IN THE SUBJUNCTIVE MODE - EPILEPSY NARRATIVES IN TURKEY

Careful analysis of transcripts of interviews we conducted with a sample of persons identified as suffering epilepsy or seizure disorders in an epidemiological study in Turkey revealed not only that life stories of illness have an overall narrative structure but that the interviews were composed as a corpus of shorter stories. Analytic concepts from reader response theory bring attention to aspects of both the overall life story and the stories told about illness. In particular, we identify 'subjunctivizing tactics' present in the narrative representation of illness that allow sufferers and their families to justify continued care-seeking and to maintain hope for positive, even 'miraculous,' outcomes. In particular, these narratives maintain multiple perspectives and the potential for multiple readings, suggesting alternative plots about source and outcome of illness, and they represent potency and the possibilities for healing through stories of encounters with the mysterious

Patients' Perceptions of Omitted Examinations and Tests: A Qualitative Analysis

OBJECTIVES: To understand the nature of patients' expectations for parts of the physical examination and for diagnostic testing and the meaning patients ascribe to their desires. DESIGN: Qualitative inquiry based on patient interviews and focused on perceived diagnostic omissions as “critical incidents.” SETTING: Three general internal medicine practices (21 practitioners) in one mid-sized northern California city. PATIENTS: Of 687 patients visiting these practice sites and completing a detailed questionnaire, 125 reported one or more omissions of care and 90 completed an in-depth telephone interview. This study focuses on the 56 patients interviewed who did not receive desired components of the physical examination or diagnostic tests. MEASUREMENTS: Qualitative analysis of key themes underlying patients' unmet expectations for examinations and tests, as derived from verbatim transcripts of the 56 interviews. MAIN RESULTS: The 56 patients perceived a total of 113 investigative omissions falling into four broad categories: physical examination (47 omissions), conventional tests (43), high-cost tests (10), and unspecified investigations (13). Patients considered omitted investigations to have value along both pragmatic and symbolic dimensions. Diagnostic maneuvers had pragmatic value when they were seen to advance the technical aims of diagnosis, prognosis, or therapy. They had symbolic value when their underlying purpose was to enrich the patient-physician relationship. Patients in this study were often uncomfortable with clinical uncertainty, distrusted empiric therapy, endorsed early detection, and frequently interpreted failure to examine or test as failure to care. CONCLUSIONS: When patients express disappointment at failing to receive tests or examinations, they may actually be expressing concerns about the basis of their illness, the rationale for therapy, or the physician-patient relationship

Stable polefinding and rational least-squares fitting via eigenvalues

A common way of finding the poles of a meromorphic function f in a domain, where an explicit expression of f is unknown but f can be evaluated at any given z, is to interpolate f by a rational function pq such that r(γi)=f(γi) at prescribed sample points {γi}Li=1 , and then find the roots of q. This is a two-step process and the type of the rational interpolant needs to be specified by the user. Many other algorithms for polefinding and rational interpolation (or least-squares fitting) have been proposed, but their numerical stability has remained largely unexplored. In this work we describe an algorithm with the following three features: (1) it automatically finds an appropriate type for a rational approximant, thereby allowing the user to input just the function f, (2) it finds the poles via a generalized eigenvalue problem of matrices constructed directly from the sampled values f(γi) in a one-step fashion, and (3) it computes rational approximants p^,q^ in a numerically stable manner, in that (p^+Δp)/(q^+Δq)=f with small Δp,Δq at the sample points, making it the first rational interpolation (or approximation) algorithm with guaranteed numerical stability. Our algorithm executes an implicit change of polynomial basis by the QR factorization, and allows for oversampling combined with least-squares fitting. Through experiments we illustrate the resulting accuracy and stability, which can significantly outperform existing algorithms