Search citation statements
Paper Sections
Citation Types
Year Published
Publication Types
Relationship
Authors
Journals
In the film Cool Hand Luke, Paul Newman stars as BLuke,^a rebellious prisoner in a southern prison camp. Unable to tolerate the confinement of prison, Luke attempts an escape but is soon captured, returned to the prison and put in chains by the captain who aims to make an example of him in front of the others. Even in this vulnerable position, Luke refuses to give in and talks back to the captain, who, enraged, beats him and utters one of the most oft quoted lines in movie history:BWhat we got here is a failure to communicate.Ĉ ommunication failures are common in medicine, and none more so than when a patient tries to tell his or her story to the doctor (or for that matter, to any health professional). Who better to communicate concerns and wishes than patients themselves? Yet too often, patients bearing insights about their diagnosis are perceived as a distraction. We know from multiple studies that doctors habitually interrupt patients, shortcutting their efforts to explain their concerns; too few doctors have the patience to listen.Our collective failure to communicate was evident to me again as a result of my father's recent experience accessing urgent medical care. I received a call from my dad, a retired behavioral health care executive, saying that he had moderately severe abdominal pain (Bmore than 5 out of 10^) lasting for several hours, and while he initially assumed that it was a result of the large yogurt parfait he had consumed for breakfast, he thought it was curious that over the course of the morning the pain had moved from the mid part of his Bstomach^to his lower right side. As any patient with access to a computer might do, he 'Googled' his symptoms and was surprised to find that according to a popular lay medical website, he most likely was suffering from appendicitis.After phone consultation with his internist (who incidentally shared his concern), he was off to the emergency department (ED) for what both thought would be urgent triage and evaluation. Instead, with unrelenting right lower quadrant abdominal pain and repeated attempts to communicate with the ED triage staff by saying something unambiguous like BI think I have appendicitis,^he was left in the waiting area for several hours with his condition gradually worsening.
In the film Cool Hand Luke, Paul Newman stars as BLuke,^a rebellious prisoner in a southern prison camp. Unable to tolerate the confinement of prison, Luke attempts an escape but is soon captured, returned to the prison and put in chains by the captain who aims to make an example of him in front of the others. Even in this vulnerable position, Luke refuses to give in and talks back to the captain, who, enraged, beats him and utters one of the most oft quoted lines in movie history:BWhat we got here is a failure to communicate.Ĉ ommunication failures are common in medicine, and none more so than when a patient tries to tell his or her story to the doctor (or for that matter, to any health professional). Who better to communicate concerns and wishes than patients themselves? Yet too often, patients bearing insights about their diagnosis are perceived as a distraction. We know from multiple studies that doctors habitually interrupt patients, shortcutting their efforts to explain their concerns; too few doctors have the patience to listen.Our collective failure to communicate was evident to me again as a result of my father's recent experience accessing urgent medical care. I received a call from my dad, a retired behavioral health care executive, saying that he had moderately severe abdominal pain (Bmore than 5 out of 10^) lasting for several hours, and while he initially assumed that it was a result of the large yogurt parfait he had consumed for breakfast, he thought it was curious that over the course of the morning the pain had moved from the mid part of his Bstomach^to his lower right side. As any patient with access to a computer might do, he 'Googled' his symptoms and was surprised to find that according to a popular lay medical website, he most likely was suffering from appendicitis.After phone consultation with his internist (who incidentally shared his concern), he was off to the emergency department (ED) for what both thought would be urgent triage and evaluation. Instead, with unrelenting right lower quadrant abdominal pain and repeated attempts to communicate with the ED triage staff by saying something unambiguous like BI think I have appendicitis,^he was left in the waiting area for several hours with his condition gradually worsening.
BackgroundContext matters for the successful implementation of medical interventions, but its role remains surprisingly understudied. Against the backdrop of antimicrobial resistance, a global health priority, we investigated the introduction of a rapid diagnostic biomarker test (C-reactive protein, or CRP) to guide antibiotic prescriptions in outpatient settings and asked, “Which factors account for cross-country variations in the effectiveness of CRP biomarker test interventions?”MethodsWe conducted a cross-case comparison of CRP point-of-care test trials across Yangon (Myanmar), Chiang Rai (Thailand), and Hanoi (Vietnam). Cross-sectional qualitative data were originally collected as part of each clinical trial to broaden their evidence base and help explain their respective results. We synthesised these data and developed a large qualitative data set comprising 130 interview and focus group participants (healthcare workers and patients) and nearly one million words worth of transcripts and interview notes. Inductive thematic analysis was used to identify contextual factors and compare them across the three case studies. As clinical trial outcomes, we considered patients’ and healthcare workers’ adherence to the biomarker test results, and patient exclusion to gauge the potential “impact” of CRP point-of-care testing on the population level.ResultsWe identified three principal domains of contextual influences on intervention effectiveness. First, perceived risks from infectious diseases influenced the adherence of the clinical users (nurses, doctors). Second, the health system context related to all three intervention outcomes (via the health policy and antibiotic policy environment, and via health system structures and the ensuing utilisation patterns). Third, the demand-side context influenced the patient adherence to CRP point-of-care tests and exclusion from the intervention through variations in local healthcare-seeking behaviours, popular conceptions of illness and medicine, and the resulting utilisation of the health system.ConclusionsOur study underscored the importance of contextual variation for the interpretation of clinical trial findings. Further research should investigate the range and magnitude of contextual effects on trial outcomes through meta-analyses of large sets of clinical trials. For this to be possible, clinical trials should collect qualitative and quantitative contextual information for instance on their disease, health system, and demand-side environment.Trial registrationClinicalTrials.gov, NCT02758821 registered on 3 May 2016 and NCT01918579 registered on 7 August 2013.Electronic supplementary materialThe online version of this article (10.1186/s13063-019-3215-9) contains supplementary material, which is available to authorized users.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.