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E-raamat: Patient-Centred Medicine in Transition: The Heart of the Matter

  • Formaat: PDF+DRM
  • Sari: Advances in Medical Education 3
  • Ilmumisaeg: 27-Jan-2014
  • Kirjastus: Springer International Publishing AG
  • Keel: eng
  • ISBN-13: 9783319024875
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  • Formaat: PDF+DRM
  • Sari: Advances in Medical Education 3
  • Ilmumisaeg: 27-Jan-2014
  • Kirjastus: Springer International Publishing AG
  • Keel: eng
  • ISBN-13: 9783319024875
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Challenging previous models of communication between patients and doctors, this publication explains how making it a broader, team-focused, non-technical encounter can improve patient outcomes as well as increase patient safely in clinical settings.



This book challenges functional models for more aesthetic and ethical models, where communication is grounded in values systems of cultures. Here, communication is treated as a distributed phenomenon involving networks of persons, activities and artifacts, and extends beyond doctor-patient relationships to working in and across teams around patients. The purpose of the book is to stimulate thinking about how patient care and safety may be improved through a focus upon the ‘non-technical’ work of doctors – interpersonal communication, teamwork and situation awareness in teams. The focus is then not on the personality of the doctor, but on the dynamics of relationships which form doctors’ multiple identities.

Arvustused

From the book reviews:

Selected as Highly Commended at BMA Medical Book Awards for 2014.

This book usefully brings together the history, development and important tenets of patient-centred medicine, making it an almost unique reference for this important area of change in how medicine is delivered. brings together a wealth of evidence and information that may well be pivotal in both changing the way we educate our future health professionals, particularly doctors, but also deliver healthcare. (BMA Medical Book Awards, September, 2014)

The book draws on psychology, sociology, the arts, humanities, feminism, linguistics and philosophy. This is a book aimed mainly at the serious student of communication gold dust if you are doing a PhD or a masters in professional practice. It would also sit well on the shelf of the front line clinician seeking to understand the numerous situations in clinical practice that are bedevilled by conflict, crossed wires, unvoiced anxieties and other communication failures. (Trish Greenhalgh, Nursing Standard, Vol. 29 (20), January, 2015)

1 Introduction
1(20)
A Health Warning
1(2)
What's the Point of Communication in Medicine?
3(6)
Styles of Communication
9(2)
The Democratic Encounter
11(10)
Part I Communication in Medicine: Democracy and Its Discontents
2 Communication Hypocompetence: An Iatrogenic Epidemic
21(10)
Introduction
21(1)
An Epidemic of Medicine's Own Making
22(2)
Communication Skills Training
24(1)
The Role of the Medical Humanities
25(2)
Evidence
27(2)
Conclusion
29(2)
3 Democracy in Medicine
31(16)
Medicine Is by Nature a Political Domain
31(2)
Articulating a Common Wealth
33(4)
Democracy and Its Discontents
37(3)
Medical Education Can Democratize Medicine
40(7)
4 Patient-Centredness Without a Centre
47(10)
Mutuality as a Model of Care
47(4)
Communication and Clinical Reasoning
51(6)
5 How Physicians Think Can Be Judged from How They Listen and Speak
57(10)
For the Hardened Students of Communication Only
57(5)
Communication Is (Necessarily) Ambiguous
62(5)
6 A New Wave of Patient-Centredness
67(12)
Introduction
67(1)
Journeys Without Maps
68(1)
The Many Faces of Patient-Centredness
69(2)
A Brief History of Patient-Centredness
71(8)
7 Models of Patient-Centred Care
79(16)
Where Is Patient-Centredness' Centred?
79(2)
Classification of Types of Patient-Centredness
81(1)
Paternalism as Patient-Centredness
81(1)
Patient-Centredness as Varieties of Patient Autonomy
82(13)
Empowerment
82(2)
Advocacy
84(1)
Patient-Centredness as Varieties of Collaboration and Mutuality
84(1)
Patient as Catalyst for Interprofessional Activity
84(1)
Mutuality: Relationship-Centred Care Model
85(1)
Deeper Mutuality: Psychodynamics and the Therapeutic Alliance
86(1)
Local Ecosystem
87(1)
Clinical Reasoning Model
88(1)
Pedagogical (Learning and Teaching) Model
89(2)
'Difference' Model
91(1)
Intertextuality Model
92(1)
Patient-Centredness as Patient Connectedness in Online Communities Model
93(1)
Dysfunctional: Default Care
93(2)
8 What Is Meant by 'Empathy'?
95(16)
Education for Communication Must Go Deeper Than 'Skills'
95(5)
All About Empathy
100(3)
Communication, Virtue, and Virtuosity
103(8)
9 Gender Matters in Medical Education
111(18)
Introduction: The Gender Shift in Medicine
111(1)
Does Gender Matter?
112(2)
A Feminist Medical Education
114(2)
Women Doctors in the Workforce
116(3)
Drawing on Women's Studies to Enrich Medical Education: Gendered Ways of Thinking
119(2)
Challenging Binary Thinking
121(2)
'Liquid' Thinking and the Use of Metaphor
123(2)
As Medicine Is Feminized, Will Medical Education Follow?
125(4)
Part II Deep Theorizing in Communication in Medicine: Relationships Between Team Process and Practitioner Identity
10 Working and Learning in 'Teams' in a New Era of Health-Care
129(10)
From Jigsaws to Systems
129(3)
What Is a 'Team'?
132(3)
'Nets' and 'Knots' in Team-Based Learning
135(4)
11 Theorizing Team Process Through Cultural-Historical Activity Theory (CHAT): Networking and Knotworking
139(10)
A Networking Primer
139(1)
A Knotworking Primer
140(2)
Two Ways of Coming Together: Metaphor and Metonymy
142(2)
Decolonizing Teamwork to Open Up New Horizons
144(5)
12 Theorizing Team Process Through a Foucauldian Perspective: Gaining a Voice in Team Activity at the Clinical Coalface
149(14)
'I Was Unhappy with Him to Carry on': Fearless Speech and Moral Courage in New Team Work Settings
149(3)
Parrhesia
152(2)
Speaking Up and Speaking Out
154(5)
Dialogical Climates and Hospitality
159(2)
Conclusions
161(2)
13 Theorizing Team Process Through Actor-Network-Theory (ANT): Communication Practice as a Theory in Action
163(20)
Prologue
163(1)
Section I: The Architecture of ANT
164(6)
Introduction
164(1)
ANT Offers an Apology
164(1)
What Are Actors and Networks and How Do They Link?
165(1)
Symmetry Between Humans, Material Objects, and Immaterial Languages
166(2)
What Are Networks?
168(2)
Feasibility
170(1)
Section II: Let's Go to Work! ANT as a Research Methodology
170(10)
Introduction
170(1)
Problematization
171(3)
Initiation of a Network: Champions Meet Sceptics
174(1)
Funding
175(1)
A Multiprofessional Conference
176(1)
Hard and Soft Design
176(1)
Team Self-Review
177(1)
Networking with Clinicians and Academics
177(1)
Research Texts
178(1)
Public Engagement Through the Arts
178(1)
Work-Net/Network Effects
179(1)
Section III: Limitations to ANT-Based Research
180(3)
ANT Research Demands Specialists
180(1)
Can ANT Demand Both Precision and Ambiguity?
180(1)
Does ANT Support Animism?
181(1)
Resisting Reduction
182(1)
14 Theorizing Team Process Through Deleuzian Rhizomatics: Becoming a Medical Professional in Nomadic Teams
183(22)
Introduction: From Being to Becoming
183(4)
Deleuzian Becoming: Processes and Assemblages
187(2)
Three Planes of Becoming
189(4)
Becoming a Diagnostician
193(1)
The Undoing of the Modern Clinical Gaze
193(3)
Becoming Medical Professionals Through New, Work-Based Textual Practices
196(6)
'Medutainment': Reflexive Accounting in the Public Realm
202(3)
15 Team Process and Complexity Theory: Blunting Occam's Razor
205(12)
Learning as a Complex Activity
205(2)
Learning Theory at the Cutting Edge
207(5)
A Close Shave with Occam's Razor
207(1)
Contrasting Approaches to Complexity Theory
207(1)
Three Approaches to Learning as a Complex Social Phenomenon
208(2)
What Unit of Analysis?
210(1)
Attractors and Dissipative Structures
211(1)
Patterns of Resistance to the Values Advertised by Complexity Theory
212(2)
Learning Defined
213(1)
The Conditions of Possibility for the Emergence of Complexity Theory as an Explanatory Model in Medical Education
214(3)
16 Building a Collaborative Community of Practice in Medical Education Research
217(16)
What Is a 'Collaborative' Community of Medical Education Researchers?
217(2)
Three Platforms for Collaboration
219(2)
Conditions for Collaboration
221(12)
Developing Interdisciplinarity
221(6)
Aligning Epistemologies, Axiologies, and Ontologies
227
Part III A Brief but Provocative Conclusion
17 Conclusion: Professing Medical Identities in the Liquid World of Teams
233(6)
Putting Medicine on the Couch
233(3)
Professing Medicine
236(3)
References 239(20)
Author Index 259(4)
Subject Index 263
Alan Bleakley is Professor of Medical Education and Medical Humanities at Plymouth University Peninsula School of Medicine, UK, recently formed from the dissolution of Peninsula Medical School, where he was Deputy Director of the Institute of Clinical Education, internationally recognized as a leading medical education academic and research centre. He initially studied zoology and physiology and biochemistry, but switched to psychology, where his interests in brain science soon faded to be replaced by a passion for a more arts and humanities based psychology. He trained as a psychotherapist, obtaining a DPhil from Sussex University, and practiced for over 25 years, also running qualifying courses in psychotherapy for the University of Exeter, and education in communication for GPs and other health practitioners. He also taught psychodynamic therapies on a doctoral qualifying course for clinical psychologists also at the University of Exeter. Alan came into medical education some years ago, where he has become a leading international figure, especially in the field of theory.