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SOCI311 > Week 9:Communication & Decision-Making: > Flashcards

Week 9:Communication & Decision-Making: Flashcards

1
Q

What is the importance of the Patient-provider Communication

A

The interaction is important so that the patient can be heard and not overlooked

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2
Q

The Doctor Patient Relationship Today

A

-Seen more business

-High rates of specializations

-Colleague dependent

-Technology depedent

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3
Q

2 Formats of Medical Encounters

A
  1. Hierarchical relationship
    a. Interview→ dialogue between
    b. Physical examination
  2. Recommendation and treatment
    -Sequential → A pattern
    a. Provider -initial
    b. patient responses
    c. Provider comments
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4
Q

4 Parts of Doctor-Patient Communications

A
  1. What we know about doctor-patient communication
  2. Consequences of communications
  3. Improving doctor-patient communication
  4. The future doctor patient communication
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5
Q

4 Ways that Doctor-Patient Communication is Asymmetric

A
  1. Flow of information
    Doctors restrict what that they tell the patient and how they tell the patient
    Providers don’t usually tell the gravity of what their condition is
  2. Structure of conversation
    The provider controls the conversations
    Controlling the content of communication
    If you are the one asking the questions than you control the content and topics
    Yes or no questions
    Force choices questions
    “Was it dark red or light red”
  3. Deflecting Patient Concerns
    Interrupting the patients talking
    Failing to answer questions so directly
    Mishler voice of medicine drowns out life world
    Not exploring the social context of a patient

4.The medical interview is shaped by the social context
A health care provider has to be a detective
Their is social conditions that have context depending on different social for geographics
Different diagnosis depending in different areas
-Bureaucratic organizations
-Colleague dependency
-Managed care
-Steep slope of health care
-Providers’ cultural assumption
-Problems in communication exacerbated by
-barriers of race, SES, gender
-Amount of information patients receive
-Patient’s willingness to ask questions
-Patient’s inclusions in medical decisions
-making (consent vs. assent)
-Differences in races between the patient and doctor races

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6
Q

Consequences of Communication

A
  1. Patient satisfaction
  2. Malpractice and doctor-patient communication
    -*70% is due to miscommunication between doctor and patient
  3. Diagnosis and misdiagnosis
    *40% of patients who unexpectedly returned after initial primary care visit had been misdiagnosed
    *80% was tied to mis communication with doctor and patient

4.Adherence to medical advice

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7
Q

Improving Doctor-Patient Communication:
The Four Habits Model

A
  1. Investing in the beginning
  2. Elicit the patient’s perspective
  3. Demonstrate empathy
  4. Invest in the end
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8
Q

Improving Doctor-Patient Communication:
Tell-ask-tell method

A

Physician might tell you something and then the patient ask what they are concerned to
Giving the patient the opportunity to ask questions and concerns

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9
Q

Improving Doctor-Patient Communication: Teaching communication to Med Students

A

-Teach effective communication

-Reward effective communication

-Actually test on it and make the credits higher

-Having a lower credit count tells students it’s not as important

-Allows enough time for communication

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10
Q

The Future of Doctor-Patient Communication

A

Positive Trends
-More informed, assertive patients
-Changing physician attitudes
Improved medical education

Negative trends
-Bureaucratization
-Capitation
-Corporatization

Tella-Medicine
-How will this affect the future of medicine
-Views on this are varied

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11
Q

Medical Decision Making

A

medical decision making is partly a
social process

Social factors enter into diagnosis and treatment decisions

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12
Q

Social Factors in Diagnosis and
Treatment Decisions

A
  1. Activism and the Medical Decision Rule
  2. Fads, Ideologies, and the “Surgical Signature”
  3. Organizational Influences
  4. Perceived patient characteristics
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13
Q

Two types of errors for medical decisions -Scheff

A

Type I error→ failing to diagnose and treat a patient who is really sick

Type II error → diagnosing and treating a well patient

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14
Q

THE MEDICAL DECISION RULE

A

Better to over-diagnose and over-treat than to under diagnose
Type II over type I

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15
Q

Rule of Halves

A

About half a time you are going to say someone is diagnosed with something when they might not even have that

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16
Q

Fads, Ideologies, Surgical Signature

A

There is trends of medical procedures depending on areas that may be unnecessary

E.g → women who lived in the west stayed for a shorter time rather than the east where they stayed longer for newborns. Thus the same results for both this relationships

17
Q

Surgical Signature

A
  • Comparing surgery rate across different regions

-Depends on the actual surgeries in the area and follows them where they go

18
Q

Episiotomy

A

used in ranges from region to region from 10-75%

-a surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues.

-Procedure to open the labia when giving birth

-Is very painful for mothers

-Not helpful

-Tradition to continue to work

19
Q

Organization Influences

A

The type of medical practice

-Client-dependent: patient refer selves

-colleague -dependent: patients referred by other doctors

-Insurance and reimbursements

20
Q

Perceived Patient Characteristics

A

-Social class

-Gender

-Race

-Social worth

21
Q

Why are there social factors in medical decisions ?

A

Our world is people and people are judged quickly for medical encounters

22
Q

Deprofessionalization of Medical System

A

Independent solo practices to a very business centric system

23
Q

Why was the Medical world DE professionalization of the medical system Socially ?

A

Social Conflict
1. Deduction of physician from medical ethics
-More medical ethics and conflict of interest
-Medical error is the third leading cause of death

2.Commodification of healthcare (how it’s a business)
-Advertising
-Primary care places

  1. Shift of professional lifestyles
    -Its less personable and catered towards patients
  2. Legitimization of profit
    Profit is valued in medicine (there is competition for money)
24
Q

Why was the Medical world DE professionalization of the medical system Ethically ?

A
  1. Extrinsic factors:
    - Government is more interested in the finances and not the actual
    -health care being provided
    -Assembly line medicine
    -Things did to be improved by third parties
    -NPCs (non doctor positions) threaten the ideas of a physicians in order to pay them less
    -Globalization → the internet and knowledge is power
    -Medicine is not just in the hands of the physicians
  2. Intrinsic:
    -Oversupply but now there is a
    -shortage of positions in primary care
    -Union → the AMA is falling apart
25
Q

Professionalization, Monopoly, and the Structure of medical Practice
-Conrad & Schneider

Medical Profession prior to the 19th century

A

-supernatural, sickness as a sin

-diagnosis often inaccurate

-no formal education in the US

26
Q

Professionalization, Monopoly, and the Structure of medical Practice
-Conrad & Schneider

Medical Profession during the 19th Century

A

-physicans were educated through apprenticeships

-heroic vs. homeopathic

-practices were no working causing doctors to not be taken seriously

-AMA was just being formed which caused medicine to become more professionalized

27
Q

Professionalization, Monopoly, and the Structure of medical Practice
-Conrad & Schneider

Medical profession in the Late 19th and early 20th century

A

-started be involve in social reform

-decrease diseases (through sanitary habits) and scientific break throughs cause doctors to gain prestige

  • medicine started to become corporate
28
Q

Professionalization, Monopoly, and the Structure of medical Practice
-Conrad & Schneider

Abortion Moral Crusade

A

-Was common prior to the civil war

-And eventually even the upper white class was doing it

-In the 1850s physicians began writing on how immoral it was

-This is how the abortion crusade started

-This was caused by a drop in birth rate

-Abortion was too popular in married people and upper white class

-Didn’t like the decline in american born babies

-Less white people = less white control

-Wanted anti abortions so that

-physicians had more control over medicine

-The ama oath did not allow abortions

-Therefore by banning it ama could get more people into their organization

-Was seen as dangerous and banned but was safer than it ever has been as time goes on

-As discussed before health was increasing in the 20th century because it upheld phys

-Medical sectarianism
The idea that medicine is sacred

-Medicine is the second largest industry in the medical field

-Medicine is 9 percent of america’s gross national product

-Medicine charges for each service provided

-Living baby → when the baby could move

29
Q

The Struggle between the voice of Medicine and the voice of the lifeworld
-Mishler
4 phases of physician patient discourse

A

1.Description
Pre req
When patient and phys start communication
Determining what details from the patient is relative

  1. Analysis
    Where the details of the patient and makes an analysis
    Lack natural occurring talk
    Determines medical interview
    Physician uses clues to make
    Maintains control over the medical
  2. interview
    Interpretation
    The work of doctoring → physicians have a tendency to ask close end questions instead of open ended questions
    Causes information bias
    Causes
  3. Interruptions
    Controls the interview
    Interrupts when patient is describing to ask questions
    What color was ___???
    Physicians are unable to give full perspective
30
Q

The Struggle between the voice of Medicine and the voice of the lifeworld
-Mishler
3 part utterances

A
  1. Opening questions
  2. Patient response
  3. Physicians response
31
Q

The Conversation Placebo
-Orfi

A

Our bodies are only meant to live until we’re 30, but with medicine people are living until their 80s

-A study showed that patients who were thoroughly talk to by doctors had less pain

-Healing can come from communication with the patient

32
Q

Notes on the Decline of Midwives and the Rise of Medical Obstetricians
-Wertz & Wertz

A

Key takeaways:

-Women (midwives) were pushed out of child birth by Obs because they created this image the Obs were more prestigious and knowledgeable even though they were not

-cultural shift where people said women did not belong in medicine

-the decline of midwifes was due to the lack of leadership, the rise in popularity in the upper class for Obs, and the cultural shift

33
Q

American Sociological Review
-Timmermans
Fredsons

A

Professions are still in status today because people lack the medical knowledge

34
Q

American Sociological Review
-Timmermans
Light

A

Professions are challenge by individuals due to suicide findings being inaccurate in their findings

35
Q

American Sociological Review
-Timmermans
Key takeaways

A

-Majority believes that suicide is under recorded

-minority believes that suicide data is biased

Lights is correct in crediting individuals

  • Fredons on focuses on power and privilege
36
Q

American Sociological Review
-Timmermans
Suicide determination depends on 3 things

A

1.Standards of death
2. Who determines death
3. How the determinator impacts society

SOCI311 (4 decks)

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