Uncovering the Intricacies of the Clinical Intake Assessment: How Clinicians Prioritize Information in Complex Contexts

Objective: Based on a single intake interview, mental health clinicians must distill their assessment to brief statements reflecting essential information. We explored how clinicians organize and prioritize the clinical information they collect during the initial assessment of their clients. Method: We conducted in-depth semistructured interviews with a convenience sample of 38 clinicians in four community-and hospital-based mental health clinics in Israel. Clinicians were interviewed immediately following an intake session with 117 clients and were asked about the client’s main problem, evaluation process, rapport with the client, and role of sociocultural factors in assessment. We identified primary themes across interviews. Results: Clinicians prioritized a psychiatric diagnosis based on DSM-5 categories, followed by psychological processes and family and social relationships. Less than a third of clinicians (29.1%) viewed sociocultural and socioeconomic factors as important in discerning expressions of distress. Conclusions: Our findings raise questions about how the structured expectation of diagnosis may influence how clinicians gather and prioritize information

Experiences of Canadian Oncologists with Difficult Patient Deaths and Coping Strategies Used

Objectives We aimed to explore and identify what makes patient death more emotionally difficult for oncologists and how oncologists cope with patient death. Methods A convenience sample of 98 Canadian oncologists (50 men, 48 women) completed an online survey that included a demographics section and a section about patient death. Results More than 80% of oncologists reported that patient age, long-term management of a patient, and unexpected disease outcomes contributed to difficult patient loss. Other factors included the doctor–patient relationship, identification with the patient, caregiver-related factors, oncologist-related factors, and “bad deaths.” Oncologists reported varying strategies to cope with patient death. Most prevalent was peer support from colleagues, including nurses and other oncologists. Additional strategies included social support, exercise and meditation, faith, vacations, and use of alcohol and medications. Conclusions Oncologists listed a number of interpersonal and structural factors that make patient death challenging for them to cope with. Oncologists reported a number of coping strategies in responding to patient death, including peer support, particularly from nursing colleagues. No single intervention will be suitable for all oncologists, and institutions wishing to help their staff cope with the emotional difficulty of patient loss should offer a variety of interventions to maximize the likelihood of oncologist participation

It takes patience and persistence to get negative feedback about patients’ experiences: a secondary analysis of national inpatient survey data

Background: Patient experience surveys are increasingly used to gain information about the quality of healthcare. This paper investigates whether patients who respond before and after reminders to a large national survey of inpatient experience differ in systematic ways in how they evaluate the care they received. Methods: The English national inpatient survey of 2009 obtained data from just under 70,000 patients. We used ordinal logistic regression to analyse their evaluations of the quality of their care in relation to whether or not they had received a reminder before they responded. Results: 33% of patients responded after the first questionnaire, a further 9% after the first reminder, and a further 10% after the second reminder. Evaluations were less positive among people who responded only after a reminder and lower still among those who needed a second reminder. Conclusions: Quality improvement efforts depend on having accurate data and negative evaluations of care received in healthcare settings are particularly valuable. This study shows that there is a relationship between the time taken to respond and patients’ evaluations of the care they received, with early responders being more likely to give positive evaluations. This suggests that bias towards positive evaluations could be introduced if the time allowed for patients to respond is truncated or if reminders are omitted

Fragmented realities: The ‘sectarianisation’of space among Iraqi Shias in London

How do the spaces we inhabit shape our lived experiences? And how do those lived experiences in turn come to shape and influence our political subjectivity? Such questions are rendered all the more important in studies of migrant or diaspora populations who, by definition, conduct their daily lives in spaces and places that were initially alien to them. The way in which migrants interact with the spaces around them can tell us much about the social, political, and religious engagements they invest in, as well as the very real way in which they experience their local milieu. Through a detailed study of Iraqi Shiis living in London, specifically in the north-western borough of Brent, this article will seek to trace the ways in which religious institutions have carved up the physical and social landscape of north-west London in ways that have enduring effect on the communities with which they engage. The increasing diversification of different religious establishments, I argue, has led to a fragmentation of the city-as-lived, in which the vast majority of practising Iraqi Shiis engage with only small isolated pockets of the urban environment on a daily basis. Moreover, the growing number of specifically Shia schools, charities, mosques, community centres and other such institutions has resulted in what I call a ‘sectarianisation’ of space in Brent, in which individuals hailing from different branches of Islam inhabit different spaces within the city despite often living within metres of each other. Drawing on a mixture of interviews, participant observation, and mapping techniques, I bring together theory and practice in order to sketch out the ways migrant lives can come to be localised in certain spaces, and what that can ultimately mean in terms of their political subjectivity and engagement