Week 4

Question 1

What do patients want

Answer 1

Humaneness
Competence/ accuracy
Patient involvement in decisions
Time for care

Question 2

What is clinical communication

Answer 2

The means through which you represent yourself as a competent, caring HCP
Any communication that takes place in a clinical setting to initiate, build and maintain an interpersonal relationship between:
HCP-patient
HCP-family member
HCP-HCP
Verbal, nonverbal, written communications

Question 3

What’s involved in competence

Answer 3

Knowledge
Skills
Attitudes

Question 4

What is unconscious bias

Answer 4

Term used to describe the associations that we hold which, despite being outside our conscious awareness, can have a significant influence on our attitudes and behaviour.
These associations are difficult to override, regardless of whether we recognise them to be wrong, because they’re deeply ingrained into our thinking and emotions

Question 5

Reflective practice

Answer 5

Prepares you for managing ill-defined &complex issues
Allows you to think about past actions and experiences leading to deeper understanding
Helps to create and clarify meaning in terms of self by examining your responses and emotions
Informs your actions, behaviours and attitudes for future experiences

Question 6

Two types of consultation styles

Answer 6

Doctor centred
patient centred

Question 7

Doctor centred consultation

Answer 7

Based on assumption that doctor is expert and patient merely required to cooperate
Focus on physical aspects of patients disease
Tightly controlled interviewing methods to elicit necessary info
Questions mainly closed
Aim to provide info to enable doctor to interpret patients disease within his or hers own biomedical disease framework, while providing little/no opportunity for patients to express their own beliefs and concerns

Question 8

Patient centred consultations

Answer 8

Doctors adopt a less controlling style and encourage and facilitate their patients to participate in the consultation, fostering a relationship of mutuality
Greater use of open questions
Requires that doctors spend more time actively listening to patients problems through picking up and responding to patients cues, encouraging patients to express own ideas or feelings

Question 9

What would medical sociologists argue about patient centred consultations

Answer 9

Most likely to result in concordance which in turn means patients more likely to take their medicine

Question 10

Definition of compliance

Answer 10

The extent to which the patient follows mutually agreeable instructions/ extent to which actual drug taking behaviour matches prescribed regimen

Question 11

Definition of adherence

Answer 11

Similar to compliance but there’s a stronger assumption that the regimen was discussed and agreed, different from patient being obedient

Question 12

Definition of non-adherence

Answer 12

Intentional: patient makes a conscious decision not to take prescribed medication
Unintentional: situations in which patient intends to take medicine but does not do so e.g. forgetting

Question 13

Definition of concordance

Answer 13

Emphasises partnership between patient and doctor
Aim of concordance is to achieve a mutually agreed treatment plan based on patients’ informed assessment of risks and benefits

Question 14

Factors that affect consultation

Answer 14

Age- very young and elderly- elderly more likely to have comorbidities, loneliness, parents worried about child
Gender- women consult more often than men-less social stigma, more problems, often the ones to take children
Ethnicity- minority ethnic groups may prefer own method of healthcare so don’t consult, others may consult more
Social class- socially deprived may consult more, unemployed get free prescriptions, poor housing increases risk of disease e.g. respiratory problems
Employment- unemployed show increased consultations may due to increased physical and psychological complaints, employed people too busy
Smoking status- smokers more likely to consult as its a major risk factor for a lot of diseases

Question 15

What are Zola’s 5 social triggers which encompass the way in which symptoms come to be seen as abnormal

Answer 15

Perceived interface with vocational or physical activity
Perceived interface with social or personal relationships
The occurrence of an interpersonal crisis - divorce or death in family somehow brings symptoms to forefront, less tolerance for ongoing symptoms
A kind of temporalising of symptomatology (set time limit for symptoms)- if have the headache in a week ill go doctors
Sanctioning (having pressure to go see doctor from family etc)

Question 16

Kleinman’s model of healthcare systems

Answer 16

Popular sector, largest sector, non healthcare population (social networks, families, community)
Professional sector (biomedical providers)- HCPs, modern medicine
Folk sector (faith and traditional healers)- alternative medicine- traditional remedies, therapies
The professional and folk sectors may overlap depending on local setting
All sectors interlinked and is dynamic model- people move between sectors continuously as they get well

Question 17

What are symptoms

Answer 17

Those feeling states patients experience which alert them to the possibility they are not well

Question 18

What are signs

Answer 18

The pointers the doctor identifies which signify the existence of an underlying pathological lesion

Question 19

Stages of illness

Answer 19

Person experiences symptoms
May seek medical advice from friends and relatives
May seek professional advice from a Dr
Doctors confirms the person is sick (legitimises sick role) either by sick note, prescription, referral to a colleague or by diagnostic label
Sick role
Recovery

Question 20

What does the clinical iceberg refer to

Answer 20

The belief that the majority of symptoms or illnesses go unreported to a Dr/healthcare professional for one reason or another

Question 21

Parson’s sick role: patients sick role

Answer 21

Patients sick role:
Must want to get well as quickly as possible
Should seek professional medical advice and cooperate with Dr
Allow (may be expected) to shed some normal activities e.g. employment and household tasks
Regarded as being in need of care and unable to get better on their own decisions and will

Question 22

Parsons sick role: doctors professional role

Answer 22

Expected to:
Apply a high degree of skills and knowledge to the problems of illness
Act for welfare of patient and community rather than for self interest
Be objective and emotionally detached
Be guided by rules of professional practise

Question 23

Parsons sick role: Drs rights

Answer 23

Granted right to examine patients physically and to enquire into intimate areas of physical and personal life
Granted considerable autonomy in professional practice
Occupies position of authority in relation to patient

Question 24

Marinkers concept

Answer 24

Disease- pathological process, most often physical, deviation from biological norm, valued as the central facts in medical view, doctors can see, touch, measure, smell
Illness- feeling, an experience of unhealth entirely personal, interior to patient,often accompanies a disease but sometimes no disease is found. Patients experience of unhealth
Sickness-external and public mode of unhealth, social role negotiated with society
Health healing- understood by religion as natural process of tissue regeneration sometimes assisted by medical means but also as the process that results in experience of greater wholeness of human spirit
Wholeness

Question 25

Public health interventions

Answer 25

Any effort or policy that attempts to improve mental and physical health on a population level. May be run by a variety of organisations including governmental health departments and non-governmental organisations

Question 26

Mechanic’s 1978 variables known to influence illness behaviour

Answer 26

Recognisability of signs and symptoms
Perceived severity of symptoms
Extent of disruption to family, work and social activity due to symptoms
Frequency of appearance of signs and symptoms
Tolerance threshold
Available knowledge, cultural assumptions and understanding of evaluator
Denial of symptoms
Needs competing with illness responses
Competing interpretations that can be assigned to symptoms
Availability of treatment resources (i.e cost, distance, stigma, social distance, cant get an appointment)