Chapter 12 - Doctor-Patient Interactions

Question 0

Managing risks for BRCA gene carriers

Answer 0

BRCA is gene associated with breast cancer.
Medical approach: mastectomy
Behavioral approach: yearly exams, avoid X-rays

Question 1

Types of screening

Answer 1

Diagnostic – shows whether a person has a given disease (Marfan syndrome)
Pre symptomatic – shows whether a person is going to develop a given disease (kidney disease)
Predisposition – shows whether a person has a genetic predisposition to a given disease but not whether they will definitely develop it (Alzheimer’s)
Carrier status – shows whether a person carries a gene for a given disease and could pass it to children (sickle cell anemia)
Parental – shows whether a fetus has a given disease (downs syndrome)

Question 2

Nonadherence to screening

Answer 2

Yerkes-Dodson law – too much fear or not enough fear

Question 3

Impact of culture on screening

Answer 3

Machismo – doctor looking at breast

Question 4

Lay referral networks

Answer 4

Informal network of family, friends who interpret symptoms and suggest whether or not to see a doctor. 55% turn to friends, family. May be online (support groups) helpful for managing chronic illnesses

Question 5

Googling symptoms

Answer 5

Incorrect diagnosis, delayed doctor visit

Question 6

Self regulatory model of illness

Answer 6

Cause of illness – severity of pain,new symptoms
How long has it been?
Does it disrupt normal life?
Is there a treatment?

Question 7

Stages of delay

Answer 7

Appraisal delay – even after experiencing and noticing symptoms, there is a delay in deciding whether they are ill
Illness delay – refers to the time between when people acknowledge they are sick and when they decide that help from a professional is required
Behavioral delay – delay in making an appointment after deciding they need a doctor
Scheduling delay – amount of time between scheduling the appointment and actually going
Treatment delay – refers to delay between receiving medical recommendations and acting on them

Question 8

Differences in medical treatment

Answer 8

People of color less likely to receive appropriate treatment, women less likely to receive treatment for heart, kidney issues

Question 9

Explicit bias

Answer 9

Not going to treat people who don’t seem like they will stick to treatment (ie heart transplants and suspected drug users)

Question 10

Implicit bias

Answer 10

Stereotypes, biases affect: recognition of symptoms, decision making (e.g. On transplants), interactions (less participatory, interactive style with minorities, less information)

Question 11

Barriers to positive interactions

Answer 11

Lack of time, use of jargon, numbers

Question 12

Improve interactions

Answer 12

Plain language, training in cultural competence, patient centered communication, pictures, frequency vs percent. Patients need to ask questions.

Question 13

Burnout

Answer 13

Dealing with patients is emotionally demanding, especially those in severe pain. Failure on a consistent basis. Lack of control in hectic time sensitive environment.

Question 14

Depersonalization due to stress

Answer 14

As a way of maintaining emotional distance, start thinking of patients in terms of ailment (the fractured leg)

Question 15

Appraisal delay

Answer 15

Appraisal delay – even after experiencing and noticing symptoms, there is a delay in deciding whether they are ill

Question 16

Illness delay

Answer 16

Illness delay – refers to the time between when people acknowledge they are sick and when they decide that help from a professional is required

Question 17

Behavioral delay

Answer 17

Behavioral delay – delay in making an appointment after deciding they need a doctor

Question 18

Scheduling delay

Answer 18

Scheduling delay – amount of time between scheduling the appointment and actually going

Question 19

Treatment delay

Answer 19

Treatment delay – refers to delay between receiving medical recommendations and acting on them