patient practioner relationship Flashcards
non verbal communication
mckinstry and wang
- aim is to find out whether participants think that the way their doctor dress is important and their reference
- also want to find out whether the way a doctor dress influence their effectiveness as a doctor
- 475 participants from scotland were given 8 photographs showing 5 different doctors wearing different clothes
- they were asked how happy are them for each doctor and their confidence in their ability as a doctor
- most of the participants thnk that the way their doctor dresses is important
- participants liked the male doctor wearing the formal suit the most and female doctor wearing the white skirt and jumper the most
- older participants and participants from higher working class had stronger preference
verbal communication
mckinlay
- investigated the level of understanding of medical terms in a maternity ward of lower social class families
- 13 words were read to participants in a context of a sentence, participants were asked to explain the meaning of it
- 2 separate doctors scored the responses independently
- results showed that utilisers had higher level of comprehension then non-utilisers
- women that already had a child can comprehend better than those having the first child
- senior doctors had greater expectation in terms of the level of understanding by participants than junior doctors
practitioner diagnosis
disclosure of information
- this is when a patient tells a doctor about the information of the symptoms for doctors to make a diagnosis
difficulty of disclosure of infomation
- when the patient becomes angry, critical of the doctor
- when the patient ignores what the doctor is asking
- when the patient insists that a kind of medication, test is not necessary
- when the patient wants to be given a certificate of a illness that they don’t have
false positive misdiagnosis (type 1 error)
- this is when a doctor misdiagnosis a healthy patient as being unhealthy
- for example when a person is mentally healthy but the doctor misdiagnosis the person having schizophrenia
false negative misdiagnosis (type 2 error)
- this is when a doctor misdiagnosis a unhealthy patient as being healthy
consequences of misdiagnosising
- type 1 error : patient may be given a test or medication that they do not need, possible side effects
- type 2 error : patient may suffer form severe illness, possible invasive treatment, hospitalisation, even death.
- misdiagnosis leads to reduction in the patient’s confidence of doctors and they will less likely to adhere to medical services in the furture
presenting a diagnosis
3 ways of presenting a diagnosis
method 1 (letter)
- can be re-read
- no need to attend a hospital for an appointment
- impersonal
- cannot ask questions straightaway
method 2 (phone)
- quickest method
- no need to attend hospital for an appointment
- patient may have difficulties having a conversation on the phone
method 3 (face to face)
- personal
- can ask questions directly
- need to attend hospital for an appointment
key study : practitioner style (directing and sharing) saavage and armstrong
- aim is to compare the effectiveness of directing and sharing style by general practitioner on the level of satisfaction by patients
- study was carried out by a general practitioner over a 4 month period
- random number generator used to choose 4 patients from each of doctor’s surgery
- patients gave written informed consent for the use of a audio recording in the consultation
- patients were randomly allocated to either conditions, directing or sharing
- cards contained prompts covering 5 main part of the consultation
- at the end of the consultation, participants were given a questionniare, given again one week later
- an individual observer analysed 40 different tape recordings to ensure every aspects were included in the consultation
results
- overall, patients rated highly, only 3 negative, neutral responses were recorded
- patients who recieved the directing style were more likely to feel that they are greatly helped, and the doctor fully understood the problem
conclusion
- directing style leads to high levels of patient satistfaction in terms of doctor’s understanding towards the problem, subjective improvement 1 week later, and quality of explanation
safer et al (delay in seeking treatment)
- investigated the reasons of delay in seeking treatment and the factors that influence this
appraisal delay
- the time when a patient judges a symptom as a sign of illness
- sensory factor and appraisal strategy associated with the length of appraisal delay
- if the patient experienced a painful symptom associated with decreased appraisal delay
- if the patient read about their symptom associated with more appraisal delay
illness delay
- the time between a person decides they are ill and time they decide to seek medical care
- imagined consequences, sensory factors associated with length of illness delay
- more imagery, if patients imagined negative consequences such as being on a operating table, they delayed more
utilisation delay
- the time when the patient decides to seek medical care and when they actually attend medical care
- sensory factor, situational factor and conceptual factor associated with the length of utilisation delay
- those who were concerned about cost, delayed more (situational factor)
- those who experienced pain, delayed less (sensory factor)
- those who waited for their symptoms to go away, delayed less (conceptual belief)
results
first most correlated variable with total delay
- a change in life that is unrelated to the medical condition
- more problems associated with more delay
second most correlated variable with total delay
- whether the patient experienced a painful symptom
- if they experienced a painful symptom, they are less likely to delay
third most correlated variable with total delay
- whether the patient read about their symptoms
- if the read more, they delayed more
fourth most correlated variable
- age
- older patients delayed more than youonger patients
borderline significant variable
- whether the patient waited their symptoms to go away
- if they waited, they delayed less
not significant variable
- whether patient think that they can be cured or not
- if they believe they can be cured, they delayed less
alternative explanation for delay in seeking treatment
health belief model
- states that a person’s decision to health related behaviours are due to health perceptions
perceived severity
- chances a person makes a change to helaht related behaviour depending on the severity of the consequences
percieved susceptibility
- a person is more likely to make a health related change if they feel they are paticularly at risk
perceived benefits
- a person is less likely to make a change if they believe that the change won’t benefit them
perceived barriers
- reasons that a person thinks that the change is hard and stops them from making a change
cues to action
- external events that triggers a person to make a change
self efficacy
- person’s belief in their ability to make a health related change
mauchausen syndrome versus malingering
mauchausen syndrome
- a serious mental health disorder where a person pretends, makes themselves unwell
- deliberately hurts themselves to seek attention
malingering
- when a person deliberately pretends to be unwell
- trying to gain disability allowance, recieve compensation, avoid criminal prosecution
disgnositic features (essential)
- pathological lying
- preregrination
- recurrent, stimulated illness
supporting features
- police records
- multiple scars
- antisocial personality
- most likely to be male
- deprivation in childhood
example study (aleem and ajarim)
- case study on a female patient aged 22 years old, reported to have numerous swelling all over her body
- she was seen in previous occasions, at 17 years old, she was diagnosed with another medical condition and was given medication
- the pain and swelling the patient experienced did not appear to have a cause, which raised suspiscious
- she was very defensive and rationalising in her answers
- upon psychiatrist admittance, a nurse found evidence that she was causing the swelling and pain by herself. A needle full of fecal material was fouund under her bed
- after she found out, she became very angry, left the hospital without further follow up
