UNIT 1: Patient - Practitioner Relationship Flashcards
5 subtopics of the “Patient-Practitioner Relationship”
- Verbal and Nonverbal Communications
- Diagnosis Style
- Errors in Diagnosis
- Importance of Disclosure of Information
- Misusage of Health Services
3 experiments under Verbal // Nonverbal communications
a) McKinstry and Wang
b) McKinlay
c) Lay
2 experiments under Diagnosis Style
a) Byrne and Long
b) Savage and Armstrong
2 kinds of Errors
Type I: FALSE POSITIVE (No illness, Told there is illness)
Type II: FALSE NEGATIVE (Has illness, told there is no illness)
1 experiment under the Importance of the Disclosure of Information
a) Robinson and West
(i) 1 experiment under Misuage of Health Services
(ii) 1 study on hypochondriasis
(iii) 3 case studies of munchausen syndrome
(i) Safer
(ii) Barlow and Durand
(iii) Nurse Beverly Allitt
Aleem and Ajarim
Blanchard Family
Define Hypochondriasis
A disorder in which a person interprets normal physical sensations as symptoms of disease
“The tendency of individuals to worry excessively about their own health, monitor their bodily sensations closely, make frequent unfounded medical complaints, and believe they are ill despite reassurances by physicians that they are not.”
Define Munchausen syndrome and its features
A mental disorder in which a person repeatedly feigns severe illness for either social or financial benefits
- MAJOR:
- Pathological Liar
- Recurrent feigned or simulated illness
- Constant travel - MINOR:
- Deprivation in childhood
- Antisocial traits
- Multiple hospitalizations
- Self-induced pain
- Mental calmness when discussing major symptoms
Define Munchausen syndrome by proxy
A mental disorder in which a person repeatedly believes that they are aiding a person with a severe illness despite that person not being ill at all
McKinstry and Wang
AIMS, PROCEDURE, FINDINGS, CONCLUSIONS, STRENGTHS & WEAKNESSES
Aim:
To investigate how acceptable patients’ found different styles of doctor’s dress codes and whether that patient felt that dress code influenced their respect for their practitioner
Procedure:
- 8 pictures (5M & 3F)
- 475 Participants (from 5 clinics)
Findings:
- MEN: White lab coats
- WOMEN: Jumper + Skirt
Conclusions:
Patients preferred traditionally dressed doctors in terms of patient happiness and satisfaction (in terms of ratings.)
Strengths:
- High applicability
- Large Sample Size
Weaknesses:
- Low ecological validity (static images)
- Potential bias (not equal number of male and female pictures) = lowering validity
McKinlay
AIMS, PROCEDURE, FINDINGS, CONCLUSIONS, STRENGTHS & WEAKNESSES
Aim: To investigate patient comprehension of 13 medical vocabulary in a maternity ward of lower-class women
Procedure:
- 13 words (Breech, Umbilicus, Navel)
- Recorded verbatim by doctors and assessed by 2 doctors (inter-rater reliability)
Findings:
- Less than 40% of women understood each term
- Women who have already had a child were more likely to comprehend words than first timers
- Women had far better understandings than doctors expected
Conclusions:
Women were unlikely to ask their doctors to explain words that they didn’t understand. (Fear of appearing uneducated)
Strengths:
- High ecological validity
- Interrater reliability
- High applicability (improve patient-doctor communication)
Weakness:
- Not generalisable (lower - class women only used)
- Unethical (may cause distress)
- Lack of quantitative data (more difficult to analyze)
Lay
AIMS, PROCEDURE, FINDINGS, CONCLUSIONS, STRENGTHS & WEAKNESSES
Aim:
To investigate the amount of information patients could recall immediately after a doctor’s consultation
Procedure:
Researchers asked patients to repeat and recall information given by doctors immediately after a consultation
Findings:
- Strong recall of the first thing they were told
- Patients recalled 55% of information they were told
- Patients easily recalled categorized information
- Patients with medical experience had greater recall of information
Conclusions:
Patient recall is improved by: Categorisation, Visual cues (Signposting // Posters), Repetition, Summarizing, Clarity, Diagrams
Strengths:
- High ecological validity
- High applicability (improved patient’s recall by 705)
Weaknesses:
- Low generalisability (only performed in one country)
Byrne and Long
(PROCEDURE, FINDINGS)
- 7 MD styles
Procedure:
- 2500 tape recordings of doctor consultation
- across different countries (Australia, Holland, England, Ireland)
- Medical jargon was avoided
Findings:
- 2 main doctor styles: “DOCTOR-CENTERED” & “PATIENT-CENTERED”
- Doctor centered: Direct, yes//no, focuses on one symptom
- Patient centered: Establishes understanding, open to discussion, listens to patients’ stories and symptoms
- 7 Medical diagnosis styles
1. Direct
2. Direct + Informative
3. Informative + Reassuring
4. Advising + Reassuring
5. Informative + Advising + Clarifying
6. Informative + Answer Patient Qs + Summarizing
7. Encouraging + Seek patient ideas
Savage and Armstrong
AIMS, PROCEDURE, FINDINGS, CONCLUSIONS, STRENGTHS & WEAKNESSES
Aim:
To investigate whether patients preferred direct or shared consultation styles (patient satisfaction)
Procedure:
- Random sampling
- 359 patients (Ages 16 -> 75)
- Measured patient satisfaction via two questionnaires (1 week apart)
Findings:
- Patients prefer doctor-centered // direct consultation
- More likely to report “greatly helped”
Conclusions:
- Direct consultation had a better effect on patient satisfaction as evidenced by:
- Positive perception of the doctor’s understanding of the question
- Quality of doctor’s explanation
- Subjective improvement 1 week later
Strengths:
- Random sampling (no bias)
- Large sample
- Informed consent
- High ecological validity
Weaknesses:
- Demand characteristics (patients may not have wanted to rate their doctor’s scores lower on the 2nd questionnaire; don’t want to appear as if they dislike their doctor)
- Individual differences = results were averaged, not everyone prefers direct consultation
Robinson and West
AIMS, PROCEDURE, FINDINGS, CONCLUSIONS, STRENGTHS & WEAKNESSES
Aim:
To investigate whether patients were more likely to report more pieces of information to a computerized questionnaire than to a doctor during consultation
Procedure:
- Genito-urinary clinic
- 33M & 36F (ages 15 -> 49)
- 37 (Computer group) vs 32 (Paper group)
- Patients were randomly assigned to either (1) a paper questionnaire or (2) a computerized questionnaire
- Data collected were: (1) Number of symptoms (2) Number of reported visits to GU clinic (3) Number of sexual partners in the last 12 weeks
Findings:
- Both computer and paper questionnaire yielded more reported symptoms than the doctor consultation
(Computer > Paper Q)
- Mean number of sexual partners reported were higher in computer questionnaire than both paper and doctor consultation
Conclusion:
- Patients are unwilling to disclose all symptoms during a doctor’s consultation
- Computer Qs should be employed to elicit greater number of information to aid doctor’s diagnosis
