6 - consultant behaviours and patient adherence to medication

Question 1

in the ideal world, what steps would one take to get better having noticed ill-health

Answer 1

1. experience ill-health
2. consult expert
3. receive a diagnosis
4. prescribe course of action
5. follow medical advice
6. get well

Question 2

why are the ideal steps not realistic or straightforward

Answer 2

at each stage there are factors that interfere with the process
(behavioural and structural)

Question 3

what do we mean by the clincial iceberg

Answer 3

may doctors do not see many of the ill people experiencing symptoms

Question 4

behavioural factors interfering with health care process

Answer 4

behavioural decision to seek medical help or to adhere to prescribed medication

Question 5

structural factors interfering with health care process

Answer 5

inability to get GP appointment
ease of appointment depends on where you live
causes more people to attend A&E

Question 6

examples as to why early diagnosis critical

Answer 6

dementia

• better management of care (planning, risk avoidance)
• earlier access to treatment

cancer

• screening services can detect early stages
  e. g. bowel, cervical, breast

Question 7

screening outcomes

Answer 7

true positive/negative

false positive/negative

Question 8

thought process underlying symptom perception

Jane Odgen

Answer 8

1. is it a symptom
2. do i need help
3. could a doctor help

Question 9

effect of personality on symptom perception

Answer 9

internally focussed individuals may be more aware/sensitive to symptoms
however they may over-estimate their symptoms and be less accurate

Question 10

other factors affecting symptom perception

Answer 10

demographics
age
gender
social context (e.g. do u identify as someone who gets that illness)

Question 11

effect of social stigma on health

Answer 11

people anticipate stigma and can prevent people from seeking help

can cause people to be in denial of their symptoms, perceive as a threat to their ‘healthy’ identity

Question 12

milgram 1963

Answer 12

experiment to show how far a person would go under experimenters orders using electric shocks

results showed that 65% people obeyed the instructions and gave electric shocks strong enough to kill

Question 13

evidence for patient adherence

Answer 13

prescription adherence is low

only 40-55%

Question 14

effect of poor patient adherence on NHS

Answer 14

accounts for more than 10% of hospital admissions

Question 15

reasons for non-adherence

Answer 15

demographics
number of symptoms
treatment duration 
dose frequency
patient factors e.g. memory

Question 16

how does social identity affect patient adherence

Answer 16

patient might adopt a different social identity in the appointment (patient-doctor identity)

might leave consultation and another identity takes priority causing patient to not think about medication

Question 17

even if we adhere to the medication why might we not get better?

Answer 17

diagnostic error from healthcare professional (10-15% misdiagnosis rate)
doctors may fail to recommend further diagnostic tests