Voices from the Silent World of Doctor and Patient

Starr, Joann; Zawacki, Bruce E.

doi:10.1017/s0963180199802023

Cited by 5 publications

(4 citation statements)

References 1 publication

(1 reference statement)

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“… 44 57 Situations where professional goals and means are incompatible with the personal goals will remain a dilemma. 58 However, a goal hierarchy may be an appropriate tool to identify and discuss openly and non-judgmentally the clashes of interest that occur when patients find that professional advice is in contradiction to their wishes.…”

Section: Discussionmentioning

confidence: 99%

How do we deal with multiple goals for care within an individual patient trajectory? A document content analysis of health service research papers on goals for care

et al. 2015

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ObjectivesPatients with complex long-term needs experience multiple parallel care processes, which may have conflicting or competing goals, within their individual patient trajectory (iPT). The alignment of multiple goals is often implicit or non-existent, and has received little attention in the literature. Research questions: (1) What goals for care relevant for the iPT can be identified from the literature? (2) What goal typology can be proposed based on goal characteristics? (3) How can professionals negotiate a consistent set of goals for the iPT?DesignDocument content analysis of health service research papers, on the topic of ‘goals for care’.SettingWith the increasing prevalence of multimorbidity, guidance regarding the identification and alignment of goals for care across organisations and disciplines is urgently needed.Participants70 papers that describe ‘goals for care’, ‘health’ or ‘the good healthcare process’ relevant to a general iPT, identified in a step-wise structured search of MEDLINE, Web of Science and Google Scholar.ResultsWe developed a goal typology with four categories. Three categories are professionally defined: (1) Functional, (2) Biological/Disease and (3) Adaptive goals. The fourth category is the patient's personally defined goals. Professional and personal goals may conflict, in which case goal prioritisation by creation of a goal hierarchy can be useful. We argue that the patient has the moral and legal right to determine the goals at the top of such a goal hierarchy. Professionals can then translate personal goals into realistic professional goals such as standardised health outcomes linked to evidence-based guidelines. Thereby, when goals are aligned with one another, the iPT will be truly patient centred, while care follows professional guidelines.ConclusionsPersonal goals direct professional goals and define the success criteria of the iPT. However, making personal goals count requires brave and wide-sweeping attitudinal, organisational and regulatory transformation of care delivery.

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Section: Discussionmentioning

confidence: 99%

How do we deal with multiple goals for care within an individual patient trajectory? A document content analysis of health service research papers on goals for care

et al. 2015

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“…Evaluations of integration initiatives have discussed paradigmatic clashes as well as practical challenges (e.g., Coulter, 2004). Situations where there is a clash between personal goals and professional goals of care, such as when cancer patients decide to use alternative treatments only (Author 1 et al, 2012(Author 1 et al, , 2016Author 1, 2013Author 1, , 2015aCoulter 2004), will remain an ethical and practical dilemma to health professionals (Starr and Zawacki, 1999;ZZ et al, 2015).…”

Section: What Can Phenomenological and Social Perspectives On Health mentioning

confidence: 99%

“…Coulter, 2004). Situations where there is a clash between personal goals and professional goals of care, such as when cancer patients decide to use alternative treatments only (Coulter, 2004;Mulkins et al, 2015;Salamonsen 2013Salamonsen , 2015Salamonsen et al, 2012a), will remain an ethical and practical dilemma to health professionals (Salamonsen 2015(Salamonsen , 2016Starr and Zawacki, 1999).…”

Section: The Need For Complementary Epistemologies In Future Public Hmentioning

confidence: 99%

Epistemological challenges in contemporary Western healthcare systems exemplified by people’s widespread use of complementary and alternative medicine

Salamonsen

Ahlzén

2017

Health (London)

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Modern Western public healthcare systems offer predominantly publicly subsidized healthcare traditionally based on biomedicine as the most important basis to cure persons who suffer from disorders of somatic or psychiatric nature. To which extent this epistemological position is suitable for this purpose is under scientific debate and challenged by some people's personal understandings of health and illness, their individual illness experiences and their decision-making. Current studies show decreasing levels of patient trust in Western public healthcare and a widespread patient-initiated use of complementary and alternative medicine which is often linked to unmet patient-defined healthcare needs. Patients'/complementary and alternative medicine users' understandings of their afflictions are often based on elements of biomedical knowledge as well as embodied and experience-based knowledge. We believe this points to the need for a phenomenologically and socially based understanding of health and illness. In this article, we analyze challenges in contemporary healthcare systems, exemplified by people's widespread use of complementary and alternative medicine and based on three ways of understanding and relating to unhealth: disease (the biomedical perspective), illness (the phenomenological perspective), and sickness (the social perspective). In public healthcare systems aiming at involving patients in treatment processes, acknowledging the coexistence of differing epistemologies may be of great importance to define and reach goals of treatment and compliance.

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“…It is not a stretch to think that Dax's case has been the primary catalyst for this belief given that it has received so much more attention than that of any other burn patient. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]24 However, Dax's case is about one burn patient with one set of experiences and but one point of view about burn care.…”

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confidence: 99%

Getting Past Dax

Gerrek

2018

AMA Journal of Ethics

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Much has been written about Dax Cowart's tragic burn injury, treatment, and recovery. While Dax's case is certainly important to conversations regarding decision making in burn care, his is not the only story there is. In this article, the case of Andrea Rubin, also a severe burn survivor, is introduced as another voice in this conversation. Her experience during treatment and recovery is very different from Dax's and should cause us to at least pause and reconsider how we think about treatment and decision making in burn care.

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Voices from the Silent World of Doctor and Patient

Cited by 5 publications

References 1 publication

How do we deal with multiple goals for care within an individual patient trajectory? A document content analysis of health service research papers on goals for care

How do we deal with multiple goals for care within an individual patient trajectory? A document content analysis of health service research papers on goals for care

Epistemological challenges in contemporary Western healthcare systems exemplified by people’s widespread use of complementary and alternative medicine

Getting Past Dax

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