Psyc 365 Ch5 Communication in Medical Settings

Ch5 Communication in Medical Settings Perceiving and Interpreting Symptoms (When do we seek medical advice) - People often don’t notice even highly visible external symptoms - People also have difficulty accurately assessing their internal states (ie. Heart rate) - People who pay a lot of attention to their internal states are more likely to notice a symptom Perceiving Factors: - Mood o People in good mood view health more positively than those in bad mood o People in bad mood report more symptoms, less likely to believe anything will relieve symptoms, and assume they are more vulnerable to future illness o Those with Negative Affectivity trait (NA trait- mood related disposition) have greater chance to report symptoms than those with low NA trait in the same objective health status - Stress Level o Stressful periods in people’s lives can precipitate or aggravate the experience of symptoms o People who believe they are more likely to get sick will pay more close attention to bodies. This inward focus of attention may lead them to interpret stress-related changes (higher HR, faster breathing), as symptoms of illness o HOWEVER, those experiencing great stress more likely to seek health care - Gender o Women seek health care more frequently than do men, but they may delay longer o Men attribute minor symptoms to major problems more readily than women - Age o Elderly may perceive age related bodily changes as illness o Older adults may over-report o HOWEVER, cancer studies have shown older adults were less likely than younger ones to notice cancer symptoms – also found that they misattributed acute myocardial infraction to pains of old age - Environment o One of the most important factors o When people are in environments that are tedious and boring they amplify their bodily sensations- usually leads to overestimation of symptoms o In contrast, exciting environments make it less likely to notice symptoms o Symptoms are also more likely to go unnoticed when engaged in physical activity  Competition of cues  Distraction can serve as a useful short-term coping method - IN SUMMARY o When attention is directed outward, symptoms less likely noticed, when inward, more likely to be noticed Interpreting Factors: - Prior experience o If you (or someone you know) have experienced similar symptoms you will assume what you are familiar with - Commonality o The more widespread a condition, the less significance attached to it - Learning o We learn how to experience symptoms, ie culturally. (eg. Men in western culture traditionally socialized to avoid complaining as it can be a sign of weakness) - Families o Lay referral system  An informal network of non-practitioners who offer their own interpretations – could be helpful or not  While potentially helpful, they are more likely to recommend something bad than an actual practitioner Seeking Medical Care - When do we seek care? o Symptoms  Those new, unexpected, painful (most effective in forcing seeking medical care), disruptive (affecting daily life, work, school), highly visible, or affecting more important parts of body encourage seeking medical care  If symptoms recognized from past experience and can be identified as unimportant or routine they may be ignored Delaying Medical Care (**POTENTIAL WRITTEN QUESTION) - Patient Delay o The period between an individual’s first awareness of a symptom and treatment of that system - Total patient delay according to Anderson et al occurs in 4 stages o Appraisal delay  Time it takes for person to decide that symptom is a sign of illness o Illness delay  Time between recognizing one is ill and seeking medical care o Behavioural delay  Time elapsed btw decision to seek care and acting on it by making appointment o Medical delay  Scheduling and treatment – interval btw making an appointment and first receiving medical care - “Classic Study” – Safer et al o Identified stages of delay in seeking med care o Interviewed 93 patients waiting in clinic or ER o Found that those with least delay were in greatest pain o Total delay was much longer for patients with current other problems in lives (such as troubled marriage), those who had read about their symptoms, those who were older, and those who had waited for symptoms to go away o Best predictor of illness delay was the novelty of symptom – they tolerate recurring o Patients who imagined being severely ill and imagined negative consequences of being ill also had lengthy illness delays – ppl who believed they couldn’t be cured delayed o Limitations:  Retrospective (can’t trust memory)  Based on people who have already sought treatment, can’t be generalized to those who haven’t - Breast cancer o 20-30% of women w/ breast cancer delay seeking care for 3+ months  Majority is appraisal delay o Both HIGH and LOW fear are associated with longer delays in reporting breast cancer  Little fear may feel seeking medical advice is unnecessary  High fear of doctors, embarrassment, pain, chemo, etc. lead to delays o Social influence  Some women believe their male partner might abandon them  Role responsibilities of married women w/ children influence delays (women report putting higher priority on children, work, etc) o Age of patient  Studies have not used standard model of delay, but they split delay up into:  Delay by patients (btw onset of symptoms and first medical consultation  Delay by providers (btw medical consultation and beginning of treat.)  Older women engage in patient delay  Younger women also engage in patient delay but experience more in provider delay as well  Delays by providers do not seem to be associated with decreased survival in patients presenting with breast cancer Physician-Patient Interaction Models: (Szasz and Hollender) - Active-Passive Model o Relationship in which patients are unable to participate in their own care or to make decisions for their own welfare because of severity of their medical condition  Eg Severe injury, Coma - Guidance-Cooperation Model o Applies when patients seek advice from physician o Patients answer questions asked of them about symptoms, but physician is responsible for determining diagnosis and treatment o Phyisician is responsible for thinking and decision making  Eg. Infection or sprain - Mutual-Participation Model o Patient has more responsibility than in other models o Patient and physician make joint decisions about every aspect of care  From deciding diagnostic tests, to choice and implementation of treatment o Partnership. More conversational o This model seen as ideal, but in practice it is not used as often as it should Communication Patterns - Roter et al used analysis of audiotapes to describe communication patterns (5 were found)