Mini-ethnography: meaningful exploration made easy.
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Anthropology, Cultural↗
Biomedical subjects
W Ventres
Publications and source records attributed to W Ventres.
Where there is no family doctor: the development of family practice around the world.
Family physicians are generalists trained at the postgraduate level to address the majority of primary care needs of patients of all ages in communities they serve. Throughout the world there is a need for family physicians to serve as cornerstones of comprehensive health care systems that provide high-quality, cost-effective medical and public health services to the entire population. To meet this need, each country must value and adequately finance essential medical and public health services and must provide family physicians with a thorough education focused on the relevant health care problems of the population being served. The authors present an overview of the status of this training throughout the world, outline challenges to the development of such training, and suggest strategies for successful development accompanied by illustrative case studies from South Korea, Venezuela, and Pakistan.
Education, Medical↗
Community-oriented primary care: the Cuban plan.
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Community Medicine↗
Limitation of medical care: an ethnographic analysis.
This ethnographic study has shown how one attempt to apply ethical principles through a routine procedure failed to fit the clinical context and, in the two cases studied, served to counteract the very foundation these principles were based on--that patients or their families have the right to determine life-and-death decisions regarding code status. The results suggest that the use of well-meaning forms that are intended to facilitate decision making can, in the absence of appropriate guidelines, routinize the doctor-patient discourse to meet bureaucratic needs, narrowing rather than expanding understanding and communication. Bioethical principles implemented in abstraction, apart from the complex intricacies of the doctor-patient-family relationship and the sociocultural influences upon which this relationship is dependent, may be counter-productive to patient interests. As bioethicists and clinicians work to implement the demands of the Patient Self-Determination Act, they will undoubtedly try to forestall legal problems, assure ethical consistency, facilitate auditing, and promote documentation by creating forms. They may look to create inventories, such as the Limitation of Medical Care form described here, or turn to other, less explicit, means of documentation. This study suggests that, in these efforts, genuine attention should be given to patient concerns, not just to the ethical or institutional needs of medicine. This shift in focus from outcome to process can enhance patient and clinician satisfaction, help resolve difficulties in reaching consensus between involved decision makers, and return the power in DNR decision making to patients and families.
Adult↗
Do-not-resuscitate discussions: a qualitative analysis.
The literature to date on Do-Not-Resuscitate (DNR) decision-making is based upon data derived from structured questionnaires, hypothetical scenarios, descriptive epidemiology, or simulated discussions. Lacking in the literature has been a critical examination of the health care professional-patient-family relationship and its impact on decision-making regarding resuscitation. The purpose of this study is to identify and describe organizational and communication factors that affect the process and outcome of DNR discussions and decision-making. Individual and focus-group interviews were conducted with sixteen key informants professionally knowledgeable about resuscitative issues. Thematic analysis of these interviews revealed that a variety of cultural and professional values, as well as previous personal experiences, influenced the assumptions that providers made when engaging in DNR decision-making. Specific recommendations are made to help family physicians identify communication strategies that foster understanding and lead to participatory decisions about resuscitation among patients and families.
Attitude of Health Personnel↗
Communication strategies in caring for the underserved.
Physicians face numerous challenges in caring for underserved patients. These include both structural barriers, such as the increasing ranks of the uninsured, and contextual barriers. Contextual problems are embedded within the communication between doctors and patients. Communication between doctors and poor patients fails principally because of inadequately shared information and a power asymmetry in the relationship. This paper addresses specific strategies which practitioners and educators can use to improve communication with poor patients and assist in their empowerment. These strategies include employing attentive patient care, attending to the use of jargon, and using self-empowering language.
Communication Barriers↗