practitioner and patient interpersonal skills

Question 1

Aim (McKinstry&Wang)

Answer 1

To determine

1. how acceptable patients found different styles of doctors’ dress
2. whether the dress style influenced patient’s opinion

Question 2

Participants (McKinstry&Wang)

Answer 2

opportunity sample
475 patients
all from Scotland

Question 3

Controls and Methods (McKinstry&Wang)

Answer 3

• same posture
• same male and female

method: self report

Question 4

Results for most acceptable style of dress (McKinstry&Wang)

Answer 4

male doctor: suit

female doctor: lab coat

Question 5

What dress do patients object the most? (McKinstry&Wang)

Answer 5

• jeans, object more strongly for female

Question 6

Which doctor do patients feel more confident being with? (McKinstry&Wang)

Answer 6

41% of patients who said that they are more confident in one specific doctor

• and the doctors who were commonly selected by these are FORMALLY DRESSED
• OLDER patients choose FORMALLY DRESSED

Question 7

conclusion (McKinstry&Wang)

Answer 7

patient attitude affected by the way doctor dresses
although other variables
age/gender also have an affect

Question 8

Aim (McKinlay, 1975; Ley, 1988)

Answer 8

To investigate common medical terminologies that doctors use.

1. To see whether doctors think patients understand them
2. whether patients actually understand them
3. and to investigate underlying causes which differentiate patients’ knowledge of medical terminologies.

Question 9

Participants (McKinlay, 1975; Ley, 1988)

Answer 9

Lower working class patients using a maternity service in Scotland.

Question 10

Procedure - terminologies (McKinlay, 1975; Ley, 1988)

Answer 10

13 medical terminologies were chosen using a pilot study
- These 13 words fell in the middle category of patient understanding

• (neither very familiar nor completely incomprehensible)
• as rated by Scottish patients in the pilot study.

Question 11

Procedure (McKinlay, 1975; Ley, 1988)

Answer 11

The interview began with a reassuring statement, “This is not a test”. They were first read the word, then heard the word in a sentence a doctor would use, then asked to explain what the doctor meant.

Patients’ answers were transcribed and their understanding was scored by 2 doctors (1 male, 1 female) as either adequate / vague / wrong / none.

The doctors were blind to the identity of each patient interviewed and to the other doctor’s score.

In order to study the effect of patient characteristics, patients were categorised as utilizers (patients who used the maternity service regularly) and underutilizers (patients who did NOT use the maternity service regularly).

Question 12

Essay: practitioner and patient interpersonal skills

Answer 12

P1 - non-verbal communications (McKinstry & Wang)

P2 - verbal communications (McKinlay, Ley)

Question 13

Essay: patient and practitioner diagnosis and style

Answer 13

P1 - practitioner style: doctor and patient-centred (Bryne and Long, Savage and Armstrong)
P2 - practitioner diagnosis: type I and type II errors
P3 - disclosure of information (Robinson & West)

Question 14

Essay: misusing health services

Answer 14

P1 - delay in seeking treatment (Safer)
P2 - misuse: hypochondriasis (Barlow and Durand)
P3 - Munchausen syndrome (Aleem and Ajarim)

Question 15

What is the key principles of Ley’s model?

Answer 15

• effective verbal communication
• adherence—understand+remember+satisfied
• improve understanding/recall/satisfaction

1. no difficult medical terminology
2. primacy/recency effect
3. categorise structured
4. respond sympathetically

Question 16

Supporting research for Ley?

Answer 16

• booklet
• 55%—70%
• can improve, using simple technique

Question 17

Describe Bryne&Long

Answer 17

• doctor centred/patient centred
• tape recorded, transcribed, analysed—medical consultations —indication for particular consultation style
• 6 phases, establishing relationship —investigation—further treatment?
• most doctors were doctor centred

—> more self-reflective, degrees of …

Question 18

Describe Savage & Armstrong

Answer 18

• patient preference for a sharing/directing
• 2 questionnaire
• quality of doctor’s knowledge + feel helped? immediately+1 week after
• high level of satisfaction in both,higher for directed —> more satisfaction with ‘explanation of doctor’ feel ‘greatly helped’
• authoritarianism + certainty = satisfy
• importance of style

Question 19

Describe Robinson & West

Answer 19

• patient disclosure
• computerised medical interivew VS paper-based questionnaire VS face to face physician interview
• not honest + exaggerate = type I and II errors
• GU clinic, 33male 36 female
• either condition + physician
• computer>paper>physician

Question 20

Describe safer

Answer 20

• factors influencing delay for 1st time
• opp sample, 93patients age 44
• if going to tell a new symptom
  1. appraisal delay
  2. illness delay
  3. utilisation delay
• individual+situational factors lengthen/shorten delay

Question 21

Describe Barlow & Durand

Answer 21

• Gail married at 21
• anxiety stress, job stressful
• minor symptom=series illness
• spent time+money visiting doctor even though she is perfectly healthy

Question 22

Describe Aleem & Ajarim

Answer 22

• Munchausen: fake symptoms of a disease/injury inorder to have hospital treatment
• exaggerating symptoms, inconsistent medical history
• problems w self esteem+longing for attention
• female uni student injected a syringe of fecal into her left breast to develop an abscess
• irrational behaviour, misuse health services, waste time of health professionals