Patient Experience of Illness Flashcards
Doctor VS Patient Agenda
- Heading in opposite directions: patients have multiple conditions but doctors are specialising more
- Important to have a wide scope & see the bigger picture - may miss things out
- Doctors - diagnosis, medication, treating symptoms
- Patients - social isolation, can’t see people, can’t do housework, changing daily life, mental health
Biomedical Model of Health
- Purely biological (pathology, physiology etc)
- Treated by medical intervention
- Health as the absence of disease
- Ill-health as the breakdown of ‘normal’ functioning bodies
- Discounts social & indvidual factors
- Mind and body can be treated seperately
- Can only be treated by trained medical experts - no-self management
- Scientifically & morally neutral (responsibility)
Long Term Conditions
- More prevalent in older or more deprived people
- £7 in every £10 of total health & social care expenditure
- Challenges traditional thinking - changes to social care
- Multi-morbidity, common causative factors (two or more factors or two or more LTCs per person)
- Socially negotiated - boundries of what makes it a disease or LTC (obesity)
- Usually care is self-care - only around 5-10 hours with a health care proffessional (appointments etc) so more of an expert at managing themselves
Physical Impacts of LTCs
- Symptoms of conditions
- Symptoms of complications - knock-on effects
- Therapeutic interventions - social care etc
- Secondary prevention - lifestyle change (behaviour change is the hardest prevention to tackle)
- Disability - change to everyday life
- Risk to health of carers - neglecting own health
- General symptoms - pains, lack of libido (relationships), fatigue, breathlessness
Pyschosocial Impacts
- Co-morbid conditions - more likely to develop more (depression is most common), effect on quality of life & expectancy
- Affects health outcomes - unable to operate, affect on mortality, deterioration
- Health service use
- Health risks to carers
Indivdual Impacts:
- Dependency - low self-esteem
- Loss of work
- Sleep deprivation
- Loneliness
- Body image
- Loss of spontatneity - loss of “self”
Impacts on Place in Society
- “sick role” - labelling legitimising conditions, lead to benefits/exclusion from responsibilites
- Stigma - being visibily ‘different, embarressment, non-concordance, percieved responsibility (heart disease & diabetes)
- Social cohesion
- Social isolation/exlcusion
Parson’s “Sick Role”
- Theory by Talcott Parsons - 1950s
- Health is generally necessary for a functional society
Role is afforded certain rights but also obligations:
- Person is not responsible for assuming sick sole
- Sick person is exempt from carrying out some/all of normal social duties (family/work)
- Sick person must try and get well - only a temporary phase
- In order to get well, sick person needs to seek & submit to appropriate medical care
False ideas - doesn’t always fit into current state of UK Health & Wellbeing
Health Care Systems
- Still acute, curative (traditional) - working on being more patient centred, intergrated (social care)
- Trying to be more integrated - multi-disciplinary health care, pharmacists, counsellors at GP surgeries
Need to adapt:
- Management of LTCs
- Continuity of care - reduces burdens, patient contact & secondary care intervention (you know the patient)
- Intergrated care - keeping people at home (secondary care - IV at home)
- Generalists - hollistic approach
- Shared goals & shared decision making (involving patients in uncertainty) - values based
Core Interventions for LTCs
- Primary Prevention - encourage healthy lifestyles etc
- Proactive case finding - people have conditions that they don’t know about (blood pressure, diabetes)
- Education - public & professional, changing ways of management
- Pharmacological & Psychosocial - should work together, best treatment path suited for the patient
- Long-term surveillance - check-ups, follow-ups to stop deterioration going unmissed (too late)
- Monitoring/assessment of quality of care - does what you’re doing help the patient in all aspects?
Shared Decision Making
- Vital for patient-centred care
- Care is personalised to the patient, getting various teams involved
- Helping patients to understand their own care needs - empowerment (healthtalks.com)
- Professionalism, compassion, dignity & respect
- Fully explore & explain options with risks/benefits
- Understand what is important to the other person
Health Associations with Lonliness & Social Isolation
Social Isolation: living alone, less than monthly contact with friends & family, don’t belong to a group
Percieved lonliness: more ‘imposed’ than isolation, can be a result of pre-existing conditions & ill health
Physical Health
- Increases mortality chances by 26%
- Effects comparable to other well known risk-factors like obesity & smoking (higher risk of stroke etc)
Mental Health
- Greater chance of cognitive decline
- 64% increased chance of developing clinical dementia
- More prone to depression, predictive of suicide in older age
Maintaining Independence
Lonely individuals are more likely to :
- Visit GP, have higher doses of medication & more falls
- Undergo early entry to residental/nursing care
- Use accident & emergency independent of chronic illness
Alleviating loneliness allows patients to remain independent for as long as possible
‘Social-prescribing’ - giving access to facilities that can provide networks for lonely/isolated people
Overdiagnosis & Medicalisation
Overdiagnosis: detection of abnormalities that wouldn’t have usually been noticed, cause symptoms or death
- starts inside medicine, adressing the problem of people recieving an unbenificial diagnosis
Medicalisation: defining a problem in medical terms - usually illness/disorder and using medical intervention to treat it
- often concerns new diagnosises, based on a widening understanding of situations
- problem usually benefits from medical involvment
- widens the boundaries of medicine
- drivers: interests, existing insitutional rules (prescription charge), the way society defines a ‘disease’ and ‘normality’
Both are context dependent and involve factors such as pahraceutical industry, media, consumers etc (‘new miracle cure’) - doctors are gatekeepers
Good Healthcare
Highlighted by patients:
- having a friendly & caring attitude
- having an understanding how how the patient’s life is affected
- letting the patient see the same professionak
- guiding the patient through difficult conversations
- taking time to answer questions & explaining things well
- pointing the patient to further support
- efficiently sharing a patient’s health information across services
- involving patients in care decisions
10 Commandments for Patient-Centred Care
