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    What makes a 'good' doctor? : the patients' perspective : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatu, New Zealand
    (Massey University, 2018) Lane, Michael Craig
    Personalised care by doctors has been shown to facilitate better engagement by patients in their care (Thorne, Oliffe, & Stajduhar, 2013). However, the communication required for care that is more effective has been primarily characterised from the perspective of medical experts. The patient perspective remains understudied. The aims of the current study were three-fold. Firstly, to explore the way patients’ interpret their General Practitioner’s (GP’s) communication behaviour. Secondly, to organise these behaviours into practice styles describing patient preferences. Finally, to compare the practice styles patients prefer to the practice styles they experience, and examine the impact of preference mismatch upon patient-doctor alliance. To address these aims participants were interviewed about their positive experiences with their GPs, and thematic analysis conducted on the transcripts. This identified a set of 90 communication behaviours, which participants sorted by similarity, and multi-dimensional scaling was utilised to map the behaviour. To organise the behaviour further into practice styles preferred and experienced, 100 participants sorted 67 of the behaviours by both degree of helpfulness and relative frequency with which their GP utilises the behaviours. As hypothesised, participants described behaviours consistent with collaborative interactions, which incorporate patient perspective, feelings, and problem-solving. The organisation of communication behaviours within the multi-dimensional map were consistent with such collaborative interactions, with decision-making and biomedical behaviours grouping with behaviours facilitating participation. Furthermore, the map also demonstrated communication varied along a unique relational dimension in addition to the predicted instrumental and affective dimensions. Participants organised GPs’ communication behaviour into five practice styles consistent with past research, but surprisingly, a high doctor-control, paternal practice style was not evident. The discrepancy between participants’ preferred and experienced styles had a weak negative impact on patient-doctor alliance. These findings support the theories of social reciprocity and socio-pragmatics in General Practice consultations. The absence of a paternalistic practice style is consistent with the personality traits associated with GPs, which include agreeableness, abasement, and nurturance. The findings imply that it is important for doctors to facilitate patient participation and tailor practice behaviour to patient preferences for a personalised experience.
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    Complaints against rural doctors : the impacts on the quality of rural health care services and on rural communities : a thesis presented in partial fulfilment of the requirements for the degree of Master in Management at Massey University, Palmerston North, New Zealand
    (Massey University, 2003) Henderson, Robert Frank
    Investigations of health care complaints are assumed to improve the standards of health care but this belief has not been tested. Using a multiple case study in sixteen remote rural areas, this study examined the effects of formal investigations of complaints on the quality of health care services and the effects on the community. Data for the study were obtained from in-depth interviews, documents and observations. Rural doctors, who struggled to cope with a heavy workload, isolation and many other difficulties, found the accusations of incompetence and the prolonged disciplinary process very threatening. The disciplinary process was more damaging than the findings. The effects of the process were: a few doctors developed a post-traumatic stress like disorder - being unable to cope with threatening situations, some doctors left and were difficult to replace, while others lost their enthusiasm for their work and adopted defensive medical practices. These defensive practices included setting up barriers to access, working more slowly, ordering more investigations and referring more people to secondary care. Other local health workers regarded the disciplinary process as a threat to them also and they adopted similar negative attitudes, as did many distant doctors who heard about the investigation. The fragile local health systems were damaged by the adversarial disciplinary process and became less efficient and less user friendly. Rural communities became involved in the adversarial process and it appeared some complainants were subjected to community pressure. Complainants also had difficulty accessing further health care services and they appeared worse off for having complained. There is an urgent need to develop better ways of dealing with complaints so that the complaint process may: find answers to the problems of health care delivery rather than damaging health care services, serve complainants better, and are fairer on health professionals. Many of the answers to a better system of complaint management are to be found in studies on: quality control in organisations, error control, safe systems in aviation and similar studies.