26.1 - Psychological Aspects of Medical Practice Flashcards
What is the difference between illness and disease?
[IMPORTANT]
- Illness - subjective perception of change in the structure or function of the body that gives rise to concern.
- Disease - objective observable abnormality in bodily structure or function.
Give some experimental evidence for disease not being able to explain all illness.
[EXTRA]
(Henningsen, 2007):
- Found that approximately 1/3rd of illness in a secondary care setting cannot be explained adequately by an underlying disease
What are the different types of factor that can contribute to illness?
Give some examples of how biological factors can influence illness.
*Disease might be present, but not be the only cause of illness.
* Physiological changes (e.g. cardiovascular and muscular effects of bed rest)
* Neurophysiological changes (e.g. sensitisation in chronic pain)
Give some examples of how psychological factors can influence illness.
- Fears and beliefs (e.g. ‘my dad died when he got chest pain so maybe I will too’)
- Focussing of attention on symptoms (e.g. ‘I need to monitor my chest pain carefully’)
- Low or anxious mood (e.g. I feel really depressed and anxious about dying)
Give some experimental evidence for how common depression is as a comorbidity in cancers.
[EXTRA]
(Walker, 2014)
Give some experimental evidence for how comorbid depression affects people’s perception of illness.
[EXTRA]
(Moussavi, 2007):
- Found that for common conditions such as angina, the mean “health” rating that patients gave themselves was lower in patients with the condition and depression, compared to a patients with just the condition
Give some examples of how social factors can influence illness.
- Common cultural beliefs (e.g. ‘Chest pain is dangerous’)
- What other people say (e.g. ‘My son had that and he died’)
- What doctors say (e.g. ‘It is probably nothing…………but take the medicine just in case.)
What is iatrogenesis?
When medicine or treatment does harm.
What are some examples of iatrogenesis?
- Physical iatrogenesis (e.g. adverse effects of medical treatment)
- Psychological iatrogenesis (e.g. illness worsened as a result of anxiety about what the doctor said)
- Social iatrogenesis (e.g. ‘medicalisation’ of common illness in our society)
Describe the components of a biopsychosocial formulation of illness. Who came up with the idea?
[IMPORTANT]
For each of the biological, psychological and social realms in an illness, we must consider:
- Predisposing factors (those that predispose to the illness)
- Precipitating factors (those that trigger the illness)
- Perpetuating factors (those that cause the illness to continue)
(Engel, 1977)
For a patient with unexplained chest pain, complete a biopsychosocial table of example factors.
What is Health?
A state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity. (WHO)
What is the proportion of Medically Unexplained Symptoms?
What treatment for Major Depression do patients with cancer receive?
How can we improve management of illness without disease?
- Acknowledge the patient’s experience as real
- Give a positive explanation of the symptoms
- Offer a management plan based on the explanation
- Beware of your frustration manifesting as hostility
toward the patient
What is Burnout?
A physiological syndrome that is characterised by overwhelming exhaustion, depersonalisation, and reduced personal efficiency.
*There are biological markers (e.g. higher cortisol in hair)
What percentage of doctors are burnt out?
0 - 85%
How does burnout affect patient care?
*Doubles risk of error
*Increased likelihood of being named in malpractice
*Decreased patient satisfaction
*Reduced adherence to medical advice
What is clinical decision making?
The process of making an informed judgement about the treatment necessary for our patients.
A contextual, continuous, and evolving process, where data are gathered, interpreted, and evaluated in order to select an evidence-based choice of action.
What factors affect clinical decision making?
What is a physiological debriefing?
*Evolved from the PTSD literature - efficiency has been questioned.
*Critical incident stress debriefing.
What are the Principles of behaviour change?
What are some typical psychological responses to illness?
*Stress
*Denial
*Emotional response (including fear, anxiety, sadness depression, anger)
*Behavioural responses (e.g. withdrawal from social activities/ changes in appetite/ sleep disturbances)
*Illness anxiety response
