Problems in Physician-Patient Communication: What do our Students See and Hear? A Qualitative Study with a Pragmatic Approach

Background: Efficient communication with patients is an indispensable necessity for physicians of the 21st century. Over the past decades, much work has been done nationally and internationally to instill this essential skill in undergraduate students and medical graduates are now formally trained to become better communicators. However, deficiencies persist and medical students of today still observe various issues when they observe physician-patient communication interactions in their training.Objective: To understand perceptions of undergraduate medical students about the difficulties in Physician-Patient communication (PPC) & take suggestions on how to overcome them.Methods: A qualitative study design was employed, with data collection through three focus group discussions with medical students studying in Wah medical college, Pakistan in October 2019. Thematic data analysis was done using Atlas-ti 8 software. A pragmatic approach was used to understand student perceptions about difficulties in PPC.Results: After open and selective coding of data, six major themes were identified. Five of these were in relation to students' perceptions about major difficulties with PPC. These included gap between teaching & practice; doctor patient ratio; lack of counselling; lack of empathy and no informational care. The last theme, Effective teaching of behavioral sciences was related to student suggestions for overcoming problems in PPC.Conclusion: The various issues regarding the problems in physician patient communication portray a realistic picture of our current communication practices. Various factors have been identified in this study and, the most practical solution to these problems lies in the effective teaching of behavioral sciences

Evaluation Of Diploma In Family Medicine Ensuring Quality Through CIPP Model

Background: To ensure quality of Diploma in Family medicine (DFM). An evaluation was conducted to determine the components and outcomes of the course for further development of the program. Methods: A Cross-sectional study was conducted with 15 students of three batches of DFM. Data collection form was designed on CIPP evaluation approach. It was used to collect information regarding goals and objectives, implementation strategy, satisfaction of instructor and trainees and impact of the program on the target population Descriptive measures (frequency and percentage distributions) were used to analyze the data on SPSS 19. Results: Majority (92%) were satisfied with the course content, organization, learning environment and teaching methods of Family medicine rotation. Most of the respondents (92%) were also satisfied with learning recourses accessible and assessment methodologies employed for ongoing assessment. They found ‘the atmosphere conducive for learning’ ,‘the rotations were a good experience, well organized with learning objectives provided at all rotations’ some suggestions made by students for improvement of the course ‘were teaching should be more interactive and more opportunity should be provided to participate with consultants’ The top rated rotations were dermatology, emergency medicine, ENT and orthopedics; where organizational learning environment and quality of delivery were considered as the best parts. Conclusion: The program was found successful in achieving its broad objectives. The graduating students found the training effective in enhancing team building abilities, independent thinking, analytical and problem solving skills and professional development. They were very satisfied with the administrative support (67%), infrastructure of the department (33%) and guidance by supervisors (67%). Key Words: Evaluation, Family medicine, Diplom

Unilateral renal agenesis with subseptate uterus and sacrococcygeal teratoma: A unique triad

Unilateral renal agenesis (URA) is a rare condition with a reported incidence of 0.93–1.8 per 1000 autopsies. It is commonly diagnosed as an incidental finding on imaging.URA is frequently associated with other genitourinary anomalies. Different associations have been described in both males and females, however, to our knowledge, it has not been reported with subseptate uterus (SSU) and sacrococcygeal teratoma (SCT) in the same individual. Here, we present a unique case of URA with SSU and SCT

Transoral flexible laryngoscope biopsy: Safety and accuracy

Objective: To determine the accuracy of transoral flexible laryngoscope (TFL) biopsy and also to identify the safety as office based procedure in terms of complications. Methods: This is a diagnostic study; the type of intervention is outpatient department based biopsy of laryngeal lesions. All patients seen in ENT outpatient department of Lyari General Hospital with suspicious lesions of Larynx were referred for Transoral Flexible Laryngoscopy Biopsy under local anesthesia. The specimens were sent for histopathology. The patients with benign pathology or carcinoma in situ were referred for direct laryngoscopy and biopsy. The sensitivity and specificity were calculated and the frequencies of complications were monitored to determine the complication rate. Results: During the course of study a total of 47 patients underwent TFL biopsy in office settings. Out of these patients 16 patients were referred for direct laryngoscopy biopsy. The study population included 32 men and 15 women with ages ranging from 28 to 52 years and mean of (39 ± 6) years. Among 43 patients squamous cell carcinoma was the final diagnosis in 31 patients. In the rest of 12 patients’ dysplasia and benign lesion was the diagnosis in 9 and 3 patients respectively. These 12 patients underwent direct laryngoscopy biopsy and 10 of them diagnosed with invasive carcinoma rest had benign lesions. Hence the specificity was 75.6% and sensitivity was 100%. None of the patients developed any serious complication. Conclusions: All patients with a suspicious lesion diagnosed by TFL biopsy as being benign or carcinoma in situ should have direct laryngoscopy for verification of the findings. But the results positive for carcinoma are reliable. In addition, this is a safe procedure. Keywords: Biopsy, Flexible laryngoscopy, Squamous cell carcinoma, Laryn

Risk factors associated with disease recurrence in patients with T4 staged Squamous Cell Carcinoma of the Oral Cavity treated with surgery and postoperative radiotherapy

Objective: To determine the association of clinical and pathological parameters on recurrence of treated stage T4squamous cell carcinoma of oral cavity patients managed with surgery followed by concomitant chemo and radiation therapy. Method: The retrospective, cohort study was conducted at Patel Hospital, Karachi, and comprised data of patients diagnosed with oral squamous cell carcinoma and admitted between January 1, 2014, and January 30, 2019. Patients of either gender aged 20-80 years who had a minimum follow-up of one year were included. Data was collected using the Head and Neck Cancer registry form and the medical record files. The subjects were also contacted by telephone when needed. The study end-points were disease-free survival and overall survival. Data was analysed using SPSS 21. Results: Out of the 83 patients, 65(78%) were male. The overall median(range) age was 46(20-80) years, and 43(52%) of them were aged 31-50 years. Overall, 15(18%) patients had positive margins and 48(58%) had proven cervical node metastasis on histopathology. Overall survival was 42.2% with the median(range) follow-up time was 14(9-21) months and 5-year disease-free survival was 45.8% with the median (range) follow-up time was 13(7-19). The factor that affected the final outcome was found to be the increasing nodal ratio (p=0.043). Conclusion: Among T4 oral squamous cell carcinoma patients treated with surgery and adjuvant therapy, the rate of disease recurrence was found to be high. Tumors with a high cervical nodal disease burden and/or margin involved were at substantially higher risk of recurrence. Key Words: Squamous cell carcinoma, Oral cancer, Recurrence, Survival