Illness and Satisfaction With Medical Care

Patients who have worse physical or mental health are less satisfied with their medical care than patients in better health. This article describes research that explores the causal underpinnings of this correlation. Does poor health cause dissatisfaction, or does dissatisfaction cause poor health? And is the dissatisfaction of sicker patients attributable to their own state of mind, or rather to how they are treated by their doctors? It appears that, predominantly, dissatisfaction follows from poorer health rather than vice versa, and moreover that sicker patients' negative outlook is a pervasive cause of their lower satisfaction. However, there is also evidence that physicians' reactions to sicker patients, in the form of curtailed social conversation, also play a role in the reduced satisfaction of these patients.     

病人自主权：未来医患关系的根本立足点

病人自主权是病人人格、尊严的重要内容。尊重病人自主权是医疗服务的最高境界,是医疗和医患关系新的立足点。在未来医疗中,提高病人权利意识,鼓励和帮助病人自主,给病人更多自主选择和决定的机会,应该是医院和医务工作者义不容辞的责任。     

Effectiveness of a Community-Based Advocacy and Learning Program for Hmong Refugees

The effectiveness of a community-based advocacy and learning intervention for Hmong refugees was assessed using a comprehensive, multi-method strategy, which included a within-group longitudinal design with four data collection points and in-depth qualitative recruitment and post-intervention interviews. The intervention's impact on five aspects of refugee well-being was examined: Participants' psychological well-being, quality of life, access to resources, English proficiency, and knowledge for the U.S. citizenship exam. Twenty-eight Hmong adults and 27 undergraduate students participated together in the intervention, which had two major components: (1) Learning Circles, which involved cultural exchange and one-on-one learning opportunities for Hmong adults, and (2) an advocacy component that involved undergraduates advocating for and transferring advocacy skills to Hmong families to increase their access to resources in their communities. Undergraduate paraprofessionals and Hmong participants worked together for 6–8 hr per week for 6 months. Growth trajectory analysis revealed promising quantitative findings. Participants' quality of life, satisfaction with resources, English proficiency, and knowledge for the U.S. citizenship test increased and their levels of distress decreased over the course of the intervention. Mediating analyses suggested that participants' increased quality of life could be explained by their improved satisfaction with resources. Qualitative data helped to support and explain the quantitative data, as well as providing insight into other outcomes and processes of the intervention. Policy, practice, and research implications are discussed.     

TRANSLATING WHAT WE KNOW ABOUT THE CONTEXT OF ANTISOCIAL BEHAVIOR INTO A LOWER PREVALENCE OF SUCH BEHAVIOR

Although we have identified many variables that affect antisocial behavior, there is no evidence that we have learned how to reduce the incidence of such behavior or the proportion of young people who repeatedly engage in antisocial behavior. It is appropriate, therefore, for behavioral scientists to turn some of their energies to research on reducing the incidence and prevalence of antisocial behavior. Small communities may be a particularly useful social unit in which to conduct experimental research. The interventions to be tested include advocacy and community organizing to influence communities to make validated school and clinical interventions widely available and to assist them in increasing other forms of supervision of young people and social and material support of families. Key components of advocacy and community organizing are suggested, and possibilities for research are described.     

Photovoice: Fulfilling the Call for Advocacy in the Counseling Field

Counselors are bound by ethical code to advocate at individual, group, institutional, and societal levels to examine potential barriers and obstacles that inhibit the growth and development of clients. Photovoice is a participatory action research method that utilizes a specific photographic technique to capture an issue from the lens of those affected. The authors of this article propose that photovoice can be adapted to individual counseling with clients to fulfill our ethical call to advocate at the individual level to address barriers and promote growth. A case example is given to demonstrate how photovoice can be used in a counseling session to advocate for clients.     

Storytelling in Liberal Religious Advocacy

Previous research suggests liberal religious advocates often find it necessary to use broadly accessible technical or moral language to communicate with policymakers and public audiences, yet this conformity to secular speech norms diminishes the distinctiveness of their religious voices. Communicating through storytelling offers them one way of overcoming this dilemma. This is demonstrated by examining liberal religious advocacy during recent healthcare reform debates in the United States, using data from interviews and public communications by advocates. By embedding stories within religiopolitical performances that highlight their religious identities, advocates convey policy‐relevant information without relying on explicitly religious language that may be inaccessible or unpersuasive to diverse audiences. They also deploy storytelling strategically, bearing witness to injustices experienced firsthand, secondhand, from the pews, and from the past, depending on the context. These findings have implications for ongoing debates about religious citizens’ capacity to communicate across lines of difference in the public sphere.     

From the body: an exchange on scholarship and advocacy

Abstract

In this article, the authors draw from their own experiences working among religious congregations that minister to unauthorized immigrants in the new destinations in the U.S. to reflect on the relationship between scholarship and advocacy. They argue that because of the scholar's embodied condition, his/her location in networks of relations characterized by power differentials, scholarship will always involve a measure of advocacy, invariably containing judgments not only about what counts as legitimate and authoritative methods, arguments, and data for the religious-studies scholarly ‘community,’ but also about the place of the scholar and her/his scholarly community in the larger society. However, as their own experiences show, not all forms of advocacy are equal – they vary in their level of publicness, as well as the intensity and type of the engagement – and these various modalities carry potential payoffs and pitfalls. Thus, rather than trying to draw fixed, sharp, and ultimately untenable boundaries between scholarship and advocacy, the task is to develop a reflexive, pragmatic, and experimental attitude that can allow for these two dimensions of praxis to benefit from each other, animated by a critical approach and an emancipatory interest focused on the intractable problems and defining dilemmas of our age.     

The Influence of a Community-Based Service-Learning Experience on the Development of Occupational Therapy Students' Feelings of Civic Responsibility

This qualitative study examined the influence of service-learning on the development of Students' feelings of civic responsibility while involved with a community-based organization. Occupational therapy students involved in a semester-long service-learning experience maintained weekly reflective journals. Six such reflective journals were randomly selected for analysis. Findings revealed that while engaged in service-learning the six participants voiced themes of increased self-awareness, awareness of homeless individuals as persons, awareness of social issues, and professional self-efficacy. These developing competencies are associated with the skills required for health care professionals to participate in civic engagement and client advocacy.     

Trends and Implications of Proposed Changes to the DSM‐5 for Vulnerable Populations

The revision process for the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) has increased consciousness for the role of diagnosis in counseling. In this article, the authors discuss 3 trends of the proposed changes: the influence of the medical model, the attention to nosology, and lowered thresholds and their potential impact on nondominant populations. Potential implications for reflection and advocacy among counseling professionals are discussed.     

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.