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.

Payment for Shelby, Cunningham, Jarvis, Mater and Jones accounts

Payment for Shelby, Cunningham, Jarvis, Mater and Jones accounts. This document has some water damage which has smeared the writing but it does not affect text, July 29, 1882.

Payment for the Shelby, Cunningham, Jarvis, Jones, Mater, Sampson, Conklin, Dennis and Griffin accounts

Payment for the Shelby, Cunningham, Jarvis, Jones, Mater, Sampson, Conklin, Dennis and Griffin accounts, Jan. 29, 1883.

Payment for the Shelby, Cunningham, Jarvis, Jones, Mater, Sampson, Dennis, Conklin and Griffin accounts

Payment for the Shelby, Cunningham, Jarvis, Jones, Mater, Sampson, Dennis, Conklin and Griffin accounts, July 30, 1883.

Payment for the Cunningham, Jarvis, Jones, Mater, Sampson, Dennis, Conklin and Griffin accounts

Payment for the Cunningham, Jarvis, Jones, Mater, Sampson, Dennis, Conklin and Griffin accounts, Jan. 29, 1884.

Payment for the Cogswell, Sample and Howard accounts

Payment for the Cogswell, Sample and Howard accounts, Feb. 29, 1884.

Payment for the Cogswell, Howard and Sample accounts

Payment for the Cogswell, Howard and Sample accounts, Aug. 29, 1884.

Payment for the Atkins and Schmidt accounts from Jarvis, Conklin and Morgan Negotiators of Farm Mortgages

Payment for the Atkins and Schmidt accounts from Jarvis, Conklin and Morgan Negotiators of Farm Mortgages, Dec. 29, 1884.

Payment for the Atkins, Schmidt, Crick, Mank, Underwood and Crew accounts

Payment for the Atkins, Schmidt, Crick, Mank, Underwood and Crew accounts, Jan. 1, 1885.

Payment for the Cogswell, Howard and Sample accounts

Payment for the Cogswell, Howard and Sample accounts, Feb. 27, 1885.

Payment for the Crick, Underwood, Crew, Mank, Atkins and Schmidt accounts

Payment for the Crick, Underwood, Crew, Mank, Atkins and Schmidt accounts, June 9, 1885.

Payment for the Cunningham, Jones, Sampson, Dennis, Conklin and Griffin accounts

Payment for Atkins, Schmidt, Crick, Mank, Underwood and Crew accounts Jan. 26, 1886.

Payment for Atkins, Schmidt, Crick, Mank, Underwood and Crew accounts

Payment for Atkins, Schmidt, Crick, Mank, Underwood and Crew accounts, June 16, 1886.

Payment for Dennis and Conklin accounts

Payment for Dennis and Conklin accounts, Jan. 27, 1887.

Payment for Sampson, Griffin, Cunningham and Jones accounts

Payment for Sampson, Griffin, Cunningham and Jones accounts, Feb. 14, 1887.