II-13 Patient-Provider Communication Flashcards
Distinguish among four types of advanced-practice nurses.
- Nurse practitioners are affiliated with physicians in private practice; they see their own patients, provide all routine medial care, prescribe for treatment, monitor the progress of chronically ill patients, and seek walk-in patients with a variety of disorders.
- Certified nurse midwives are responsible for some obstetrical care and child births.
- Clinical nurse specialists have a specialty such as cardiac or cancer care, surgery, or ICUs.
- Certified registered nurse anesthetists can administer anesthesia.
Name the criteria by which patients judge the quality of the care they receive
People often judge the adequacy of their care based on patient-provider communication. They tend to respond most favorably to providers who are warm, confident, and friendly.
Identify at least three sources of patient dissatisfaction with HMOs.
- Providers may not be particularly concerned with patient satisfaction, because the patient no longer pays directly for service and because the provider’s income is not directly affected by whether the patient is pleased by the services.
- Cost-cutting measures have resulted in shortened stays and unwillingness on the part of providers to perform expensive tests.
- Patients tend to experience long waits and short office visits.
- Diagnostic-related groups (DRGs) are poor predictors of patient needs.
List three components of holistic health care.
Holistic health care treats health as a positive state of balance and wholeness, as opposed to merely being the absence of disease. This type of care has three components: health education, self-help, and self-healing. Natural, low-technology interventions and non-Western techniques of medical practice may be substituted for traditional care and include herbal medicine, acupuncture, acupressure, massage, psychic diagnosis, and spiritual healing. These changes alter the relationship between provider and patient, making it more open, equal, and reciprocal and potentially bringing emotional contact into the relationship between patient and provider.
Discuss the findings of Beckman & Frankel (1984)
In a study of physicians’ initial responses to patient-initiated visits, Beckman and Frankel studied 74 office visits. In only 23% of the cases did patients have the opportunity to finish their explanation of concerns before the provider began the process of diagnosis. In 69% of the visits, the physician interrupted, directing the patient toward a particular disorder. On average, physicians interrupted after their patients had spoken for only 18 to 22 seconds.
Offer three possible reasons why health care providers may use jargon.
- In some cases, jargon-filled explanations may be used to keep the patient from asking too many questions or from discovering that the provider is not certain what the patient’s problem is.
- Physicians’ use of jargon may be a carryover from their technical training. Providers learn a complex vocabulary for understanding illnesses and communicating about them to other professionals; they often find it hard to remember that the patient does not share this expertise.
- The use of jargon may also stem from an inability to gauge what the patient will understand and an inability to figure out the appropriate non-technical explanation.
Describe four types of negative stereotypes that providers may have of patients, including the effects of each stereotype on the quality of treatment.
Race/Ethnicity: Research shows that physicians give less information, are less supportive, and demonstrate less proficient clinical performance with Black and Hispanic patients and patients of lower socioeconomic class that is true for more advantaged patients, even in the same health care settings. When a person is seen by a physician of the same race or ethnicity, satisfaction with treatment tends to be higher, underscoring the importance of increasing the number of minority physicians.
Age: Many physicians also have negative perceptions of the elderly. The negative attitudes of physicians seem to be reciprocated in the elderly, in that among people 65 and over, 54% express high confidence in physicians.
Sex: Male physicians and female patients do not always communicate well with each other. Research suggests that in comparison with male physicians, female physicians generally conduct longer visits, ask more questions, make more positive comments during a visit, and show more nonverbal support, such as smiling and nodding.
Psychological Disorders: Patients who are regarded as seeking treatment largely for depression, anxiety, or other psychological disorders also evoke negative reactions from physicians. With these patients, physician attention may be especially cursory. Physicians also prefer healthier patients to sicker ones, and they prefer acutely ill to chronically ill patients; chronic illness poses uncertainties and questions about prognosis, which acute disease does not.
Identify three ways that patients may contribute to faulty communication with providers.
- Neurotic patients often present an exaggerated picture of their symptoms. This style an, unfortunately, compromise a physician’s ability to effectively gauge the seriousness of a patient’s condition.
- When patients are anxious, their learning can be impaired. Anxiety makes it difficult to focus attention and process incoming information and even harder to retain it. Focusing directly on the patient’s concerns can alleviate this barrier to effective communication.
- As patients have been expected to assume more responsibility and a larger share of the decision-making with respect to their care, lack of medical knowledge clearly interferes with playing a consumer role effectively. About 40% of patients over 50 have difficulty understanding their prescription instructions. Extra time and care may be needed to communicate this vital information to older patients.
nurse practitioners
Nurses who, in addition to their training in traditional nursing, receive special training in primary care so they may provide routine medical care for patients.
physicians’ assistant
Graduates of 2-year programs who perform routine health care functions, teach patients about their treatment regimens, and record medical information.
health maintenance organization (HMO)
An organizational arrangement for receiving health care services, by which an individual pays a standard monthly rate and then uses services as needed at no additional or at greatly reduced cost.
managed care
A health care arrangement in which an employer or employee pays a predetermined monthly fee to a health care or insurance agency that entitles the employee to used medical services at no additional (or a greatly reduced) cost.
holistic health
A philosophy characterized by the belief that health is a positive state that is actively achieved; usually associated with certain nontraditional health practices.
