians and nurses working in two state-funded southern French hospitals, this article explores why and how medical care providers connected their everyday deliberations about patient care to what they considered to be distinctively French forms of medical responsibility. Many healthcare professionals saw French medical morality in opposition to ‘Anglo-Saxon’ discourses of individual autonomy and transactional choice. In contrast to such ‘transactionalism’, they insisted that ‘French’ ethics required limits that transcended particular circumstances. And yet it was difficult for doctors and nurses working in secular and increasingly neoliberal hospitals to argue against individual transactionalism in an overtly moral register, one that might appear religious and paternalist. Through a close look at two different cases – one in assisted reproduction and one in palliative care – I show how the language of folk psychoanalysis provided some health professionals with a way out of this impasse. Care providers used pseudo-psychoanalytic accounts of patient subjectivities to depict individuals as incapable of knowing, let alone ‘owning’ or rationally mastering, themselves. This, in turn, suggests that some aspects of French secularity may be far less Protestant and liberal than contemporary anthropological work tends to assume.     

Misunderstanding as therapy: Doctors,patients and medicines in a rural clinic in Sri Lanka

In this paper I want to draw attention to the integration of Western medicine into therapeutic choices among patients in rural Sri Lanka. These patients' interpretation and use of Western pharmaceuticals is discussed in relation to the Ayurvedic theory of balance. The influence of this theory on people's ideas of health and illness is highlighted in encounters where laymen and professionals alike use Western medicines according to context and their respective perspectives. Such therapeutic encounters are used to describe how the meaning of therapy is negotiated and communicated. The modes of perception used by doctors and patients seem to be mutually exclusive but each has its own logic. Western medicines are used as a symbolic means which help the patients and the practitioners of Western clinical medicine in a rural health unit to communicate through — rather than despite — misunderstandings based on their differing cultural assumptions about the body, about disease and about therapy. This argument is raised in relation to recent theoretical discussions among medical anthropologists concerning doctor-patient relationships, asymmetric medical relations and the analysis of meaning systems     

A cross-cultural adaptation of a psychiatric epidemiologic instrument: The diagnostic interview schedule's adaptation in Puerto Rico

The advent of the use of structured interview schedules that generate psychiatric diagnoses in epidemiologic studies has promoted an intense interest in its cross-cultural use. However, the valid use of these instruments across cultures requires a careful adaptation process which goes beyond mere language translation. In this article the authors illustrate the application of a comprehensive cross-cultural adaptation model to both the translation into Spanish and the adaptation to the population of Puerto Rico of a widely used psychiatric epidemiologic research instrument: the Diagnostic Interview Schedule (DIS). The process aimed to ensure the development of a research instrument that is not only in correct Spanish and comprehensible for most Spanish-speaking people, but also culturally adapted to Puerto Rico's population. Various steps were taken (including bilingual committee, back-translation, instrument testing and diagnostic comparisons) to address cross-cultural validity in five important dimensions (i.e., semantic, technical, content, criterion and conceptual equivalence). The result is an interview schedule that is not only linguistically and culturally adequate for the targeted population but also includes elements which can contribute to the development of the instrument both in its original English language and in its translated versions.     

Fragile Castles: The Paradox of Research Politics,Scientific Progress,and the Mutation of Medical Knowledge

This paper is based on fieldwork done from 1996-1999 in different locations among village communities from Central Anatolia afflicted with the deadly malignancy of mesothelioma. Medical research has long established the relationship between mesothelioma and the environment; yet in earlier work correlations deduced through my genealogies provide evidence of a possible genetic cofactor causing these cancer deaths. This paper illustrates how medical research becomes an arena for local and global political interests and how the disruption of the doctor-cancer patient relationship impedes medical research. Methods include illness and clinical narratives, kinship charts and pedigrees, and observation of involved doctors and patients in multiple sites and geographical locations. Under focus are the anthropologist's involvement in global biomedical research and her interconnectedness with its political events.     

Native language background and academic achievement: Is socioemotional well-being a mediator?

This study examined the extent to which socioemotional well-being mediated the relationship between language status and achievement, while exploring variability in this relationship based on informant (student versus teacher reports of socioemotional problems) and native language background (Spanish-speaking English language learners [ELLs] versus ELLs from Asian-language backgrounds). Participants included 9,046 fifth-grade students from the Early Childhood Longitudinal Study-Kindergarten Cohort of 1998. Results from structural equation modeling showed that Spanish-speaking ELLs reported more social-emotional problems as compared to English-monolingual (EM) and Asian-language ELL classmates in third grade, which partially explained their lower achievement levels in fifth grade. The model accounted for approximately 34% of the variance in students’ academic achievement in fifth grade (R² = .343, p < .001). When comparing ELL and EM students, results differed when using teachers’ versus students’ reports of socioemotional well-being. For both Spanish-speaking and Asian-language ELLs, teachers perceived fewer social and emotional difficulties than the students themselves reported in comparison to their EM classmates.     

Encountering nature through fieldwork: expert knowledge,modes of reasoning,and local creativity

The concept of ‘relation’ has been central to the anthropological reworking of the nature/culture and nature/society dichotomies. However, ecology is relational in a way that has often been ignored or dismissed in contemporary socio‐cultural anthropology. This article shows that there is more to ethnoecology than an ethnocentric form of analysis representing other people's understandings of the natural world through the prejudiced lens of Western scientific classifications. Three ‘fieldwork on fieldwork’ experiments involving encounters between natural scientists and indigenous communities in Amazonian Ecuador and Southern Guyana are discussed to illustrate the heterogeneity of human knowledge, the role of expert knowledge in intercultural communication, and the need to differentiate ecological reasoning from moral reasoning.     

Improving cross-cultural skills of medical students through medical school-community partnerships.

Postulating that a program integrating language skills with other aspects of cultural knowledge could assist in developing medical students'' ability to work in cross-cultural situations and that partnership with targeted communities was key to developing an effective program, a medical school and two organizations with strong community ties joined forces to develop a Spanish Language and Hispanic Cultural Competence Project. Medical student participants in the program improved their language skills and knowledge of cultural issues, and a partnership with community organizations provided context and resources to supplement more traditional modes of medical education.     

No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End-of-Life Conversations with Diverse Patients

Objective

Though most patients wish to discuss end-of-life (EOL) issues, doctors are reluctant to conduct end-of-life conversations. Little is known about the barriers doctors face in conducting effective EOL conversations with diverse patients. This mixed methods study was undertaken to empirically identify barriers faced by doctors (if any) in conducting effective EOL conversations with diverse patients and to determine if the doctors’ age, gender, ethnicity and medical sub-specialty influenced the barriers reported.

Design

Mixed-methods study of multi-specialty doctors caring for diverse, seriously ill patients in two large academic medical centers at the end of the training; data were collected from 2010 to 2012.

Outcomes

Doctor-reported barriers to EOL conversations with diverse patients.

Results

1040 of 1234 potential subjects (84.3%) participated. 29 participants were designated as the development cohort for coding and grounded theory analyses to identify primary barriers. The codes were validated by analyses of responses from 50 randomly drawn subjects from the validation cohort (n= 996 doctors). Qualitative responses from the validation cohort were coded and analyzed using quantitative methods. Only 0.01 % doctors reported no barriers to conducting EOL conversations with patients. 99.99% doctors reported barriers with 85.7% finding it very challenging to conduct EOL conversations with all patients and especially so with patients whose ethnicity was different than their own. Asian-American doctors reported the most struggles (91.3%), followed by African Americans (85.3%), Caucasians (83.5%) and Hispanic Americans (79.3%) in conducting EOL conversations with their patients. The biggest doctor-reported barriers to effective EOL conversations are (i) language and medical interpretation issues, (ii) patient/family religio-spiritual beliefs about death and dying, (iii) doctors’ ignorance of patients’ cultural beliefs, values and practices, (iv) patient/family''s cultural differences in truth handling and decision making, (v) patients’ limited health literacy and (vi) patients’ mistrust of doctors and the health care system. The doctors'' ethnicity (Chi-Square = 12.77, DF = 4, p = 0.0125) and medical subspecialty (Chi-Square = 19.33, DF = 10, p =0.036) influenced their reported barriers. Friedman’s test used to examine participants relative ranking of the barriers across sub-groups identified significant differences by age group (F statistic = 303.5, DF = 5, p < 0.0001) and medical sub-specialty (F statistic =163.7, DF = 5, p < 0.0001).

Conclusions and Relevance

Doctors report struggles with conducting effective EOL conversations with all patients and especially with those whose ethnicity is different from their own. It is vital to identify strategies to mitigate barriers doctors encounter in conducting effective EOL conversations with seriously ill patients and their families.     

Descriptive study of cooperative language in primary care consultations by male and female doctors

ObjectiveTo compare the use of some of the characteristics of male and female language by male and female primary care practitioners during consultations.DesignDoctors’ use of the language of dominance and support was explored by using concordancing software. Three areas were examined: mean number of words per consultation; relative frequency of question tags; and use of mitigated directives. The analysis of language associated with cooperative talk examines relevant words or phrases and their immediate context.Subjects26 male and 14 female doctors in general practice, in a total of 373 consecutive consultations.SettingWest Midlands.ResultsDoctors spoke significantly more words than patients, but the number of words spoken by male and female doctors did not differ significantly. Question tags were used far more frequently by doctors (P<0.001) than by patients or companions. Frequency of use was similar in male and female doctors, and the speech styles in consultation were similar.ConclusionsThese data show that male and female doctors use a speech style which is not gender specific, contrary to findings elsewhere; doctors consulted in an overtly non-directive, negotiated style, which is realised through suggestions and affective comments. This mode of communication is the core teaching of communication skills courses. These results suggest that men have more to learn to achieve competence as professional communicators.

Key messages

• Standard teaching on medical communication promotes a cooperative approach to doctor-patient interaction
• In everyday life, however, cooperative language is more typical of female speech style, and this suggests that male doctors may find it harder to develop appropriate consulting styles; in a sample of 373 consultations, male and female general practitioners used examples of cooperative language equally
• Language based study of doctor-patient interaction can deepen understanding and provide useful insights

     

患者的道德权利在医患纠纷中的重要性

近年来医患冲突不断发生,一系列由伦理道德而引发的医疗纠纷事件反映了我国医院管理存在的问题。患者及家属的观念偏移、医患双方信息不对等、医务人员态度不佳以及医疗资源分配不均等问题均是医患冲突的影响因素。我们通过分析患者的道德权利在医患关系中重要地位,认为医务人员应当树立"以人为本"的服务理念,重视患者及家属的社会心理需求,促进医学道德的发展,构建和谐的医患关系。     

Medicine and the Gulag.

The nature of the medical treatment of prisoners in the Gulag has emerged from accounts published by survivors. Over a period of 70 years some doctors entrusted with the medical care of prisoners failed to discharge their ethical duties, contributing to the prisoners'' neglect and suffering. The medical profession must carefully examine what occurred and properly assign responsibility for ethical as well as unethical medical acts. Understanding the history of these ominous events will alert doctors worldwide to the importance of medical autonomy in the support of imprisoned patients.     

Attitudes Toward Women Physicians: A Study of 500 Clinic Patients

A questionnaire was administered to 500 clinic patients and their replies about men and women physicians were analyzed. Ninety-six percent stated that the typical doctor is a man, and 78 percent expressed a preference for a male doctor. A significant number of patients said they would be unwilling to discuss certain subjects with a woman doctor or to follow her advice. Women physicians were considered less competent and less experienced than their male counterparts.Attitudes toward women doctors were correlated with patients'' sex, age, ethnicity, occupation, and chief complaint. Most impressive statistically were the negative attitudes of Spanish-speaking patients and the positive responses of obstetrics and gynecology patients and black women patients. Patients who had previously consulted women physicians were more favorable toward them, suggesting that increased exposure may lead to reduced prejudice.     

When (if ever) may doctors discuss religion with their patients?

There is ongoing debate within the bioethics literature regarding to what extent (if any) it is ethically justifiable for doctors to engage in religious discussion with their patients, in cases where patients cite religious considerations as influencing their medical decision-making. In this paper, we concede that certain forms of religious discussion between doctors and patients are morally permissible (though not necessarily morally obligatory), insofar as patients’ religious beliefs may comprise an important part of their overall wellbeing and can influence their medical decisions. However, we argue that it is not morally permissible for doctors to engage in substantive religious discussion with their patients, beyond simply inquiring about the patient's values (which may include their religious values) or referring patients to a chaplain or religious figure for further discussion. In support of this claim, we put forward two key arguments which have remained relatively unaddressed in the current debate. First, we argue that it is not practical for doctors to engage in substantive religious discussion with patients, and hence it cannot be morally obligatory for them to do so. Second, we argue that, while doctors might have a professional duty to ensure that their patient's religious interests (if any) are addressed, this does not entail that doctors themselves are the ones who should directly address these interests. Along the way, we anticipate and respond to some possible objections to these two key arguments.     

Patients' responsibilities in medical ethics

Patients have not been entirely ignored in medical ethics. There has been a shift from the general presumption that 'doctor knows best' to a heightened respect for patient autonomy. Medical ethics remains one–sided, however. It tends (incorrectly) to interpret patient autonomy as mere participation in decisions, rather than a willingness to take the consequences. In this respect, medical ethics remains largely paternalistic, requiring doctors to protect patients from the consequences of their decisions. This is reflected in a one–sided account of duties in medical ethics. Duties fall mainly on doctors and only exceptionally on patients. Medical ethics may exempt patients from obligations because they are the weaker or more vulnerable party in the doctor–patient relationship. We argue that vulnerability does not exclude obligation. We also look at others ways in which patient responsibilities flow from general ethics: for instance, from responsibilities to others and to the self, from duties of citizens, and from the responsibilities of those who solicit advice. Finally, we argue that certain duties of patients counterbalance an otherwise unfair captivity of doctors as helpers.     

A Systematic Review of Patients’ Experiences in Communicating with Primary Care Physicians: Intercultural Encounters and a Balance between Vulnerability and Integrity

Communication difficulties persist between patients and physicians. In order to improve care, patients’ experiences of this communication must be understood. The main objective of this study is to synthesize qualitative studies exploring patients’ experiences in communicating with a primary care physician. A secondary objective is to explore specific factors pertaining to ethnic minority or majority patients and their influence on patients’ experiences of communication. Pertinent health and social sciences electronic databases were searched systematically (PubMed, Cinahl, PsychNet, and IBSS). Fifty-seven articles were included in the review on the basis of being qualitative studies targeting patients’ experiences of communication with a primary care physician. The meta-ethnography method for qualitative studies was used to interpret data and the COREQ checklist was used to evaluate the quality of included studies. Three concepts emerged from analyses: negative experiences, positive experiences, and outcomes of communication. Negative experiences related to being treated with disrespect, experiencing pressure due to time constraints, and feeling helpless due to the dominance of biomedical culture in the medical encounter. Positive experiences are attributed to certain relational skills, technical skills, as well as certain approaches to care privileged by the physician. Outcomes of communication depend on patients’ evaluation of the consultation. Four categories of specific factors exerted mainly a negative influence on consultations for ethnic minorities: language barriers, discrimination, differing values, and acculturation. Ethnic majorities also raised specific factors influencing their experience: differing values and discrimination. Findings of this review are limited by the fact that more than half of the studies did not explore cultural aspects relating to this experience. Future research should address these aspects in more detail. In conclusion, all patients seemed to face additional cultural challenges. Findings provide a foundation for the development of tailored interventions to patients’ preferences, thus ensuring more satisfactory experiences. Health care providers should be sensitive to specific factors (cultural and micro-cultural) during all medical encounters.     

Critical notes regarding the dislocation of Chicanos by the Spanish‐language television industry in the United States

The growth of the Spanish‐speaking Hispanic population in the United States has fostered the creation of an extensive Spanish‐language media industry. In particular, while the Spanish‐language media industry has expanded in correspondence with the growth of the Spanish‐speaking Hispanic population in the United States, Spanish‐language television has done so in order to capitalize on the consumer and commercial value of the population. In doing so, we argue in this article that the Spanish‐language media industry serves to dislocate Chicanos in US society by not promoting their sociocultural and ethnolinguistic identity.     

How easy is it to contact the duty medical doctor responsible for acute admissions?

OBJECTIVE--To ascertain ease or difficulty of contacting duty junior doctors responsible for acute medical admissions by telephone. DESIGN--Telephone survey of hospitals in six health regions in England and Wales. SETTING--70 Randomly selected hospitals, 15 of which were excluded because of non-acceptance of acute medical admissions. PARTICIPANTS--71 Duty doctors (duty house physicians, senior house officers, or registrars responsible for acute medical admissions) in 48 hospitals; seven duty doctors in seven hospitals were excluded (four declined to participate and three required a written explanation of the survey). 67 Doctors gave full information to all questions. MAIN OUTCOME MEASURES--Time taken for hospital switchboards and duty doctors to reply to telephone call, diagnoses of patients recently admitted, and on call rotas and hours of sleep of duty doctors. RESULTS--Hospital switchboards responded within 30 seconds in 87 (74%) calls, and in 76 calls (64%) the duty doctor requested was contacted within a further two minutes. Chest pain, possibly due to myocardial infarction, was the most common reason for acute medical admissions. Nearly half (48%) of the duty doctors in larger hospitals reported having 4-5 hours sleep or less on their nights on call. Most (30) were on a one in three rota; two were on a one in two rota. CONCLUSIONS--Despite impressions to the contrary contacting the duty medical team by telephone seemed fairly easy. Although most junior doctors were on a rota of one in three or better, insufficient recognition may be given to their deprivation of sleep during nights on duty.     

Survey of "do not resuscitate" orders in a district general hospital.

OBJECTIVE--To evaluate the local use of written "Do not resuscitate" orders to designate inpatients unsuitable for cardiopulmonary resuscitation in the event of cardiac arrest. DESIGN--Point prevalence questionnaire survey of inpatients'' medical and nursing records. SETTING--10 acute medical and six acute surgical wards of a district general hospital. PARTICIPANTS--Questionnaires were filled in anonymously by nurses and doctors working on the wards surveyed. MAIN OUTCOME MEASURES--Responses to questionnaire items concerning details about each patient, written orders not to resuscitate in the medical case notes and nursing records, whether prognosis had been discussed with patients'' relatives, whether a "crash call" was perceived as appropriate for each patient, and whether the "crash team" would be called in the event of arrest. RESULTS--Information was obtained on 297 (93.7%) of 317 eligible patients. Prognosis had been discussed with the relatives of 32 of 88 patients perceived by doctors as unsuitable for resuscitation. Of these 88 patients, 24 had orders not to resuscitate in their medical notes, and only eight of these had similar orders in their nursing notes. CONCLUSIONS--In the absence of guidelines on decisions about resuscitation, orders not to resuscitate are rarely included in the notes of patients for whom cardiopulmonary resuscitation is thought to be inappropriate. Elective decisions not to resuscitate are not effectively communicated to nurses. There should be more discussion of patients'' suitability for resuscitation between doctors, nurses, patients, and patients'' relatives. Suitability for resuscitation should be reviewed on every consultant ward round.