17.12. Encounters in health care – the voice of the patient

Public examination of a doctoral dissertation in the field of General Practice

Doctoral candidate: Lic Med Pirkko Salokekkilä

Time and venue: 17.12.2011 at 12 noon, Mediteknia auditorium, Kuopio Campus

Language of the public examination: Finnish

Language of the dissertation: English

The consultation is the core event in medicine. Both the physician and the patient have influence on the outcome of the visit. This is a study of the experiences of people consulting their doctors and narratives they have told in the interviews with one researcher based on these experiences.

The participants of the study were people suffering from a chronic pain and disabilities due to osteoarthritis. During the interviews, the interviewees were asked to tell about successful and failed encounters with the health care providers. The respondents were also asked to give their own definitions for “benefit” and “unnecessary visit”. Episodic interview technique was applied and no questionnaires were used.

The texts have been analyzed by using the content analysis method. Three main categories were developed based on the concepts that emerged from the data. These were named as Narratives of survival, Quality of care and System encounters. In addition to the qualitative content analysis the Bayesian method was applied because there could have been elements in the data which may have remained undetected if only the content analysis was used. The Bayminer (www.BayMiner.com) non-linear visualization modeling software was used together with B-course classification and dependence model. With these tools it was possible to analyze the data for multivariate probabilistic dependencies which are represented as Bayesian network models.

The main result of the study is that the competent doctor gives face to the system and influences the patient perception towards the whole health care system and makes it more trustworthy and acceptable. Based on the content analysis the predictors of a successful and a failed encounter are presented. A successful encounter included continuity of care, doctor competence, caring doctor, taking the patient seriously, private care, respect and trust in doctor, information giving and perceived benefit together with satisfaction with care. In a failed encounter the predictors were feelings of disappointment, anger and bitterness connected to experiencing indifference and talking to a doctor’s back.

The conclusion is that the informants of the study as patients were outcome-oriented. They wanted to gain benefit when they finally had made the decision to consult the physician. Being disappointed with the health care provider had a negative impact on the perception of the health care system. These results are in alignment with the Bayesian network modeling. The model predicted the result with 72% probability.The messages from this study are directed to the decision makers of the medical education and those of the health care system. An innovative and user friendly approach with a strong moral dimension and concern for ethical issues is needed when building the health care system for the next decades.

The doctoral dissertation of Licentiate of Medicine Pirkko Salokekkilä, entitled Encounters in the Health Care – The Voice of the Patient will be examined at the Faculty of Health Sciences. The opponent in the public examination will be Professor Sirkka Keinänen-Kiukaanniemi and the custos will be Professor Esko Kumpusalo of the University of Eastern Finland.

Photo available for download at http://www.uef.fi/vaitoskuvat

For further information, please contact: Pirkko Salokekkilä, tel. 040 527 5335, pirkko.salokekkila@helsinki.fi

Publishing year: 2011

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