Determinants of patient satisfaction with the medical consultation

Abstract

This study assessed patient satisfaction with the medical consultation in ambulatory settings. A multistage sampling method, stratified by geographical location in metropolitan Sydney and type of medical practice, was employed. Two hundred and seventy-two patients attending medical consultations completed a brief questionnaire and interview immediately following a medical consultation with either a general practitioner or a medical specialist. Factor analysis of the questionnaire indicated that 58% of the variance in patient satisfaction ratings was accounted for by the level of interpersonal warmth and respect and the amount of information communicated by the doctor. Other factors impacting on satisfaction included the number of patient requests perceived to be met by the doctor, and the characteristics of the medical encounter, such as the length of the consultation and whether the visit was a first or subsequent consultation. There was no association between level of satisfaction and gender of doctor or the type of medical practice attended.     

Structural Ecosystems Therapy for HIV+ African‐American Women and Drug Abuse Relapse

To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full‐text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ). This report examines the effect of Structural Ecosystems Therapy (SET) for (n=143) HIV+ African‐American women on rate of relapse to substance use relative to both a person‐centered approach (PCA) to therapy and a community control (CC) group. A prior report has shown SET to decrease psychological distress and family hassles relative to these 2 comparison groups. In new analyses, SET and CC had a significant protective effect against relapse as compared with PCA. There is evidence that SET's protective effect on relapse was related to reductions in family hassles, whereas there was not a direct impact of change in psychological distress on rates of relapse. Lower retention in PCA, perhaps caused by the lack of a directive component to PCA, may have put these women at greater risk for relapse. Whereas SET did not specifically address substance abuse, SET indirectly protected at‐risk women from relapse through reductions in family hassles.     

Avoiding Colonizer Positions in the Therapy Room: Some Ideas About the Challenges of Dealing with the Dialectic of Misery and Resources in Families

Some authors have argued that certain acts of family therapists—despite their best intentions—may represent a form of colonizing the family. When acting as a colonizer, a therapist is understood as becoming overly responsible for the family and focusing too strongly on change. In so doing, the therapist disrespects the family's pace, and neglects their own resources for change. This paper aims to highlight the need for therapists to be hypersensitive both to the resources of families entering therapy as well as to the impact of prevailing ideologies on their own positioning in the session. The kind of sensitivity advocated here is dialectical in the sense that every family is understood as having potentials promoting dynamism, happiness, and well-being as well as potentials contributing to stagnation, unhappiness, and misery. In this article, using illustrations from clinical practice, we present some ideas for resisting the tendency by the therapist to assume a colonizing position as a professional solver of problems for families. Our main aim here is to redirect the therapist toward connecting with the family's suffering, as well as with the resource repertoire it has developed for navigating and negotiating its way through life.     

Reasonable Hope: Construct, Clinical Applications, and Supports

To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full-text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ).
Hope may be the most laden shorthand term of all time. Everyone wants it; few know how to articulate what it is. Although family therapists frequently work to restore hope with hopeless families, they have contributed little to the abundant literature on hope. I present a new conceptualization of hope—reasonable hope—that reflects how family therapists think and practice. By subscribing to reasonable hope, clinicians enhance their ability to offer accompaniment and bear witness to clients. I describe clinical practices that, informed by reasonable hope, also facilitate its cocreation. Finally, I suggest supports for clinicians who practice reasonable hope.     

Parental Separation and Children's Behavioral/Emotional Problems: The Impact of Parental Representations and Family Conflict

In this longitudinal study, we examine whether the effect of parental separation on kindergarten children's behavioral/emotional problems varies according to the level of family conflict, and children's parental representations. One hundred and eighty seven children were assessed at ages 5 and 6. Family conflict was assessed using parents' ratings. Children's parental representations were assessed using a story-stem task. A multiinformant approach (parent, teacher, child) was employed to assess children's behavioral/emotional problems. Bivariate results showed that separation, family conflict, and negative parental representations were associated with children's behavioral/emotional problems. However, in multivariate analyses, when controlling for gender and symptoms at age 5, we found that children of separated parents who showed negative parental representations had a significantly greater increase in conduct problems between 5 and 6 than all other children. In terms of emotional symptoms and hyperactivity, symptoms at 5 and (for hyperactivity only) gender were the only predictors for symptoms 1 year later. Our results suggest that kindergarten children's representations of parent-child relationships moderate the impact of parental separation on the development of conduct problems, and underline play and narration as a possible route to access the thoughts and feelings of young children faced with parental separation.