Patient-doctor communication on smoking and drinking: lifestyle in medical consultations.

Lifestyles of groups and individuals are significant determinants of the health status of a population. Behaviour with respect to such areas as alcohol, food, drugs, tobacco, physical exercise, etc., correlates with medical and social well-being and are thus on the agenda for modern health care. The present article reports a study of how such lifestyle habits, notably alcohol and tobacco consumption, are addressed in medical consultations. The results indicate that the areas of smoking and drinking are sensitive and that specific communicative strategies are used for introducing these topics and for eliciting information. Smoking habits are addressed in 75% of the consultations and alcohol habits in 30%. In most cases, the information exchanged is shallow and gives only a fragmentary picture of patients' habits. There is little evidence of attempts to influence patients' attitudes and behaviours and the physicians do not contextualise possible relationships between such lifestyle habits and health in the light of their medical knowledge. In this sense, a potentially very influential face-to-face encounter is not used as a vehicle for attempting to eliminate such significant causes of poor health.

Patient involvement in decision-making in surgical and orthopaedic practice: the Project Perioperative Risk.

As part of the Project Perioperative Risk (PROPER), which is a clinical and epidemiological study of surgical complications, patient involvement in the decision to operate was evaluated by means of a questionnaire. The sample of 666 patients, on the waiting list for an operation, received a questionnaire on a broad range of issues concerning their involvement in the decision-making process one week before the operation. The results show that 41% regarded the decision to have an operation as a joint patient-doctor decision, in 29% of the cases the doctor advocated an operation and in 8% the patient asked to be operated. A clear majority, 73% felt involved in the decision-making as much as they wished. Two groups--women and immigrants from non-European countries--were least satisfied with their involvement and they also found the decision more difficult to make. In the discussion, it is argued that the comparatively high degree of patient satisfaction with involvement in the decision-making process cannot be taken as evidence of a high level of influence in an absolute sense. In a normative perspective--and considering the fact that the increased responsibility of the health sector is aimed at involving patients in decision-making in health matters--patient satisfaction can just as well be understood as resulting from low expectations with respect to one's own influence. The results also indicate that patient's information needs when facing surgery relate to three issues; possible complications, precise nature of the operation as such, and nature and consequences of anaesthetic procedures.

Addressing life style in primary health care.

The problem studied concerns how patients and physicians talk about and make use of information regarding patient life style in the daily practice of primary health care. The study has been carried out at two primary health care centers in central Sweden. Transcribed dialogues between 42 patients and 12 physicians have been used as a data corpus. The analyses concern the interactional patterns in the dialogues between patient and physician, how the interlocutors address life style and for what purposes. The results show a similarity between patients and physicians with respect to the extent to which they use the discourse space. However, salient differences were found in the following way: the physicians not only introduced and closed life style topics more frequently than the patients did, they also used what is referred to as an agenda driven strategy to introduce them. The patients, on the other hand, used an interactively anchored strategy. The patients, by taking the reference in the life world and by making use of the life style topics, present and articulate their identity. The physicians subsume life style issues under a medical framing of the patients' problem and they mainly address life style in order to construe a proto-typical patient rather than an individual.

Lifestyle in primary health care discourse.

This study is the first part of the project "Lifestyle Questions in Primary Health Care". The study aims at exploring how lifestyle enters into the health care discourse and what significance such factors are given in the clinical work. The particular problem thus concerns the extent to which lifestyle issues are brought up and attended to in the clinical encounters as well as in the medical records. The study was performed at two primary health care centres in central Sweden. The analyses are based on 42 transcribed consultations and on the medical records produced on the basis of these dialogues. The results show that lifestyle issues are given considerable attention in the primary health care encounter. Roughly one third of the discourse space is devoted to these kinds of topics, and the patients and doctors share the discourse space equally between them. There is also a high consistency between topics given space in the discussion and those that are entered into the medical records. The results also point to what could be conceived as a common discursive code between the health centres studied, indicating that there are similar communicative strategies for discussing lifestyle issues.

Lifestyle discussion in the provision of health care. An empirical study of patient-physician interaction.

The main issue explored is how patients and physicians communicate about lifestyle in the clinical encounter and what role this talk plays in terms of the outcome of the consultation. The data, collected at two primary health care centers, consist of 42 audiorecorded consultations. The analyses are based on these transcribed dialogues. Our study shows that communication about lifestyle issues is used as a source for determining what health care measures are relevant. Physicians provided a variety of types of information and explicit connections were made between lifestyle and the medical problem by physicians as well as patients. Within the process of reaching decisions on advice or treatment, two forms of interaction appeared referred to here as "paternalism" and "mutuality". In general, the results show that the physicians are very cautious about making explicit medical inferences concerning specific issues of the individual's lifestyle.

An interview study of men discovering testicular cancer.

Testicular cancer affects men between 15 and 45 years old. The aim of this study was to show how men with testicular cancer discover their cancer, react to physical changes, and take action. In the follow-up phase, 21 who had undergone surgery for testicular cancer were interviewed. The results show clearly that the men focus on their physical pain. The progress from the discovery of changes in the testicular glands to medical care can be divided into three phases. In the first phase, "something has happened," the men consider the changes and try to define the reasons. In the second phase, "facing the situation," they consider the situation and decide whether to talk to someone. In the third phase, "seeking medical help," it is a question of seeking help and being confronted by the medical diagnosis. In terms of time, the progression in the current study took from 1 day to 1 year. The men sought help when complications arose that made normal daily functions difficult. Six of the men suspected that the cause of their problems was cancer. Almost half of the participants in this study, including the six who suspected cancer, did not talk to anyone before they decided to seek medical help. The men who did talk to other people did not seek medical help any more quickly than the other men. None of the men routinely inspected their bodies.

Complications after surgery as expressed by patients and health care--the Project Peri-Operative Risk (PROPER).

In the present study, which is a part of a clinical-epidemiological study of complications, (the Project Peri-Operative Risk, PROPER), 510 patients, admitted for elective surgery, participated. During their time in hospital, the incidence of complications was registered by nurses. Three months after surgery, the patients were asked in a questionnaire if they had, during their time in hospital or during their convalescence at home, suffered from postoperative complications. Statements by patients and health care professionals regarding the nature and frequency of complications have been compared. Our results confirm the findings that a prospective method in registering complications results in the detection of a higher incidence than if a retrospective method is used. The analysis also reveals that patients and professionals report different types of complications. They also describe complications from different perspectives and present identical complications in different terms.

Patient involvement in decision-making in surgical and orthopaedic practice. Effects of outcome of operation and care process on patients' perception of their involvement in the decision-making process.

As part of the project Perioperative Risk,--an epidemiological study of complications associated with surgical and orthopaedic operations--the article reports a study of patients' perception of their involvement in decision-making in medical consultations, and how the outcomes of surgery and subsequent care determine patients' evaluation of the treatment. Patients' view of their involvement in the decision-making process was obtained before as well as after surgery. The results reveal that the more satisfied the patients were with the outcome of the operation, and the post-operative situation, the more they were inclined to assume responsibility for the decision to have surgery. The opposite response pattern, indicating a negative evaluation of either the operation or the post-operative care, resulted in an outcome where patients described others--especially the physician--as being responsible for the decision to have surgery. The results suggest that patients' evaluations of surgery are based upon a more global reaction to what happened during the entire care process. Dissatisfaction with either the operation or the post-operative care leads to a negative outcome in terms of patients' perceptions of their own involvement. This emphasizes the importance of all health care professionals seeing themselves as a team with complementary responsibilities for success in health care.

Patients' and health care professionals' views of complications after elective surgery.

In this study, which is a part of a clinical-epidemiological study of post-operative complications, the Project Peri-operative Risk (PROPER), patients' and health professionals' perceptions of complications during the patients' stay in hospital are analysed. Five hundred and ten patients admitted for elective (= planned) surgery and attending a pre-operative outpatient clinic set up for this project were seen pre-operatively and then monitored closely during and after surgery. Three months after having been operated on, they were sent a postal questionnaire in which they were asked to indicate whether they had suffered post-operative complications and to evaluate the care process. The incidence of complications reported by patients and staff was similar, but there were large differences at the individual level. Two-thirds of the staff-reported complications were not reported by the patients and vice versa. Patients generally classified complications as more severe than the staff did. Patients' evaluation of the care process was clearly related to reported complications. Most dissatisfied were those patients who reported complications not reported by the staff, and the most satisfied were those who had complications according to the staff but no complications according to themselves. The implication of these findings is discussed.

Sensitive patient-doctor communications relating to the breasts and prostate.

This study was carried out at two primary health care centers in separate counties in central Sweden. Data derive from recordings of consultations of 42 patients and their general practitioners. The patients and the doctors were interviewed separately after each consultation. The analysis is based on the audio-recordings as well as on verbatim transcripts of the consultations. It focuses on communications about the topics relating to the breasts and the prostate and how these topics are dealt with during the consultations. These topics were brought up in seven (29.2%) of the 24 consultations with female patients and four (22.2%) of the 18 consultations with male patients. A common pattern of the outcome as regards information was that the patient was given neither the tool, i.e., knowledge about bodily functions, nor methods for detecting an abnormality. The patients indirectly evinced ignorance with regard to the body, examinations, and diseases, and did not ask any direct questions that required answers.