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The Journal of Medical Humanities Mar 2015Is it possible to distinguish, as sociologist Arthur Frank proposes, an 'ideal of wonder' within which ill persons could recover some of their former sense of life and...
Is it possible to distinguish, as sociologist Arthur Frank proposes, an 'ideal of wonder' within which ill persons could recover some of their former sense of life and flourishing, even within the constraints of ill-health? Beyond this, are there more general benefits in terms of health and well-being that could accrue from cultivating an openness to wonder? In this paper I will first outline and defend a notion of wonder that gives philosophical support to Frank's proposal, noting why thinking about medical treatment may readily provoke a sense of wonder. Second I will however limit the normative force of such an 'ideal of wonder' noting its demands and some of the challenges facing it. The paper goes on, third, to conjecture wider benefits within and beyond the clinical encounter arising from being mindful of the wonder of embodied human agency. Fourth the paper will consider alignments between the foregoing analysis and some theoretical commitments in recent work in health geography. Finally I will briefly reconsider the notion of the body-as-territory, and the role of the imagination in bringing it under wonder's gaze.
Topics: Humanities; Humans; Imagination; Patients; Personal Satisfaction
PubMed: 25483615
DOI: 10.1007/s10912-014-9320-6 -
The Oncologist Jul 2016A medical student reflects on his experience as a patient with leukemia.
A medical student reflects on his experience as a patient with leukemia.
Topics: Humans; Leukemia; Patients; Students, Medical
PubMed: 27286789
DOI: 10.1634/theoncologist.2016-0002 -
Frontiers in Public Health 2022Long waiting time for treatment in the outpatient department has long been a complaint and has influenced patient's experience. It is critical to schedule patients for...
BACKGROUND
Long waiting time for treatment in the outpatient department has long been a complaint and has influenced patient's experience. It is critical to schedule patients for doctors to reduce patient's waiting time. Nowadays, multi-channel appointment has been provided for patients to get medical services, especially for those with severe illnesses and remote distance. This study aims to explore the factors that influence patient appointment channel choice in the context of multi-channel appointments, and how channel choice affects the waiting time for offline visiting.
METHODS
We collected outpatient appointment records from both online and offline appointment channels to conduct our empirical research. The empirical analysis is conducted in two steps. We first analyze the relationship between appointment channel choice and patient's waiting time and then the relationships between three determinants and appointment channel choice. The ordinary least squares and the logistic regression model are used to obtain the empirical results.
RESULTS
Our results show that a patient with an online appointment decision has a shorter consultation waiting time compared with a patient with on-site appointment (β = -0.320, < 0.001). High-quality resource demand (β = 0.349, < 0.001), high-severity disease (β = 0.011, < 0.001), and high non-disease costs (β = 0.039, < 0.001) create an obvious incentive for patients to make appointments the Internet. Further, only the effect of non-disease cost on channel choice is lower for patients with multiple visit histories (β = -0.021, < 0.001).
CONCLUSIONS
Our study confirms the effect of Internet use on reducing patient's waiting time. Patients consider both health-related risk factors and cost-related risk factors to make decisions on appointment channels. Our study produces several insights, which have implications for channel choice and patient's behavior literature. More importantly, these insights contribute to the design of appointment systems in hospitals.
Topics: Appointments and Schedules; Empirical Research; Humans; Outpatients; Physicians; Referral and Consultation
PubMed: 35979451
DOI: 10.3389/fpubh.2022.923661 -
Clinical Medicine (London, England) Jan 2022Clinicians are responsible for both commencing and stopping medications. This study evaluates the attitudes of older acute medical inpatients about deprescribing....
Clinicians are responsible for both commencing and stopping medications. This study evaluates the attitudes of older acute medical inpatients about deprescribing. Overall, patients are positive toward stopping medications, want to be involved and do not feel a clinician is giving up on them if a medication is stopped. Patients on fewer medications counterintuitively feel a greater medication burden, are more interested in being involved in decision making and consider deprescribing appropriate to a greater degree than patients who are taking more medications. Conversely, they also reported greater concerns about stopping medications. We discuss these findings in the context of the positive and negative effects of deprescribing, in the context of patient engagement and shared decision making, and how clinicians can work with inpatients to reduce potentially inappropriate medications.
Topics: Aged; Attitude to Health; Deprescriptions; Hospitals; Humans; Inpatients
PubMed: 35078795
DOI: 10.7861/clinmed.2021-0445 -
Annals of Palliative Medicine Jul 2023Geographic cohorting refers to localization of inpatients to designated hospital areas (typically a unit or a set of beds) based on specified criteria. One such... (Review)
Review
BACKGROUND AND OBJECTIVE
Geographic cohorting refers to localization of inpatients to designated hospital areas (typically a unit or a set of beds) based on specified criteria. One such criterion that has been commonly discussed and studied since the early days of the hospitalist movement in the US is a patient's assigned clinical care team. Because implementing cohorting of this type requires substantial operational investment, it is important to understand the benefits and the tradeoffs associated with bringing patients into closer spatial proximity with their full team of providers and allowing clinicians to work within a defined clinical space.
METHODS
We conducted a narrative review of the evidence around geographic cohorting of patients by clinical care team. We performed a comprehensive search of the PubMed, Embase, Cinahl and Scopus databases, identifying relevant English language articles. We used an inductive approach to developing thematic domains for categorization of article content.
KEY CONTENT AND FINDINGS
We reviewed eighteen articles published between 2008 and 2022, and identified four thematic outcomes domains: patient-centered outcomes, communication, efficiency, and satisfaction. The existing literature demonstrates associations with improved communication and staff satisfaction. The data regarding patient outcomes and overall work efficiency, on the other hand, are equivocal and, in general, limited by study methodology.
CONCLUSIONS
Geographic cohorting of inpatients according to clinical care team offers some promise for improved workplace culture. More rigorously designed studies are needed, however, to understand its impact on patient outcomes, and there should be added attention paid to throughput metrics and tradeoffs that often limit its implementation.
Topics: Humans; Inpatients; Communication; Databases, Factual; Hospitals; Patient Care Team
PubMed: 37081705
DOI: 10.21037/apm-22-1400 -
Medical Care Oct 2021Quality of life and psychosocial determinants of health, such as health literacy and social support, are associated with increased health care utilization and adverse...
BACKGROUND
Quality of life and psychosocial determinants of health, such as health literacy and social support, are associated with increased health care utilization and adverse outcomes in medical populations. However, the effect on surgical health care utilization is less understood.
OBJECTIVE
We sought to examine the effect of patient-reported quality of life and psychosocial determinants of health on unplanned hospital readmissions in a surgical population.
RESEARCH DESIGN
This is a prospective cohort study using patient interviews at the time of hospital discharge from a Veterans Affairs hospital.
SUBJECTS
We include Veterans undergoing elective inpatient general, vascular, or thoracic surgery (August 1, 2015-June 30, 2017).
MEASURES
We assessed unplanned readmission to any medical facility within 30 days of hospital discharge.
RESULTS
A total of 736 patients completed the 30-day postoperative follow-up, and 16.3% experienced readmission. Lower patient-reported physical and mental health, inadequate health literacy, and discharge home with help after surgery or to a skilled nursing or rehabilitation facility were associated with an increased incidence of readmission. Classification regression identified the patient-reported Veterans Short Form 12 (SF12) Mental Component Score <31 as the most important psychosocial determinant of readmission after surgery.
CONCLUSIONS
Mental health concerns, inadequate health literacy, and lower social support after hospital discharge are significant predictors of increased unplanned readmissions after major general, vascular, or thoracic surgery. These elements should be incorporated into routinely collected electronic health record data. Also, discharge plans should accommodate varying levels of health literacy and consider how the patient's mental health and social support needs will affect recovery.
Topics: Aged; Female; General Surgery; Hospitals, Veterans; Humans; Interviews as Topic; Male; Middle Aged; Patient Readmission; Patients; Postoperative Period; Prospective Studies; Qualitative Research
PubMed: 34149017
DOI: 10.1097/MLR.0000000000001600 -
The Journal of Surgical Research Jan 2022Same-day surgery in the carefully selected patient decreases costs, improves inpatient capacity, and decreases patient exposure to hospital-acquired conditions....
INTRODUCTION
Same-day surgery in the carefully selected patient decreases costs, improves inpatient capacity, and decreases patient exposure to hospital-acquired conditions. Outpatient adrenalectomy has been shown to be safe and effective, but patients' perspectives have yet to be addressed. This study compares patient satisfaction following inpatient and outpatient adrenalectomy.
METHODS
An institutional database was queried for minimally-invasive adrenalectomies performed from 2017 to 2020. Patients were contacted up to two times to participate in a phone survey consisting of 25 questions modeled after the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems Survey (OAS CAHPS) assessing preparation for surgery, discharge experience, post-operative course, and overall satisfaction. Statistical analysis was performed using Kruskal Wallis, Wilcoxon-Mann Whitney, and Chi-square tests, as appropriate.
RESULTS
One hundred five adrenalectomy patients were identified, of which 98 were contacted and 58 responded (59%). Two surgeons contributed patients, with no difference in the percentage of patients in the outpatient group (51.7% versus 62.1%, P = 0.423). Outpatient adrenalectomy patients had slightly higher overall experience scores, but this difference was not statistically significant (9.12 ± 1.36 versus 8.93 ± 1.51, P = 0.367). Patients undergoing outpatient adrenalectomy were more likely to have their discharge plan discussed pre-operatively (94% versus 62%, P = 0.005), but no significant differences were noted between inpatient and outpatient groups regarding preparation for surgery, readiness for discharge, night of surgery experiences, or self-reported pain or complications (P > 0.05 for all). Significantly higher overall experience scores were reported by patients counseled about their discharge plan (9.27 versus 7.9, P = 0.036), felt prepared for recovery (9.39 versus 5.5, P < 0.001), received information about pain control (9.13 versus 7.00, P = 0.031), felt prepared at time of discharge (9.33 versus 5.80, P < 0.001), and received information about potential complications (9.29 versus 7.00, P = 0.001). Although not statistically significant, there was a trend towards outpatients being more likely to choose the same approach if they were to undergo surgery again (97% versus 84%, P = 0.081).
CONCLUSIONS
Patient satisfaction following adrenalectomy is significantly associated with patients' self-reported degree of preparation for surgery and discharge, with no significant difference in patient satisfaction between inpatient and outpatient groups. Patients undergoing outpatient adrenalectomy would be likely to choose the same approach compared to inpatients. Targeted pre-operative counseling can contribute to enhanced patient outcomes for all patients undergoing adrenalectomy.
Topics: Adrenalectomy; Ambulatory Surgical Procedures; Humans; Inpatients; Outpatients; Patient Satisfaction
PubMed: 34601371
DOI: 10.1016/j.jss.2021.08.019 -
BMC Medical Informatics and Decision... Feb 2022Online patient portals have the potential to improve patient engagement and health care outcomes. This is especially true among rural patient populations that may live...
BACKGROUND
Online patient portals have the potential to improve patient engagement and health care outcomes. This is especially true among rural patient populations that may live far from their health care providers and for whom transportation is a barrier to accessing care. This study compared the characteristics of active users of an online patient portal to non-users and assessed utilization among users in a rural academic primary care clinic to identify disparities in adoption and use.
METHODS
We conducted a cross sectional study of 28,028 patients in a general internal medicine clinic between June 2019 and May 2020 to assess (a) characteristics of patients who had an online patient portal account and used the patient portal compared to those who did not register for an account, and (b) the frequency of use of the patient portal (number of logons and number of messages sent and received) by patients over the study period. We compared results based on demographic characteristics, focusing on gender, age, race, presence or absence of nine chronic illnesses, smoking status, and BMI.
RESULTS
In the study cohort of 28,028 patients, 82% were active users of the patient portal. Females, patients aged 41-65, and non-smokers were more likely to use the portal than their counterparts. In total, patients with eight out of nine chronic illness groups studied (heart failure, cerebrovascular disease, history of a myocardial infarction, peripheral vascular disease, and renal disease) were less likely to use the patient portal than patients without these chronic conditions. On average, patients log onto the patient portal 25 times per year and send and receive 6 messages to and from the clinic. We found that females, patients older than 65, former smokers and obese patients logged on and sent and received more messages compared to the overall cohort. Although the sample size was small, on average Black patients logged onto the patient portal 19 times and sent and received 3.6 messages compared to White patients who logged on 25 times with 5.8 messages on average over the yearlong study period.
CONCLUSIONS
In a rural academic internal medicine clinic, female patients, aged 41-65, non-smokers, and those without certain chronic conditions were more likely to use an online patient portal. Recognizing and addressing barriers to patient portal use is essential for robust and sustained patient portal uptake and ensuring that the benefits of portal use are equally distributed among all patients.
Topics: Adult; Aged; Cohort Studies; Cross-Sectional Studies; Female; Humans; Internal Medicine; Male; Middle Aged; Patient Acceptance of Health Care; Patient Portals; Patients; Rural Health Services
PubMed: 35172805
DOI: 10.1186/s12911-022-01778-w -
Annals of Family Medicine 2013
Topics: Attitude of Health Personnel; Attitude to Health; Cognition; Humans; Intuition; Patients; Physicians; Prejudice; Professional-Patient Relations; Thinking
PubMed: 23444522
DOI: 10.1370/afm.1447 -
Canadian Respiratory Journal 2001
Topics: Humans; Patient Satisfaction; Patients; Physician-Patient Relations; Physicians
PubMed: 11223494
DOI: 10.1155/2001/272895