Barbara F. Sharf

Racial and ethnic disparities in the use of health services: Bias, preferences, or poor communication?

African Americans and Latinos use services that require a doctor’s order at lower rates than do whites. Racial bias and patient preferences contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and health behaviors. Research has shown that doctors have poorer communication with minority patients than with others, but problems in doctor-patient communication have received little attention as a potential cause, a remediable one, of health disparities. We evaluate the evidence that poor communication is a cause of disparities and propose some remedies drawn from the communication sciences.

Racial differences in doctors' information‐giving and patients' participation

Whether doctor‐patient communication differs by race was investigated in patients with pulmonary nodules or lung cancer.

The Dark Side of Truth(s) Ethical Dilemmas in Researching the Personal

This article explores the sometimes problematic issue of truth when conducting qualitative research on peoples lives. Four ethical dilemmas are presented relating to the potentially harmful consequences of truth encountered by the authors in their own research: a promise to share the analysis of a patients medical record containing unflattering comments by her physicians; the unintended sharing of a traumatic event, held secret since its occurrence, by a woman inmate; a disagreement with the Institutional Review Board over what constitutes ethical practice in online research; and an interview with a recently released political dissident in a totalitarian country. The authors advocate for multiple venues in which qualitative researchers can discuss ethical dilemmas such as these to learn from one anothers experience and together develop a more reflexive practice.

Confronting Cancer on thirtysomething: Audience Response to Health Content on Entertainment Television

This study addresses the potential of entertainment television to educate about serious subject matter, such as health content. Through the use of open-ended, in-depth interviews of regular viewers in two metropolitan sites, this study explores audience response to a fictionalized, serialized portrayal of ovarian cancer on thirtysomething. Our questions were directed to the audiences (a) viewing process, including interpersonal contact, identification with characters, and prior experience with cancer, (b) understanding of content, especially illness imagery and coping strategies, and (c) applications to real life, including questions, insights, knowledge, and actions. The details of this exploration indicate the complexity of audience response to this kind of content and suggest guidelines for health communicators as they work with the entertainment industry to embed health-promoting messages in the media.

Student response to gynecologic teaching associates

Gynecologic teaching associates teach the communication and psychomotor skills for breast and pelvic examinations in most medical schools in the United States and Canada. Evaluations of these gynecologic teaching associate programs have included faculty impressions of program effectiveness and measurement of student retention of skills but not student evaluations of the effectiveness and value of such programs. At the University of Illinois at Chicago students evaluated their gynecologic teaching associate program. High ratings were given to program organization and content; the knowledge, ability, and professionalism of the teaching associates; and the outcomes of the sessions with respect to the learning skills needed to perform the examinations. Students emphasized the importance of the ability of the teaching associates to provide immediate informative feedback and to reduce anxiety during the teaching sessions. Students tended to view their ability to perform breast examination to be greater than for the pelvic examinations but felt they learned more about both in the sessions. This information supports the value of the gynecologic teaching associate model in medical education.

Teaching patients to speak up: Past and future trends

The patient role as discussed in popular and professional literature is in a transitional period, but actual patient behaviors remain predominantly traditional. This article summarizes advice to the public concerning patient-physician communication from the past 25 years of popular periodicals and recent self-help literature. The few extant programs for improving patient communication skills are identified. Recommendations are made for more extensive patient-focused education and research regarding skills development and behavior change.

A rhetorical analysis of leadership emergence in small groups

A rhetorical framework based on Burkean theory is used to analyze the relative success of leadership contenders in small groups in obtaining cooperation of the other members and resolving the struggle for leadership. The study adds to a gradually accumulating body of qualitative group research. A series of five steps delineates critical responsibilities for this analysis. To illustrate and support the conceptual schema, it has been applied to recorded discourse generated in two small, zero‐history, leaderless task groups. The analyses reveal the importance of transcending symbolic divisions in leadership emergence.

Training gynaecological teaching associates

Summary. The Gynecological Teaching Associate (GTA) instructional method is recognized as excellent by the Association of Professors of Gynecology and Obstetrics Undergraduate Education Committee for the instruction of medical students and doctors in the skills required for performance of womens reproductive health evaluation (obstetric‐gynaecological history, breast and pelvic examinations, and PAP smear). The method is used in over 90% of American and Canadian medical schools and thus represents a major allocation of educational resources. This success is to a large extent dependent on the quality of training programmes for the GTAs. This paper provides a description of the training programme for GTAs at the University of Illinois at Chicago which has operated successfully for the last 3 years, resulting in a group of 18 GTAs who train approximately 450 medical students and residents each year. It is hoped that this information will help medical educators and planners to develop and/or maintain their GTA programmes (or equivalent in other countries) in the fiscally difficult times facing institutions of higher learning.

Trailblazing healthcare: institutionalizing and integrating complementary medicine.

OBJECTIVES This study examines three integrative health centers to understand their (1) historical development, organizational goals, and modalities, (2) the processes and challenges of integrating complementary and allopathic medicine, while encouraging staff collaboration, and (3) how each center becomes institutionalized within their community. METHODS We focus on three organizational case studies that reflect varying forms of integrative health care practices in three U.S. cities. Participant-observation and in-depth interviews with center directors were analyzed qualitatively. RESULTS Important patterns found within the three cases are (1) the critical role of visionary biomedical practitioners who bridge complementary and allopathic practices, (2) communicating integration internally through team interaction, and (3) communicating integration externally through spatial location, naming, and community outreach. CONCLUSION IM centers continue to blaze new trails toward mainstream access and acceptance by gathering evidence for IM, encouraging team collaboration within organizational contexts, constructing organizational identity, and negotiating insurance reimbursements. PRACTICE IMPLICATIONS IM is not the enactment of specific modalities, but rather a philosophy of healing. Though scheduling conflicts, skepticism, and insurance coverage may be obstacles toward IM, collaboration among specialists and with patients should be the ultimate goal.

Charting the Chart—An Exercise in Interpretation(s)

The multiauthored article is standard in the medical sciences, where the politics of the laboratory and the academy often loom larger than the singularity of the argument or grace of its execution. The following paper, however, depends upon the singularity of each of its authors and hails the individual grace of their arguments. Although collaborative, this paper is primarily collective, composed of unique readings of the same document. In its array of individual viewpoints and interpretations, it underscores the collective nature of the entries that constitute the single entity identified as the chart. As the record of one patients hospitalization is really a diverse collection of individual voices as well as professional interactions or viewpoints, so the responses of these readers are unique to each ones personal and professional backgrounds.1 —Suzanne Poirier, Ph.D., Literature2