Week 9:Communication & Decision-Making:

Question 1

What is the importance of the Patient-provider Communication

Answer 1

The interaction is important so that the patient can be heard and not overlooked

Question 2

The Doctor Patient Relationship Today

Answer 2

-Seen more business

-High rates of specializations

-Colleague dependent

-Technology depedent

Question 3

2 Formats of Medical Encounters

Answer 3

1. Hierarchical relationship
   a. Interview→ dialogue between
   b. Physical examination
2. Recommendation and treatment
   -Sequential → A pattern
   a. Provider -initial
   b. patient responses
   c. Provider comments

Question 4

4 Parts of Doctor-Patient Communications

Answer 4

1. What we know about doctor-patient communication
2. Consequences of communications
3. Improving doctor-patient communication
4. The future doctor patient communication

Question 5

4 Ways that Doctor-Patient Communication is Asymmetric

Answer 5

1. Flow of information
   Doctors restrict what that they tell the patient and how they tell the patient
   Providers don’t usually tell the gravity of what their condition is
2. Structure of conversation
   The provider controls the conversations
   Controlling the content of communication
   If you are the one asking the questions than you control the content and topics
   Yes or no questions
   Force choices questions
   “Was it dark red or light red”
3. Deflecting Patient Concerns
   Interrupting the patients talking
   Failing to answer questions so directly
   Mishler voice of medicine drowns out life world
   Not exploring the social context of a patient

4.The medical interview is shaped by the social context
A health care provider has to be a detective
Their is social conditions that have context depending on different social for geographics
Different diagnosis depending in different areas
-Bureaucratic organizations
-Colleague dependency
-Managed care
-Steep slope of health care
-Providers’ cultural assumption
-Problems in communication exacerbated by
-barriers of race, SES, gender
-Amount of information patients receive
-Patient’s willingness to ask questions
-Patient’s inclusions in medical decisions
-making (consent vs. assent)
-Differences in races between the patient and doctor races

Question 6

Consequences of Communication

Answer 6

1. Patient satisfaction
2. Malpractice and doctor-patient communication
   -*70% is due to miscommunication between doctor and patient
3. Diagnosis and misdiagnosis
   *40% of patients who unexpectedly returned after initial primary care visit had been misdiagnosed
   *80% was tied to mis communication with doctor and patient

4.Adherence to medical advice

Question 7

Improving Doctor-Patient Communication:
The Four Habits Model

Answer 7

1. Investing in the beginning
2. Elicit the patient’s perspective
3. Demonstrate empathy
4. Invest in the end

Question 8

Improving Doctor-Patient Communication:
Tell-ask-tell method

Answer 8

Physician might tell you something and then the patient ask what they are concerned to
Giving the patient the opportunity to ask questions and concerns

Question 9

Improving Doctor-Patient Communication: Teaching communication to Med Students

Answer 9

-Teach effective communication

-Reward effective communication

-Actually test on it and make the credits higher

-Having a lower credit count tells students it’s not as important

-Allows enough time for communication

Question 10

The Future of Doctor-Patient Communication

Answer 10

Positive Trends
-More informed, assertive patients
-Changing physician attitudes
Improved medical education

Negative trends
-Bureaucratization
-Capitation
-Corporatization

Tella-Medicine
-How will this affect the future of medicine
-Views on this are varied

Question 11

Medical Decision Making

Answer 11

medical decision making is partly a
social process

Social factors enter into diagnosis and treatment decisions

Question 12

Social Factors in Diagnosis and
Treatment Decisions

Answer 12

1. Activism and the Medical Decision Rule
2. Fads, Ideologies, and the “Surgical Signature”
3. Organizational Influences
4. Perceived patient characteristics

Question 13

Two types of errors for medical decisions -Scheff

Answer 13

Type I error→ failing to diagnose and treat a patient who is really sick

Type II error → diagnosing and treating a well patient

Question 14

THE MEDICAL DECISION RULE

Answer 14

Better to over-diagnose and over-treat than to under diagnose
Type II over type I

Question 15

Rule of Halves

Answer 15

About half a time you are going to say someone is diagnosed with something when they might not even have that

Question 16

Fads, Ideologies, Surgical Signature

Answer 16

There is trends of medical procedures depending on areas that may be unnecessary

E.g → women who lived in the west stayed for a shorter time rather than the east where they stayed longer for newborns. Thus the same results for both this relationships

Question 17

Surgical Signature

Answer 17

• Comparing surgery rate across different regions

-Depends on the actual surgeries in the area and follows them where they go

Question 18

Episiotomy

Answer 18

used in ranges from region to region from 10-75%

-a surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues.

-Procedure to open the labia when giving birth

-Is very painful for mothers

-Not helpful

-Tradition to continue to work

Question 19

Organization Influences

Answer 19

The type of medical practice

-Client-dependent: patient refer selves

-colleague -dependent: patients referred by other doctors

-Insurance and reimbursements

Question 20

Perceived Patient Characteristics

Answer 20

-Social class

-Gender

-Race

-Social worth

Question 21

Why are there social factors in medical decisions ?

Answer 21

Our world is people and people are judged quickly for medical encounters

Question 22

Deprofessionalization of Medical System

Answer 22

Independent solo practices to a very business centric system

Question 23

Why was the Medical world DE professionalization of the medical system Socially ?

Answer 23

Social Conflict
1. Deduction of physician from medical ethics
-More medical ethics and conflict of interest
-Medical error is the third leading cause of death

2.Commodification of healthcare (how it’s a business)
-Advertising
-Primary care places

3. Shift of professional lifestyles
   -Its less personable and catered towards patients
4. Legitimization of profit
   Profit is valued in medicine (there is competition for money)

Question 24

Why was the Medical world DE professionalization of the medical system Ethically ?

Answer 24

1. Extrinsic factors:
   - Government is more interested in the finances and not the actual
   -health care being provided
   -Assembly line medicine
   -Things did to be improved by third parties
   -NPCs (non doctor positions) threaten the ideas of a physicians in order to pay them less
   -Globalization → the internet and knowledge is power
   -Medicine is not just in the hands of the physicians
2. Intrinsic:
   -Oversupply but now there is a
   -shortage of positions in primary care
   -Union → the AMA is falling apart

Question 25

Professionalization, Monopoly, and the Structure of medical Practice -Conrad & Schneider Medical Profession prior to the 19th century

Answer 25

-supernatural, sickness as a sin -diagnosis often inaccurate -no formal education in the US

Question 26

Professionalization, Monopoly, and the Structure of medical Practice -Conrad & Schneider Medical Profession during the 19th Century

Answer 26

-physicans were educated through apprenticeships -heroic vs. homeopathic -practices were no working causing doctors to not be taken seriously -AMA was just being formed which caused medicine to become more professionalized

Question 27

Professionalization, Monopoly, and the Structure of medical Practice -Conrad & Schneider Medical profession in the Late 19th and early 20th century

Answer 27

-started be involve in social reform -decrease diseases (through sanitary habits) and scientific break throughs cause doctors to gain prestige - medicine started to become corporate

Question 28

Professionalization, Monopoly, and the Structure of medical Practice -Conrad & Schneider Abortion Moral Crusade

Answer 28

-Was common prior to the civil war -And eventually even the upper white class was doing it -In the 1850s physicians began writing on how immoral it was -This is how the abortion crusade started -This was caused by a drop in birth rate -Abortion was too popular in married people and upper white class -Didn’t like the decline in american born babies -Less white people = less white control -Wanted anti abortions so that -physicians had more control over medicine -The ama oath did not allow abortions -Therefore by banning it ama could get more people into their organization -Was seen as dangerous and banned but was safer than it ever has been as time goes on -As discussed before health was increasing in the 20th century because it upheld phys -Medical sectarianism The idea that medicine is sacred -Medicine is the second largest industry in the medical field -Medicine is 9 percent of america's gross national product -Medicine charges for each service provided -Living baby → when the baby could move

Question 29

The Struggle between the voice of Medicine and the voice of the lifeworld -Mishler 4 phases of physician patient discourse

Answer 29

1.Description Pre req When patient and phys start communication Determining what details from the patient is relative 2. Analysis Where the details of the patient and makes an analysis Lack natural occurring talk Determines medical interview Physician uses clues to make Maintains control over the medical 3. interview Interpretation The work of doctoring → physicians have a tendency to ask close end questions instead of open ended questions Causes information bias Causes 4. Interruptions Controls the interview Interrupts when patient is describing to ask questions What color was ___??? Physicians are unable to give full perspective

Question 30

The Struggle between the voice of Medicine and the voice of the lifeworld -Mishler 3 part utterances

Answer 30

1. Opening questions 2. Patient response 3. Physicians response

Question 31

The Conversation Placebo -Orfi

Answer 31

Our bodies are only meant to live until we're 30, but with medicine people are living until their 80s -A study showed that patients who were thoroughly talk to by doctors had less pain -Healing can come from communication with the patient

Question 32

Notes on the Decline of Midwives and the Rise of Medical Obstetricians -Wertz & Wertz

Answer 32

Key takeaways: -Women (midwives) were pushed out of child birth by Obs because they created this image the Obs were more prestigious and knowledgeable even though they were not -cultural shift where people said women did not belong in medicine -the decline of midwifes was due to the lack of leadership, the rise in popularity in the upper class for Obs, and the cultural shift

Question 33

American Sociological Review -Timmermans Fredsons

Answer 33

Professions are still in status today because people lack the medical knowledge

Question 34

American Sociological Review -Timmermans Light

Answer 34

Professions are challenge by individuals due to suicide findings being inaccurate in their findings

Question 35

American Sociological Review -Timmermans Key takeaways

Answer 35

-Majority believes that suicide is under recorded -minority believes that suicide data is biased Lights is correct in crediting individuals - Fredons on focuses on power and privilege

Question 36

American Sociological Review -Timmermans Suicide determination depends on 3 things

Answer 36

1.Standards of death 2. Who determines death 3. How the determinator impacts society