Jean M. Goodwin

Physician behaviors that correlate with patient satisfaction.

The behavior of 15 internal medicine residents, each with 10 patients, was observed through a one-way mirror. Ratings by the patients of satisfaction with their physicians were also obtained. Patient satisfaction correlated strongly with ratings for physician courtesy and information-giving, Nonverbal behaviors such as eye contact, bodily positioning, and physical contact did not correlate with patient satisfaction. The correlations between physician behavior and patient satisfaction did not hold for the four women physicians studied.

Patient characteristics that influence physician behavior

We examined whether four patient characteristics (age, ethnicity, sex and appearance) influenced five physician behaviors with the patient (interviewing, nonverbal attention, courtesy, information giving and empathy). Ten physician-patient interactions were observed through a one-way mirror for each of 15 physicians. Physicians were rated higher on information giving (p = 0.002) and empathic skills (p = 0.02) when they were with female patients; on interviewing (p = 0.02) and empathy (p = 0.0007) with Anglo-American compared with Spanish-American patients; on interviewing (p = 0.01), nonverbal attention (p = 0.001) and courtesy (p = 0.02) when with the best groomed patients; and on courtesy (p = 0.03) with elderly patients. In addition, there were fewer physician-initiated interruptions with female patients (p = 0.03) and with well-groomed patients (p = 0.02). Each of the four patient characteristics studied acted independently in influencing physician behavior. The recognition that patient characteristics influence physician behavior should stimulate physicians to examine their reactions in order to insure that all types of patients receive thorough, courteous and empathic care.

Prior incest in mothers of abused children

Previous studies have shown that most abusing parents have a history of physical abuse or neglect in their own childhoods. There is little data on the frequency of prior sexual abuse among parents who physically or sexually abuse their children. Many case reports describe the uncovering of a prior incest experience in a parent during the investigation of the childs current incest accusation, but it is unclear how frequently this occurs. One hundred mothers of abused children were asked about sexual incidents that occurred before age 18; the control group consisted of 500 normal women from the same community who were surveyed during meetings of various voluntary organizations. Age and ethnicity did not differ in the two groups. Of the mothers of abused children, 24% reported a prior incest experience, whereas only 3% of the control women reported prior incest. This eightfold difference was highly significant. The 34 mothers from families where sexual abuse was occurring were no more likely to report prior incest than were the 66 mothers from families where physical abuse occurred. The one case of genital mutilation of a child occurred in a family where both parents had been incest victims. Case studies indicate that the parent who has been an incest victim has inhibitions and fears about tenderness, traceable to the childhood incest experience, which are important in the development of either physical abuse or sexual abuse in the family.

Psychiatric symptoms in disliked medical patients.

Twenty-two patients seen in a clinic for systemic lupus erythematosus were tested for organicity, depression, anxiety, and hostility. Four of the clinics physicians ranked these patients from most liked to least liked. In three of the four physicians, dislike was significantly correlated with the patients degree of organicity. Ten of the patients were ranked among the three most disliked patients by one or more of the ranking physicians. This group of most disliked patients contained all patients with signs of organic brain damage and all suicidal patients. Dislike of a patient by the physician may be a clue to serious psychiatric impairment.

Suicide attempts in sexual abuse victims and their mothers

Suicide attempts occurred in 11 of 201 (5.4%) families in which sexual abuse was substantiated during a 2-year study period. Thirteen attempts occurred in the eleven families--five in mothers and eight in daughter-victims. No perpetrators in this social agency sample attempted suicide. Three mothers made attempts within the 1st week after the sexual abuse report; these three had borderline personalities, prior suicide attempts, personal histories of incest, and, surprisingly, all returned rapidly to adequate maternal functioning. The two mothers who made attempts later had primary depressions with underlying dependent personalities and never returned to successful mothering of their victimized daughters, both of whom themselves attempted suicide later in the familys treatment course. All eight daughters who attempted suicide were 14 to 16 years old and had been involved in incest with father figures. None of their families remained intact after the disclosure of incest, and their mothers actively blamed and disbelieved these victims. Seven of the eight had behavior problems which may have masked depression.

Psychological effects of vulvectomy

Abstract A survey of post-vulvectomy patients revealed that compared with post-hysterectomy patients, they are more likely to be depressed, to harbor feelings of sexual guilt, and to have encapsulated deficits in reality testing. Some of these problems may be prevented. The patient undergoing vulvectomy should receive detailed information before and after the surgery, and psychosexual counseling should be offered to her and her sexual partner on a long-term basis.

Social bonds in a healthy elderly sample: Characteristics and associated variables

Social bonds were examined in 256 healthy, independent-living elderly men and women using the Interview Schedule for Social Interaction (ISSI). Multivariate techniques were used to test for relationships between six dimensions of social bonds, as measured by the ISSI, and demographic characteristics as well as scores from the Kellner-Sheffield Symptom Questionnaire, the Jacobs Cognitive Screening Exam, the Halstead Category Test and the Wechsler Memory Scale. The study participants reported involvement in a range of satisfying, supportive, interpersonal relationships. Significant associations were found between social bonds and income, marital status, work status and health status. Emotional status, cognitive functioning, and memory were found to be independent of social bonds in our statistical model.

Mother-daughter incest

Abstract Reports of mother-daughter incest are conspicuously absent from the extensive literature on the sexual abuse of children. When homosexual incest has been reported, the relationship usually involves father and son. In some reported cases of father-daughter incest, the mother had an active role in the sexual act. There is one reported case of grandmother-grand-daughter incest. In the present case, the victim, L., entered psychotherapy because of migraine headaches. She was a university student, struggling, ambivalently, to separate from a jealous and possessive mother. She had been involved in several homosexual affairs which had ended with L. rejecting her partner. Early in therapy, she made a self-mutilating suicide attempt. L. was the only child of an older, lower middle class couple. Father was a passive, ineffectual man, overshadowed by L. s mother. Soon after L. was born, mother and father began sleeping in separate bedrooms. When L. was six years old, mother invited her to share her bed. L. had a room of her own, but was allowed to sleep there only when mother entertained her homosexual lover. L. recalls being extremely jealous of her mothers lover. Starting at age 8, L. recalls awakening to find mother kissing L. on the lips or fondling her breasts. L. thinks that genital fondling also took place while L. was asleep. At age 14 L. insisted that she sleep alone because she felt there was “something wrong” with her relationship with mother. After two years of psychotherapy, L. was able to separate successfully from mother. Soon after this, she rekindled a relationship with a male friend and later married. It can be difficult to distinguish a sexually exploitative mother-daughter relationship from a normal physical closeness that occurs between mothers and female children. This closeness is critical in the development of mothering behaviors in the daughter. Seductive behavior in mothers is more socially tolerated than similar behavior in male caretakers. In some cultures, mothers actively masturbate their nursing infants. In the case of L., the sexual relationship between mother and daughter parallels the patterns seen in father-daughter incest. The incest behavior occurred in the context of a deteriorated husband-wife relationship. L. was confused about whether to relate to mother as a parent or as a sex partner. Sexual contact began when the patient was pre-pubertal and consisted mainly of fondling. Ls memories of this contact are vague and dreamlike, and were revealed after a substantial therapeutic relationship had been established. Ls subsequent homosexual encounters were a repetition of her seduction by her mother. Less explicit maternal seductions have been implicated in the pathogenesis of female homosexuality. As more women with homosexual life-styles take on the single parenting of daughters, reports of mother-daughter incest may become more common.

Grandfather - granddaughter incest: A trigenerational view

Grandfather-granddaughter incest accounts for about 10% of all reported cases of intrafamilial childhood sexual abuse. In a sample of 10 such cases, all referrals came from mothers of the child victims; six of these mothers had themselves been abused in childhood by the perpetrator. For eight of the 10 perpetrators, multiple child sexual victims were identified in a pattern that suggests facultative pedophilia. Only two of the 18 grandchildren sexually abused by the 10 grandfathers were asymptomatic at the time of report. Grandchild victims from chaotic families showed educational and behavioral symptoms; those from stable families exhibited fears and phobias. Eight of the 18 grandchildren were victimized by multiple perpetrators. The results cast doubt on the assumption that grandparent incest is a benign form of abuse and indicate that there is some justification for the fears expressed by adult incest victims about visitation between their children and the father-perpetrator.

Use of drawings in evaluating children who may be incest victims

Five semi-structured drawing tasks are described which have been helpful in evaluating children who may be incest victims. Such children can be asked to do a kinetic family drawing, a drawing of the alleged perpetrator, a drawing of their house, a drawing of their own body, or a drawing of a dream. In a sample of 19 alleged victims, all children under 12 drew freely and expressed relief at being asked to draw. Children 12 and over tended to accept a drawing task only if it was structured as diagramming. These tasks were also found to be helpful in evaluating brothers of alleged victims to determine how aware the boys were of the incest situation and how critical it was for them to be included in therapy. Such drawings can be collected in pediatric and gynecologic settings as well as in the playroom. Use of drawings allows the physician to respect the childs developmental needs while obtaining the information about the incest complaint necessary for medical, protective, and forensic purposes.