Lecture 9

Question 1

Physician Descriptors in US

Geography

Answer 1

35 million in US live in 2010s health professional shortage areas

Question 2

Physician Descriptors in US

Specialization

Answer 2

Large % of physicians opt for specialization

beyond primary care

Question 3

Medical School Experience

Tolerance for Uncertainty (Fox): 3 Kinds

Answer 3

– First: cannot know all the facts
– Second: knowledge base of medicine incomplete
– Third: Inner conflict b/w two while providing care • Isitmeorisitthefield?

Question 4

Medical School Experience

Detached Concern

Answer 4

concern for patient without emotional attachment (Fox)
– Learn to intellectualize and technicalize encounters
– Some reach the point of emotional numbness

Question 5

Medical School Experience

Curing Rather than Caring

Answer 5

Conrad (1988) analyzed for insider accounts of medical students

– Depersonalized the patient as much as possible
– No eye contact, non attention and abruptness with
patients

Question 6

Medical School Experience

Stress in the First Four Years (3 categories)

Answer 6

– Exams
– Patient contact
– No time for others

Question 7

Medical School Experience

Stressors during Internship and Residency

Answer 7

– Grueling Schedule: 100 hrs per week
– Worries about debts: average $100K
– Feelings of mistreatment
– Toll of Stress: Distress (programs to assist now)
• 1-8 residents increase drug use
• 1-5 fear relationship will not survive
• 1-3 significant depression

Question 8

Medical School Experience

Career Choices

Answer 8

Shifting choice of specialties is common

Question 9

Medical Education Curriculum: Criticisms

Five items

Answer 9

• Too little teaching priority is given by faculty members
• Extensive amount of departmental and research specialization = lack integrative curriculum
• Memorizing of facts = lack judgment clinical matters
• Social medicine many times ignored
• Curriculum can be out of step with reality, such as chronic illness patterns and financing of health care and analytics: lacks preventive health care, social factors, and lifestyle changes education

Question 10

Physician-Patient Relationship

Definition

Answer 10

Encounter between Physician and Patient remains the central element of the health care system

Question 11

Key Dimensions of the Phys-Pat Relationship

Three dimensions

Answer 11

Health has biological, psychological and social
dimensions

• Patient is seen as a whole person who is on a continuum of health
• Physicians use technical and interpersonal skill
• Doctors and patients have a negotiated order

Question 12

Key Dimensions of the Phys-Pat Relationship

obligation

Answer 12

Physicians have an ethical obligation to patients which includes (Hippocrates)

Question 13

Key Dimensions of the Phys-Pat Relationship

commitment and realization

Answer 13

Extent of commitment and realization of genuine therapeutic communication is up to both parties

Question 14

Parson’s Model of the Physician-Patient Relationship

Three aspects

Answer 14

The relationship is asymmetrical: Three reasons why
– Professional Prestige: medical expertise, training, societal
legitimation
– Situational Authority: the physician established the medical practice and the patients come to them
– Situational Dependency: the patient become subservient by seeking care and playing the patient role

Competency Gap: during each encounter the knowledge and expertise gap is brought to the forefront

Physicians were supposed to use this power wisely to promote the patient’s interests and patients would accept this

Question 15

Criticisms of Parson’s Model – Power Model

Freidson

Answer 15

Overstatesthemutualityofinterests between doctor and patient (Weberian)

Question 16

Criticisms of Parson’s Model – Power Model

Conflict theorists

Answer 16

Conflict Theorists argue that the relationship is not Conflict Theorists argue that the relationship is not harmonious and both sides are not satisfied

Question 17

Szasz & Hollander Model

Activity-Passivity Model (like Parson’s)

Answer 17

Doctor is expert, control communication, makes all decisions, while patient lacks knowledge and relies on doctor

Question 18

Szasz & Hollander Model

Guidance-Cooperation Model (Typical Relationship)

Answer 18

Patient has feelings and is alarmed, hopes for treatment. Patient has increased involvement and doctor controls the communication but needs cooperation to occur. Doctor is less autocratic.

Question 19

Szasz & Hollander Model
Mutual-Participation Model (Most Egalitarian)
5

Answer 19

Patient must be central player, both communicate the essential information, mutually satisfying relationship, not appropriate for children due to power differences

Question 20

Veatch Model of the Phys-Pat Relationship (1972)

Moral Relationship between two parties (4 relationships)

Answer 20

• Engineering Model: Value free model, physician presents
all facts, patient no involvement in decision making

• Priestly Model: Physician quasi-religious figure, expert on all matters: Veatch disagrees with this model
• Collegial Model: Both are colleagues working on a common goal. Veatch sees this as unrealistic due to socio- demographic differences
• Contractual Model: Both have obligations and expectations for benefits in the relationship. Physician recognizes that the patient still has control over their destiny when decisions are made.

Question 21

Outcome of the Relationship: Patient Satisfaction

Levels of Satisfaction

Answer 21

– Most people are satisfied with their primary care

– Most survey patients score very high

Question 22

Outcome of the Relationship: Patient Satisfaction

Most patients distinguish b/w technical competence and socio-emotional aspects of their encounter

Answer 22

– Factors of Patient Satisfaction
– Patient background little to do with satisfaction
– Most can’t judge the technical competence of physicians
– Satisfaction influence by quality of communication
– Satisfaction affected by physicians who talk about psychosocial matters and their connection to health

Question 23

Outcome of the Relationship: Patient Compliance

Definition

Answer 23

Compliance is the extent to which people follow medical regimens