EXAM 1 Flashcards by Madison Allen

A state of complete physical, mental, and social well-being, not merely the absence of disease (WHO, 1948)
- Considers that a person’s environment influences the degree to which they are able to function effectively in everyday life

Health

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Three models of health care

Biomedical
Biopsychosocial
Sociocultural

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_ model of health care
- premise that ill health is a physical phenomenon that can be explained, identified, and treated through physical means

biomedical

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_ model of health care
- An approach that takes into account people’s physical conditions (biology), their thoughts and beliefs (psychology), and their social expectations

biopsychosocial

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_ model of health care
- The view that health reflects a complex array of factors involving personal choice, social variables, and culture

sociocultural

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(sociocultural model)
- childhood experiences
- housing
- education
- social support
- family income
- employment
- community
- access to health care

social determinants of health

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Effective health communication techniques

collaboration
multiple levels of meaning
context and culture

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_ effective health communications technique
- meaning does not lie in discrete units of information or in any one person, emerges with experiences that participants collaboratively create
- patient-provider collaboration
- NOT provider does all the talking and patient sits there silently

collaboration

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_ effective health communications technique
- meaning is interpreted at both content and a relational level

multiple levels of meaning

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_ effective health communications technique
- We are influenced by larger environments and contexts such as past experiences, neighborhoods we live in, cultures we identify as
- Each of these is likely to influence what we consider acceptable and how we interpret what happens around us

Context and Culture

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communication is crucial to the success of health care encounters
wise use of mass media and social media can help people learn about health and minimize the influence of unhealthy and unrealistic media portrays
communication is an important source of personal confidence and copying ability
effective communication saves time and money
communication helps health care organizations operate effectively
Health communications may be important to you because of career opportunities

Communications influence on health

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_ level of multiple levels of meaning
- meaning considered to be mostly denoted - subject to literal interpretation

content

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_ level of multiple levels of meaning
- participants consider the implications of communication in terms of their relative status and feelings about each other

relational

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Communications influence on health _
- without it, caregivers cannot hear patient’s concerns, make diagnoses, share their recommendations, or follow up on treatment
- Patients who take an active role in medical encounters are more likely than others to be satisfied with their care

communication is crucial to the success of healthcare encounters

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Communications influence on health _
- media consumers are likely to be well informed about health issues and to take an active role in maintaining their own health
- Be aware of fake news

Wise use of mass media and social media can help people learn about health and minimize the influence of unhealthy and unrealistic media portrays

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Communications influence on health _
- Health professionals are less likely to experience burnout and less likely to leave the profession if they are satisfied

Communications is an important source of personal confidence and copying ability

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Communications influence on health _
- Caregivers who listen attentively and communicate a sense of caring and warmth are less likely to be sued for malpractice

Communication helps health care organizations operate effectively

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Communications influence on health _
- Communication skills are central to jobs in clinical care, public relations, marketing, health care administration, Human Resources, education, community outreach, crisis management and more

Health communications may be important to you because of career opportunities

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Early and preventative care
Access and health disparities
Navigating a complex system

Current issues in health care

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Current issue in health care:
- It is healthier and ultimately less costly, to prevent illness and injuries than to treat then once they become serious

Early and preventative care

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Current issue in health care:
- Experts can predict roughly how long a person will live based on where the person lives and how much money they make
- 14.7% of Americans 18-64 are uninsured (approx. 30 million)
- 25.8% of poor persons
- 26.8% of near poor persons
- 9% of not poor persons

Access and health disparities

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Current issue in health care:
- Most common frustrations involve communication: unclear instructions, contradictory information from different providers, hard-to-understand insurance policies, and a sense that health professionals don’t communicate with each other
- results include added stress, communication gaps, adverse patient outcomes, and additional emergency department visits and hospitalizations

Navigating a complex system

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Overall US ranked 11/11(worst)
Access with cost-related problems ranked 11/11
Efficiency ranked 11/11
Equality ranked 11/11
Healthy lives ranked 11/11
Most health expenditures/capita in 2011 was $8,508

US health care system in comparison to 10 other OECD countries
- The Commonwealth Fund Study (2014)

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increasing older population creates increasing demand for health care providers
increasing % of racial/ethnic minorities creates increasing % of underprivileged population and increasing demand for health care providers who are aware/sensitive of intercultural differences

Impact of the changing population in the US on its health care system

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Practice of paying a care provider for specific care provided - Doctors, hospitals, physical therapists and so on, only make money if people use their services

fee-for-service

Three parties involved, the provider, the patient, and the payer (insurance companies) - a benefits provider (usually an insurance company) that is separate from the patient and the care provider

Third-party payer

Flat rate reimbursement amounts for specified inpatient hospital procedures Ex: A certain amount paid for an appendectomy, established in advance rather than based on actual costs incurred by the health provider

Diagnosis-related groups (DRGs)

A membership fee paid by subscribers in a conventional insurance or managed plan care - often deducted from paychecks

Premium

The portion of a health care bill the patient is required to pay when services are rendered - a cost per visit

Copay

An upper limit on the amount of out-of-pocket expense an insurance subscriber is required to pay each year beyond that limit insurance pays 100%

Catastrophic cap

The amount of out-of-pocket expense an insured individual is required to pay before receiving financial assistance from insurer Ex: you might pay first $500 of your emergency room bill, and insurance will pay 80% of the remaining cost

Deductible

- HMO - PPO - HDHPs

Different types of managed health care

A managed health care organization that offers enrollees a variety of health services for a set monthly fee and copays - Provider networks - Cannot see specialist unless such care is recommended by a provider - Not third-party or fee-for-service

Health Maintenance Organization (HMO)

A managed health care organization that pays independent caregivers a discounted fee for each service they provide to their members - Patients may visit providers not on the preferred list, but they pay higher fees to do so - operate on a fee-for-service basis

Preferred Provider Organization (PPO)

A managed health care plan with lower than normal premiums but higher than normal deductibles and out-of-pocket spending caps - most qualify members to establish tax-exempt health saving accounts - appealing to people on limited budgets

High-deductible health plans (HDHPs)

The provision that all citizens ( and in some countries, temporary residents and visitors) are assured health care Ex: Italy

Universal coverage

A system of universal coverage in which one source (a government or a privately run national health insurance plan) pays - usually funded by tax dollars

single-payer system

A system in which health insurance is provided by a variety of sources, usually including both private companies and government programs - may or may not include universal coverage - typically funded by a mixture of individual contributions and tax dollars

multi-payer system

A rule requiring everyone to have health insurance - option for universal coverage in a multi-payer system

indvidual mandate

Goal: universal coverage Funding: increasing tax revenue and lowering costs (long-term) by covering more people

Affordable Care Act (ACA)

1. multi-payer system 2. health benefit exchange 3. coverage of the "essential 10" 4. parental coverage until 26 years old 5. free prevention and wellness exams 6. individual mandate 7. employer mandate 8. Insurance policy reforms 9. health care resources 10. federal-state partnership

provision of the Affordable Care Act (ACA)

Part of ACA - no discrimination against pre-existing conditions - rate hike review - no limit in lifetime and annual coverage - spending 80% or more of premiums on health benefits and quality improvements

Insurance policy reforms

1. emergency care 2. outpatient care 3. inpateint hospitalization 4. maternity and newborn care 5. mental health services 6. prescription drugs 7. rehabilitation for injury and disease recovery 8. lab work 9. pediatric care 10. preventative care

The "essential 10" of the Affordable Care Act

Decreased number of US residents without health insurance

Health insurance status of Americans between 2012-2014

- caregiver-centered conversation - close-ended questions - directives - blocking - patronizing

caregiver-centered communication

- Be clear about your goals for the visit and what you want caregivers to know - create a one-page healthy history - write it down and rank-order your concerns - choose health care providers carefully - don't over look valuable resources - know what treatment you are supposed to get and make sure caregivers know it - help set agenda - take an active role - acknowledge reservations - be assertive

Tips for caregivers to cultivate dialogue with patients

_ tips for caregivers to cultivate dialogue with patients - start on a friendly note and small talk - use open questions - determine the real issue before exam - don't rush, listen - avoid abrupt topic shifts (transitions) - pay attention to distress markers - ask for feedback - reassure patients and treat as equals - coach patients - consider using humor - minimize distractions

verbal communication

_ tips for caregivers to cultivate dialogue with patients - look interested - touch - allows silence - pay attention to nonverbal displays

nonverbal communication

1. interviewing and collecting information 2. counseling and delivering information 3. rapport 4. personal manner

four primary components of Interpersonal and Communication Skills (ICS) as part of clinical skills assessment for caregivers

a directive, client-centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence - gaps - interviewer's job is respectfully and judgmentally - ask questions about a person's feelings, - to help clarify feelings, and - to support the person in making choices

motivational interviewing

Patient's tell caregivers stories about their illness - "a movement from biology to biography" - informs - shape interpretation and viewpoints - can be therapeutic in itself - can build trust between patients and caregivers - can allow caregivers to learn about themselves

narrative medicine

- dialogue - motivational interviewing - narrative medicine

communications skills set

a pattern in which patients blurt out their concerns at the last instant of a visit

doorknob disclosure

the prerogative sometimes granted to physicians to withhold information from patients if they feel that disclosing the information would do more harm than good

therapeutic privilege

inappropriate actions that cross the line between intimacy and professionalism

transgressions

component of ICS _ - clarity of questions - open vs closed questions - jargon

skills in interviewing and collecting information

component of ICS _ - giving information - counseling - language - closure

skills in counseling and delivering information

component of ICS _ - attentiveness - body language - attitude - empathy and support

rapport

component of ICS _ - introduction - mood disorder - physical examination - physical examination draping

personal manner

a style of communicating about a patient's health that is characterized by carefully controlled compassion and a concern for accuracy and expediency - illness exists through empirical verification - in approaching illness, specific and precise

voice of medicine

typical power difference between patients and professionals, and the dilemmas people face when they disagree with their caregivers - illness exists through physical experience and feelings - in approaching illness, diffuse in understanding the cause, consequences, and goals of treatment

voice of lifeworld

- clearly identify reasons for a visit and priorities - recognize the emotions of care providers and self - recognize the limits of emergency medicine - accept medical uncertainty - ask questions

good communication skills for patients

1. nature of illness: chronic vs acute 2. demographic attributes 3. Psychographic attributes 4. identity

patient characteristics

patient characteristic _ - communication for diagnosis: - chronic/hard to define conditions vs acute conditions - communication for continuing care: - chronic/hard to define conditions vs acute conditions

nature of illness: chronic vs acute

patient characteristic _ - education -- physician partnership building - race -- physician supportive talk

demographic attributes

patient characteristic _ - personality (ex: communication apprehension, self-confidence) - familiarity with care settings - self-advocate

psychographic attributes

patient characteristic _ - personal identity - social identity (ex: Nevadan, transgender, college student) - health status-related identity (ex: cancer survivor, diabetic)

identity

- attentiveness - respect - convenience - privacy - empathy - sense of control - genuine caring

determinants of patient satisfaction

the requirement that patients must - be fully aware of known treatment risks, benefits, and options - be deemed capable of understanding such information and making a responsible judgement - be aware that they may refuse to participate or may cease treatment at any time

requirements of the Informed Consent Laws

1. respect for patient's preferences 2. coordination and integrated care 3. information and education 4. physical comfort 5. emotional support 6. involvement of family and friends

dimensions of patient-centered care

originally designed: - to produce data to compare hospitals - to incentivize to improve quality - to enhance public accountability in healthcare

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPPS)

(22 questions in 8 topics) - communication with nurses (4) - communication with doctors (3) - hospital environment: cleanliness and quietness (2) - responsiveness of hospital staff (2) - communications about medicines (3) - transition of care (3) - overall rating (2) - discharge information (3)

topics and questions in HCAPPS

when patient satisfaction is up, patient outcomes are down - satisfied patients are getting what they want not what they need - not getting better care quality and end up paying more and having to come back to the hospital

paradox between patient satisfaction and patient care outcomes

- stereotypes in society - deeply embedded, long standing myths - outdated education - society effects health disparities, not biological differences

causes of racial care gap in medical treatment

operates different imaging scanners to perform diagnostic imaging on patients

radiology technologist

focuses on diagnosing and treating speech, language, cognitive-communication, and swallowing disorders

speech-language therapist

provides preventative care for patients by examining for oral diseases, such as gingivitis

dental hygenist

performs medical services during emergency calls and transports patients to medical facilities for further care

emergency medical technician

assist the team and conducts a variety of tasks, including keeping records, scheduling appointments, taking x-rays, and overall patient care

dental assistant

provides care for patients with breathing issues

respiratory therapist

collects samples and performs testing on specimens, such as bodily tissue and fluids

clinical laboratory assistant

assists customers and health professionals by dispensing, prescription medications and providing expertise on their safe use

pharmacist

treats injuries and illnesses through surgical procedures

surgeon

focuses on collecting data and analyzing workplace environments and safety procedures

occupational health/ safety technician

educates patients about health conditions as well as provides and coordinates patient care

registered nurse

helps patients improve movement and manage pain

physical therapsist

Positives - science-based curricula - tightened admission criteria - elimination of sub-standard for-profit schools - incorporation of medical schools into universities Negatives - marginalization of holistic and folk medicine - lack of compassion in care, rote learning - underrepresentation of minorities and women among medical students - "patients in the service of science, not science at the service of patients"

The legacy of Flexure Report (1910) on medical education in the US

the perspective that positions within a society (ex: healer, patient) are defined by unique sets of rights, responsibilities, and privileges

hidden curriculum

The process of framing a new identity typically involves a phase during which people experience a sense of limbo - Care providers-in-training are no longer laypersons, but they are not full-fledged professionals either

identity in limbo

sometimes as medical students begin to feel more like professionals and less like students, the emotional distance between them and their patients can widen

privileges

long hours means less time in the company of family and friends - intense training programs typically involve both physical and experiential isolation - uniqueness of student's experiences can make them feel different from others

isolation

if students are persuaded by the curriculum and mentors that diseases is best understood in physical terms, depersonalizing patients begins to feel acceptable

loss of empathy

- reimbursement issues - administrative business goals - medical liabilities - lifestyle - federal regulation - policies - procedures

cause of job dissatisfaction for physicians

Patient rights: - access - amendment - authorization - accounting of disclosures - contact information - sharing information - notice of privacy practices - file a complaint

Health Insurance Portability and Accountability Act (HIPAA)

habitual or prescribed ways of doing things (ex: what people talk about, when, and with whom) - the feeling of being "drained or used up"

emotional exhaustion

the tendency to treat people in an unfeeling, impersonal way, often as a result of feeling depleted onself

depersonalization

members' basic beliefs and assumptions about an organization, its members, and the organization's place in the larger environment - involves feeling like a failure

reduced sense of personal accomplishment

a sense of caring about other people without becoming emotionally involved in the process

detached concern

- 3rd leading cause of death - CDC does not recognize medical errors as cause of death - 1/4 people experience a medical error

facts about medical errors in the lecture question video

- 9% of surgeons made a major medical error in the last 3 month - 70% attributed the errors to fatigue, stress, or a lapse in judgement

medical erros

1-point increase in emotional exhaustion -- _ increase in odds of medical mistakes

1-point increase in depersonalization -- _ increase in the odds of medical mistakes

11%

1. rehearse how to disclose the information 2. deliver it as simply, and clearly as possible 3. stop talking and listen 4. assess how the news is being received 5. respond empathetically 6. apologize profusely, but do not let doubt and remorse cripple your confidence

how to deal with medical mistakes effectively

1. establish trust 2. invite feedback 3. respond to complaints and requests quickly 4. show that you care 5.create realistic expectations 6. put everything in writing 7. do not shy about giving referrals 8. do not forget family 9. own up to small mistakes

how to avoid medical mistakes