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.

Interprofessional Collaboration: The Experience of Nursing and Medical Students’ Interprofessional Education

In this hermeneutic phenomenological study, we examined the experience of interprofessional collaboration from the perspective of nursing and medical students. Seventeen medical and nursing students from two different universities participated in the study. We used guiding questions in face-to-face, conversational interviews to explore students’ experience and expectations of interprofessional collaboration within learning situations. Three themes emerged from the data: the great divide, learning means content, and breaking the ice. The findings suggest that the experience of interprofessional collaboration within learning events is influenced by the natural clustering of shared interests among students. Furthermore, the carry-forward of impressions about physician–nurse relationships prior to the educational programs and during clinical placements dominate the formation of new relationships and acquisition of new knowledge about roles, which might have implications for future practice.

Marriage Certificate - Hamilton K. Woodruff and Julia C. Cleveland

The marriage certificate of Mr. Hamilton K. Woodruff of St. Catharines and Miss Julia C. Cleveland of Erie, Pennsylvania. This is certificate no. 5221 signed by James C. Wilson. This is accompanied by 2 envelopes; one envelope is from Henry L. Rea, clerk of courts, Erie Pennsylvania to Mr. H. K. Woodruff, the other envelope just says "marriage certificate Mrs. H. K. Woodruff", Nov. 21, 1894.

Christian Education and the Ethics of Authenticity

A qualitative study was undertaken to explore the concept of authenticity in Christian education. The study was situated in the context of Christian schools in Ontario. Some of these schools have experienced declining enrolment and all of these schools face the challenge of being distinctive in a secular culture. To investigate the potential of the concept of authenticity for reclaiming the vision of Christian education, interviews were conducted with 3 experienced principals of Christian schools. Data analysis yielded an emergent conceptual framework of authenticity consisting of 5 concepts: authorship, relatedness, reflection, autonomy, and excellence. Authenticity was found to be a useful tool for school analysis of both the deep structures and the surface structures within Christian schools. To offset unauthentic tendencies that can arise within these schools, this study calls for an intentional use of the lens of authenticity to expose these tendencies and revitalize core expectations. Through the narratives shared by the Christian school principals, the study also develops a picture of the role of authentic Christian education in the development of the authentic Christian person.

Indenture between Hamilton K. Woodruff and Margaret Julia Band

Indenture (Registrar’s printed Certified Copy) between Hamilton K. Woodruff and Margaret Julia Band. This is in regard to parcels and tracts of land in the townships of Sherbourne (no.367), registered June 14, 1926 and Stanhope (no.784) registered Jan. 28, 1926 in the Provisional County of Haliburton, Nov. 3, 1942.

The law and economics of good faith in the civil law of contract

Good faith plays a central role in most legal systems, yet appears to be an intractable concept. This article proposes to analyse it economically as the absence of opportunism in circumstances which lend themselves to it. One of the objectives underlying the law of contract on an economic view is to curtail opportunism. In spelling out what this means, the paper proposes a three-step test: bad faith is present where a substantial informational or other asymmetry exists between the parties, which one of them turns into an undue advantage, considered against the gains both parties could normally expect to realise through the contract, and where loss to the disadvantaged party is so serious as to provoke recourse to expensive self-protection, which significantly raises transactions costs in the market. The three-step test is then used to analyse a set of recent decisions in international commercial transactions and three concepts derived from good faith: fraud, warranty for latent defects and lesion.

The Law and Economics of the Civil Law of Mandate

Présentation à la Annual Law & Economics Conference 2007, Université de Bologne.

Impoverishment of The Law by The Law: A Critique of The Attorney General's Vision of The Rule of Law and The Federal Principle

This brief article is devoted to a critique of the arguments put forward by the Attorney General of Canada in connection with the Reference concerning certain questions relating to the secession of Quebec (hereinafter, "the Reference"). This critique will not be presented from a plainly positivist standpoint. On the contrary, I will be examining in particular (1) how the approach taken by the Attorney General impoverished the legal concepts of the rule of law anf federalism, both of which were, however, central to her submission; and, in a more general way, (2) how the excessively detailed analysis of constitutional texts contributes to the impoverishment of the symbolic function of the law, however essential that dimension may be to its legitimacy. My criticism will take into account the reasons for judgement delivered recently by the Supreme Court in the Reference.

La légitimité d'une éventuelle application de la thérapie germinale humaine : les aspects juridiques et éthiques

La thérapie germinale est une avenue médicale qui est loin de pouvoir être appliquée de manière sécuritaire et responsable car les connaissances médicales actuelles sont insuffisantes. De surcroît, l'encadrement normatif qui l'entoure est unanime et clame la non-acceptabilité de son application humaine. Certains instruments adoptent une approche rigide en la prohibant formellement, d'autres adoptent une approche flexible en demeurant ouverts à une éventuelle application. Il y a donc divergence quant à la légitimité de cette technique. La médecine moderne doit reposer sur des principes directeurs issus de diverses sources, empruntées au droit et à l'éthique. Les principes retenus pour examiner la légitimité de la thérapie germinale sont tirés, d'une part, des droits et libertés fondamentales: ce sont les principes fondamentaux de dignité, de liberté, d'égalité. D'autre part, ils sont issus des règles d'éthique de la recherche: plus particulièrement le principe de bienfaisance (nonmalfaisance) et celui du respect de la personne. La perspective d'une éventuelle application humaine de la thérapie germinale ne porte pas nécessairement atteinte aux principes fondamentaux, dépendamment du genre d'application qui est envisagé. Une application restreinte, appliquée dans des circonstances particulières et en vue de soulager ou d'éliminer certaines formes de détresses et de souffrances, pourrait être conforme aux principes qui soutiennent les droits et libertés fondamentales. La thérapie germinale soulève des questions éthiques difficiles et parfois inédites, notamment l'extension des risques aux générations futures et l'obligation d'un suivi à long terme pour des descendants qui n'auront pas eux-mêmes donné leur consentement à cette «thérapie». La thérapie germinale est présentement non acceptable mais ne devrait pas faire l'objet d'une prohibition totale.

The placebo effect: international patent law and the protection of traditional plant medicine

Une préoccupation essentielle traverse cette thèse: l'indifférence systémique de la Loi internationale sur la propriété intellectuelle a l'égard des savoirs traditionnels autochtones. De manière générale, un écart semble d'ailleurs croissant entre l'importance des accords internationaux sur les questions d'intérêt commercial et ceux de nature sociale. Les savoirs traditionnels autochtones sur les plantes médicinales sont particulièrement désavantagés dans ce système dichotomique puisqu'ils sont non seulement à l'origine d'énormes profits commerciaux mais se trouvent aussi au cœur de multiples croyances propres à ces sociétés. L'Accord sur les aspects des droits de propriété intellectuelle qui touchent au commerce (ADPIC) de l'Organisation mondiale du commerce (OMC) a cristallisé le souci de la législation internationale à l'égard d'une protection efficace des intérêts commerciaux. Deux années auparavant, la Convention sur la diversité biologique (CDB) était signée, traduisant une préoccupation à l'égard du développement durable, et elle devenait le premier accord international à tenir compte des savoirs traditionnels autochtones. On considère souvent que ces deux accords permettent l'équilibre du développement commercial et durable, requis par l'économie internationale. Après plus ample examen, on a plutôt l'impression que l'idée d'une CDB défendant, avec succès et efficacité, la nécessité du développement durable et des savoirs traditionnels autochtones contre les pressions opposées de l'ADPIC et de l'OMC est, au mieux, simpliste. La thèse explore également la fonction de la Loi sur les brevets dans la création d’industries, notamment pharmaceutique, et la manière dont ces industries influencent la législation nationale et en particulier internationale. De même, elle traite du rôle que jouent les brevets dans l'affaiblissement et la dépossession des peuples autochtones dotés de savoirs traditionnels sur les plantes médicinales, conduisant à une situation ou ces savoirs sont marginalisés ainsi que leurs détenteurs. La thèse aborde les failles institutionnelles du système juridique international qui permet une telle situation et indique l'urgente nécessité d'examiner attentivement les inégalités économiques et sociales au Nord comme au Sud, et non seulement entre eux. Finalement, la thèse suggère que la législation internationale gagnerait à s'inspirer des diverses traditions juridiques présentes à travers le monde et, dans ce cas particulier, peut être les détenteurs des connaissances traditionnelles concernant les plantes médicinales seront mieux servi par le droit des obligations.

On cultural property and its protection: a law-and-economics comment

The term cultural property seems to have come into vogue after the Second World War as part of efforts to prevent the recurrence of the massive war-time destruction of objects of cultural significance to various groups and, in some cases, to all of humanity. The 1954 Convention for the Protection of Cultural Property in the Event of Armed Conflict symbolises those efforts. Destruction is not the only doomsday scenario for cultural property. Removal of objects from their owners or region of origin is another concern. This, too, had occurred during the Second World War with the nazis’ looting treasures of all kinds from occupied territories, not to mention the massive confiscation of the property of their Jewish victims everywhere. But the concern was older, as Merryman for one shows in the story of the Elgin marbles, brought from Greece to England during the 19th century. This concern has found expression in a 1970 UNESCO treaty and in a 1995 Unidroit Convention seeking to halt international traffic in cultural property.

Comparative Lessons on Corporate law and CSR: Hard Law as Solution? Do the French offer the way ahead?

This paper provides a comparative analysis of corporate law and CSR and asks whether there are lessons for Australia from corporate law and CSR developments in France. This presentation presents a summary of the provisions of the new French Act Number 2010-788 passed on 12 July 2010 – called “Grenelle 2” –. Firstly, article 225 of Law’s Grenelle 2 changes the Commercial Code to extend the reach of non-financial reporting and to ensure its pertinence. Secondly, article 227 Law’s Grenelle 2 amends certain provisions of the Commercial and Environmental Codes and incorporates into substantive law the liability of parent companies for their subsidiaries. In fine, article 224 of Law’s Grenelle 2 reinforces the pressure on the market to act in a responsible manner. It modifies article 214-12 of the Monetary and Financial Code in order to compel institutional investors (mutual funds and fund management companies) to take social, environmental and governance criteria into account in their investment policy.

The Influence of ICC Arbitral Decisions on Canadian Law: Comparative Study between Civil Law and Common Law Jurisdictions

L’objectif de cette recherche est de démontrer que les décisions arbitrales de la Chambre de commerce internationale peuvent être considérées comme une source potentielle de droit au Canada. Il existe actuellement une incertitude quant au droit matériel utilisé en arbitrage international pour résoudre les différends commerciaux. Bien que l’utilisation de la lex mercatoria pour résoudre un litige soit une option, elle se heurte à de nombreuses incertitudes terminologiques et conceptuelles. L’utilisation d’une approche méthodologique de la lex mercatoria permettrait une classification de ses sources en deux branches: (1) le droit statutaire international et (2) le stare decisis des tribunaux d’arbitrage commercial international. Une telle approche méthodologique conférerait plus de certitude quant à l’application d’un droit uniforme. De plus, elle faciliterait l’étude de l’interlégalité entre les règles de la lex mercatoria et le droit matériel interne. Plus particulièrement, elle permet de comparer les similitudes et les différences des règles du droit matériel entre les décisions arbitrales internationales, le droit statutaire international et les juridictions canadiennes de common law et de droit civil. Cette comparaison rend possible une évaluation de l’influence potentielle des décisions arbitrales de la Chambre de commerce internationale sur le droit matériel canadien et si cette influence est plus importante en droit civil ou en common law.

Adam Smith, Moral Motivation and Business Ethics

This paper shows how Adam Smith’s concept of moral motivation applies to business ethics and ethical consumption. Moral motivation for Smith is embedded in his moral psychology and his theory of virtue, particularly in terms of socialization and our social interactions and in his view that people always seek approval for their conduct, either though actual or ideal spectators. It follows that right conduct depends on the spectator’s awareness of one’s conduct. Thus concerning business ethics, transparency and accountability are essential, as opposed to anonymity which is detrimental. Applying Smith’s theory of motivation to consumption entails two further points: One, information concerning business conduct without consumers seeking it and acting accordingly will only have a limited effect. Two, people’s concern for the propriety of their action can and should include consumption, such that purchasing behavior becomes a moral issue rather than a mere economic one.