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Y3R3 - Behavior ⚛️ > L2: Physician-Patient Relationship > Flashcards

L2: Physician-Patient Relationship Flashcards

1
Q

Only about ……. of Americans with symptoms seek medical care; most people contend with illnesses at home with OTC medications and home management.

A
  • one-third
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2
Q

Patients’ behavior when ill are influenced by:

A
  • Culture
  • Previous experiences with medical care
  • Physical and mental conditions
  • Personality styles
  • Coping skills.
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3
Q

Many psychiatric patients fail to seek help

WHY?

A
  • As There is a stigma to having a psychiatric illness (Psychiatric symptoms are considered a moral weakness or a lack of self-control).
  • Morbidity rates and mortality rates increase between psychological illness and physical illness in patients who need psychiatric attention.
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4
Q

The Sick Role

A
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5
Q

Patient Personality Styles & Behavioral Characteristcs During Illness

  • Paranoid
A

Blames the physician for the fact that he or she is ill

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6
Q

Patient Personality Styles & Behavioral Characteristcs During Illness

  • Schizoid
A

Becomes even more withdrawn during illness

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7
Q

Patient Personality Styles & Behavioral Characteristcs During Illness

  • Schizotypal
A

Bizarre behavior may mask serious illness

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7
Q

Patient Personality Styles & Behavioral Characteristcs During Illness

  • Histirionic
A

May be dramatic, emotionally changeable, and approach the physician in an inappropriate sexual fashion during illness

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8
Q

Patient Personality Styles & Behavioral Characteristcs During Illness

  • Narcisstic
A

Has a perfect self-image, which is threatened by illness and may refuse needed treatment which can alter his or her appearance

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9
Q

Patient Personality Styles & Behavioral Characteristcs During Illness

  • Antisocial
A

May self-write or alter prescriptions and lie to the physician

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10
Q

Patient Personality Styles & Behavioral Characteristcs During Illness

  • Borderline
A

Idealizes the physician at first, may make gestures of self-harm when ill

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11
Q

Patient Personality Styles & Behavioral Characteristcs During Illness

  • Avoidant
A

Interprets physician health suggestions as criticisms, fears rejection by the doctor, is overly sensitive to a perceived lack of attention or caring

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12
Q

Patient Personality Styles & Behavioral Characteristcs During Illness

  • Obsessive-Compulsive
A

Fears loss of control and may in turn become more controlling during illness

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13
Q

Patient Personality Styles & Behavioral Characteristcs During Illness

  • Dependent
A

Becomes more needy during illness and wants the physician to make all decisions and assume all responsibility

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14
Q

Patient Personality Styles & Behavioral Characteristcs During Illness

  • Passive-aggresive
A

Asks for help but then does not adhere to the physician’s advice

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15
Q

Telling patients the truth

  • Adults
A

In the United States:

  • adult patients must be told the medical information directly (not relayed to the patient through relatives).
  • The patient is told the complete truth about the diagnosis, the management and its side effects, and the prognosis of their illness.
  • Falsely reassuring in response to patient questions is not appropriate (e.g., “Do not worry, we will take good care of you” or “You can get pregnant again” [after a miscarriage]).
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15
Q

Telling patients the truth

  • Child
A
  • Parents decide if, how, and when such information will be given to an ill child.
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16
Q

Telling patients the truth

  • Relatives
A
  • With the patient’s permission, the physician can tell relatives this information in conjunction with, or after, telling the patient.
  • Relieving the fears of close relatives of a seriously ill patient → encourage the support system → help the patient.
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17
Q

Patients may be afraid to ask questions about distressing issues (e.g., sexual problems) or fear provoking (e.g., laboratory results).

  • HOW TO DEAL?
A

A physician should not try to guess what is troubling a patient; address them truthfully and fully with the patient.

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18
Q
  • Physicians have the primary responsibility or dealing with adherence issues as well as with angry, seductive, or complaining behavior by their patients.
  • Referrals to other physicians should be reserved only when a medical and psychiatric problems outside of the treating physician’s range of their knowledge.
A

…..

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19
Q

Def of Adherence

A
  • It refers to the extent to which a patient follows the recommendations of the physician, such as taking
    medications on schedule, having a needed medical test or surgical procedure, and following directions or changes in lifestyle, such as diet or exercise.
20
Q

Patients need to recognize that their behavior or condition (e.g., obesity) is problematic before they are motivated to change or seek medic care.

A

……

21
Q

Patients’ unconscious transference reactions to their physicians, which are based in childhood and parent-child relationships, can affect adherence.

A

….

22
Q

Percentage of Patients adherence

A

Only about one-third of patients adhere fully to management recommendations, one-third adhere some of the time, and one third do not adhere to such recommendations.

23
Q

Factors that increase or decrease adherence (In Brief)

A
  • Adherence is not related to patient intelligence, education, sex, religion, race, socioeconomic status, or marital status.
  • Adherence is most closely related to how well the patient likes the doctor.
24
Q
  • The strength of the doctor-patient relationship is also the most important factor in whether or not patients sue their doctors when an error or omission is made or when there is a poor outcome.
A

…

25
Q

what are factors that increase adherence?

A
  • Good physician patient relationship
  • Patient feels ill and usual activities are disrupted by the illness
  • Short time spent in the waiting room
  • Belief that the benefits of care outweigh its financial and time costs
  • Written diagnosis and instructions for management
  • Acute illness
  • Recommending only one behavioral change at a time
  • Simple management schedule
  • Older physician
  • Peer support
26
Q

What are factors that decrease adherence?

A
  • Poor physician-patient Relationship
  • Patient experiences few symptoms and little disruption of usual activities
  • Long time spent in the wailing room
  • Belief that financial and time costs of care oulweigh its benefits
  • Verbal diagnosis and instructions for management
  • Chronic illness
  • Recommending multiple behavioral changes at once
  • Complex management Schedule
  • Younger physician
  • Little peer support
27
Q

Effect on Adherence

  • Physian-Patient Relationship
A
27
Q

Effect on Adherence

  • Presence of Symptoms
A
28
Q

Effect on Adherence

  • Waiting Time
A
29
Q

Effect on Adherence

  • Belief that benefits of care outweight its cost
A
30
Q

Effect on Adherence

  • Type of illness
A
31
Q

Effect on Adherence

  • No of behavioural changes
A
32
Q

Effect on Adherence

  • Simple or complex managment schedule
A
33
Q

what to do and what not to

  • Angry Patient
A
34
Q

what to do and what not to

  • Patient complaining about another doctor
A
35
Q

what to do and what not to

  • Patient Complaining about you & your staff
A
36
Q

what to do and what not to

  • Crying Patient
A
37
Q

what to do and what not to

  • Nonadherent patient: Needs to improve health behavior
A
38
Q

what to do and what not to

  • Nonadherent patient: Needs a lest or treatment (e.g., mammogram)
A
39
Q

what to do and what not to
- Seductive Patient

A
40
Q

what to do and what not to

  • Suicidal Patient
A
41
Q

Stages of Change model

A
42
Q

aim of interview

A

To obtain the patient’s psychiatric history, including information about prior mental problems, drug and alcohol use, sexual activity, current living situation, and sources of stress.

42
Q

How to interview patients?

A
43
Q

interviewing young children

A
  • First establish rapport by interacting with the child in a non-medical way (e.g. drawing pictures).
  • Use direct rather than open-ended questions (see next page), for example, “What is your sister’s name?” rather than “Tell me about your family.”
  • Ask questions in the third person, for example, “Why do you think that the little boy in this picture is sad?”
44
Q

Direct questions

A

Direct questions are used to elicit specific information quickly from a patient:

  • in an emergency situation (e.g., “Have you been shot?”)
  • when the patient is seductive or overly talkative.
45
Q

Open-ended questions

A
  • open-ended types of questions are more likely to aid in obtaining information about
    the patient, and not close off potential areas of pertinent information.
  • Using open-ended questions (e.g., “What brings you in today?”), the interviewer gives little structure to the patient and encourages the patient to speak freely.
45
Q

Aims of the Clinical Interview and Specific Interviewing Techniques

A

Y3R3 - Behavior ⚛️ (7 decks)

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