Biomedical subjects

T Hak

Publications and source records attributed to T Hak.

5 recordsLinked to original sources

PubMed2001

Collusion in doctor-patient communication about imminent death: an ethnographic study.

OBJECTIVE: To discover and explore the factors that result in the "false optimism about recovery" observed in patients with small cell lung cancer. DESIGN: A qualitative observational (ethnographic) study in 2 stages over 4 years. SETTING: Lung diseases ward and outpatient clinic in a university hospital in the Netherlands. PARTICIPANTS: 35 patients with small cell lung cancer. RESULTS: False optimism about recovery usually developed during the first course of chemotherapy and was most prevalent when the cancer could no longer be seen on x-ray films. This optimism tended to vanish when the tumor recurred, but it could develop again, though to a lesser extent, during further courses of chemotherapy. Patients gradually found out the facts about their poor prognosis, partly by their physical deterioration and partly through contact with fellow patients in a more advanced stage of the illness who were dying. False optimism about recovery was the result of an association between physicians' activism and patients' adherence to the treatment calendar and to the "recovery plot," which allowed them to avoid acknowledging explicitly what they should and could know. The physician did and did not want to pronounce a "death sentence," and the patient did and did not want to hear it. CONCLUSION: Solutions to the problem of collusion between physician and patient require an active, patient-oriented approach by the physician. Perhaps solutions have to be found outside the physician-patient relationship itself--for example, by involving "treatment brokers."

Aged↗

PubMed2000

Collusion in doctor-patient communication about imminent death: an ethnographic study.

OBJECTIVE: To discover and explore the factors that result in "false optimism about recovery" observed in patients with small cell lung cancer. DESIGN: A qualitative observational (ethnographic) study in two stages over four years. SETTING: Lung diseases ward and outpatient clinic in university hospital in the Netherlands. PARTICIPANTS: 35 patients with small cell lung cancer. RESULTS: "False optimism about recovery" usually developed during the (first) course of chemotherapy and was most prevalent when the cancer could no longer be seen in the x ray pictures. This optimism tended to vanish when the tumour recurred, but it could develop again, though to a lesser extent, during further courses of chemotherapy. Patients gradually found out the facts about their poor prognosis, partly because of physical deterioration and partly through contact with fellow patients who were in a more advanced stage of the illness and were dying. "False optimism about recovery" was the result an association between doctors' activism and patients' adherence to the treatment calendar and to the "recovery plot," which allowed them not to acknowledge explicitly what they should and could know. The doctor did and did not want to pronounce a "death sentence" and the patient did and did not want to hear it. CONCLUSION: Solutions to the problem of collusion between doctor and patient require an active, patient oriented approach from the doctor. Perhaps solutions have to be found outside the doctor-patient relationship itself - for example, by involving "treatment brokers."

Attitude to Health↗

PubMed2000

Group process: the black box of studies on problem-based learning.

A considerable number of medical schools worldwide have implemented, at least in part, a problem-based learning (PBL) approach in their curricula. Research to date has largely neglected the issue of the actual activities and learning processes that mediate and moderate the relationship between these programs and their cognitive outcomes. In this essay the authors discuss the few studies that have empirically investigated what students actually do in PBL tutorials, which arguably is the pivotal mediating process. These studies demonstrate that it is possible to observe, identify, and describe group activities (such as brainstorming and the joint identification of learning issues) that promote interactionally shared and achieved cognition. However, such studies have been confined to case studies in which isolated fragments of tutorials have been analyzed and described. Future studies need to provide a broader description and analysis of actually performed cognitive activities in all relevant phases of the entire PBL process.

Curriculum↗

PubMed1999

Achieving a patient-centred consultation by giving feedback in its early phases.

The traditional medical consultation comprises history, examination, and investigations, followed by explanation to the patient of diagnosis and management. In the course of studying a series of tape-recorded consultations in a specialist medical clinic for chronic fatigue, we have observed a different structure. In some consultations, those categorized as more 'patient-centred', doctors introduced explanation and education into the early history-taking stage. This strategy is contrasted with the traditional approach, where the doctor only elicits information during the history, and gives an explanation later. The 'early feedback' strategy may result in patients with chronic illnesses achieving greater understanding of their symptoms. We discuss the implication of these findings for medical training.

Communication↗

PubMed1987

The effect of cytochrome c oxidase on lipid polymorphism of model membranes containing cardiolipin.

The effect of cytochrome c oxidase incorporation on the lipid polymorphism of the cardiolipin-Ca2+ system was investigated by 31P NMR and freeze-fracture electron microscopy. The integral membrane protein has a stabilizing effect on the bilayer organization of cardiolipin, in that it inhibits the Ca2+-induced HII phase formation of this lipid for Ca2+/cardiolipin molar ratios of 1-10. At a Ca2+/cardiolipin molar ratio of 25, about 80% of the lipid is organized in the HII phase and a structural phase separation occurs between the cardiolipin-Ca2+ complex organized in the hexagonal HII phase without protein and bilayer structures with incorporated protein.

Animals↗