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2015, Zeitschrift für Allgemeinmedizin
Letter to the editor concerning Petzold TD "A good physician-patient cooperation requires common intentionality" : A g. Z Allg Med 2015; 91 (12): 525 German non English.
2008 •
The principle of informed consent to invasive diagnostic or therapeutic procedures is not applicable in most patients suffering from consciousness disorders. As in other medical situations, German law assigns priority to the patient's autonomy and employs the concept of presumed will inferred from third-party (e.g. relatives) communications or deduced from a living will. While discussion concerning the validity of such advance directives is ongoing, their applicability needs to be checked carefully in every case. When the patient's attitude or wish however remains unclear or not discernible, in an emergency situation medical activities must be directed without loss of time towards damage reduction and life preservation under all circumstances ("guaranteed provision of medical attention"). In clinical practice, efforts to deduce the patient's will must relate to the urgency and invasiveness of the intended medical procedures. This paper describes the framework of current legal rules and important case decisions involved in the process of decision-making for patients unable to give informed consent. Any such decisions must be documented comprehensively in hospital records.
Quality in Primary Health Care BIBLIOTICS JOURNALS Qual Prim Health Care
Negotiation of physician error2017 •
The research, adapted from a publication in a 2016 issue of the Journal of Pragmatics, reports on how a doctor and a patient negotiate the doctor's error which had negative implications for the patient's health in a Nigerian hospital consultative session. The patient who ultimately had a medication different from the one announced by the doctor placed the blame of her stagnated health on the doctor, a scenario that resulted in an interactive negotiation of responsibility for the error. The object of the case study report is therefore to highlight the negotiation strategies deployed by the parties and their socio-medical implications. Only one out of the two cases cited in Odebunmi has been selected on the basis of its high implications for patient-centred medicine and acceptable medical professional conduct. To foreground consultative issues, while the top down and bottom up analytical model has been used, strict theoretic details have been played down. Two main and six embedded discursive strategies interspesedly used by the doctor and patient are reported. The patient (Patient) evokes physical co-presences and Doctor's medical error respectively as a common ground mechanism and an accusative locution. In the full negotiation that follows, while the doctor (Doctor) constructs the therapy recommendation problem and poor health as an index of Patient's disorientation to his cues, Patient constructs her poor health as a product of Doctor's mismatched actions. Doctor, in spite of Patient's accusation, insists on her disorientation to his therapy directives, but Patient successfully constructs Doctor's action as professional negligence. Doctor's inability to provide a counterargument to the accusation leads him to manage the accused negligence with professional power and to strategically normalise the consultative encounter to reclaim his lost professional face and regain his authority and Patient's confidence. Although both parties suffer different degrees of memory loss in the interaction, the deontic status of the patient validates more of her claims than the doctor's does. This implicates the doctor as accountable for the patient's poor health. The doctor's redemption of his face notwithstanding, his display of professional negligence, not pardonable by overwork, and non-use of a systematic patient-centred style constitute core socio-professional issues that hampered the consultative, structural and Aesculapian processes in the clinic.
2017 •
The research, adapted from a publication in a 2016 issue of the Journal of Pragmatics, reports on how a doctor and a patient negotiate the doctor's error which had negative implications for the patient's health in a Nigerian hospital consultative session. The patient who ultimately had a medication different from the one announced by the doctor received placed the blame of her stagnated health on the doctor, a scenario that resulted in an interactive negotiation of responsibility for the error. The object of the case study report is therefore to highlight the negotiation strategies deployed by the parties and their sociomedical implications. Only one out of the two cases cited in Odebunmi has been selected on the basis of its high implications for patient-centred medicine and acceptable medical professional conduct. To foreground consultative issues, while the top down and bottom up analytical model has been used, strict theoretic details have been played down. Two main and six embedded discursive strategies interspesedly used by doctors and patients are reported. The patient (Patient) evokes physical co-presences and Doctor's medical error respectively as a common ground mechanism and an accusative locution. In the full negotiation that follows, while the doctor (Doctor) constructs the therapy recommendation problem and poor health as an index of Patient's disorientation to his cues, Patient constructs her poor health as a product of Doctor's mismatched actions. Doctor, in spite of Patient's accusation, insists on her disorientation to his therapy directives, but Patient successfully constructs Doctor's action as professional negligence. Doctor's inability to provide a counterargument to the accusation leads him to manage the accused negligence with professional power and to strategically normalise the consultative encounter to reclaim his lost professional face and regain his authority and Patient's confidence. Although both parties suffer different degrees of memory loss in the interaction, the deontic status of the patient validates more of her claims than the doctor's does. This implicates the doctor as accountable for the patient's poor health. The doctor's redemption of his face notwithstanding, his display of professional negligence, not pardonable by overwork, and non-use of a systematic patient-centred style constitute core socio-professional issues that hampered the consultative, structural and Aesculapian processes in the clinic.
Healthcare compliance has a very important influence on the final outcome of clinical treatment. Accordingly, the fulfilment/failure of compliance is mainly attributed to the patients' role in adhering to what clinicians have indicated and advised, instead of an agreed negotiation between the patient and the clinician's treatment objectives. In the paper, we define how the clinical colloquium can be a space of intentional sharing, in which both patients and health professionals can be involved in order to arrive at mutually agreed goals. We therefore introduce the deontic normative of joint commitments and discuss it in terms of clinical concordance and present various possibilities of an intersubjective negotiation of concordance as part of a dyadic conversation, which is detectable from a social ethology approach in the observation of 'bodily-centred signals'.
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TST. Transportes, Servicios y Telecomunicaciones
LOPES, Bruno, «Bruno Feitler, A Fé dos Juízes: inquisidores e processos por heresia em Portu-gal (1536-1774), Coimbra, Imprensa da Universidade de Coimbra, 2022, 355 páginas», TST. Transportes, Servicios y Telecomunicaciones, n.º 52, 2023, pp. 101-106.2023 •
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