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This chapter examines the ethical positions of local scientists and clinicians from the perspective of Soviet and post-Soviet scientific trajectories as well as in relation to international scientific influences. More specifically, it considers how the radiation research process makes connections between ailments and the Chernobyl disaster real—that is, organic. It also explores how scientific and political pressures at the international level restrict local discourses on the health effects of radiation from the Chernobyl disaster and influence the processes through which the biology of such effects becomes an object of contested scientific understanding and research. Finally, it shows how patients become captives of a new sociality in Ukraine and describes the changing doctor–patient relations, along with the in utero research carried out, at the Radiation Research Center.

This chapter describes meditation as an historical and cross-cultural phenomenon, demonstrating its ubiquity in secular and religious domains. Instructions for a simple and relatively permissive type of meditation are presented so that the reader with no previous experience of meditation can, to a limited extent, explore meditation in a practical way. The chapter goes on to discuss why people meditate, examining this question from a wide variety of viewpoints, before concluding that stress management is a peculiarly Western orientation and that meditation is more widely used for spiritual purposes. Psychological approaches to understanding meditation are presented via a history of psychological research in this area. The discussion explores the causes and consequences of the particular research orientations which have developed, arguing that there has been slow progress in understanding. Finally some of the problems of conducting meditation research are described.

This chapter reviews traditional evidence and describes the difficulties of interpeting the results before arguing for a skills-based approach to understanding meditation. The chapter separates out what it states are the three principal skills involved in meditation practice and urges that we focus on these rather than on the generic notion of meditation. Using this strategy the chapter shows how clinicians can effectively use meditation to help others and how new and possibly more effective research can be conducted.

This chapter takes a constructivist approach to the topic of communication, information, and support. This view recognizes that individuals actively generate their own understanding and ‘rules’ are then used to make sense of their experiences, rather than accepting that communication, information, and support are passive things that health and social care workers do to, and for, others. It begins with a discussion of the key issues and what patients want. It then considers changes in the patient-clinician relationship, relevant information and services policy context and initiatives in the UK, and the rise of computer-mediated communications, such as blogs.

This chapter considers the early development of clinical legal education in a group of countries that have proven influential in the spread of clinical methods across the globe: the United States, Britain, Canada, and Australia. There are both similarities and differences in the stories of how clinics emerged during the 1960s and 1970s with volunteer-based student services developing into academic programs that pursued both social justice and student learning objectives while emphasizing ethics and professional responsibility. The points of contrast relate to the academic-professional divide in British and Australian legal education, accreditation requirements, funding arrangements, and the treatment of clinicians in the legal academy. The chapter also considers the lasting legacy of these early programs, suggesting that the distinctiveness of clinical legal education is a source of both strength and vulnerability.

Business Process Reengineering (BPR) was used to implement transformatory change in the Leicester Royal Infirmary, a large National Health Service (NHS) teaching hospital in the UK. This NHS Trust was under pressure to improve performance but at the same time it needed to retain the support of doctors and other health care professionals in achieving these improvements. This programme received support from stable top-level leadership and ‘hybrid’ help from both doctors and managers. This change, however, produced uneven outcomes and required managers to form partnerships with clinicians. This chapter introduces how BPR works and relates this with the limits of organizational transformation. Also, BPR here is presented as an example of process organization and not merely a managerial fad. This chapter generally looks at health care and hospitals from a management perspective.

This chapter discusses the importance of being part of the mainstream in an acute hospital for the survival and effective functioning of a hospital palliative care team. However, this may pose specific challenges because most clinicians in palliative care are working in a predominantly advisory role. To address potential problems and become successfully integrated into the mainstream, palliative care should maintain a high profile, take all opportunities for service development, and keep a public image that is flexible, approachable, and responsive.

This chapter provides an introduction to the concept of supportive care in heart failure (HF). It starts by presenting the concepts of supportive and palliative care. It addresses the delivery of supportive care and the framework for supportive care in HF. It is shown that the comprehensive HF care combines evidence-based HF care and supportive care. Further study is important to determine how best to enhance quality of life and reduce the symptoms and burdens associated with HF. While challenges presented by delivery and reimbursement systems may require organized schemes to achieve comprehensive HF care, framing supportive care as integral to comprehensive HF care allows clinicians to better meet the needs of the patient and family now recognized as essential to ‘patient-centered care’.

This chapter discusses the subject of spiritual care in two distinct and complementary ways and from two different perspectives: Ira Byock views spiritual care from the eyes of an American physician and secular academic, while Chris Davies explores spiritual care from the viewpoint of an Anglican priest. Spirituality is one of the inherent characteristics that every human being posesses, and in order to improve spiritual care giving clinicians must aim to have a full understanding of this concept.

This chapter discusses three kinds of information, namely: empirical facts, value-laden terms, and aesthetic. It shows that these kinds of information about sick persons are necessary to the work of clinicians, and also attempts to show that clinicians treat particular patients in particular circumstances at particular moments in time, thus requiring information that particularizes the individual and the moment.

This chapter discusses the experience of the clinician, beginning with the science and art of the practice of medicine. It then moves on to the importance of the clinician's experience, the relation of knowledge to experience, and why experience has a bad name. The chapter then discusses the advantage of experience, the physician as the instrument, and how experience is able to mediate between science and art. It also looks at the experience of uncertainty.

This chapter summarizes what is known about communication between clinicians and heart failure (HF) patients (and families), and proposes approaches to important aspects of communication, based on literature developed largely in oncology and general medical care. It begins by addressing general principles of physician communication with patients. The communication issues at initial diagnosis of ‘HF’, communication issues during the early phases, and communication issues that cut across all phases of HF are explored. The chapter then explains the exacerbations and remissions, gradual functional decline, exploration of invasive measures, maximizing quality of life, and preparation for the likelihood of death. Although few data exist to inform communication between physicians, or other healthcare providers, and their HF patients, approaches to physician–patient communication from research in other conditions can be applied to HF care.

Both non-verbal communication and gender play an important role in the clinical encounter. They not only affect the impact of the diagnosis, but also patient outcomes such as satisfaction and appointment-keeping. Dominance or power asymmetries in the providerȓpatient interaction have been assumed to affect the relationship, but have rarely been studied. This chapter gives an overview of the empirical findings pertaining to non-verbal communication, gender, and power within the patient-clinician interaction; shows how gender, non-verbal communication, and power are intertwined; and offers guidance about communication skills training to help physicians and improve outcomes for cancer patients.

The importance of the topic of ‘breaking bad news’ to cancer patients is underscored by a recent Medline search, which revealed close to 500 articles published on this subject in the past ten years, and by the fact that the cancer clinician is likely to give bad news many thousands of times during the course of his or her career. Paradoxically, however, despite the argument for its importance, very few training programmes in oncology thoroughly cover the topic and provide adequate learning experiences for trainees. Only a minority of oncologists have formal training in breaking bad news and other key communication skills. This chapter reviews the concept of breaking bad news, highlighting salient points and controversies in the literature and making training recommendations. It considers a definition of bad news, why the topic is so important, the challenges to clinicians in breaking bad news, protocols for giving bad news, research on bad news disclosure, and directions for the future.