Can complementary medicine enhance doctor-patient communication skills? Insights from an international medical student project.

INTRODUCTION: Communication is an essential component of patient care, and although medical schools provide training on this topic, patients and physicians alike express the need to improve their communication skills. An international medical student collaboration explored whether complementary medicine (CM) has the ability to further enhance patient-doctor communication. METHODS: Twenty-two medical students, nine mentors and two public representatives from Israel and Germany participated in this 18-month international group project. The goal was to explore CM methods that could enrich doctor-patient communication in several aspects. The group eventually chose to focus on four CM modalities, which included Chinese medicine; Mind-Body medicine; Touch therapies; Mindfulness and Herbal medicine. One workshop took place in Haifa and two workshops in Berlin, with continued inter-group work in-between. The workshops included interactive group formats such as "World Café", self-experience sessions in CM, working in small groups and delivering presentations to the entire group. RESULTS: Besides benefitting from cultural exchange and networking, students learned various aspects of CM, with a particular focus on their relevance for enriching their communication skills. The main CM aspects that were highlighted included patient characterization in the context of Chinese medicine diagnosis, mindfulness, anamnesis regarding herbal use, and a physical exam based on concepts from touch therapies. Students summarized and condensed their observations into five educational modules, which are available online: http://www.b-zion.org.il/pages_e/6683.aspx. CONCLUSION: The cultural exchange and explorative process in this international medical student collaboration led to insights regarding the potential contribution of CM to patient-doctor communication. The outcomes of this international collaboration, specifically the educational modules it produced, should be further explored by medical schools, and assessed in clinical trials.

Bridging individual, family and community care: a comprehensive treatment program for the chronic mentally ill.

For about 25 years an integrated individual-family-community program for chronic mentally ill patients has been implemented in Israel, mostly in the kibbutz setting. The treatment model is based on a combined professional and paraprofessional therapeutic team that designs a structured community program in the following areas: individual and family therapies, life-skills training, medication management, and enhancing performance in work and social spheres and in physical and leisure-time activities. This study reports on the treatment of 124 psychiatric patients who have been followed-up for at least four years. Fifty percent of these chronically incapacitated patients achieved the goals of the community program and were found to be totally or greatly improved in terms of marked improvement of functioning and quality of life, resocialization, work stability and avoidance of rehospitalization. Fourteen percent of the patients were substantially improved, and 36% did not achieve the desired goal of satisfactory integration into community life. A case study that demonstrates the clinical application of the program is presented and the implications of the findings are discussed with respect to the community mental health service delivery system in Israel.

Divorce in the Kibbutz: lessons to be drawn.

The kibbutz in Israel constitutes one of the few places in Western culture where one is able to examine the essence of an "authentic emotional divorce" because of the minor role of factors that are extraneous to the disruption of the emotional marital attachment itself. This is the case because the kibbutz is a society that is based and functions upon principles that neutralize to a large extent the legal, economic, and co-parenting obstacles to a constructive divorce. Although there are significant differences in the severity of the postdivorce conflict, the divorce crisis is rather similar in kibbutz and non-kibbutz settings regarding both the quality of the emotional responses and the nature of the influencing factors--thus pointing to the ubiquitousness of the human condition.

The Israeli High-Risk Study: some critical remarks.

This article addresses a number of methodological weaknesses in the group comparison design of the Israeli High-Risk Study. It would seem that 25 years ago constraints of experimental design may have led the investigators to select as schizophrenic probands patients who today would no longer qualify for schizophrenic diagnosis according to DSM-III. In addition, a series of relevant dimensions (e.g. the course of the assumed schizophrenic process, family variables, life circumstances, and psychosocial factors) were not taken into account. For these reasons, many of the study's hypotheses and conclusions can be considered basically speculative, and it is suggested that many of the findings may be artifacts of the research design. Nor are there any evident grounds for the supposition that the differences between kibbutz and town children, in terms of the nature and severity of particular psychopathological problems, should be decisively ascribed to the differences in social framework and childrearing practices in the kibbutz and in town. The weight of many other variables, in particular intrafamily influences, is no less marked in the kibbutz setting than in town.

Twenty years of family therapy in Israel: a personal journey.

This article is a personal statement of my beliefs and practice of family therapy, from the time I first introduced the concept to Israel over twenty years ago to the present day. It reflects the evolution and changes in my clinical work against the background of major developments in the field of family therapy.

Factors influencing the severity of childhood bereavement reactions.

As part of a longitudinal study of 25 preadolescent kibbutz children who lost their fathers during the October War of 1973, child, family, and circumstantial variables were examined in an effort to assess their relative contribution to the intense emotional disturbance exhibited by half of the group. Findings suggest that pretraumatic family and environmental factors are significant determinants of the duration and severity of bereavement.

Bereavement responses of kibbutz and non-kibbutz children following the death of the father.

This article examines the comparative prevalence of grief reactions, behavioral symptoms and 'pathological bereavement' in 25 kibbutz and 21 non-kibbutz children aged between 3 1/2 and 11 1/2 yr eighteen months after the death of the father in war. The findings indicate that in both kibbutz and urban settings the loss of a father becomes a serious traumatic situation for a large proportion of the children, influencing multiple areas of functioning and causing manifold behavioral symptoms. The particular differences regarding the quality of the reactive symptoms exhibited by kibbutz and non-kibbutz children appear to be related to the different sociocultural surrounding influences.

Monoideism in psychiatry: theoretical and clinical implications.

The incessant repetition of disturbing monoideistic thoughts which cannot be eliminated from the patient's mind is a symptom of a variety of psychiatric conditions. The persistent monoideistic preoccupation tends to acquire the quality of a repetitive hypnotic suggestion or "inner commands" and creates an altered state of consciousness that transcends the limits of volitional control. The one-sided ideational context permeates interpersonal relations, intensifies family conflict and drains a considerable portion of available psychic energy. Disregard or an incorrect approach to this factor may result in painful therapeutic failure, since no exploratory psychotherapy or verbal intervention technique will be able to penetrate the monoideistic armour. THe continuous repetition of the dominant idea functions as a cumulative suggestion stimulus leading to disruption of spontaneous processes and self-defeating thinking, behavioral, motivational, and affective changes. The monoideistic preoccupation may be total and pervade the individual's entire life. Any comprehensive form of therapy should offer formulations and precise procedures--for the identified patient, nuclear family, and network of significant others--to block the feedback supplying system attached to the monoideistic pattern.

Kibbutz civilian population under war stress.

During the Arab-Israeli war of 1973 measures had to be taken by the kibbutz civilian population in Israel to cope with the stresses of war. The measures adopted, and the specific characteristics of an organized cohesive group, appear to have succeeded in reducing the severity of the reactions to stress and in lowering the incidence of psychiatric casualties among children and adult members of the kibbutzim.