Health Services and Patient relationships Flashcards
What affects symptom recognition?
Individual differences and personality
(hypochondriacs who interpret symptoms in a more negative way)
Neuroticism (more likely to notice and report symptoms and to catastrophise)
Cultural norms: menopause is defined differently by different cultures.
When Busy people are less attentive of their bodies
Mood: positive and negative
Chronic stress
What influences your interpretation of symptoms?
Prior Experience
Expectations (personality and what you expect)
Seriousness (pain plays a major role)
What are common ways people seek info and advise?
Lay referral network (fam and friends who help you interpret, might get good advise or different from doctor)
Internet: good depending on source and if you’re looking up specific symptoms or not
What is an illness schema?
Organizing illness related information
- causes of illness
- consequences of illness
- duration of illness
- cure for illness.
They influence how we recognize, interpret, and the actions we take against particular illnesses.
Aquired through media and campaigns and experience.
What is Fast?
Face, Arms, Speech, Time !
What is Treatment delay?
Detecting a symptom and obtaining treatment. 4 Delay stages.
- Appraisal delay: time it takes to decide symptom is illness
- Illness Delay: time it takes from recognizing illness to deciding to seek treatment
- Behavioral Delay: time it takes from deciding to seek treatment to actually doing so (perceptions of barriers and benefits are important here)
- Medical delay: time between seeking care and receiving treatment (scheduling, waiting for tests, follow ups)
Who uses health services?
Children and older adults
Women more than men - more sensitive to bodily changes (their care is more fragmented and they see more specialists)
Social and cultural factors
Lower in SES are less likely to get treatment but paradoxically use ER services more (less preventative healthcare)
Rural areas less, language barriers stop people from seeing doctors.
What is patient centered communication?
Active listening (open ended qs), empathy, no interruptions, clear explanations. Results in greater satisfaction and health outcomes (adherence to treatment)
Enlists a sense of partnership.
What are problems with patient provider communicaton?
- not listening (interuptions - there is a gender difference here too) and distraction
- jargon: dont understand terms that providers use, lack of understanding leads to less ability to follow reccomendations
- Babytalk/elderspeak
- oversimplification, talking down’ to the patient - Stereotypes base on sex (women’s pain is more dismissed), ethnicity/race, SES, age
All these problems lead to patients being unable to repeat their diagnosis within minutes of discussing it. Pts. with neuroticism are more likely to exaggerate symptoms making it harder, there can be language barriers, embarrassment, and anxiety associated
What is adherence?
following reccomendations. Can be
- medications (self report, mems cap, pill count, pharmacy records)
- lifestyle changes
- medical devices (sleep apnea)
Average rate is about 75%, but varies with difficulty and level of comfort !!
What are some examples of non adherence?
failing to fill a prescription, missing a dose of prescription, taking a different dose, taking an old medication , not booking followup appointments
There is unintentional and intentional
What does adherence vary based on?
Quality of patient provider communication
Pain
Percieved seriousness
Visibility of symptoms
Complexity of treatment (length and dose)
Side effects of treatment
Mental health
SOCIAL SUPPORT
What is the placebo effect?
Inactive treatment that makes you think you will benefit from it, means “i will please” in latin. Can produce theraputic effects.
historically docotors would do this when they didn’t have an actual cure for something.
examples: sugar pills, sham surgery, neutral psychotheraputic techniques (write down everything you did that day and you’ll be happier)
When is the placebo effect stronger? when does it not work?
Stronger: when provider seems warm, competent, and provides reassurance, whe pateints are anxious and have low self esteem, when pt. is highly persuadable.
Stronger when precise dosages, prescribed schedule, and pills taste bad!!!
Nocebo: negative expectations coming true (side effects that aren’t even there)
How is placebo used as a methodological tool?
no drug can be marketed until its evaluatd against a placebo or effective treatment of today (3 group)
double blind experiments
