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Lecture 6

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PSYC 2301
Tarry Ahuja

Using Health Services & Patient-Provider Relations Overview - Recognition and interpretation of symptoms - Predictors of use of health services - Patient experience - Health care provider - Non-adherence - Placebo effect Symptom recognition - Factors that influence symptoms can include: • Individual differences/personality  Hypochondriacs, neuroticism  Negative affectivity (depression, anxiety)  Positive people have better health in general. If negative, makes you more prone to illnesses such as depression • Cultural differences  Differences in emotional responses  In some cultures, illness is considered a weakness  In China, India, and otherAsian countries, illness is not accepted, however, being really ill and having a lack of function is acceptable • Situational factors  Sitting in a movie, you forget your aches and pains. If in a boring lecture, you are checking every ache and pain  Medical student’s disease  They learn about diseases in depth and they experience it. They reflect and are hyposensitive to looking for these symptoms • Stress • Mood Cognitive representations of illness - Illness representation (or schema): • Apatients’own implicit common sense beliefs about their illnesses • What does this patient think about this disease? • Ex: “Ah, I just have the flu” that person’s schema is different to the other person’s- “OMG I have the flu. Get the fuck away from me” *puts on a mask - What do you know about the disease/symptoms? - 5 distinct components of illness schemas include: • Identity (label)  The doctors cab diagnose your rash and it’s simple, curable, and you can simply identify it • Consequences  The doctor cannot diagnose the rash and sends you back and says that he will get back to you. You will obviously get worried. • Causes • Duration • Cure - Most individuals have 3 models of illness: • Acute illness- bacterial or viral, short duration (ex: flu) • Chronic illness- multi-factorial, long duration (ex: cancer) • Cyclic illness- alternating periods of activity (ex: herpes) - Other factors that can influence interpretation of symptoms include: • Lay referral network- input from friends, family, peers  The close group of people you can talk to about your abnormalities of your body (friends, family, peers, etc...)  Ex: you have a butt rash and you go to your friends and they tell you to apply Vaseline and take a bath. However, are these people qualified? But we end up listening and trying and believing. • Internet- background info, lifestyle modification  Everyone has access to the internet, and if you Google up “butt rash” you’ll get thousands of results. You read some articles and you use the internet for your remedies  Should only be used as background information and not a diagnosis Predictor of health service users - Canada’s public health care system is publically funded, so anyone can get access to the hospital - America health care system is privately funded - Accessibility vs. cost. • Do we trade accessibility for cost? Usually a pharmacist can tell you that there is a generic version of the pill and there is a test how different the generic pill is in comparison to the original pill. With Tylenol its fine, however, if it is a pill for an illness it may be dangerous. If you swapped to the generic pill the dosage might change and you may be under dosed or you may be over dosed. - Factors that can predict the use of health services: • Age- infant vs. late adulthood vs. elderly  When you are a baby/infant, you go to the hospital a lot (for immunization, checkups, etc...)  When you are middle-aged, you don’t need to go to the doctors that much, you may just got for your annual checkup  When you hit 40+, you tend to go to the hospital a while lot more again  Then you see another spike in the elderly (they are getting sick, they need long term care, etc...) • Gender- women > men  Women tend to use the system more  Accounts for labor (pregnancy)  Women have a lower threshold for pain and symptoms, therefore they are least likely to self-report  Men report less sometimes due to social stigma and its more “socially acceptable” for women to admit themselves to the hospital • Socio-economic status- specialists vs. general care  Lower on the scale  Got to the doctors less often, but those who do visit, visit repeatedly  Higher on the scale  Access to specialists/ higher level care (higher tier level of care) • Culture  Visible minorities more commonly visit a physician  Fewer visits to specialists  Ethnics made more 4+ visits  Linguistic barriers  Perceived quality of care • Social psychological  Individual’s attitude and beliefs about symptoms and health care  Believer of health care means you will go to the hospital  Sometimes, you don’t want to go because you don’t want to wait in line all day  Health belief model states predictors include:  1. Perceived threat to health  2. Belief of efficacy of intervention Misuse of health services - Someone who goes to the doctors for the wrong reasons • Doctor, I can’t sleep, I’m really tired, I can’t focus in class”- the doctor will go through a list of causes. However, the doctor hasn’t asked how the person is doing and whether or not there is a stressor in their life - Symptoms associated with emotional disturbances - Individuals report physical symptoms which are triggered by psychological drivers • University students’disease  Students tend to get really sick during exam time  Students stressed out with money, grades, and social life  Generally what is driving the illness is mood and stress • Inappropriate assessment by pt. (physician vs. specialist)  The general practitioner (GP) tends to rush through things since they have a whole room of patients to deal with • Limited access  Hard to get a specialist - Worried well individuals place over emphasis on symptoms due to heightened self-care • Sometimes you can be a hypochondriac and use the system more than they should - Somaticizers express symptoms after personal emotional insult (depression, mood disorder) - Medical disorders are perceived as more legitimate than psychological disturbances - Secondary gains includes downstream benefits arising from the illness • Time off/rest • Removal from responsibility • Medical symptoms vs. psychological symptoms Delay behavior - Delay behavior- patients live with 1 or more potentially serious symptoms without p
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