The patient practitioner relationship

Question 1

Sub-topics

Answer 1

1. Practioner and patient interpersonal skills
   (a) non-verbal communications (Mckinstry and Wang)
   (b) verbal communications (McKinlay; Ley)
2. Patient and practitioner diagnosis nd style
   (a) Practitioner style: doctor and patient-centered (Bryne and Long; Savage and Armstrong)
3. Practioner diagnosis: Type I and Type II errors
   (a) Disclosure of information (Robinson and West)
4. Misusing health services
   (a) Delay in seeking treatment (Safer et al)
   (b) Misuse: hypochondriasis (Barlow and Durand)
   (c) Munchausen syndrome (Aleem and Ajarim)

Question 2

Interpersonal skills

Answer 2

-‘inter’ and ‘personal’ means between people’; the abilities we have that allow us to communicate effectively with others

Question 3

Non-verbal communications

Answer 3

• Mckinstry and Wang
• investigated doctor’s clothing as a form of non-verbal communication
• 475 participants seeing 30 different doctors from five different medical centres in one area of Scotland
• 8 photographs
• were asked
  1. which doctor they would fell happiest seeing for the first time (0-5)
  2. whether they would have more confidence in the ability of one of these doctors
  3. whether they would be unhappy abt consulting any of them
  4. which doctor looked most like their own doctor

Question 4

Result of non-verbal

Answer 4

• preferred male doctors wearing a suit and tie
• female doctors wearing lab coat or small skirt and blouse
• preference of traditionally dressed doctors was most common among older people and people from higher social classes
• 28%said would be unhappy seeing the doctors shown.
• 64% said dress was important
• variations between patients from different centres.
• In general, the findings show that patients prefer formally dressed doctors although this is somewhat affected by age, social class and the particular medical practice used.

Question 5

Verbal communications (1)

Answer 5

• Mckinlay
• barriers to communication between patients and doctors has been on patient’s failings: unwilling to listen to unpleasant information, anxiety caused by differences in status, social class
• conducted a pilot study on the words which doctors used in a Scottish maternity hospital
• 13 words that some but not all doctors use ‘grey area’
• patients responses were recorded verbatim on a standard form identified only be the participants’ number and then scored independently by two doctors.
• those who underused the maternity service had less understanding of the words

Question 6

Verbal communications (2)

Answer 6

• Ley
• reported on the frequency with which patients forgot the verbal advice given to them by their doctor.
• forgetting is linked to factors such as age, anxiety, medical knowledge
• suggested that practitioner should use simple language, state the key info first, giving concrete specific advice which is categorised and repeat the key points and summarize

Question 7

Practioner style (1)

Answer 7

• Bryne and Long
• tape recorded and analyzed about 2500 medical consultations in several countries
• 6 phases that doctor go through during a consultation: ERCCDE
• 7 different styles of consultation from extremely doctor-centered to extremely patient-centerd

Question 8

Practioner style (2)

Answer 8

• Savage and Armstrong
• wanted to compare the effect of directing and sharing styles of consultation on patients’ satisfaction with the consultation
• 359 patients between the ages of 16 and 75 presenting with any symptoms
• 200 results were used
• patient satisfaction was measured by two questionnaires that asked abt the quality of the communication in the consolation and any thoughts afterward; one immediately and one after a week
• overall, satisfaction in both conditions but more in directing style of consultation
• authoritarianism and certainty are elements of the doctor’s style that satisfy the patients more

Question 9

Type I and Type II error

Answer 9

• Type I error: False positive, is declaring an illness when one does not exist
• Type II error: False negative, is declaring that a person is well when he or she is ill.

Question 10

Disclosure of Information

Answer 10

• Robinson and West
• wanted to investigate the difference between, and effectiveness of, a computer-based medical questionnaire against a paper-based questionnaire in eliciting medical histories from patients
• 33 male and 36 female patients of a GU(genito-urinary) clinic in Northern England
• ages ranged from 15-49; mean age 27
• 37 in computer group, 32 in paper
• they also had a medical consultation with a doctor
• computer will elicit more info

Question 11

Delay in Seeking treatment

Answer 11

• Safer et al
• wanted to investigate what factors influence delays in seeking medical treatment for the first time for a particular symptom.
• 93 patients, 38 M, 55 F, avg age 44, 4 clinics in a large inner-city hospital
• appraisal delay, illness delay, utilisation delay
• interview lasted 45 mins
• concluded that a variety of factors, perceptual, situational and appraisal strategies, affect delay in seeking medical treatment

Question 12

Misuse: Hypochandriasis

Answer 12

• a persistent fear of having a serious medical illness
• Symptoms: Misinterpretation of body symptoms, absence of delusions or psychosis, clinical distres, preoccupation with having a serious illness

Question 13

Munchausen Syndrome

Answer 13

• one of the most intriguing of factious disorders
• Factious disorders are charaterised by physical or pyschologcl symptoms that are intentionally produced or faked in order to assumethe sick role.
• Aleem and Ajarim report the case of a 22-year-old female who attented their hospital in Saudi Arabia