Behavioural And Social Sciences Flashcards
What factors influence the doctor-patient relationship?
Patient characteristics
- Increasing patient knowledge e.g. internet
- Gender, SES (Socioeconomic), education, ethnicity and race
Doctor characteristics
- Specialty, gender, models of health and illness
Culture clashes between different social worlds
- Doctor and patient health beliefs
- Biomedical versus psychosocial models of illness
- Expectations
Rise of complementary and alternative medicines (CAM)
- Declining status and trust in the medical profession?
Changing policy and organisational context and priorities
- Patient responsibility over health, self-management
- Increase in patient choice and consumerism in healthcare
What are the models of the doctor-patient relationship?
What is the paternalistic relationship?
- Communication style: instructive/ prescriptive
- Patient control = low
- Doctor control = high
- Doctor-centred - the doctor directs and is responsible for decision-making
- Follows a biomedical model of disease
- Doctor is the expert
- Disease is a biological phenomenon with an identifiable cause
- Eg. Oakley 1984
Criticisms:
- Patient is expected to be the passive recipient of care
- May be appropriate in certain clinical contexts e.g. A&E and for some patients (differences between patients)
- Overlooks the patient’s own knowledge and experiences
- Can result in low patient satisfaction and complaints
- May impact on adherence, disclosing of key information, understanding and therapeutic relationship
- May lead to conflict if patient tries to take more control
What is the mutualistic relationship?
- Patient and doctor control = high
- Involves mutual respect where patient plays a more active role
- Doctor acknowledges the patient’s beliefs, knowledge and experiences as important
- The consultation is more patient-centred
- Shared decision-making: both parties involved in decision-making
- Eg. Mead and Bower 2002-
Five dimensions:
- Biopsychosocial perspective
- ‘Patient-as-person’: personal meaning of the illness for each patient
- ‘Doctor-as-person’: awareness of influence of personal qualities and subjectivity of the doctor
- Sharing power and responsibility
- The therapeutic alliance
What is the consumerist relationship?
- Patient control = high
- Doctor control = low
- Greater levels of patient choice
- Patients becoming more active and demanding
- e.g. internet
- Patients as consumers of health and health care
- Increased choice, participation in decision-making policy, design and provision of services
- Nationally and internationally e.g. health tourism
What is the conflict relationship?
- Relationship characterised by conflict
- Disagreement and difference in perspectives
- ‘Clash of perspectives’ (Freidson, 1970)
- Doctors and patients come from different social worlds
- want more information than the doctor is willing to give
- Different expectations about the behaviour of each agent e.g. treatment, access
- ‘Patients expected to have enough knowledge to be able to judge when to seek care but then relinquish all power to professionals. A&E presentations said to be 70%
‘rubbish’ reasons by healthcare professionals - ‘Double bind’ (Bloor and Horobin, 1975)
What is the default relationship?
- Patient control = low
- Doctor control = low
- Lack of engagement on both sides e.g. doctor’s attempts to involve the patient in the consultation are unsuccessful
What are the benefits of patient centred medicine?
- More may be disclosed
- Better handling of ‘ticket of entry’ consultations
- Greater likelihood of clarification being sought
- Better concordance, and therefore adherence to treatment
- Fewer repeat consultations
- Increased satisfaction
- Choose the degree of engagement in decision making.
- Nice patient decision aids
What is shared decision making?
What are the 6 domains of quality of life?
Why is QoL important in healthcare?
What are examples of complementary and alternative medicine?
What are the 5 categories of complementary and alternative medicine?
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Alternative medical systems: involve complete systems of theory and practice that have been developed outside the Western biomedical approaches.
- Traditional Chinese Medicine (TCM) (Acupuncture and Oriental medicine)
- Traditional indigenous systems (e.g. Ayurvedic medicine, Siddha, Unani-tibbi, native American medicine, Kampo medicine, traditional African medicine)
- Unconventional Western systems (e.g. Homeopathy, psionic medicine, functional medicine, environmental medicine)
- Naturopathy -
Mind-body interventions: Mind–body medicine involves behavioural, social and spiritual approaches to health.
- mind–body methods (e.g. yoga, internal Qi Gong, hypnosis, meditation, relaxation, visualisation)
- religion and spirituality (e.g. confession, spiritual healing, prayer)
- social and contextual areas (e.g. intuitive diagnosis, community-based approaches). -
Biologically based treatments natural and biologically-based practices, interventions and products. Many overlap with conventional medicine’s use of dietary supplements.
- Phytotherapy or Herbalism (plant-derived preparations that are used for therapeutic and prevention purpose, e.g. Ginkgo biloba, garlic, ginseng, turmeric, aloe vera, echinacea, saw palmetto, capsicum, bee pollen, mistletoe)
- Special diet therapies (e.g. vegetarian, high fibre, pritikin, ornish, Mediterranean, natural hygiene)
- Orthomolecular medicine (products used as nutritional and food supplements and are not covered in other categories. These are usually used in combinations for prevention or therapeutic purpose, e.g. ascorbic acid, carotenes, folic acid, vitamin-A, riboflavin, lysine, iron, probiotics, biotin).
- Pharmacological, biological and instrumental interventions (include product and procedures applied in an unconventional manner, e.g. Coley’s toxin, ozone, 714X, enzyme therapy, cell therapy, EDTA, induced remission therapy, chirography, neural therapy iridology, MORO device, bioresonance, apitherapy). -
Manipulative and body-based methods: based on manipulation and/or movement of the body.
- Chiropractic medicine
- Massage and body work (e.g. Osteopathic Manipulative therapy, Kinesiology, Reflexology, Alexander technique, Rolfing, Shiatsu and Acupressure; Aromatherapy)
- Unconventional physical therapies (e.g. hydro-therapy, colonics, diathermy, light, music and colour therapy, heat and electrotherapy). -
Energy therapies- Biofield medicine involves systems that use subtle energy fields in and around the body for medical purpose
- Healing
- Therapeutic touch
- Reiki
- external Qi Gong
What are the protected characteristics?
- Age
- Disability
- Gender Reassignment
- Marriage and Civil Partnership
- Pregnancy & Maternity
- Race
- Religion & Belief (spirituality)
- Sex
- Sexual orientation
What is the biomedical model of disability?
- Subject of disability written about by professionals who work with, medically treat or study disability. Discourse heavily medicalised and oriented towards care and treatment.
- Biological impairment key determinant of disability; deviation from ‘normal’ body functioning has ‘undesirable’ consequences for the affected individual; rehabilitation or adaptations meant to facilitate ‘normal’ functioning.
- Associated with ‘otherness’
- Aims to identify and meet the ‘needs’ of disabled individuals so that they may ‘fit’ into and readily ‘function’ in wider society.
- Medicalisation of disability - the ‘solution’ to disability lies in curative and rehabilitative medical intervention.
What is the social model of disability?
- People with impairments are argued to be disabled by the social system which creates barriers to their participation (built environment, lack of captions in broadcasts).
- Redefines disability as ‘social oppression’
- Politicises disability: succeeded in shifting the debate about disability from biomedically dominated agendas to discourses about politics and citizenship.
- Breaks the causal link between impairment and disability. The impairment is not the cause of disabled people’s economic and social disadvantage.
- It is not an impairment that creates a disability, but rather the incompatibility of impaired bodies with social norms and material environments that are determined by the able-bodied majority, and the discrimination that frequently follows.
- The focus is on how far and in what ways society restricts opportunities to participate in mainstream economic and social activities rendering disabled people more or less dependent.
Medical vs social model of disability
What are the strengths and limitations of the biomedical and social models of disability?
Medical-
- Abnormal physiology or sub optimal functioning - what is ‘normal’ functioning?
- Historically constructed classification systems (individual behaviour and bodily and cognitive functions). Normality is socially defined? (ideal in Ancient Greece, normal arrives quite late)
- Other societies may not accord the same importance to functional efficiency (dyslexia in agricultural societies, seen important only in places where numeracy and literacy are important to social and economic participation?)
- Out of the ordinary manifestations in bodies and behaviours may be perceived anomalous, but not necessarily stigmatised (Micronesia: birth defects seen as disabling only if paired with speech or hearing impairments - ability to participate in social life)
- Biological reductionism: individual deficit without social context
Social-
- Overemphasises the social, and holds that all of the issues that negatively impact upon the lives of disabled people are to be found in society that changing society would eliminate disability
- By proposing a separation of impairment and disability, proposes the separation of body and mind.
- Follows traditional, cartesian, western meta-narrative of the body as a machine, as a pre-social, inert, physical object, separate from the self
- Ignores the ‘lived experience’ of impairment
- The continuum of impairments
What are the different forms of disability discrimination?
- (Dis)ableism - discrimination and prejudice against people with disabilities.
- Social/economic – education and employment
- Physical – access to built environment (housing, transport)
- Cultural – language used/images of disability
- Behavioural – Hate Crime, abuse and violence, staring, lack of friendship and intimacy
- EDUCATIONAL SEGREGATION: the debate over special needs schooling
- ECONOMIC DISCRIMINATION: disabled people are twice as likely to be unemployed as non-disabled people
What is social constructivism in gender and health?
Gender socialisation theory:
- Females become women through a process where they acquire feminine traits and learn feminine behaviour. Gendered behaviour often reinforces existing inequalities/gender roles.
What is hegemonic masculinity?
the way of ‘doing’ gender that is most valued in our society. A culturally idealised form of manhood - being assertive, aggressive, bread-winner.
People who conform to hegemonic masculinity:
- Are rewarded by society
- Have better access to power and status in society
- Obvious disadvantage for women
- But also disadvantage for men (e.g., ‘real’ men are not supposed to cry)
- Those who do not or cannot conform to the informal hegemonic masculine norms face discrimination and stigma (e.g., gay and transgender people)
What is Heterosexism and cissexism?
Heterosexism
System of attitudes, bias, and discrimination in favour of opposite-sex relationships
E.g. A female patient mentions she is married and the nurse asks the name of her husband
Cissexism
Cissexism – system of attitudes, bias, and discrimination in favour of the cisgender gender identity
E.g. A men’s bathroom does not have sanitary bins meaning that a transman is unable to dispose of his sanitary pad correctly
What is minority stress theory?
What is the Gender identity clinic pathway?
What is the short and long term management for someone with gender dysphasia?
What are the effects of oestrogen and testosterone?
What are the risks of hormones and how to monitor them?
What is the self-regulatory model of illness behaviour?
How does depression affect prognosis in heart disease?
What are perke’s stages of normal bereavement?
What is the dyer model of grief?
What are the experiential models?
What are the key challenges of chronic conditions?
What are the types of stigma?
What is felt and enacted stigma?
What is biographical disruption in chronic illness?
What are the different types of delay?
(1) appraisal delay (deciding the symptom indicates an illness);
(2) illness delay (deciding that the illness merits a consultation with a doctor);
(3) behavioural delay (making the appointment)
(4) scheduling delay (time between making appointment and actually seeing the doctor)
