Exam 2

Question 1

Defensive Medicine

Answer 1

The practice of recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but an option that mainly serves the function to protect the physician against the patient as potential plaintiff.

Question 2

Voice of Lifeworld/Medicine

Answer 2

Lifeworld: What patients speak. Relating to everyday experiences, reflect on their feelings.
Medicine: Evidence

Question 3

Therapeutic Privilege

Answer 3

An uncommon situation whereby a physician may be excused from revealing information to a patient when disclosing it would pose a serious psychological threat, so serious a threat as to be medically contraindicated.

Question 4

Blocking

Answer 4

Topic of shifts, avoiding patient disclosures.

Question 5

Doorknob Disclosure

Answer 5

Patient brings up a medical concern at the end of a meeting or conversation.

Question 6

Narrative Medicine

Answer 6

The care of the sick unfolds in stories. The effective practice of healthcare requires the ability to recognize, absorb, interpret, and act on the stories and plights of others. Rita Charon.

Question 7

Never Events

Answer 7

A mistake that is due to complete negligence with serious consequences. Insurance companies will not pay.

Question 8

Transgression

Answer 8

Episodes of inappropriate behavior many are not at liberty to switch caregivers.

Question 9

Empathic model of communication

Answer 9

Health care is appealing to people who are concerned about others and are able to imagine others’ joy and pain.

Question 10

Burnout

Answer 10

Overwhelming responsibilities, 50% of physicians are burnt out. Leads to dangerous situations, heated competition, sleep deprivation, withdrawal, resentment, regarding patients as enemies and becomes acceptable to see patients as diseases.

Question 11

Depersonalization

Answer 11

tendency to treat people in an unfeeling impersonal way

Question 12

Social and tertiary identities

Answer 12

social: characterized by perceived membership in social groups such as teenagers.
tertiary: a label that defines simultaneously the illness and our alignment to it

Question 13

Tuskegee Syphilis Experiments

Answer 13

600 impoverished black men. 399 of them had syphilis. After funding for treatment was lost, the study was continued without informing the men they would never be treated. None of the men infected were ever told they had the disease, and none were treated with penicillin even after the antibiotic became proven for the treatment of syphilis. Brought about the issue of needing Informed consent.

Question 14

Informed consent

Answer 14

Patients must be fully aware, deemed capable and aware they can refuse.

Question 15

Speech Community

Answer 15

Group whose members share a common set of speech goals and expectations.

Question 16

Socialization

Answer 16

Able to behave with relative ease and appropriateness in a community. New comers of a culture attempt to fit in (assimilate) while still maintaining a sense of their own identity.

Question 17

Pendular approach to illness and identity

Answer 17

a reshaping of self among adults with traumatic spinal cord injury

Question 18

Planetree

Answer 18

Non profit organization who helps hospitals redecorate to create a more soothing and relaxing environment.

Question 19

Motivational interviewing

Answer 19

A method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior.

Question 20

Rote learning vs. problem-based learning

Answer 20

Flexner Report started to change medical school’s tactics from rote learning (memorization) to problem-based learning (apply information to actual scenarios.)

Question 21

Patronizing behavior in medicine

Answer 21

Patient feeling of inferiority

Question 22

Directives

Answer 22

instructions or commands

Question 23

Can you name and describe the four stages in Kathy Charmaz’s model of identity management during chronic illness? If asked, could you give an example of a statement someone in each stage might offer?

Answer 23

Super normal identity, Restored Self, Contingent person identity, Salvaged Self

1.) Supernormal identity
determined not to let the illness stop them from being better than ever

2.) Restored self
not quite as optimistic but deny the illness has not changed them

3.) Contingent personal identity
admit that they may not be able to do everything they could previously do and confront consequences of the changed identity

4.) Salvaged self
represents the development of a transformed identity that integrates former aspects of self with current limitations

Question 24

How does the case of Henrietta Lacks apply to our understanding of ethical consent?

Answer 24

Lacks’ cells were taken without her consent when she was being treated for cervical cancer and were considered to be immortal; unlike most other cells, they lived and grew continuously in culture. Henrietta Lacks is the woman behind the cells that revolutionized the medical field – helping develop the polio vaccine, cloning and numerous cancer treatments. The story of Henrietta Lacks is a prime example of the ethical tradeoffs the scientific community grapples with in pursuit of the common good, but it also signaled a turning point.

Question 25

duPre outlines three legal stipulations for informed consent in your text. Name these.

Answer 25

patients must
1 be made fully aware of known treat,met risks, benefits and options
2 be deemed capable of understanding such info and making responsible judgement
3 be aware that they may refuse to participate of may cease treatment at anytime

Question 26

Why do some individuals fail to comply with the medical advice and treatments offered by their physicians?

Answer 26

Lack of understanding. Lack of funds. Forgetfulness.

Question 27

How does physician talk in medical interactions differ from patient talk? What do physicians typically do differently?

Answer 27

Physicians control the medical consultations by asking more questions than patients and interrupting frequently.

Question 28

What are some communicative patterns/behaviors used to encourage patients’ communication?

Answer 28

Motivational interviewing (not coercive or prescriptive role. The interviewer does not presume that they know what’s best for them. )

Question 29

What are some communicative patterns/behaviors associated with the physician-centered model?

Answer 29

when physicians do most of the talking

Interruptions and Patronizing Behavior (talking down to them, due to low socioeconomic class)

Question 30

Compare physician-centered and collaborative communication. How is the caregiver’s role different in physician-centered communication verses collaborative communication? How is the patient’s role different?

Answer 30

Physician centered where the physician does most of the talking, interruptions, and patronizing behavior. In collaborative communication, desire to teach each other the process, and openly discuss the options that arise, and make mutual decision. In physician centered, the patient lacks a role and does not have much say and can be completely clueless when it comes to the medical process they may encounter, but when collaborative it is broken down and it is come to an agreement, rather than a superiority relationship they are both equal and come to a consensus together.

Question 31

How many physicians are estimated to commit suicide each year, per the discussion in your text?

Answer 31

300-400

Question 32

When are patients most likely to be their own self-advocates in medical encounters?

Answer 32

If the physicians let them speak and don’t patronize or belittle them

Question 33

How does the Voice of Lifeworld differ from the Voice of Medicine, and how do we see this difference translated to specific communication behaviors between patients and physicians?

Answer 33

The voice of lifeworld is a patients feelings, emotions, and personal views where the voice of medicine are hard facts/data that can be tested such as a test result. Feelings vs evidence

Question 34

Who was Willie King, and what does his story teach us about health communication?

Answer 34

Willie King was a patient who had the wrong leg amputated. He received a large settlement because of this mistake. This story teaches us that communication is extremely important in order to avoid these types of mistakes from happening.

Question 35

What are the primary lessons about medical school as discussed in the Doctors’ Diaries video shown in class?

Answer 35

Probably to show how difficult being a practitioner is. Putting in so much time and effort into this career takes a toll on not only you but also your spouse and family.

Question 36

What stakes do physicians hold in their patient’s choice to comply or adhere to suggestions?

Answer 36

?

Question 37

How many times should a provider ask “what else?” to ensure that a patient has revealed full information in a medical encounter?

Answer 37

?

Question 38

Per discussion in duPre, what factors lead to increased patient satisfaction?

Answer 38

1) Physician’s active listening
2) Physician’s awareness about the depth of the patient’s knowledge
3) Honesty
4) Partnership
5) Interest in the patient as a person
6) Touch

Question 39

Are certain kinds of patients more likely to be satisfied than others?

Answer 39

Yes, if a patient feels belittled, if the caregivers discourage patients from talking etc. Also depends on what they are being treated for, self perceived health status and personal attitude.

Question 40

Some justify the intense demands and demoralizing rituals often faced by medical students because they serve several functions. What are those functions?

Answer 40

High pressure environment prepares med students for real world situations.

Question 41

What are the steps that a physician should take when admitting a medical mistake on their behalf?

Answer 41

Sometimes all people want is an apology.

Question 42

Per class discussion, what are some patient outcomes associated with positive provider-patient communication?

Answer 42

patient recall, patient understanding, and patient adherence to therapy