Challenges to physician–patient communication about medication use: a window into the skeptical patient’s world

Patients frequently do not take medicines as prescribed and often do not communicate with their physicians about their medication-taking behavior. The movement for “patient-centered” care has led to relabeling of this problem from “noncompliance” to “nonadherence” and later to a rhetoric of “concordance” and “shared decision making” in which physicians and patients are viewed as partners who ideally come to agreement about appropriate treatment. We conducted a qualitative content analysis of online comments to a New York Times article on low rates of medication adherence. The online discussion provides data about how a highly selected, educated sample of patients thinks about medication use and the doctor–patient relationship. Our analysis revealed patient empowerment and self-reliance, considerable mistrust of medications and medical practice, and frequent noncommunication about medication adherence issues. We discuss how these observations can potentially be understood with reference to Habermas’s theory of communicative action, and conclude that physicians can benefit from better understanding the negative ways in which some patients perceive physicians’ prescribing practices

BDSM Disclosure and Stigma Management: Identifying Opportunities for Sex Education

While participation in the activities like bondage, domination, submission/sadism, masochism that fall under the umbrella term BDSM is widespread, stigma surrounding BDSM poses risks to practitioners who wish to disclose their interest. We examined risk factors involved with disclosure to posit how sex education might diffuse stigma and warn of risks. Semi-structured interviews asked 20 adults reporting an interest in BDSM about their disclosure experiences. Most respondents reported their BDSM interests starting before age 15, sometimes creating a phase of anxiety and shame in the absence of reassuring information. As adults, respondents often considered BDSM central to their sexuality, thus disclosure was integral to dating. Disclosure decisions in nondating situations were often complex considerations balancing desire for appropriateness with a desire for connection and honesty. Some respondents wondered whether their interests being found out would jeopardize their jobs. Experiences with stigma varied widely