Pub Date : 2026-06-01Epub Date: 2026-02-05DOI: 10.1016/j.pec.2026.109516
Paul K.J. Han , Margrethe Schaufel , Edvin Schei
Objective
To analyze the nature and etiology of shame, a common problem that diminishes the well-being of learners and clinicians in medical education and practice, and to explore the relationship between shame and medical uncertainty.
Discussion
We draw upon various theoretical insights on both shame and uncertainty, and argue that shame is ultimately a product of uncertainty and its transformation by medical learners. We argue that this transformation involves two key processes. The first is a personalization of uncertainty—i.e., a transformation of medical uncertainties focused on clinical care into personal uncertainties focused on one’s self-worth. The second is a resolution of personal uncertainty—i.e., a transformation of personal uncertainties about one’s self-worth into personal certainties about one’s lack of self-worth. These key processes linking medical uncertainty to shame suggest that shame might be prevented or mitigated by targeted interventions aimed at 1) depersonalizing medical uncertainties, 2) helping learners maintain their personal uncertainties, rather than resolving them in self-destructive ways, and 3) making uncertainty and its management a more central, explicit focus of medical training.
Conclusions
Medical uncertainty has a central, paradoxical relationship to shame among medical learners—representing both a source of the problem and a potential solution. Key processes that lead from uncertainty to shame represent potential targets for interventions to prevent and mitigate shame among medical learners, and fruitful directions for future research.
{"title":"Shame among medical learners: An uncertainty-focused conception","authors":"Paul K.J. Han , Margrethe Schaufel , Edvin Schei","doi":"10.1016/j.pec.2026.109516","DOIUrl":"10.1016/j.pec.2026.109516","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the nature and etiology of shame, a common problem that diminishes the well-being of learners and clinicians in medical education and practice, and to explore the relationship between shame and medical uncertainty.</div></div><div><h3>Discussion</h3><div>We draw upon various theoretical insights on both shame and uncertainty, and argue that shame is ultimately a product of uncertainty and its transformation by medical learners. We argue that this transformation involves two key processes. The first is a personalization of uncertainty—i.e., a transformation of medical uncertainties focused on clinical care into personal uncertainties focused on one’s self-worth. The second is a resolution of personal uncertainty—i.e., a transformation of personal uncertainties about one’s self-worth into personal certainties about one’s lack of self-worth. These key processes linking medical uncertainty to shame suggest that shame might be prevented or mitigated by targeted interventions aimed at 1) depersonalizing medical uncertainties, 2) helping learners maintain their personal uncertainties, rather than resolving them in self-destructive ways, and 3) making uncertainty and its management a more central, explicit focus of medical training.</div></div><div><h3>Conclusions</h3><div>Medical uncertainty has a central, paradoxical relationship to shame among medical learners—representing both a source of the problem and a potential solution. Key processes that lead from uncertainty to shame represent potential targets for interventions to prevent and mitigate shame among medical learners, and fruitful directions for future research.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"147 ","pages":"Article 109516"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-02-05DOI: 10.1016/j.pec.2026.109518
Alan Schwartz , Saul J. Weiner
Objective
Contextualizing care results in better outcomes for patients. Several different prompts to clinicians to increase contextualization have been studied: audit & feedback (A&F), clinical decision support (CDS), or making recording of visits openly accessible to patients (OA). We measured the effects of prompting interventions on probing of contextual red flags and incorporation of contextual factors into care plans.
Methods
Individual participant data meta-analysis of data from three controlled studies of prompts. The first (A&F, 4160 visits to 667 physicians at 6 sites) employed reports to provider teams of missed and successful contextualization opportunities. The second (CDS, 450 visits to 39 physicians at 2 sites) employed a real-time CDS tool. The third (OA, 317 visits to 30 physicians at 2 sites) cued providers that visits were recorded and would be available to patients. In each, the audios were coded using the 4 C system to identify contextual red flags, clinician probes of red flags, contextual factors, and contextualization of care plans.
Results
Prompting interventions increased the odds of probing by 71 % (95 % CI 54 % - 79 %) on average, with the largest impact in the A&F study but the highest probing rate in the CDS study. Overall, they increased the odds of contextualizing care plans by 33 % (95 % CI 13 %-58 %), an effect partially mediated by probing of red flags, which increased the odds of contextualization by 337 % (95 % CI 287 % - 396 %). Contextual factors in the domains of Access to Care, Financial Situation, Emotional State, and Skills, Abilities, and Knowledge were most likely to be incorporated into plans and those in Competing Responsibilities least so.
Conclusion
Multiple strategies prompt clinicians to consider patient life context in care planning, with varying effectiveness according to the patient context.
Practical implications
Future efforts should consider combining prompting interventions and provide clinicians with additional domain-specific resources.
目的情境化护理可提高患者的预后。已经研究了几种不同的提示临床医生增加情境化：审计和反馈（A&；F），临床决策支持（CDS），或使访问记录对患者开放（OA）。我们测量了提示干预对探查情境危险信号和将情境因素纳入护理计划的影响。方法对三项提示性对照研究的个体参与者数据进行meta分析。第一项研究（在6个地点对667名医生进行了4160次访问）向医疗团队报告了错过和成功的情境化机会。第二组（CDS，在2个地点对39名医生进行450次访问）采用实时CDS工具。第三份（OA，在2个地点对30名医生进行了317次就诊）提示医疗服务提供者，就诊记录已被记录下来，并可供患者使用。在每个音频中，使用4 C系统对音频进行编码，以识别上下文危险信号、临床医生对危险信号的探测、上下文因素和护理计划的上下文化。结果提示干预平均使探查的几率增加71 %(95 % CI 54 % - 79 %)，在A&；F研究中影响最大，但在CDS研究中探查率最高。总体而言，他们将情境化护理计划的几率增加了33 %(95 % CI 13 %-58 %)，这一效应部分由探测危险信号介导，它将情境化的几率增加了337 %（95 % CI 287 % - 396 %）。在获得护理、财务状况、情绪状态、技能、能力和知识等领域的背景因素最有可能被纳入计划，而在竞争责任方面的因素则最少。结论多种策略促使临床医生在护理计划中考虑患者的生活环境，根据患者的生活环境不同，其效果也不同。实际意义未来的努力应考虑结合提示干预措施，并为临床医生提供额外的领域特定资源。
{"title":"Increasing contextualization of care rates through clinician prompting interventions","authors":"Alan Schwartz , Saul J. Weiner","doi":"10.1016/j.pec.2026.109518","DOIUrl":"10.1016/j.pec.2026.109518","url":null,"abstract":"<div><h3>Objective</h3><div>Contextualizing care results in better outcomes for patients. Several different prompts to clinicians to increase contextualization have been studied: audit & feedback (A&F), clinical decision support (CDS), or making recording of visits openly accessible to patients (OA). We measured the effects of prompting interventions on probing of contextual red flags and incorporation of contextual factors into care plans.</div></div><div><h3>Methods</h3><div>Individual participant data meta-analysis of data from three controlled studies of prompts. The first (A&F, 4160 visits to 667 physicians at 6 sites) employed reports to provider teams of missed and successful contextualization opportunities. The second (CDS, 450 visits to 39 physicians at 2 sites) employed a real-time CDS tool. The third (OA, 317 visits to 30 physicians at 2 sites) cued providers that visits were recorded and would be available to patients. In each, the audios were coded using the 4 C system to identify contextual red flags, clinician probes of red flags, contextual factors, and contextualization of care plans.</div></div><div><h3>Results</h3><div>Prompting interventions increased the odds of probing by 71 % (95 % CI 54 % - 79 %) on average, with the largest impact in the A&F study but the highest probing rate in the CDS study. Overall, they increased the odds of contextualizing care plans by 33 % (95 % CI 13 %-58 %), an effect partially mediated by probing of red flags, which increased the odds of contextualization by 337 % (95 % CI 287 % - 396 %). Contextual factors in the domains of Access to Care, Financial Situation, Emotional State, and Skills, Abilities, and Knowledge were most likely to be incorporated into plans and those in Competing Responsibilities least so.</div></div><div><h3>Conclusion</h3><div>Multiple strategies prompt clinicians to consider patient life context in care planning, with varying effectiveness according to the patient context.</div></div><div><h3>Practical implications</h3><div>Future efforts should consider combining prompting interventions and provide clinicians with additional domain-specific resources.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"147 ","pages":"Article 109518"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Curiosity is increasingly recognized as a core element of person-centered healthcare communication, yet empirical evidence about how curiosity is recognized, valued, and constrained in clinical encounters remains limited. This study aimed to explore how curiosity manifests in healthcare communication and to identify its perceived value and barriers from the perspectives of patients, relatives, healthcare professionals, and communication experts.
Methods
A qualitative participatory design was used, comprising three sequential workshops: a World Café workshop with patients and relatives, a participatory theater workshop involving clinicians, patients, and researchers, and an international expert workshop with healthcare communication specialists. Data included written reflections, observational field notes, and video recordings. Analysis followed a reflective sense-making approach, integrating insights across workshop phases.
Results
Curiosity was identified as both a professional quality and a communicative skill, expressed through attentive listening, acknowledgment, openness, responsiveness, and the use of exploratory questions. Participants associated curiosity with enhanced trust, deeper dialogue, and more individualized care. Meaningful curiosity, perceived as relevant to patients’ lives and treatment decisions, was distinguished from curiosity experienced as intrusive. Barriers included time pressure, emotional stress, preconceived notions, cognitive overload, and clinician burnout.
Discussion
Curiosity emerged as both a professional quality and a communicative skill, expressed through attentive listening, acknowledgment, nonverbal presence, and explorative questioning. The findings highlight a reciprocal relationship between curiosity and trust, supporting deeper dialogue, patient empowerment, and partnership in care. Curiosity also creates reflective pauses that enhance understanding and meaning in clinical encounters.
Conclusion
Curiosity is a critical yet underdeveloped component of person-centered healthcare communication. Explicitly integrating curiosity into communication education and training may strengthen patient engagement, support shared decision-making, and enhance the quality of clinical encounters. Organizational efforts to address time pressure, workload, and clinician well-being are essential to fostering curiosity in everyday practice.
{"title":"Curious on curiosity – a qualitative study on curiosity in healthcare communication","authors":"Connie Timmermann , Christina Prinds , Terese Stenfors , Jette Ammentorp","doi":"10.1016/j.pec.2026.109513","DOIUrl":"10.1016/j.pec.2026.109513","url":null,"abstract":"<div><h3>Objective</h3><div>Curiosity is increasingly recognized as a core element of person-centered healthcare communication, yet empirical evidence about how curiosity is recognized, valued, and constrained in clinical encounters remains limited. This study aimed to explore how curiosity manifests in healthcare communication and to identify its perceived value and barriers from the perspectives of patients, relatives, healthcare professionals, and communication experts.</div></div><div><h3>Methods</h3><div>A qualitative participatory design was used, comprising three sequential workshops: a World Café workshop with patients and relatives, a participatory theater workshop involving clinicians, patients, and researchers, and an international expert workshop with healthcare communication specialists. Data included written reflections, observational field notes, and video recordings. Analysis followed a reflective sense-making approach, integrating insights across workshop phases.</div></div><div><h3>Results</h3><div>Curiosity was identified as both a professional quality and a communicative skill, expressed through attentive listening, acknowledgment, openness, responsiveness, and the use of exploratory questions. Participants associated curiosity with enhanced trust, deeper dialogue, and more individualized care. Meaningful curiosity, perceived as relevant to patients’ lives and treatment decisions, was distinguished from curiosity experienced as intrusive. Barriers included time pressure, emotional stress, preconceived notions, cognitive overload, and clinician burnout.</div></div><div><h3>Discussion</h3><div>Curiosity emerged as both a professional quality and a communicative skill, expressed through attentive listening, acknowledgment, nonverbal presence, and explorative questioning. The findings highlight a reciprocal relationship between curiosity and trust, supporting deeper dialogue, patient empowerment, and partnership in care. Curiosity also creates reflective pauses that enhance understanding and meaning in clinical encounters.</div></div><div><h3>Conclusion</h3><div>Curiosity is a critical yet underdeveloped component of person-centered healthcare communication. Explicitly integrating curiosity into communication education and training may strengthen patient engagement, support shared decision-making, and enhance the quality of clinical encounters. Organizational efforts to address time pressure, workload, and clinician well-being are essential to fostering curiosity in everyday practice.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"147 ","pages":"Article 109513"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-02-09DOI: 10.1016/j.pec.2026.109522
Arnstein Finset
{"title":"Pål Gulbrandsen: Researcher, educator, activist and team-builder And a man of solid wood","authors":"Arnstein Finset","doi":"10.1016/j.pec.2026.109522","DOIUrl":"10.1016/j.pec.2026.109522","url":null,"abstract":"","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"147 ","pages":"Article 109522"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-02-09DOI: 10.1016/j.pec.2026.109536
Alejandro Aranda-Gutierrez , Cynthia Villarreal-Garza , Dione Aguilar-y-Mendez , Salvador Gonzalez-Santiesteban , José Luis Rodríguez-Olivares , Fernanda Mesa-Chavez , Andrea Becerril-Gaitan , Bryan F. Vaca-Cartagena , Alex Lagunas-Medina , Laura Kay Lagarde-Santillán , Andrés Rodríguez-Faure , Daniela Obregon-Leal , Araceli Carrillo-Bedoya , Gregorio Quintero-Beuló , Maria Fernanda Ochoa-Chavez , Melina Miaja , Jeffrey N. Weitzel , Yanin Chavarri-Guerra
Objective
To assess knowledge of genetic cancer risk among Mexican carriers of cancer-associated pathogenic variants (PVs) using the Spanish version of the KnowGene Cancer Genetics Questionnaire, and to examine whether knowledge is associated with uptake of risk-reducing surgery (RRS) or cascade testing (CT).
Methods
We conducted a cross-sectional study of adult PV carriers who had received post-test genetic cancer risk assessment (GCRA) at two referral centers in Mexico. Participants completed the 16-item KnowGene Cancer Genetics Questionnaire assessing inheritance, result interpretation, clinical implications, and screening/risk reduction. Sociodemographic and clinical data were collected. Associations between knowledge scores and participant characteristics were evaluated using univariate analyses and multivariable linear regression. Associations between knowledge and uptake of RRS and CT were explored descriptively.
Results
Among 384 eligible carriers, 261 (68.0 %) completed the questionnaire. Median age was 44 years (range 20–77); 87.0 % were female, and 63.2 % were probands. The most frequent PVs were BRCA1 (36.8 %) and BRCA2 (25.7 %). The mean knowledge score was 9.42 out of 16 (SD 3.0), with item-level gaps most pronounced in inheritance and interpretation of variants of uncertain significance. Higher educational attainment was independently associated with higher knowledge scores in multivariable analysis (β = 1.92, p < 0.001). Knowledge scores were not significantly associated with uptake of RRS or CT.
Conclusion
Mexican carriers of cancer-associated PVs demonstrated moderate genetic knowledge after GCRA, with persistent gaps in clinically relevant concepts. Educational attainment was the primary determinant of knowledge, but greater knowledge alone did not translate into higher uptake of preventive interventions.
Practice implications
GCRA programs should incorporate tailored, patient-centered communication strategies and address structural and psychosocial barriers to improve informed decision-making and engagement with recommended preventive actions.
{"title":"Genetic cancer risk knowledge among Mexican pathogenic variant carriers","authors":"Alejandro Aranda-Gutierrez , Cynthia Villarreal-Garza , Dione Aguilar-y-Mendez , Salvador Gonzalez-Santiesteban , José Luis Rodríguez-Olivares , Fernanda Mesa-Chavez , Andrea Becerril-Gaitan , Bryan F. Vaca-Cartagena , Alex Lagunas-Medina , Laura Kay Lagarde-Santillán , Andrés Rodríguez-Faure , Daniela Obregon-Leal , Araceli Carrillo-Bedoya , Gregorio Quintero-Beuló , Maria Fernanda Ochoa-Chavez , Melina Miaja , Jeffrey N. Weitzel , Yanin Chavarri-Guerra","doi":"10.1016/j.pec.2026.109536","DOIUrl":"10.1016/j.pec.2026.109536","url":null,"abstract":"<div><h3>Objective</h3><div>To assess knowledge of genetic cancer risk among Mexican carriers of cancer-associated pathogenic variants (PVs) using the Spanish version of the KnowGene Cancer Genetics Questionnaire, and to examine whether knowledge is associated with uptake of risk-reducing surgery (RRS) or cascade testing (CT).</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study of adult PV carriers who had received post-test genetic cancer risk assessment (GCRA) at two referral centers in Mexico. Participants completed the 16-item KnowGene Cancer Genetics Questionnaire assessing inheritance, result interpretation, clinical implications, and screening/risk reduction. Sociodemographic and clinical data were collected. Associations between knowledge scores and participant characteristics were evaluated using univariate analyses and multivariable linear regression. Associations between knowledge and uptake of RRS and CT were explored descriptively.</div></div><div><h3>Results</h3><div>Among 384 eligible carriers, 261 (68.0 %) completed the questionnaire. Median age was 44 years (range 20–77); 87.0 % were female, and 63.2 % were probands. The most frequent PVs were <em>BRCA1</em> (36.8 %) and <em>BRCA2</em> (25.7 %). The mean knowledge score was 9.42 out of 16 (SD 3.0), with item-level gaps most pronounced in inheritance and interpretation of variants of uncertain significance. Higher educational attainment was independently associated with higher knowledge scores in multivariable analysis (β = 1.92, p < 0.001). Knowledge scores were not significantly associated with uptake of RRS or CT.</div></div><div><h3>Conclusion</h3><div>Mexican carriers of cancer-associated PVs demonstrated moderate genetic knowledge after GCRA, with persistent gaps in clinically relevant concepts. Educational attainment was the primary determinant of knowledge, but greater knowledge alone did not translate into higher uptake of preventive interventions.</div></div><div><h3>Practice implications</h3><div>GCRA programs should incorporate tailored, patient-centered communication strategies and address structural and psychosocial barriers to improve informed decision-making and engagement with recommended preventive actions.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"147 ","pages":"Article 109536"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-02-05DOI: 10.1016/j.pec.2026.109520
Amanda McArthur , Alya Ahmad , Anne R. Links , Kathleen R. Warner , Paul Drew , Mary Catherine Beach , Somnath Saha
Objective
Language in electronic health records (EHRs) can transmit stigma, discrediting patients in ways that undermine the clinician-patient relationship and compromise future care. We sought to develop a taxonomy of stigmatizing language in EHRs to understand what patients are being stigmatized for, how that stigma is conveyed linguistically, and why.
Methods
We conducted a two-stage qualitative analysis of EHR notes from multiple clinical contexts in a large U.S. academic health system. For both stages, we drew enriched samples using natural language processing (NLP) to identify notes with at least one stigmatizing keyword from prior studies. First, we open coded 296 notes to generate categories of stigmatizing language and linguistic mechanisms, and to develop a preliminary taxonomy. We then applied and refined this framework by coding 400 additional notes.
Results
We identified six categories of stigmatizing sentiments characterizing patients as: (1) Socially Undesirable, (2) Difficult to Interact With, (3) Incompetent, (4) Manipulative, (5) Noncompliant, and (6) Not Credible. These were implied through negative descriptions of patient behavior portraying them as, e.g., Demanding, Adversarial, Deceptive, etc. Linguistic mechanisms extended beyond keywords, including practices for emphasizing the intensity of patient behavior (e.g., intensifiers), marking distance or divergence from the patient’s perspective (e.g., skeptical evidentials), and casting the clinician as the neutral or rational party (e.g., euphemisms).
Conclusion
Stigmatizing language in EHRs is not limited to discrete terms but is embedded in broader linguistic practices that shape how patients are represented and understood, particularly those describing how they fail to align with clinical expectations. This language may serve to document professional challenges, but it nonetheless reinforces paternalistic norms and compromises care. Understanding these dynamics is critical for moving toward patient-centered documentation and reducing harm in the EHR.
{"title":"How words discredit: A taxonomy of stigmatizing language in the electronic health record","authors":"Amanda McArthur , Alya Ahmad , Anne R. Links , Kathleen R. Warner , Paul Drew , Mary Catherine Beach , Somnath Saha","doi":"10.1016/j.pec.2026.109520","DOIUrl":"10.1016/j.pec.2026.109520","url":null,"abstract":"<div><h3>Objective</h3><div>Language in electronic health records (EHRs) can transmit stigma, discrediting patients in ways that undermine the clinician-patient relationship and compromise future care. We sought to develop a taxonomy of stigmatizing language in EHRs to understand <em>what</em> patients are being stigmatized for, <em>how</em> that stigma is conveyed linguistically, and <em>why</em>.</div></div><div><h3>Methods</h3><div>We conducted a two-stage qualitative analysis of EHR notes from multiple clinical contexts in a large U.S. academic health system. For both stages, we drew enriched samples using natural language processing (NLP) to identify notes with at least one stigmatizing keyword from prior studies. First, we open coded 296 notes to generate categories of stigmatizing language and linguistic mechanisms, and to develop a preliminary taxonomy. We then applied and refined this framework by coding 400 additional notes.</div></div><div><h3>Results</h3><div>We identified six categories of stigmatizing sentiments characterizing patients as: (1) Socially Undesirable, (2) Difficult to Interact With, (3) Incompetent, (4) Manipulative, (5) Noncompliant, and (6) Not Credible. These were implied through negative descriptions of patient behavior portraying them as, e.g., Demanding, Adversarial, Deceptive, etc. Linguistic mechanisms extended beyond keywords, including practices for emphasizing the intensity of patient behavior (e.g., intensifiers), marking distance or divergence from the patient’s perspective (e.g., skeptical evidentials), and casting the clinician as the neutral or rational party (e.g., euphemisms).</div></div><div><h3>Conclusion</h3><div>Stigmatizing language in EHRs is not limited to discrete terms but is embedded in broader linguistic practices that shape how patients are represented and understood, particularly those describing how they fail to align with clinical expectations. This language may serve to document professional challenges, but it nonetheless reinforces paternalistic norms and compromises care. Understanding these dynamics is critical for moving toward patient-centered documentation and reducing harm in the EHR.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"147 ","pages":"Article 109520"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-02-02DOI: 10.1016/j.pec.2026.109512
Jennifer Gerwing , Julia Menichetti , Anne Marie Landmark , Eirik Ofstad
{"title":"An ethos of inspiration: A special section in honour of Pål Gulbrandsen","authors":"Jennifer Gerwing , Julia Menichetti , Anne Marie Landmark , Eirik Ofstad","doi":"10.1016/j.pec.2026.109512","DOIUrl":"10.1016/j.pec.2026.109512","url":null,"abstract":"","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"147 ","pages":"Article 109512"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-02-07DOI: 10.1016/j.pec.2026.109519
Richard M. Frankel
Objective
The scientific study of doctor-patient communication got its start with a textbook published almost nine decades ago. Based on 16 years of conversations between psychiatry residents and patients, it featured audio recordings as a method for studying the subtleties of verbal interaction in the clinical context. Hundreds of studies based on audio and video technology have been published since. The purpose of this paper is threefold. First, I provide a brief history of a line of inquiry based on direct observation and coding of recorded encounters. Second, I describe the development of the Four Habits of Highly Effective Clinicians, one of several evidence-based frameworks for studying and teaching about the medical interview. Third, I describe the phenomenon of documenting in the electronic health record (EHR) while simultaneously providing care. Documenting while doctoring (DWD) is both a resource and a constraint on clinicians’ time and attention. Notwithstanding, its effects on processes and outcomes of care have not typically been accounted for in doctor patient communication frameworks. To that end I describe a mnemonic POISED, to facilitate EHR use in the exam room.
Discussion
In 2004 only 1 of 10 US physicians’ offices used an EHR; in 2023, it was 9 out of 10. Pressures to increase efficiency and billing have resulted in a migration of the EHR from the back room into the exam room. A gap currently exists in research on the effects of DWD on doctor patient communication and outcomes of care. Accumulating evidence suggests that DWD has resulted in increased distraction, inaccurate data recording, and in some cases poorer outcomes of care.
Highlights
Larger studies across multiple medical specialties and a range of patient populations will be necessary to better understand the costs and benefits of the intersection of talk, text, and technology in doctor-patient communication and relationships.
{"title":"From talk to text: Extending the arc of doctor patient communication research to real-time visit documentation","authors":"Richard M. Frankel","doi":"10.1016/j.pec.2026.109519","DOIUrl":"10.1016/j.pec.2026.109519","url":null,"abstract":"<div><h3>Objective</h3><div>The scientific study of doctor-patient communication got its start with a textbook published almost nine decades ago. Based on 16 years of conversations between psychiatry residents and patients, it featured audio recordings as a method for studying the subtleties of verbal interaction in the clinical context. Hundreds of studies based on audio and video technology have been published since. The purpose of this paper is threefold. First, I provide a brief history of a line of inquiry based on direct observation and coding of recorded encounters. Second, I describe the development of the Four Habits of Highly Effective Clinicians, one of several evidence-based frameworks for studying and teaching about the medical interview. Third, I describe the phenomenon of documenting in the electronic health record (EHR) while simultaneously providing care. Documenting while doctoring (DWD) is both a resource and a constraint on clinicians’ time and attention. Notwithstanding, its effects on processes and outcomes of care have not typically been accounted for in doctor patient communication frameworks. To that end I describe a mnemonic POISED, to facilitate EHR use in the exam room.</div></div><div><h3>Discussion</h3><div>In 2004 only 1 of 10 US physicians’ offices used an EHR; in 2023, it was 9 out of 10. Pressures to increase efficiency and billing have resulted in a migration of the EHR from the back room into the exam room. A gap currently exists in research on the effects of DWD on doctor patient communication and outcomes of care. Accumulating evidence suggests that DWD has resulted in increased distraction, inaccurate data recording, and in some cases poorer outcomes of care.</div></div><div><h3>Highlights</h3><div>Larger studies across multiple medical specialties and a range of patient populations will be necessary to better understand the costs and benefits of the intersection of talk, text, and technology in doctor-patient communication and relationships.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"147 ","pages":"Article 109519"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-02-05DOI: 10.1016/j.pec.2026.109517
Jennifer Gerwing , Julia Menichetti , Anne Marie Landmark
Objective
Dialogues between clinicians and patients constitute complex, dynamic systems comparable to human physiology. While human physiology focuses on the internal regulation of the body, interaction physiology focuses on the observable regulation between participants who are talking with each other. We draw attention to just one fundamental property of interaction physiology, namely that interaction is a continuous process of participants inferring meaning from what each other says and does. We unpack several sequences from authentic clinical dialogues to exemplify such inferential processes.
Discussion
Each contribution in a dialogue serves a function and meaning beyond its literal sense, indeed it has meaning potential, in that its meaning is dependent on the sense that interlocutors make of it, based on its immediate context (i.e., what has happened so far in the conversation and the broader context of time, purpose, and setting). Concrete, practical implications for clinicians are the following: to appreciate what is gained by paying close attention to what the patient says and does; to notice possible misalignments in understanding; to use opportunities that dialogue offers to bring the topic of understanding to the fore. For researchers, particularly ones who are not working within established analytical traditions, awareness of inferential processes entails developing the discipline (and humility) of differentiating between one’s own inferences as an observer and the participants’ displayed inferences while they respond to each other in real time.
Conclusions
We suggest that clinicians need communication recommendations to help them make sense of their interactions with patients in situ, supporting their ability to pay attention to what each patient is saying and doing in the moment. Such advice depends on distilling and promoting practice from a solid foundation of basic research on language use.
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