Using Ethnographic Discourse Analysis to Understand Doctor-Patient Interactions in Clinical Settings

Using ethnographic discourse analysis in an Emergency Department in Hong Kong, this study explored the features of doctor-patient interactions in a hospital setting. By audio-recording 10 patient journeys, from triage to disposition, we analyzed the complexity of turn-taking patterns in spoken interactions between patients and doctors, as well as the subsequent complexities in this communication process. In particular, we traced the flow of communication surrounding the patients’ medical conditions at different stages of their journeys (e.g., taking patient history, making diagnosis and translating medical information in a bilingual environment). Communication in this Emergency Department, as in all Emergency Departments in Hong Kong, involves repeated translation from spoken Cantonese interactions to the written English patient notes and vice versa. For this study, the ethnographic discourse analysi

Restoring Core Values: An International Charter for Human Values in Healthcare

Background: The human dimensions of healthcare are fundamental to the practice of compassionate, safe, and ethical relationship-centered care. Attending to the human dimensions improves patient and clinician satisfaction, outcomes and quality of care; however, these dimensions have not received the emphasis necessary to make them central to every healthcare encounter. We established an international collaborative effort to identify and promote the human dimensions of care. Objectives: a) To describe work to date on the International Charter for Human Values in Healthcare; b) To discuss translation of the Charter's universal values into education, research, and practice. Methods: An international working group of expert educators, clinicians, linguists, and researchers identified initial values that should be present in every healthcare interaction. The working group and four additional groups -- National Academies of Practice (NAP) USA, International Conference on Communication in Healthcare, Interprofessional Patient-Centered Care Conference, American Academy on Communication in Healthcare Forum -- identified values for all healthcare interactions and prioritized top values. The NAP group also prioritized top values for interprofessional interactions. Additional data was gathered via a Delphi process and 2 focus groups of Harvard Macy Institute scholars and faculty. Results: Through iterative content analyses and consensus, we identified 5 categories of core human values that should be present in every healthcare interaction: Capacity for Compassion, Respect for Persons, Commitment to Integrity and Ethical Practice, Commitment to Excellence, and Justice in Healthcare. Through further consensus and Delphi methodology, we identified values within each category. Conclusions: The International Charter for Human Values in Healthcare [1] is a cooperative effort to restore core human values to healthcare around the world. Major healthcare and education partners have joined this international effort. We are working to develop methods to translate the Charter's universal values into education (teaching, assessment, curricula), research and practice

Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses

Objectives Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up. Design A mixed-methods design with quantitative and sequential qualitative components was used. Setting and participants Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices. Results The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases. Conclusions Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.This work was supported by funding from the Hospital Authority’s Kowloon Central Cluster Research Grant (grant number: KCC/RC/G/1516-B03)

Physiological responses during ascent to high altitude and the incidence of acute mountain sickness.

Acute mountain sickness (AMS) occurs when there is failure of acclimatisation to high altitude. The aim of this study was to describe the relationship between physiological variables and the incidence of AMS during ascent to 5300 m. A total of 332 lowland-dwelling volunteers followed an identical ascent profile on staggered treks. Self-reported symptoms of AMS were recorded daily using the Lake Louise score (mild 3-4; moderate-severe ≥5), alongside measurements of physiological variables (heart rate, respiratory rate (RR), peripheral oxygen saturation (SpO2 ) and blood pressure) before and after a standardised Xtreme Everest Step-Test (XEST). The overall occurrence of AMS among participants was 73.5% (23.2% mild, 50.3% moderate-severe). There was no difference in gender, age, previous AMS, weight or body mass index between participants who developed AMS and those who did not. Participants who had not previously ascended >5000 m were more likely to get moderate-to-severe AMS. Participants who suffered moderate-to-severe AMS had a lower resting SpO2 at 3500 m (88.5 vs. 89.6%, p = 0.02), while participants who suffered mild or moderate-to-severe AMS had a lower end-exercise SpO2 at 3500 m (82.2 vs. 83.8%, p = 0.027; 81.5 vs. 83.8%, p 5000 m (OR 2.740, p-value 0.003) predicted the development of moderate-to-severe AMS. The Xtreme Everest Step-Test offers a simple, reproducible field test to help predict AMS, albeit with relatively limited predictive precision

Potential Risk Points in Doctor-Patient Communication: An Analysis of Hong Kong Emergency Department Medical Consultations

Human beings are meaning makers, putting language and other semiotic systems to work in the various contexts of daily life- to entertain, to retell experiences, to amuse, to build relationships, to complete tasks, to inform, to explore, to teach, to warn, to sell, to form partnerships, to collaborate-inter alia. Most humans, most of the time, are not conscious of what they do with language, what they achieve lhrough language, how they use language, perhaps reflecting the way they developed as social beings

Factors affecting communication in emergency departments: doctors and nurses' perceptions of communication in a trilingual ED in Hong Kong

Background: This study investigates clinicians’ views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong. Methods: Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs. Results: The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians’ engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills. Conclusions: These communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the primary causes of communication problems in EDs, (2) accepting the tenets and practices of patient-centred care, (3) establishing clear and consistent knowledge transfer procedures and (4) lowering the patient-to-clinician ratio in order to create the conditions that foster successful communication. The research provides a model for future research on the relationship between communication and the quality and safety of the patient safety. Keywords: Interviews, Emergency medicine, Clinician-patient communication, Clinician-clinician communication, Quality of car

The International Centre for Communication in Healthcare: Creating Safer and More Compassionate Healthcare Systems around the World

Background: The role of communication in healthcare receives increasing attention, yet little research exists that brings together perspectives from interprofessional healthcare researchers and practitioners with linguists and communication specialists. The International Centre for Communication in Healthcare[1] is a response to increasing recognition of the central role of communication and relationships in the delivery of safe, effective and compassionate healthcare

Health professional-patient communication practices in East Asia: An integrative review of an emerging field of research and practice in Hong Kong, South Korea, Japan, Taiwan, and Mainland China

Objective: To provide an integrative review of literature on health communication in East Asia and detail culturally-specific influences. Methods: Using PRISMA model, search of PubMed, PsychInfo, Web of Knowledge, ERIC and CINAHL databases were conducted for studies between January 2000 and March 2017, using the terms ‘clinician/health professional-patient', ‘nurse/doctor-patient, ‘communication' and ‘Asia'. Results: 38 studies were included: Mainland China, Hong Kong, Japan, South Korea, and Taiwan. The existing body of research on clinician patient communication in East Asia can be classified: 1) understanding the roles and expectations of the nurse, clinician, patient, and family in clinician-patient consultations: a) nurse-patient communication; b) doctor-patient communication; c) the role of family member; and 2) factors affecting quality of care: d) cultural attitudes towards death and terminal illnesses; e) communication preferences affecting trust, decision-making and patient satisfaction; f) the extent to which patient centred care is being implemented in practice; and g) communication practices in multilingual/multi-disciplinary environments. Conclusion: The review detailed the complexity and heterogeneity of clinician-patient communication across East Asia. The studies reviewed indicate that research in East Asia is starting to move beyond a preference for Western-based communication practices. Practice implications: There is a need to consider local culture in understanding and interpreting medical encounters in East Asia. The paper highlights the need for a specific culturally-appropriate model of health communication in East Asia which may significantly improve relationships between clinicians and patients

Patterns of Interaction in Doctor-Patient Communication and Their Impact on Health Outcomes

STUDIES ACROSS THE WORlD have demonstrated that effective communication is fundamental to the delivery of safe and high-quality health care. However, identifying the direct relationship between effective communication and patient health outcomes that can affect patient safety has proved more problemati

Complexities of emergency communication: clinicians' perceptions of communication challenges in a trilingual emergency department

Aims and objectives. To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department. Background. Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication. Design. A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview. Methods. Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis. Results. Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting.This study was funded by the Dean’s Reserve of the Faculty of Humanities, The Hong Kong Polytechnic University, under two grants (1-ZVA3) and (1-ZVBB