Social science & medicine
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Social science & medicine · Oct 1997
"Painting a Leonardo with finger paint": medical practitioners communicating about death with aboriginal people.
This article describes 19 semi-structured interviews with medical practitioners working in the Northern Territory of Australia. The interviews explored the practitioners' perceptions of the differences between Aboriginal and Western beliefs about disease causation and death. The interviews further explored how these perceptions affected the practitioners' communication of mortality information and their response to the practical and legal tasks of reporting deaths to the coroner, requesting postmortems and certifying death. ⋯ The first was the variety of interpretations placed by medical practitioners on the concept of "respect", and the difficulty they had in showing that respect in light of competing Western legal and professional obligations. The second theme was that medical practitioners felt that Aboriginal people's notions of "blame" did not match their own; this led some medical practitioners to become despondent, whilst others negotiated this tension creatively. Use of the word "blame" almost solely to refer to the Aboriginal discourse served to exoticise the Aboriginal process and obscure its areas of similarity with the Western discourse of "responsibility".
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Recent evidence has indicated that physician judgments of patients can be influenced by contextual factors. This study examined three contextual factors relevant to hypothetical patients with low back pain, using vignettes that were varied in a 2 x 2 x 2 factorial design: level of reported pain (high vs low), level of supporting medical evidence (high vs low), and the valence of the physician-patient interaction (positive vs negative). ⋯ Ratings of pain and disability were lower for patients without supporting medical evidence; ratings of distress, somatic preoccupation, and disability were greater for patients who exhibited negative rather than positive affect; internist ratings of pain were lower than patient ratings among patients reporting high levels of pain, while ratings were inflated for patients with low levels of pain. The results suggest that characteristics of both the patient and the situation may influence medical judgments.