A Narrative Study of Patient Encounter Accounts of Physicians, Nurses, and Medical Receptionists after Two Decades of a Paradigm of Patient-Centered Care

Despite recent well-known advancements in patient care in the medical fields, such as patient-centeredness and evidence-based medicine and practice, there is rather less known about their effects on the particulars of clinician-patient encounters. The emphasis in clinical encounters remains mostly on treatment and diagnosis and less on communicative competency or engagement for medical professionals. The purpose of this narrative study was to explore interactive competencies in diagnostic and therapeutic encounters and intake protocols within the context of the physicians’, nurses’, and medical receptionists’ perspectives and experiences. Literature on narrative medicine, phenomenology and medicine, therapeutic relationships, cultural and communication competency, and non-Western perspectives on human communication provided the guiding theoretical frameworks for the study. Three data sets including 13 participant interviews (5 physicians, 4 nurses, and 4 medical receptionists), policy documents (physicians, nurses, and medical receptionists) and a website (Communication and Cultural Competency) were used. The researcher then engaged in triangulated analyses, including N-Vivo, manifest and latent, Mishler’s (1984, 1995) narrative elements and Charon’s (2005, 2006a, 2006b, 2013) narrative themes, in recursive, overlapping, comparative and intersected analysis strategies. A common factor affecting physicians’ relationships with their clients was limitation of time, including limited time (a) to listen, (b) to come up with a proper diagnosis, and (c) to engage in decision making in critical conditions and limited time for patients’ visits. For almost all nurse participants in the study establishing therapeutic relationships meant being compassionate and empathetic. The goals of intake protocols for the medical receptionists were about being empathetic to patients, being an attentive listener, developing rapport, and being conventionally polite to patients. Participants with the least iv amount of training and preparation (medical receptionists) appeared to be more committed to working narratively in connecting with patients and establishing human relationships as well as in listening to patients’ stories and providing support to narrow down the reason for their visit. The diagnostic and intake “success stories” regarding patient clinical encounters for other study participants were focused on a timely securing of patient information, with some acknowledgement of rapport and emapathy. Patient-centeredness emerged as a discourse practice, with ambiguous or nebulous enactment of its premises in most clinical settings.

Dr. Stuart D. Scott Papers, 1837-2010 (non-inclusive)

Dr. Stuart D. Scott has written extensively in the fields of prehistory and history. As an archaeologist, he has traveled to some of the most significant sites in the world, including Pompeii, Stonehenge, the Valley of the Kings, Egypt’s pyramids and the Taj Mahal. He spent nine months excavating with the Tikal Project in Guatemala before returning to the University of Arizona where he received a Ph.D. in 1963. He excavated in New Zealand as a Fulbright scholar in 1963-1964. In the fall of 1964, Dr. Scott started a long career in the Anthropology Department of the State University of New York. He taught graduate and undergraduate archaeology courses and continued his archaeological and historical research. In 1979, Scott established the Old Fort Niagara Archaeology in Progress Project at Old Fort Niagara in Youngstown, New York. For many years, he became involved with historical archaeology in western New York. It was during this work that he became interested in the Upper Canada Rebellion of 1837-1838 and its aftermath. Dr. Scott and his wife, Patricia Kay Scott, would use Christmas breaks, summer vacations, and sabbatical years to travel. They were repeatedly lured back to the South Pacific, conducting research in New Zealand, Australia and many of the Micronesian and Polynesian islands. To tell the whole story of the Rebellion and the prison exiles, they traveled extensively in Canada, the United States, England and Tasmania to collect archival research and to experience the scenes of this remarkable narrative. In 2004, Dr. Scott published To the Outskirts of Habitable Creation: Americans and Canadians Transported to Tasmania in the 1840s, which told the story of the men captured, tried, convicted, and exiled as a result of the Rebellion, also called the Patriot War. Other contributions include: • A collaboration with Dr. Charles Cazeau on the book Exploring the Unknown, Great Mysteries Reexamined published by Plenum Press in 1979 • The Patriot Game: New Yorkers and the Canadian Rebellion of 1837-1838, which appeared in New York History, Vol. 68, No.3. 1987 • A Frontier Spirit: The Life of James Gemmell published in Australiasian Canadian Studies, Vol. 25, No. 2 2007 • To the Outskirts of Habitable Creation which appeared in the Friends of the National Archives, Vol. 20, No. 1 2009 • Numerous academic journal publications • Service on conference panels • Various research papers and proposals Before retiring in 1997 and while still a resident of Buffalo, N.Y., Dr. Scott spent considerable time with Brock University President Emeritus James A. Gibson and History Professor Colin Duquemin. The three shared a love of Rebellion history. It was largely because of this connection that Brock University was chosen as the recipient of Dr. Scott’s research materials.