The patient-practitioner relationship

Question 1

State the aim of McKinstry and Wang (1991).

Answer 1

To investigate whether patients think the way their doctor dresses is important, what their preference is and whether it influences their effectiveness as a doctor.

Question 2

Describe the eight pictures participants were shown in McKinstry and Wang (1991).

Answer 2

5 pictures of male doctors wearing a white coat over formal suit; formal suit; tweed jacket with informal shirt and tie; cardigan, sports shirt and casual trousers; and jeans and t-shirt.

3 pictures of female doctors wearing white coat with jumper and skirt; skirt, blouse and woolen jumper; and pink trousers, jumper and gold earring.

All pictures have the same pose.

Question 3

Describe the results of McKinstry and Wang (1991).

Answer 3

Formal suit is most popular for male doctor. Doctor in jeans scored lowest.

Jumper, blouse and skirt is most popular for female doctors. Doctor in pink trousers scored the lowest.

Question 4

Describe the aim of McKinlay (1975).

Answer 4

To investigate the perceived and actual understanding of medical terms by a sample of lower working-class families in Scotland.

Question 5

Describe the procedure of McKinlay (1975).

Answer 5

Researchers presented 13 common maternity medical terms to respondents. The words are sounded out and then used in a sentence. Then, respondent were asked to explain what it means.

The responses were recorded and scored independently by two doctors.

Another group of doctors were given the list of words and asked to give their expectations on the level of understanding by the respondents.

Question 6

Describe the results of McKinlay (1975).

Answer 6

Utilisers had a better understanding than under-utilisers.

Utilisers who were not pregnant for the first time had a better understanding than first time mothers.

Doctors greatly underestimated the mothers’ understanding.

Question 7

State three main parts of a diagnosis.

Answer 7

1. Making a diagnosis.
2. Presenting a diagnosis.
3. Coping with a diagnosis.

Question 8

What is meant by a false positive diagnosis?

Answer 8

It occurs when the patient is healthy but the doctor misdiagnoses them as being unwell.

Question 9

What is meant by false negative diagnosis?

Answer 9

It occurs when the patient is unwell but the doctor misdiagnoses them as being healthy.

Question 10

What are the strengths and weaknesses of presenting a diagnosis through letter?

Answer 10

Strengths:
1. It can be re-read at any time for better understanding.
2. No need to leave the house.

Weaknesses:
1. Takes longer time to be typed and posted.
2. Impersonal
3. Patients can’t ask follow-up questions.

Question 11

What are the strengths and weaknesses of presenting a diagnosis through telephone?

Answer 11

Strengths:
1. Quickest method.
2. No need to leave the house to go to hospital.
3. Able to ask follow-up questions.

Weaknesses:
1. Patients might not pick up the phone.

Question 12

What are the strengths and weaknesses of presenting a diagnosis face-to-face?

Answer 12

Strengths:
1. Able to ask follow up questions.
2. More personal

Weakness:
1. Need to leave the house to go to the hospital.
2. Need to go through some administration procedures before getting diagnosis so longer time is needed.

Question 13

Summarize the findings of Schofield et al. (2003).

Answer 13

Evidence show that there are individual differences in how a patient prefers to receive a diagnosis and that most remain happy with their choice.

The way a patient cope with a diagnosis seems to be more to do with clarity of information presented and whether individual needs are met, rather than the method of presentation.

Question 14

Describe the difference between a patient-centred style and a doctor-centred style.

Answer 14

The doctor-centred style is led by doctor and the patient is passive. Doctor will ask closed questions. Atmosphere is impersonal.

Patient-centred style is less controlled by doctor and patient is more active. Doctor asks more open questions. Atmosphere is more personal, medical jargon avoided and the patient is involved in decision-making.

Question 15

Describe the aim of Savage and Armstrong (1990).

Answer 15

To compare the effect of sharing and directing styles of consultation by a general practitioner in terms of patient satisfaction.

Question 16

Describe the sample and sampling technique of Savage and Armstrong (1990).

Answer 16

Random number generator used to select patients from London Medical Practice.

Patients were aged 16 to 75 years.

200 patients in total.

Patients gave written consent to the use of an audio recording of their consultation for research.

Question 17

Describe the procedure of Savage and Armstrong (1990).

Answer 17

When the patients entered the counsultation room, the doctor turned over a card that determined the style: directing or sharing.

The patient completed a questionnaire about satisfaction after the consultation and another one a week later.

Question 18

Describe the results of Savage and Armstrong (1990).

Answer 18

Higher levels of satisfaction reported for directing style, especially for patients with physical problems, those who had excellent understanding of terminology and those receiving a prescription.

Question 19

Describe the types of delay in seeking treatment, according to Safer et al. (1979).

Answer 19

Appraisal delay is the time the patients takes to appraise a symptom as a sign of illness.

Illness delay is the time between the patient decides they are ill and when they decide to seek medical care.

Utilisation delay is the time from the decision to seek care until they actually access services.

Question 20

Describe the study by Safer et al.

Answer 20

Study done in 4 clinics of a large city hospital.

93 patients with average age 44. Patients with severe illness were excluded.

45-minute interview and questionnaire about types of delay and predictors of delay. Total delay was measured. Results found there are three stages of delay: appraisal, illness and utilisation. A variety of factors predict the length of the delay for each of the three stages. For example, illness delay is affected by perceived severity of the illness.

Concluded that a wide variety of factors affect total delay in seeking
treatment. Strong sensory signals led to shorter delays. The more patients researched their illness, the longer the delay.

Question 21

Describe explanations for delay based on Health Belief Model.

Answer 21

Perceived severity.

Perceived susceptibility.

Perceived benefits.

Perceived barriers.

Cues to action.

Self-efficacy.

Question 22

Describe Munchausen syndrome and its diagnostic criteria.

Answer 22

It is a mental disorder in which an individual pretends to be unwell or deliberately make themselves unwell for no obvious incentives.

The essential features include:
1. Peregrination
2. Pathologic lying
3. Recurrent, feigned or simulated illness

Supporting features include:
1. Borderline or antisocial personality traits
2. Deprivation in childhood
3. Equanimity for diagnostic procedures
4. Equanimity for treatments and operations
5. Evidence of self-induced physical signs
6. Knowledge or experience of a medical field
7. Most likely to be male
8. Multiple hospitalisations
9. Multiple scars
10. Police record
11. Unusual or dramatic presentation

Question 23

Describe the study by Aleem and Ajarim (1995).

Answer 23

A case study of a 22 year old woman with Munchausen who was reported with swelling on her body. She had been seen on numerous occasions in the hospital since she was 17 and given various treatments. Suspicions were raised
by the hospital when it was felt that the ailments she had did not appear to have a physical cause. Upon admittance to the psychiatric ward the nursing staff eventually found a needle with faecal material in it. It is believed the patient had injected this into her breast tissue. The patient left the hospital when confronted and did not return again.