Patient Practitioner Relationship

Question 1

Outline the P&P relationship in terms of the syllabus

Answer 1

Interpersonal Skills
———Non Verbal (Mckinstry & Wang)
———Verbal Communications (McKinlay)
Diagnosis Style
———Practitioner Style (Byrne & Long)
———Practitioner Style (Savage & Armstrong)
Type I and Type II
———–Disclosure of Information (Robinson and West)
Misuing Health Services
———–Delay in seeking treatment (Safer et al)
———–Hypochondriasis (Barlow & Durand)
———–Munchausen Syndrome (Aleem & Ajarim)

Question 2

Aleem and Ajarim

Answer 2

Munchausen Syndrome- seek attention by telling factitious tales to fulfill a “sick role”

22yo F university student painful swelling over the right breast, surgically removed abcesses in different areas, inability to explain the nature or cause of the swelling, found a needle and syringe full of faeces.

Question 3

Barlow & Durand

Answer 3

Hypochondriasis: Persistent fear of having an serious illness, clinical distress, functional impairment, usually accompanied by bipolar or OCD, or depression.

Trigger > Preceived Threat > Apprehension > Increased focus on body > Body reacts > Checking behaviour > Preoccupation leads to misinterpretation > Increased sensation of threat

Question 4

Safer et al

Answer 4

Ninety three participants in waiting rooms
avg age 44, interviewed about their illness for those presenting a new symptom

Appraisal Delay: b4 u conclude u are ill
Illness delay: b4 u decide to go to hospital
Utilization delay: after u decide to go, before u actually arrive.

Question 5

Robinson and West

Answer 5

33 M and 36F, in a GU clinci and northern england

Questionnaire (digital & physical) was comapred to doctor’s notes to find:

1. number of symptoms
2. number of sexual partners
3. number of previous reported attendances

Computer group reported 3 symptoms vs 1.1 in records
Questionnaire reported 1.9 vs 0.9
similar for other questions, more honest on questionnaires

Question 6

McKinstry & Wang

Answer 6

Non Verbal Comm
475 participants seeings 30 diff doctors from 5 general medical centers were interviewed

“which theyd feel happiest seeing 0-5”
“would u have confidence in their ability”
“any you would be unhappy with”
“which looks lik your doctor”

+Male doctors wearing formal suit and tie
+Females in white lab coat, or smart skirt and blouse
-28% said they’d be unhappy, mostly with informal, some with white lab coats
-41% had a significant belief in the ability of a given doctor, showing that it does play a crucial role, etc.

Question 7

McKinlay

Answer 7

got 13 words that fell into a “Grey area” of communication and interviewed patients to test their understanding, whose understanding was rated by 1M and 1F doctor blindly.

the M/F doctors gave around the same predictions if they know/don’t know the word but often the male would underestimate the knowledge of the female patietns relative to the female doctor

usually they did know the words, except “navel” and “rhesus” which were usually known only among regular patients at the maternity clinic, and the word “purgative” which few knew.

Question 8

Ley

Answer 8

people forget things or misunderstand instructions easily. (“frequency at which verbal advice is forgotten”)

suggestions?: “use simple language, categorize ur advice into diagnosis, treatment, medication, give key information first.”

Question 9

Savage & Armstrong

Answer 9

359 ppl 200 were used

basically directing is better than sharing, esp at 1 week follow up,
more likely to feel convinced of the diagnosis, report better understanding of their problems, more likely to feel “greatly helped”

Question 10

Bryne & Long

Answer 10

7 differenct communication styles,
from tape recrodings of 2.5k medical interactions
extremely doctor centered to extremely patient centered