Chapter 4 Flashcards
(70 cards)
Active Passive Model
a situation in which patients are unable to participate in their care or to make decisions because of their medical condition.
e.g. severe injuries or coma
Dennis gashed himself with a knife while camping in the bush. He cut an artery and the blood was spurting out. His buddies placed him in the back of their pickup truck and sped down the highway toward the nearest town. By the time they reached the hospital, Dennis was unconscious. A few seconds after they arrived at the hospital emergency ward, Dennis was placed on a gurney and wheeled to the operating room. Then Dennis’s clothing was speedily cut off and the severed artery was found and tied. At the same time, others worked to find a vein that had not collapsed in order to put in an intravenous line. The entire emergency room staff worked with skill and speed. Dennis, who was unconscious, could neither participate in nor fight their efforts.
Active-passive model
Guidance-Cooperation Model
communication in which
the patient seeks advice from the physician and answers the questions that are asked, but the physician is responsible for determining the diagnosis and treatment.
e.g. infection or sprain
Diego was told by his physician to “take one of these little pills three times a day. If you do what I tell you to, you will be just fine.” Diego was convinced that asking the physician questions would be challenging physician authority, so he simply nodded in agreement. Diego was to take the medication to control his hypertension. However, he couldn’t seem to remember to take the pills. This may have been due to the fact that he didn’t feel sick (hypertension is often referred to as “the silent killer”), or because he had never been told exactly what the medication would do.
guidance-cooperation model
Mutual Participation Model
a health care model in which the physician and patient make joint decisions about every aspect of care.
Care-seekers prefer being called patient to client
Patient: I don’t know how I’ll be able to eliminate caffeine from my diet. That will be quite a challenge, especially if there needs to be an immediate reduction in my caffeine consumption.
Physician: What do you think you’ll be able to manage? Can you try to reduce your caffeine intake a little bit every day?
Patient: I can try, but it won’t be easy. And you don’t just mean reducing coffee drinking, do you? You also mean reducing the amount of chocolate I consume. I think I’m going to be pretty grumpy over the next while; perhaps you should warn my partner.
Physician: Is there anything you can think of that I might be able to do to help you?
Patient: Tell me again exactly why this is necessary. Also, is there anything else I should be doing to help my medical condition?
mutual participation model
What is the most effective partnership with the physician?
mutual participation model
What is a typical physician-patient relationship?
which the physician possesses a greater degree of power than the patient.
Communication Patterns
- narrowly biomedical communication
- expanded biomedical communication
- psychosocial communication
- consumerist communication
Narrowly Biomedical communication
characterized mainly by biomedical talk, closed- ended medical questions, and very little discussion of psychosocial issues.
(e.g., “The medication may make you sleepy”)
(e.g., “Are you in pain when you walk?”),
occurred in 32 patient visits
Expanded Biomedical Communication
includes numerous closed-ended medical questions and moderate levels of biomedical and psychosocial exchange between physician and patient.
occured in 33 patient visits
Biosychosocial communication
suggests that biological, psychological, and social factors are all involved in any given state of health or illness.
20 percent of patient visits
Psychosocial Communication
includes substantial psychosocial exchange between physician and patient.
8 percent
Consumerist Communication
the use of the physician as
a consultant who answers questions rather than asking them.
8 percent
Szasz and Hollender stated that the mutual participa- tion model was “essentially foreign to medicine.
Now more than 50 years have elapsed, and this statement no longer seems to be true. Indeed, Schwartz and col- leagues (2017) suggest that we’ve seen an evolution of styles with the more biomedi- cal approaches being most common in the 1950s and 1960s, a transition to a more cooperative approach, and the collaborative or psychosocial model now being the most common. We might say that the psychosocial model is deemed to be the gold standard (October, Dizon, & Roter, 2018).
Top 10 Physician Attributes for Patient Satisfaction in Rank Order
- Always honest and direct
- Listens to me
- Encourages me to lead a healthier lifestyle
- Does not judge; understands, supports
- Someone I can stay with as I grow older
- Tries to get to know me
- Acts as a partner in maintaining health
- Treats both serious and non-serious conditions
- attends to emotional and physical health
- can help with any problem
Factors in Physician-Patient Communication
Information Giving
Participation
General Patient Satisfaction
Patient Satisfaction, Communication, and Malpractice Claims
Information Giving
patients are generally dissatisfied —> want more information
takes up 1 in 20 minutes of appointment
True or false “patients tend to be more dissatisfied about the information they receive from their physicians than about any other aspect of medical care”
True
physicians drastically overesti- mated the amount of time they were engaged in this task.
physicians underestimate patients’ desire for information
sometimes physicians choose to withhold information from patients in an attempt to protect their patients from worry and because they find providing such information too difficult
True or False providing such information to patients results in lowered blood pressure and less psychological distress as well as improvement of symptoms when the information presented is coupled with emotional support (Roter, 2000).
True
Participation
more satisfaction and better recovery when patients get amount they want
patient-physician mismatch can be harmful
some want more details and involvement in decisions and some prefer less
- healthier, younger, and better-educated patients prefer greater involvement in health-related decisions
- lower social classes tend to prefer a more passive role
- compared to white patients, Hispanic and Asian patients are less satisfied with the involvement allowed them by their physicians
- Black patients also expe- rience less patient-centred care than do their white counterparts
True or False Some physicians are more inclined than others to share their authority and decision making
True
General Patient Satisfaction
primarily a function of the quality of the physician-patient relationship
- non-verbal behaviours
- competence of physicians by their emotional satisfaction with care - physicians who are more emotional expressive are preferred
