Background To allow patients to reflect about a decision to participate in a clinical trial, guidelines suggest a 24-h delay from when they are informed about the trial to when they give consent. In certain clinical settings, this is likely to hamper recruitment. Method After oral and written information about the trial has been given in person, the patient signs the declaration of consent knowing that they will be asked again after 24 h whether they confirm or regret the decision. (...) This procedure can be done by SMS. The investigators must document the response. The procedure was tried in a study in which the doctors were randomly assigned to receive a clinical communication skills course, and encounters with patients were videotaped before and after the course. Results 553 patients were approached, 530 (95.8%) gave initial consent, eight of these later regretted their consent. Discussion The low level of regrets suggests this is an acceptable procedure for patients. Trial registration The RCT was registered before initiation – registration # ISRCTN22153332. (shrink)

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters. Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations. Setting A 500-bed general teaching hospital in Norway. Participants 71 doctors working in clinical non-psychiatric departments and their patients. Results The doctors were concerned about their patients' health and how their (...) medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients' existential concerns onto medical facts and rarely addressed the personal aspects of a patient's condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them. Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors' social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof. (shrink)

Building on critical approaches that understand algorithms in terms of communication, culture and organization, this paper offers the supplementary conceptualization of algorithms as organizational figuration, defined as material and meaningful sociotechnical arrangements that develop in spatiotemporal processes and are shaped by multiple enactments of affordance–agency relations. We develop this conceptualization through a case study of a Danish fintech start-up that uses machine learning to create opportunities for sustainable pensions investments. By way of ethnographic and literary methodology, we provide an in-depth (...) analysis of the dynamic trajectory in and through which the organization gives shape to and takes shape from its key algorithmic tool, mapping the shifting sociotechnical arrangements of the start-up, from its initial search for a viable business model through the development of the algorithm to the public launch of its product. On this basis, we argue that conceptualizing algorithms as organizational figuration enables us to detail not only what algorithms do but also what they are. (shrink)

IntroductionThe assisted reproductive technology field deals with consistent and predictable gaps in knowledge. Expressing lack of knowledge with a sentence like “I don’t know” can be challenging for doctors. This study examined physicians’ negative epistemic disclaimer “non lo so” in Italian ART doctor-couple interactions. In particular, it aimed to reveal specific features of “non lo so”: function, topic, temporality, responsibility, and interactional aspects.MethodsThis was a video-based observational study. We used microanalysis of face-to-face dialogue to analyze 20 purposively selected triadic consultations (...) from a corpus of 85. This inductive analysis focused on the function, the content and some selected interactional aspects of the “non lo so”, quantifying and capturing the interaction between these qualitative features.ResultsWe found 82 doctors’ “non lo so” in the corpus. We discovered three main functions of this expression: propositional, relational, discursive. The most frequent topics raising doctors’ “non lo so” were costs, treatment-related aspects, and timing issues. In more than half of the cases, present issues emerged. The majority of “non lo so” was framed using the “I,” with doctors’ taking personal responsibility. Patients played a role in these expressions from doctors: Patients initiated more than one third of them, and in one fourth of the cases, patients followed up immediately.ConclusionOur findings may be related to characteristics of the specific field of ART. Doctors in this setting must frequently express a direct lack of knowledge to their patients, and when they do, they mean it literally. Patients contribute to such disclosures, and their responses suggest that they find them acceptable, showing that they may expect limitations in their potential to conceive. (shrink)

The Forest Stewardship Council (FSC) is a global private governance system overseeing the sustainability and biodiversity of the world forestry system through certification of forests and forestry processes and products, and is perceived as the strongest of the various certification schemes available (Domask, Globalization and NGOs: Transforming Business, Government, and Society , 2003 ; Gulbrandsen, Global Environmental Politics , 2004 ). It has seen more success in developed than developing countries in terms of amount of forest certified and number (...) of chain-of-custody certificates issued, raising questions as to its ability to promote biodiversity Gulbrandsen, Global Environmental Politics , 2004 ). A number of challenges have risen to the pragmatic and moral legitimacy of the FSC as a global governance system: alternative certification schemes, output and market access, cost of certification, plantations, and illegal logging. I examine each of these challenges as they pertain to the dimensions of pragmatic and moral legitimacy of the FSC. I conclude with a discussion of theoretical implications for global governance systems using ecolabel schemes, as well as a discussion of practical implications for the FSC in particular. (shrink)