Providing Care for the “Whole Patient” in the Cancer Setting: The Psycho-Oncology Consultation Model of Patient Care

This paper describes a psycho-oncology consultation model of care (POCM) that provides a framework for psychosocial clinical work with cancer patients. Goals for care are addressed that follow the recommendations of the Institute of Medicine report advocating care for the “whole patient.” Specific goals include reducing distress and symptoms, building on the patient’s existing strengths, enhancing self-efficacy, expanding the patient’s repertoire of healthy coping strategies, and addressing informational needs. Specific interventions are described that clinicians can implement in order to address the above goals. The paper also addresses the unique challenges encountered in working with cancer patients, as well as programmatic difficulties that are inherent in providing mental health care in a medical setting.     

Arguing ‘for’ the Patient: Informed Consent and Strategic Maneuvering in Doctor–Patient Interaction

As a way to advance integration between traditional readings of the medical encounter and argumentation theory, this article conceptualizes the doctor–patient interaction as a form of info-suasive dialogue. Firstly, the article explores the relevance of argumentation in the medical encounter in connection with the process of informed consent. Secondly, it discloses the risks inherent to a lack of reconciliation of the dialectical and rhetorical components in the delivery of the doctor’s advice, as especially resulting from the less than ideal conditions of the internal states of the doctor and the patient, and the lack of symmetry in their status.     

Shame in Physician–Patient Interactions: Patient Perspectives

This study estimated the extent to which shame is elicited in physician–patient interactions and examined the emotional and behavioral reactions of patients to such interactions. A large adult sample (N = 915) reported on their shame-provoking experiences in interactions with physicians through an anonymous survey. Half of all respondents (n = 456) recalled one or more interactions with a physician that left them feeling ashamed, with significantly more women (59%) than men (39%) reporting this. Forty-five percent of those reporting such experiences stated they terminated treatment with, avoided, or lied to their physician to avoid experiencing further shame. However, 33% believed the shame-provoking interaction provoked useful behavioral changes, and 46% were, on balance, grateful to the physician. Women, relative to men, reported that the interaction led to more negative emotional and behavioral consequences. The type of health issue involved in the interaction also was associated with differential outcomes. Thus, it appears that inducing shame in medical contexts is widespread and may well have both positive and negative effects.     

Have You Ever Googled a Patient or Been Friended by a Patient? Social Media Intersects the Practice of Genetic Counseling

Patients and healthcare providers are becoming increasingly connected via social media, bringing new opportunities and challenges. Direct connection can occur between patients and providers using online tools such as Facebook and LinkedIn. In addition, providers can gather information about patients using a search engine such as Google, referred to as patient-targeted Googling (PTG). An online 54-item survey was used to gain information on (1) how and to what extent genetic counseling students and genetic counselors connect directly with patients via social media sites, and (2) gather information on providers using PTG. Four hundred genetic counseling students and genetic counselors participated in the survey. The majority of respondents (88.9%; n?=?344/387) find it is never or rarely acceptable to interact with current patients via social media sites; however, 27.7% (n?=?110/397) have visited a patient’s social media site. Gathering information for patient care was the most commonly reported reason (76.8%; n?=?43/56). Thirty-three percent (n?=?130/394) have considered searching online or actually searched online for information about a patient. Curiosity was the most common reason (92.7%; n?=?114/123); although, respondents also used PTG to obtain contact information and to prepare for patient sessions. Our study supports the need for development and dissemination of professional guidelines to serve as a valuable resource for practicing genetic counselors and genetic counseling training programs.     

Patient — heal thyself

(This is a story of a courageous woman who refused to accept the fact that her medical disease was incurable or irreversible. This paper was written about 18 months ago. Since then, the author has continued her struggles, her risk-taking searches, and her hope. -Ed.)     

Multiple Selves, Multiple Gods? Functional Polytheism and the Postmodern Religious Patient

The experience of self as multiple and the sense of self as unified and continuous are both experiential realities with equal psychological importance. Clinically, appreciation of both the multiplicity and unity of self engenders a corresponding attention to the “functional polytheism” in the religious lives of patients. In both the psychological and religious realms, there needs to be some ground beneath us when we are standing in the spaces between multiple self-states and multiple god-states.     

Was William James a Patient at McLean Hospital for the Mentally Ill?

Rumors that William James was a patient at McLean Asylum near Boston have persisted for several decades. I focus on the reasons why the question has been so difficult to answer in any definitive way; assess the evidence presented in support of the rumors; note that two different periods in James’s life (late twenties and early sixties) have been judged the most likely; and explore the diagnostic question as well: If he was in fact a patient, for what was he being treated? I also discuss evidence that his younger brother Robertson was a patient at McLean and consider the bearing of this evidence on the question of whether William James was a patient at McLean and on the diagnostic issue.     

What is the Role of the Arts in Medical Education and Patient Care? A Survey-based Qualitative Study

To inform medical education reform efforts, we systematically collected information on the level of arts and humanities engagement in our medical school community. Attitudes regarding incorporating arts and humanities-based teaching methods into medical education and patient care were also assessed. An IRB-approved survey was electronically distributed to all faculty, residents, fellows, and students at our medical school. Questions focused on personal practice of the arts and/or humanities, as well as perceptions of, and experience with formally incorporating these into medical teaching. Of 13,512 community members surveyed, 2,775 responded (21% overall response rate). A majority of respondents agreed or strongly agreed that medical education and patient care could be "enhanced" by the integration of the arts (67% and 74% respectively). There was enthusiastic support for the creation of a formal program in the arts at our medical school (72 %). Integration of the arts into medical education may have a role in improving the quality of medical training and would likely be well received by teachers and learners.     

How Does Your Doctor Talk with You? Preliminary Validation of a Brief Patient Self-Report Questionnaire on the Quality of Physician–Patient Interaction

The quality of physician–patient interaction is increasingly being recognized as an essential component of effective treatment. The present article reports on the development and validation of a brief patient self-report questionnaire (QQPPI) that assesses the quality of physician–patient interactions. Data were gathered from 147 patients and 19 physicians immediately after consultations in a tertiary care outpatient setting. The QQPPI displayed good psychometric properties, with high internal consistency and good item characteristics. The QQPPI total score showed variability between different physicians and was independent of patients’ gender, age, and education. The QQPPI featured high correlations with other quality-related measures and was not influenced by social desirability, or patients’ clinical characteristics. The QQPPI is a brief patient self-report questionnaire that allows assessment of the quality of physician–patient interactions during routine ambulatory care. It can also be used to evaluate physician communication training programs or for educational purposes.     

“Getting the Knowledge Right”: Patient Communication,Agency, and Knowledge

In 2013, in accordance with a provision in the Patient Protection and Affordable Care Act (2010), the U.S. government began fining hospitals with “excessive” patient readmission rates. Those working to respond to this issue have identified discharge communication with patients as a critical component. In response to this exigency and to contribute to the conversation in the medical humanities about the field’s purview and orientation, this article analyzes studies of and texts about communication in health and medicine, ultimately arguing that the on-going circulation of compliance rhetoric and assumptions has limited efforts to improve patient communication. The article, furthermore, considers that humanist ideals of agentic action, the patient-centered care movement’s emphasis on the patient, and biomedicine’s tendency to treat evidence-based knowledge as fixed and given may have combined to support a rationale for using patient adherence to treatment guidelines as metrics in measurement studies designed to identify effective communication strategies. Finally, the article proposes that those working in the medical humanities consider the value of interdisciplinary posthumanist scholarship—specifically, its treatment of agency and knowledge as emergent, distributed, and contingent—and its potential to transform or extend in productive ways the conversation about what constitutes effective communication with patients.     

Who is the Hero in the Life of the Traumatized Patient? Reflections on Bodansky’s Work with Mrs. E

The vexed question of how to explain analytic success with traumatized patients like Bodansky’s Mrs. E is considered from a perspective on psychoanalytic history and the specific theory-buttressed assumptions and practices of earlier generations of analysts that led them to conclude that traumatized patients couldn’t be helped via psychoanalytic work. I then consider Mrs. E’s life with an organizing question, Who is its hero?, applying perspectives from Charles Dickens and from Fraiberg and colleagues’ work, and use these perspectives to question the theory-based assumption that Mrs. E must have somewhere had a good object experience to have a life. These perspectives allow contemplation of a saving forceful agency at Mrs. E’s core (perhaps one experienced by her as “animal”) that seems essential to understanding her successes in living. The success of her treatment in assisting her with building a life suggests that her analyst’s helping her with mirroring and, even more important, with mentalizing, contribute importantly to her life improvement. Some potential limitations of his approach to her are also implied in his account; in particular, his limited work with her intimate desires and feelings, both libidinal and aggressive.     

Development of the Measure of Adaptations for Pelvic Symptoms (MAPS): the Importance of Incorporating the Female Patient’s Voice

Women with pelvic floor disorders use many adaptations in an attempt to minimize symptoms and enhance the quality of their lives. Existing condition-specific measures fail to capture the extent or impact of these adaptive behaviors. The present paper seeks to extend the women’s health literature and expand the registry of available measures to assess pelvic floor disorders by: 1) documenting the steps taken in the development and initial validation of the Measure of Adaptations for Pelvic Symptoms (MAPS); and 2) describing the added value of incorporating the patient’s voice in the instrument development process through in-depth focus groups. The rigorous process used to develop the measure (i.e., literature review, clinical experts, anecdotal patient reports, telephone-administered pilot study, and focus groups with female patients) is described. Analysis of the focus group data yielded eight important adaptation themes used to further refine the MAPS: disclosure, seclusion, being prepared, planning, clothing considerations, sexuality, order and intensity, and outlook. Specifically, focus group participants confirmed the use of sanitary pads and limiting food and beverage consumption. Women did not endorse keeping a jar or commode nearby. Discussions yielded important modifications to items about restroom use, clothing preferences, “survival kits” and “informal” pessary use. Participants described social isolation and preparations for sexual relations that led to new items. This study confirmed the value of incorporating women’s voices in the questionnaire development process through in-depth focus groups. The process revealed important patient experiences and led to significant refinements of the final measure.     

Flexibility of the Psychoanalytic Approach in the Treatment of a Suicidal Patient: Stubborn Silences as “Playing Dead”

The author presents the clinical case of a patient in his third analysis who seemed emotionless, did not feel alive, and complained of an uncontrollable urge to gamble, with disastrous financial results. His previous four-session-a-week “orthodox” analysis had left him prey to a sense of emptiness and to intense suicidal urges. He wanted only two weekly sessions, which became three after some analytic work. The author stresses the danger of rigidly following inflexible standards and the consequent activation of a pseudo-compliance in the analysand. A more slowly paced psychoanalysis should not be considered lower in the pecking order than “high-frequency” treatment, the author maintains: It requires great creative subjective involvement on the part of the analyst and close interaction in the context of the analytic couple. The author shows how this analysis involved a series of interactions in which the analyst was called upon to exercise a complex responsiveness, attuned in each instance to the patient's current needs. Finally he focuses on some clinical passages to show how the patient's internal theories represent a glaring assault on common sense and how death was not recognized perceptionally on a realistic level, but was instead replaced with acting out death against himself by keeping himself mentally dead and by suicidal urges.