L'expérience intersubjective de la maladie chronique : ces maladies qui tiennent une famille en haleine...

[Table des matières] 1.1. Le problème du choix d'un paradigme en médecine. 1.2. Setting et méthodologie de l'étude. 2. Première situation : Héléna Brahms. 2.1. Situation médicale. 2.2. Face à la maladie. 2.3. Résultats du test de Szondi. 2.4. L'histoire de la famille. 2.5. La formation du couple. 2.6. La maladie : son irruption et ses conséquences. 3. Deuxième situation : un couple de malades - la famille Pergolès. 3.1. Situation médicale. 3.2. Face à la maladie. 3.3. L'histoire de la famille. 3.4.Résultats du test de Szondi. 3.5. Les maladies dans le couple. 3.6. Le style de communication et l'éthique des échanges dans la famille. 3.7. L'évolution de la famille durant l'intervention. 4. Troisième situation : Jérémie Poulenc. 4.1. Situation médicale. 4.2. Cadre de l'intervention. 4.3. La gestion de la maladie par le patient. 4.4. Le rapport au diagnostic, au traitement, au pronostic. 4.5. Le style de communication de la famille. 4.6. La survenue de l'invalidité. 4.7. Le climat familial actuel et l'horizon d'avenir. 5. Quatrième situation : Andreas Schoek. 5.1. Situation médicale. 5.2. Face à la maladie. 5.3. Le rapport au système de soins. 5.4. La maladie dans la famille. 6. Cinquième situation : Madeleine Fauré. 6.1. Situation médicale. 6.2. Contexte de l'intervention. 6.3. Définition du problème par la patiente, par les différents membres de la famille. 6.4. Attentes et évolution dans la compréhension du problème. 6.5 L'histoire de Madeleine et de Jean Fauré dans leur famille d'origine. 6.6. L'histoire du couple. 6.7. L'arrivée du premier enfant. 6.8. La formation d'une relation conjugale triangulaire. 6.9. Les aventures financières du mari et l'oppression croissante de l'épouse. 7. Sixième situation : Charlotte Offenbach. 7.1. Situation médicale. 7.2. Situation familiale. 7.3. Le mariage. 7. 4. La maladie dans la famille. 7.5. Rapport au système de soins. 7.6. Perspective du médecin traitant. 8. Synthèse. 8.1. Variables biologiques à retentissement psychosocial significatif. 8.2. L'expérience pathique de la maladie. 8.3. L'histoire des familles

L'adaptation au risque VIH/sida chez les couples homosexuels: version abrégée

[Table des matières] I. Introdution. 1. Objectifs de la recherche. 2. Hypothèse de la recherche. II. Méthodologie. 1. Méthodes d'observation. 2. Instruments de récolte des données. 3. Collectif. III. Résultats. 1. Résultats des interviews et des tests FAST. 2. Synthèse du test FAST. 3. Stratégies de protection contre le VIH dans les couples. 4. Usage du préservatif à l'intérieur du couple et à l'extérieur du couple. 5. Fidélité des deux partenaires, pas d'usage du préservatif entre eux. 6. Usage du préservatif à l'intérieur du couple pendant une longue durée puis abandon, pas de fidélité, accords concernant les partenaires extérieurs. 7. Stratégie mal appliquée ou discordance dans la déclaration. 8. Conclusions générales sur les stratégies de protection contre le VIH. 9. Circonstances et moments de la vie de couple problématiques pour la prévention du sida. 10. La formation du couple. 11. Stratégies de protection contre le VIH dans les couples. 12. Usage du préservatif à l'intérieur du couple et à l'extérieur du couple. 13. Fidélité des deux partenaires, pas d'usage du préservatif entre eux. 14. Usage du préservatif à l'intérieur du couple pendant une longue durée puis abandon, pas de fidélité, accords concernant les partenaires extérieurs. 15. Stratégie mal appliquée ou discordance dans la déclaration. 16. Conclusions générales sur les stratégies de protection contre le VIH. 17. Circonstances et moments de la vie de couple problématiques pour la prévention du sida. 18. La formation du couple. 19. Préservatifs peu appréciés et/ou "le feu de l'action". 20. Les nouveaux partenaires extérieurs ou les incidents de protection avec les partenaires extérieurs, lorsque les préservatifs ne sont pas utilisés au sein du couple. IV. Recommandations. V. Annexes. 1. Grilles d'entretiens. 2. Actions entreprises pour contacter des couples. 3. Synthèse des interviews et des tests FAST. 4. Mise en relation de la prise de risque et des capacités de négociation des couples

Patient expectations at a multicultural out-patient clinic in Switzerland

Background. Recognizing patient expectation is considered as an important objective for primary care physicians. A number of studies suggest that failure to identify patient expectations can lead to patient dissatisfaction with care, lack of compliance and inappropriate use of medical resources. It has been suggested that identifying patient expectations in multicultural contexts can be especially challenging. Objectives. The aim of the study was to compare health care expectations of Swiss and immigrant patients attending the out-patient clinic of a Swiss university hospital and to assess physicians' ability to identify their patients' expectations. Methods. Over a 3-month period, all patients attending the out-patient clinic at a Swiss university hospital were requested to complete pre-consultation surveys. Their physicians were requested to complete post-consultation surveys. Outcome measures were patients' self-rated health, resort to prior home treatment, patients' expectations of the consultation, physicians' perception of their patients' expectations and agreement between patients and physicians. Results. We analysed 343 questionnaires completed by patients prior to their consultation (> 50% immigrants) and 333 questionnaires completed by their physicians after the consultation. Most expectations were shared by all patients. Physicians had inaccurate perceptions of their patients' expectations, regardless of patients' origin. Conclusions. Our study found no evidence that immigrant patients' expectations differed from those of Swiss patients, nor that physicians had more difficulty identifying expectations of immigrant patients. However, physicians in our study were generally poor at identifying patients' expectations, and therefore inter-group differences may be difficult to detect. Our results point to the need to strengthen physicians' general communication skills which should then serve as a foundation for more specific, cross-cultural communication trainin

Physician Response to "By-the-Way” Syndrome in Primary Care

ABSTRACT: BACKGROUND/OBJECTIVE: "By-the-way” syndrome, a new problem raised by the patient at an encounter's closure, is common, but little is known about how physicians respond when it occurs. We analyzed the content of the syndrome, predictors of its appearance, and the physician response. DESIGN/PARTICIPANTS: Cross-sectional study of 92 videotaped encounters in an academic primary care clinic. RESULTS: The syndrome occurred in 39.1% of observed encounters. Its major content was bio-psychosocial (39%), psychosocial (36%), or biomedical (25%), whereas physician responses were mostly biomedical (44%). The physician response was concordant with the patient's question in 61% of encounters if the content of the question was psychosocial, 21% if bio-psychosocial, and 78% if biomedical; 32% of physicians solicited the patient's agenda two times or more in the group without, versus 11% in the group with, the syndrome (P = 0.02). In 22% of the encounters, physicians did not give any answer to the patient's question, particularly (38.5%) if it was of psychosocial content. CONCLUSIONS: "By-the-way” syndrome is mainly bio-psychosocial or psychosocial in content, whereas the physician response is usually biomedical. Asking about the patient's agenda twice or more during the office visit might decrease the appearance of this syndrom

Violence in primary care: Prevalence and follow-up of victims

BACKGROUND: Primary care physicians underestimate the prevalence of domestic violence and community violence. Victims are therefore at risk of further episodes of violence, with psychological and physical consequences. We used an interview to assess the prevalence of domestic and community violence among Swiss natives and foreigners. In a follow-up study, we evaluated the consequences of the interview for the positive patients. METHODS: We evaluated the prevalence of violence by use of a questionnaire in an interview, in an academic general internal medicine clinic in Switzerland. In a follow-up, we evaluated the consequences of the interview for positive patients. The participants were 38 residents and 446 consecutive patients. Questionnaires were presented in the principal language spoken by our patients. They addressed sociodemographics, present and past violence, the security or lack of security felt by victims of violence, and the patients' own violence. Between 3 and 6 months after the first interview, we did a follow-up of all patients who had reported domestic violence in the last year. RESULTS: Of the 366 patients included in the study, 36 (9.8%) reported being victims of physical violence during the last year (physicians identified only 4 patients out of the 36), and 34/366 (9.3%) reported being victims of psychological violence. Domestic violence was responsible for 67.3% of the cases, and community violence for 21.8%. In 10.9% of the cases, both forms of violence were found. Of 29 patients who reported being victims of domestic violence, 22 were found in the follow-up. The frequency of violence had diminished (4/22) or the violence had ceased (17/22). CONCLUSION: The prevalence of violence is high; domestic violence is more frequent than community violence. There was no statistically significant difference between the Swiss and foreign patients' responses related to the rates of violence. Patients in a currently violent relationship stated that participating in the study helped them and that the violence decreased or ceased a few months later