L2: Physician-Patient Relationship

Question 1

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

Answer 1

• one-third

Question 2

Patients’ behavior when ill are influenced by:

Answer 2

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

Question 3

Many psychiatric patients fail to seek help

WHY?

Answer 3

• 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.

Question 4

The Sick Role

Answer 4

Question 5

Patient Personality Styles & Behavioral Characteristcs During Illness

• Paranoid

Answer 5

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

Question 6

Patient Personality Styles & Behavioral Characteristcs During Illness

• Schizoid

Answer 6

Becomes even more withdrawn during illness

Question 7

Patient Personality Styles & Behavioral Characteristcs During Illness

• Schizotypal

Answer 7

Bizarre behavior may mask serious illness

Question 7

Patient Personality Styles & Behavioral Characteristcs During Illness

• Histirionic

Answer 7

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

Question 8

Patient Personality Styles & Behavioral Characteristcs During Illness

• Narcisstic

Answer 8

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

Question 9

Patient Personality Styles & Behavioral Characteristcs During Illness

• Antisocial

Answer 9

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

Question 10

Patient Personality Styles & Behavioral Characteristcs During Illness

• Borderline

Answer 10

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

Question 11

Patient Personality Styles & Behavioral Characteristcs During Illness

• Avoidant

Answer 11

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

Question 12

Patient Personality Styles & Behavioral Characteristcs During Illness

• Obsessive-Compulsive

Answer 12

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

Question 13

Patient Personality Styles & Behavioral Characteristcs During Illness

• Dependent

Answer 13

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

Question 14

Patient Personality Styles & Behavioral Characteristcs During Illness

• Passive-aggresive

Answer 14

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

Question 15

Telling patients the truth

• Adults

Answer 15

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]).

Question 15

Telling patients the truth

• Child

Answer 15

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

Question 16

Telling patients the truth

• Relatives

Answer 16

• 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.

Question 17

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

• HOW TO DEAL?

Answer 17

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

Question 18

• 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.

Answer 18

…..

Question 19

Def of Adherence

Answer 19

• 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.

Question 20

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

Answer 20

……

Question 21

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

Answer 21

….

Question 22

Percentage of Patients adherence

Answer 22

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.

Question 23

Factors that increase or decrease adherence **(In Brief)**

Answer 23

- 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.

Question 24

- 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.

Answer 24

...

Question 25

what are factors that increase adherence?

Answer 25

- 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

Question 26

What are factors that decrease adherence?

Answer 26

- 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

Question 27

**Effect on Adherence** - Physian-Patient Relationship

Question 27

**Effect on Adherence** - Presence of Symptoms

Question 28

**Effect on Adherence** - Waiting Time

Question 29

**Effect on Adherence** - Belief that benefits of care outweight its cost

Question 30

**Effect on Adherence** - Type of illness

Question 31

**Effect on Adherence** - No of behavioural changes

Question 32

**Effect on Adherence** - Simple or complex managment schedule

Question 33

**what to do and what not to** - Angry Patient

Question 34

**what to do and what not to** - Patient complaining about another doctor

Question 35

**what to do and what not to** - Patient Complaining about you & your staff

Question 36

**what to do and what not to** - Crying Patient

Question 37

**what to do and what not to** - Nonadherent patient: Needs to improve health behavior

Question 38

**what to do and what not to** - Nonadherent patient: Needs a lest or treatment (e.g., mammogram)

Question 39

**what to do and what not to** - Seductive Patient

Question 40

**what to do and what not to** - Suicidal Patient

Question 41

Stages of Change model

Answer 41

Question 42

aim of interview

Answer 42

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.

Question 42

How to interview patients?

Question 43

interviewing young children

Answer 43

- 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?"

Question 44

Direct questions

Answer 44

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.

Question 45

Open-ended questions

Answer 45

- 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.

Question 45

Aims of the Clinical Interview and Specific Interviewing Techniques