Doctor-Patient Relationship: The Difficult Balance between Patient Psychology and Community Sociology

Psychology and sociology share a common object of study, human behaviour, but from different perspectives. Sociologists have focused on macro variables, such as social structure, education, gender, age, race, etc., while psychology has focused on micro variables such as individual personality and behaviours, beliefs, empathy, listening, etc. Despite the importance of interpersonal relationship skills, they depend on the community or social context in which communication takes place, and by themselves may have little relevance in the consultation. The purely psychological analysis of the doctor-patient relationship often leads to an idyllic vision, with the patient-centred consultation as the greatest exponent, which rarely occurs in real life. The purely sociological or community / social analysis of the doctor-patient relationship leads to a negative view of the consultation, which is always shown as problematic. But, the psychological system in the doctor-patient relationship cannot be neglected, and its study is of importance, at least as an intermediate mechanism that is created through socio-community relations. Although the same social causes are behind the doctor-patient relationship, when acting on psychological factors in the consultation, they act as an optical prism scattering socio-community relations that affect the doctor and the patient, giving rise to a beam of different colors of doctor-patient relationship. In doctor-patient relationship there is a modality of psychotherapy, where attitudes, thoughts and behaviour of the patient, can be change, as well as it can be extended on the way of understanding and therefore changing, his social context. Because of the distance between socio-community relations and the form of doctor-patient relations is growing in complex societies, under these conditions, the sociological factor gives the important place to the psychological factor. Given these difficulties of the doctor-patient relationship one may ask how general medical practice can persist with the usual model of doctor-patient relationship. Pain and the desire to relieve them are the basic reasons for the patient and the doctor, and they do not disappear due to the contradictions of the doctor-patient relationship. In this way, the confrontation between sociological and psychological vision is replaced by an alliance of both currents, and each of them takes on meaning only in the general vision.

Strategies to Improve Therapeutic Compliance in General Medicine

Within the framework where overlap therapeutic alliance, patient-centred consultation and shared decision-making, the strategies to increase compliance during the consultation in general medicine are inserted. A strategy is, in a strict sense, an organized, formalized and oriented procedure to obtain a clearly established goal. Its application in daily practice requires the improvement of procedures and techniques whose detailed choice and design are the responsibility of the doctor. To achieve the goal of improving compliance in general medicine, within this model of patient-centred medicine / therapeutic alliance / shared decisions, a number of strategies can be cited: 1) Establish rapport and continuity of care that allows building trust; 2) Ensure confidentiality; 3) Sensitive exploration of adverse drug reactions and prevention of their effects on compliance; 4) Simplify the therapeutic regimen; 5) Self-monitoring; 6) Avoid giving the impression that the drug replaces the need for changes in habits (such as diet, exercise and smoking cessation); 7) Know the patient's agenda, explore perceptions of the disease, and assess the importance that the patient attaches to compliance, and their confidence in achieving it; this also includes understand and tolerate that the chronic patient sometimes gets tired and abandons the treatment that is necessary; 8) Involve the patient in the decision; and, 9) Motivational Interviewing and negotiation of therapeutic objectives, although they seem minimal from doctor point of view. Finally, it must be remembered that the patient always has the last word to accept our indications or not.

A public health program and others for about 10,000 villagers in the Kutubu area of Papua New Guinea (PNG)

The paper describes the health conditions in villages of the Kutubu area in the Southern Highlands province of Papua New Guinea from 1993 to 1995. A set of actions were planned aiming at improving the health status of people living in these villages as well as the efficiency of medical services provided to these communities through a public health program, which did not exist earlier. After two years, it was shown that the combination of an adequate action plan, appropriate human and financial resources can produce significant results and marked improvement health wise for a population in dire needs.

Automatic classification of Malaria Using Artificial Neural Network

Malaria is one of the three most serious diseases worldwide, affecting 225 million infections each year in Sudan, mainly in the tropics where the most serious illnesses are caused by Plasmodium parasite. Automatic diagnosis design systems have been implemented to detect the presence of two types of Malaria (falciparum, vivax) using neural network. Firstly, the data has been acquisition from website and laboratory. The images were filtered to remove the noise using morphological filter, in order to separate the parasite from the other cell in the image k-means method is carried out. Then features (statics first order) were selected from textural features by t-test method, and neural network has been used to classify two types of Malaria. Finally, a graphical user interface has been designed to show result for two types of Malaria. After Complete the designing 95.45% accuracy 90.9%, sensitivity and 100% specificity has been determined.

Health Service Utilization and associated factors Among Older Adults in Ambo Town, West Shoa Zone, Oromia, Ethiopia

In any country use of health services by elderly could vary according to the cultural, social, economic and demographic situation of the person who may need care. In certain contexts, it particularly varies with age and sex of the potential service user. However; there is paucity of information on the level and associated factors on health service utilization among elderly population in Ethiopia in general and in the study site in particular. To assess Factors Health Service Utilization and associated factors Among Older Adults in Ambo Town, West Shoa Zone, Oromia, Ethiopia. A community based cross sectional study carried out on 284 elderly populations residing in Ambo town from February- March 2018. The collected data was cleaned, coded and entered into computer and analyzed using SPSS windows version 20.0. Descriptive statistics were done to summarize data. Binary and multiple logistic regression was undertaken to determine the independent predictor of health service utilization. The following factors were identified as determinants of health service utilization among the elderly in Ambo: a medical history of at least one chronic condition (OR = 1.737; [0.425-2.562]; p < 0.000), who had reported enough money to meet their need were 75% utilize health services when compared to participants who did not have enough money to meet their need 47.3% (OR = 1.587; 95% CI = [1.236 – 2.037], p = 0.004). Age, Income, education, medical history of at least one chronic condition and poor perceived health status were the most pervasive determinants of health service utilization. These factors could help health policy makers and health service providers identify and understand the situation of the elderly and consequently create conducive environment for providing appropriate health services.

Health Surveillance along with Application of Age-based Scheduled Training Program for Down syndrome

Rehabilitation of the family of DS child to provide long-standing follow-up and support as well as the early detection of different health problems. A prospective observational study was accomplished on 65 children with DS selected randomly from the outpatient clinic of pediatric genetics. Application of Health Supervision Guidelines for Individuals with DS for specialized management and monitoring based on different of age groups. Also, the parents of DS children underwent scheduled training plan for solving their children difficulties as hypotonia and associated problem as feeding problem, cervical spine problem and hip dislocation by doing prefeeding exercises and some home physiotherapy in weekly visits. Then these children were evaluated at the end of every four months to assess outcome and retraining of the caregivers as needed. The prevalence of the most associated health problem with DS was the speech difficulty followed by iron deficiency anemia, medically treated ear problems , physical disability , urinary and bowel incontinence ,feeding problems, hypothyroidism and bilateral SNHL (72%, 64.6% , 35%, 33%, 29.2%, 24.6%, 16.9%, 10.7% respectively). After application of our scheduled training program, 84% of trained parents carried out prefeeding exercises, 86% of children showed adequate positioning during feeding as well as improved child cooperation during feeding. Furthermore, 84% got balanced nutritious diet. 68% of children developed urinary control by daytime whereas 60% developed urinary control by day and night. 81% showed improvement in bowel control by decreased frequency of encopresis. An effective early intervention, positive home environment and continuous supportive training of mothers of children with DS are helpful in improving the overall functioning and productivity of these children.