Chp 21 The Physicians Patients relationship

Question 1

A. Seeking medical care

Who seeks medical care and How are they influenced?

Answer 1

1. Patients’ behavior when ill and their expectations of physicians are influenced by:
   their culture (previous experiences with medical care, physical and mental conditions, personality styles, and coping skills.
2. Only about 1/3 of Americans with symptoms seek medical care; most people contend with illnesses at home with over-the-counter medications and home management.

Question 2

B. Seeking psychiatric care

Answer 2

B. Seeking psychiatric care

1. Psychiatric symptoms are considered by many Americans to indicate a moral weakness or a lack of self-control. Because of this stigma, many patients fail to seek help.
2. It is important for patients to seek help since there is a strong correlation between psychological illness and physical illness. Morbidity rates and mortality rates are much higher in patients who need psychiatric attention.

Question 3

I. MEDICAL PRACTICE:

Incorporates what 5 areas of focus: name each

Answer 3

A. Seeking medical care
B. Seeking psychiatric care
C. The“sick-role”
D. Telling patients the truth
E. Special situations

Question 4

D. Telling patients the truth

Answer 4

D. Telling patients the truth
1. In US, adult patients are told the complete truth about the diagnosis, management and side effects, and the prognosis of their illness. Falsely reassuring or patronizing statements in response to patient questions (e.g., “Do not worry, we will take good care of you” or “You can get pregnant again” [after a miscarriage]) are not appropriate.
2. Information about the illness must be given directly to the adult patient and not relayed to the patient through relatives. Parents decide if , how, and when such information will be given to an ill child.
a. With the patient’s permission, the physician can tell relatives this information in con-
junction with, or a ter, telling the patient.
b. Relieving the fears of close relatives of a seriously ill patient can bolster the support
system and thus help the patient.

Question 5

C. The“sick-role”

Answer 5

C. The“sick-role”
1. A person assumes a particular role in society and certain behavioral patterns when he or she is ill (the “sick role,”). The sick role includes exemption from usual responsibilities and expectation of care by others, as well as working toward becoming healthy and cooperating with health care personnel in getting well.

Question 6

During “sick role”

Name some Pt’s personality style and Behavioral characteristics during illness

Answer 6

1. Paranoid = Blames the physician for the fact that he or she is ill
2. Schizoid= Becomes even more withdrawn during illness
3. Schizotypal = Bizarre behavior may mask serious illness
4. Narcissistic= Has a perfect self-image, which is threatened by illness and may refuse needed treatment, which can alter his or her appearance
5. Borderline= Idealizes the physician at first, may make gestures of or attempt self-harm when ill
6. Obsessive –compulsive = Fears loss of control and may in turn become more controlling during illness
7. Passive–aggressive= Asks for help but then does not adhere to the physician’s advice

Question 7

E. Special situations

Answer 7

E. Special situations

1. Patients may be afraid to ask questions about issues that are embarrassing (e.g.,sexual problems) or fear provoking (e.g., laboratory results). A physician should not try to guess what is troubling a patient; it is the physician’s responsibility to ask about such issues in an open-ended fashion and address them truthfully and fully with the patient.
2. Physicians have the primary responsibility or dealing with adherence issues, angry, seductive, or complaining behavior by their patients. Referrals to other physicians should be reserved only or medical and psychiatric problems outside of the treating physician’s range of expertise.