Lecture 9 - Patient-Provider relationships

Question 1

what is Nurse practitioner -

Answer 1

=Trained in traditional nursing and has additional education in health assessment, diagnoses, and management of injuries and illness
ì Can order tests and prescribe drugs
ì Responsibilities include providing routine medical care, prescribing treatment, and attending to the chronically ill

Question 2

what does a nurse have an impact on -

Answer 2

=1. On patient outcomes

2. On satisfaction with health care

Question 3

what was the traditional patent-provider relationship -

Answer 3

=ì Authoritarian ì Unequal

ì Dominance hierarchy

Question 4

what is the ‘new’ patent-provider relationship -

Answer 4

=ì Open
ì Equal
ì Reciprocal

Question 5

what are the three main barriers to Effective Communication -

Answer 5

=setting, structure of health care system and changes in physician’s role

Question 6

what are the barrier ‘setting’ to Effective Communication -

Answer 6

=1. Patients sick, in pain

2. Need for many questions
3. Time pressure

Question 7

what are the barrier ‘Structure of Health Care System in Canada’ to Effective Communication -

Answer 7

=1. GPs are entry point, no specialists

2. Many do not have GP

Question 8

what are the barrier ‘Changes in Physician’s role’ to Effective Communication -

Answer 8

=1. More interdisciplinary teams (more equality)

2. Patients asking for more involvement
   - > Physicians dominance, autonomy, authority challenged

Question 9

what are some Problematic Communication ì Behaviours

Answer 9

- =• Not listening
• Jargon
• Babytalk and elderspeak
• Nonperson treatment
• Stereotyping and disparaging language

Question 10

explain Not Listening -

Answer 10

=ì Only 23% of patients finished explanations before diagnosis
ì Physician interrupted within 18-22 seconds
ì Physicians knew they were recorded!

Question 11

why is Using Jargon an issue? -

Answer 11

=Many patients do not understand this language

Question 12

why is jargon still used -

Answer 12

=habitual, cultural (hospital cultural), to educate the patient

Question 13

what is elder-speak -

Answer 13

=Baby Talk for older adults
ì Using overly familiar terms to address elderly patients, such as
“dear” or “sweetheart”
ì Using pronouns “we”, “us”, and “our” in place of “you” ì Answering questions for the older adult
ì “You would like to have your bath now, wouldn’t you?” ì Talking for the older adult
ì You had a great time with your family today, I saw. And you were watching ‘Gone with the Wind’, which you love. Right?”

Question 14

what are consequences of elderspeak -

Answer 14

=agist, takes away agent; learned helplessness

Question 15

why does elder speak happen -

Answer 15

=it is well intended but shouldn’t happen

Question 16

what is Nonperson Treatment -

Answer 16

=Depersonalizing the patient
ì Not talking to the patient during an exam
ì Not talking to the patient in the presence of other providers
ì Not knowing the patient’s name

Question 17

what are consequences of Nonperson Treatment - =dehumanizes person, makes them uncomfortable
why is Nonperson Treatment done -

Answer 17

=culture of hospital, bad bedside manners

Question 18

why is stereotyping an issue in the hospital setting -

Answer 18

=doctors assume that an individuals issue could be one thing and disregards everything else

Question 19

explain what is included in Other Potential Barriers: Patient Characteristics -

Answer 19

=ì Certain personality traits 
ì Anxiety
ì Knowledge
ì Education
ì Language proficiency

Question 20

explain the differing concerns of patients and providers -

Answer 20

=Patient 
ì Pain
ì Symptoms interfering with activities
Provider
ì Underlying disease
 ì Severity
 ì Treatment options

Question 21

Why it is Difficult for Practitioners to Change Some Maladaptive Communication Behaviours? -

Answer 21

=ì Little feedback from patients
ì If the patient does not return, it is unclear what it means

essentially few opportunities for practitioner to learn

Question 22

what are some options for Improving Patient-Provider Communication -

Answer 22

=ì Teaching providers patient-centred communication

ì Teaching patients how to elicit information from providers

Question 23

what are the three types of Treatment Adherence -

Answer 23

=adherence, non-adherence and creative non-adherence

Question 24

explain adherence -

Answer 24

=Following a prescribed behavioural and/or treatment regimen

or routine

Question 25

explain Non-adherence -

Answer 25

=Patients don’t adopt behaviours and treatments their

providers recommend

Question 26

explain Creative non-adherence -

Answer 26

=ì Patients modify or supplement a prescribed treatment
regimen (e.g., adjusting dosages, supplementing treatments)
ì May be a patient’s attempt to reassert control over their illness and its treatment.

Question 27

what are some diseases with high adherence -

Answer 27

=ì HIV
ì Arthritis
ì Gastrointestinal disorders
ì Cancer

Question 28

what are some diseases with low adherence -

Answer 28

=ì Pulmonary disease ì Diabetes

ì Sleep disorders

Question 29

what are the Causes of Non-adherence -

Answer 29

=Many 'valid' reasons
ì Faulty patient-provider communication is the greatest cause of
non-adherence to treatment!
ì Forgetting
ì Memory overload
ì Side-effects
ì Not agreeing with the treatment
ì Does not believe in the treatment's effectiveness
ì Uses other ways to treat it

Question 30

how many patients cannot repeat what they need to do within minutes of discussing it! -

Answer 30

=1/3

Question 31

how to Improving Adherence -

Answer 31

=Establish effective & empathic communication

1. Improve patient understanding
2. Improve patient satisfaction
3. Provide patient with space to make a decision
4. Provide patient with written information about what they agreed on

Question 32

what is The Placebo Effect and why does it work -

Answer 32

=when patients just believe they are being treated

it works because of psychological and physiological effects

Question 33

who responds most to The Placebo Effect -

Answer 33

=ì Big Five Factors and placebo
responding
ì People scoring high in extraversion were more likely to experience placebo effects

Question 34

what makes the placebo effect strong -

Answer 34

=provider behaviours (- Confidence and competence
- Expressing faith in treatment)
Settings that have medical formality
Appearance of placebo (shape, size, colour, quantity)
Regimens hat seem medical (precise instructions)

Question 35

what are the ethics of placebo -

Answer 35

=ì Placebos cannot be used in regular medical care

ì Placebos unethical in clinical trials when an effective treatment exists