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PSY333H1 Lecture 7 (first lecture after the midterm)

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Lisa Lipschitz

PSY333H1F L7 Oct 31, 2013 (first lecture after the midterm) Cultural Differences  There are differences in the recognition & reporting of Ch. 8: Using Health Services symptoms o Ex. A study in Vancouver found that Chinese Using Health Services… respondents were less likely (w the same symptoms) to recommend enlisting emergency medical aid than  When & how does a person decide they are sick?  When are symptoms dismissed as inconsequential? English or Punjabi respondents in response to  When does a person decide that they are in need of treatment symptoms  The reason for the differences are less well from a professional? known 3 types of health-related bhvrs:  Learning is an important component o As children learn which symptoms to attend to & which 1. Health bhvr: bhvr that is designed to promote a person’s good to ignore from parents health & prevent illness  May be related to cultural variations in emotional responses & o Ex. wearing seatbelt, exercising learning 2. Symptom or Illness bhvr: bhvr that is directed toward o Ex. Western culture men have been socialized to avoid determining one’s health status after experiencing symptoms complaining about emotional & physical symptoms of o Ex. talking to other ppl (family, health care discomfort professionals), o Men are less likely than women to report such o doing research, symptoms o taking no-action (most common) 3. Sick-role bhvr: bhvr that is directed at helping ppl who are iSituational Factors return to good health; helping yourself Boring situation, isolation makes ppl more attentive to o Ex. receive sympathy & care, responsibility to try get symptoms better o Not necessarily more accurate, just more likely to notice it at this time Sick-role bhvr o Ppl are more likely to recognize a symptom when that  When ppl are sick, they exhibit a sick-role bhvr & hhave are less busy vs. excited, demanding situation certain privileges and responsibilities  Competition of cues – useful short-term coping method 3 rights/privileges: o Salient symptoms 1. Right to make decisions  If person or envt (ex. hospital) reminds us of 2. Right to be exempt from normal duties (ex. go to school) symptoms 3. Right to become dependent  Visible symptoms  Pay more attention 3 duties/responsibilities:  ex. Medical students’ disease 1. Duty to maintain health & get well  Studying symptoms of a disease cause 2. Duty to perform health care management med students to focus on their own 3. Duty to use range of health care resources fatigue & internal states; symptoms _______________________________________________________________ related to the disease being studied seem How Do We Recognize & Interpret Symptoms? to emerge  Individual Differences: There are different levels of bodily  As they begin to learn more about the awareness symptoms & disease, it appears that the  Hypochondriacs distress decrease o Ppl who are preoccupied and worried that normal  As we learn about the reaction, realize it’s bodily symptoms are indicators of illness just a psychological factor making you  Ex. think a headache means a brain tumour worry o 4-5% of the population o Older ppl Age  Neuroticism o Characterized by (-)ve emotions, self-consciousness,  Elderly ppl: o frequently complain of physical symptoms that prompt and a concern w bodily fns them to seek medical intervention o Symptom perception hypothesis: ppl high in o perceive normal age-related bodily changes as illness neuroticism recognize their symptoms more quickly o experience more severe & lengthy symptoms and report more quickly, report higher levels of o more likely to attribute their symptoms to some other distress and dissatisfaction disorder o May exaggerate symptoms or may be more attentive to  Mild cognitive impairment is associated w the perception of real symptoms poorer body fn’ing  Ex. Exaggerate pain of a headache  Older men delay seeking care due to embarrassing symptoms o See a physician more often than hypochondriac o Will experience more psychological distress from a Stress diagnosis, need to see counselor  Ppl who are under stress may believe that they are more vulnerable to illness  attend more closely to their bodies Recognition of a Symptom  May be the result of experiencing the physiological reactions o Can be underdeveloped, inaccurate or accurate and to stress (ex. heart rate, breathing) complete  Stressful periods can result in precipitated or aggravated  Illness schemas have 5 distinct components: experiences of symptoms 1. Identity (name of illness) o Ex. Panic disorder (tingling, dizziness, etc.) – think they2. Conseqs are going to die 3. Causes  Those experiencing tremendous stress are more likely to seek 4. Duration health care (even w equal symptoms) 5. Cure o Heightened to their bodily systems’ changes What Predicts the Use of Health Services? Mood  Self-regulatory model of illness bhvr (Leventhal et al., 1980)  Influences self-appraised health (ppl’s beliefs about their health status) o Ppl form commonsense illness representations about  Ppl in a (+)ve mood: their symptoms and these representations determine o rate themselves as more healthy the steps they take to manage their illness o report fewer illness related memories 1. Identify the nature of the illness o report fewer symptoms. o Heartburn vs. heart attack  Ppl in a (-)ve mood: 2. Identify its causes o report more symptoms o Out of the blue vs. knowing o more pessimistic 3. Try to figure out the time line, how long it will last o perceive themselves are more vulnerable. o Acute vs. chronic 4. Think about the conseqs  In sum, symptom recognition is determined by situational o Physical, social (ex. roles), emotional (adaptation) factors, personality traits, culture, stress, and mood 5. Can it be treated? Cured? o Controllability Interpretation of Symptoms (Heavily Involves Psychological Processes) Cognitive Represenations of Illness  Schemas influence: Prior Experience o preventative health bhvrs  Meaning is affected by history w symptom o reactions when they experience symptoms or are diagnosed o We know how to deal w it, make it go away, know it’s not serious o adherence to treatment regimens  Highly prevalent disorders are seen as less serious than rare o health expectations ones  In sum, interpreted as more serious & more likely to seek medical care if symptoms are: o Ex. High prevalence of colds in fall  taken less seriously o new  High anxiety more likely to seek medical care o unexpected o painful o Might not have prior experience o Ex. Think a headache is more serious than it is o disruptive  Coping resources o highly visible o affect highly valued parts of the body Expectations  Ppl may ignore symptoms they are not expecting & amplify Most ppl have 3 Disease Models of Illness:  Acute: symptoms they do  Ex. symptoms of a heart attack:, ppl may recognize a sharp o caused by bacterial or viral agents, short term, and no chest pain but ignore a dull chest pain (don’t expect that to be long term conseqs  ex. flu part of heart attack diagnosis)  Chronic: Seriousness of the Symptoms o multiple causal factors (health habits, genetics, envt) o long term  Symptoms affecting highly valued parts of the body are o possible severe conseqs interpreted as more serious (eyes, or face; limits mobility, highly valued organ)  ex. heart disease  Cyclic:  Perceived to have a profound impact on one’s life (hand, o alternates btwn symptoms & no symptoms throat) o ex. Affecting work  ex. herpes  Affects how one respond:  If a symptom causes pain, it will lead a person to seek o Ex. treat disorders differently, levels of vigilance, treatment more promptly patterns of treatment Cognitive Representations of Illness How does treatment of a symptom begin?  Illness representations (schemas): concepts of health and illness that influence how ppl react to symptoms and illness  The meaning of a symptom blends into diagnosis: a process o Acquired thru the media, personal experience, and the that begins not in the physician’s office but in an indiv’s conversations w friends, neighbors, and relatives experience of others  Lay referral network o Informal; family & friends (provide advice & support)   consequently, more sensitive to bodily changes  Ex. Getting your mom to make you chicken soup or disruptions for your cold o Social Norms: concerning the expression of pain o Provide own interpretations before medical  Men may be anxious but are reluctant to seek treatment care o Provide advice, personal views  Women who report devoting their time & o Provide support attention to the needs of others delay seeking o Sometimes this is the preferred method of treatment care  ex. an elder in the community o In regards to stress, women under high stress are o Ethnic communities judged as less likely to have a physical disease than  incorporate beliefs that may not be accepted by men traditional medicine  Discrimination  may recommend home remedies  Women told they are just stressed 7& that nothing is wrong Ex. Children’s hospital in Montreal Economic factors  Mothers who consulted their lay referral system about their child’s symptoms were less likely to take their children to he More women are part-time workers & non-workers than men emergency department unnecessarily o they do not have to take time off to seek treatment and they do not lose income when they are ill  But, Lay persons are more likely than health professionals to o However, underemployment & unemployment recommend actions: contribute to economic hardship which also contributes o that worsen the condition to poor health among women o or result in a delay in seeking appropriate & needed treatment Fragmented Health Care  Women visit a wide variety of doctors & specialists for the Internet as Source of Health Info wide variety of health care they require  ~4 million Canadians seek health info online on a typical day o  more visits & utilization of health services o Increase of 262% btwn 1998-2002 o Ex. pediatrician, gynecologist, GP, mammogram appts  Opens a vast source of medical info & misinformation to the public Socio-Economic Status  Who uses internet for health info?  SES & utilization of health services: paradoxical o Women 2x as likely relationship o Households w kids vs. w/o kids o Lower SES & w less than High School education use o Those w a higher education medical services less than upper SES   conditions worsen, need to make more visits  Topics searched: o Specific diseases & health conditions o Ppl w lower incomes & education who do use medical o Lifestyle info (ex. Diet, nutrition, exercise) services are more likely to make 4 or more visits vs. higher SES o Specific symptoms, drugs, medications, alternative & complementary therapies, health care system  Also make more ER visits & have more hospital  Ex. can help those in rural areas to find info they can’t get from admissions local  This is because those in low SES tend to wait longer before seeking care  treatment is What Predicts the Use of Health Services? difficult Age o Lower SES results in less access to medical care & travel longer to facilities  Young children o Childhood infectious disease  Ex. Parking costs; not all cancer drugs are o maturing of the immune system covered by health care o unintentional injuries  Young adults Culture o Greatest reluctance  Canadians from ethnic minorities make fewer specialist visits o may be due to cultural differences in how symptoms  Elderly o Frequently complain, over-report are expressed or disclosed o Chronic conditions & diseases  Linguistic barriers  Discrimination (trust) o Mild cognitive impairment associated w the perception of poorer body fn’ing; ageing o Older men delay seeking help for embarrassing Social Psychological Factors  Attitudes & beliefs about symptoms and health services symptoms  HBM explains ppl’s use of health services well (perceive Gender threat, bhvr will be affective)  Women use medical services more than men o Ppl also learn from the experiences of others o Pregnancy / childbirth account for some of the  Socialization (family members) differences - reproductive health o Homeostatic mechanisms: Women tend to report pain How are Health Services Misused? earlier, experience temperature changes more rapidly  One type of misuse occurs when ppl seek out health services o Time btwn deciding to seek treatment & making an for problems that are not exclusively medically significant appointment o Typically stems from anxiety & depression 4. Medical delay  Ppl w mental health might not realize their o The time elapse btwn the person making an appointment physical symptoms are due to a mental illness  & receiving appropriate medical care o Patient deviates from the profile of the avg person w go to hospital  Ex. anxiety, panic attacks, pain, fatigue the disease o Overloading the medical system  Why do ppl seek physician care when they should be Stages of Delay in Seeking Treatment for Symptoms addressed by a mental health specialist? o Don’t fully understand that their symptoms are due to mental illness o Certain types of mental illness disorders (specifically somaticizers) experience pain or symptoms but there is no actually reason for it Using Health Services for Emotional Disturbances Worried well  Concerned about physical & mental health, inclined to perceive minor symptoms as serious  Believe that they should take care of their own health  Actually leads them to use health services more Somaticizers  Indivs who express distress & conflict thru bodily symptoms  Convince themselves that they are physically ill o Threats to self esteem, accomplishments, may become depressed Secondary gains  Illness brings benefits o Include the ability to rest, to be freed from unpleasant tasks and to be cared for by others  Reinforcements for being ill Malingering  Ex. Doesn’t want to go to work/school o Exaggerate symptoms Research on Stages of Delay  Looks for a doctor that will provide documentation for  Longer delay: dismissal for absenteeism, or disability payments o Total delay in seeking care was significantly longer for those who had other problems in their lives, Stigma read about their symptoms, and waited for  Absence of mental health care coverage symptoms to go away o Psychologists not covered o Patients were more likely to view an old symptom o Psychiatrists covered since deal w medication at as normal and tolerate it for a long period hospital o Those who imagined (-)ve conseqs of being ill had lengthy delays o Need to have a referral from a family doctor  Worried about stigma of mental illness o Ppl who believed they could not be cured delayed o  so say they’re going to their family doctor instead of treatment o Those low & high in fear are likely to delay their therapist   Denial  Want to have a medium level or fear to decrease delay Another Misuse of the Health Care System: Delay Bhvr  When you don’t use the health care system but you need it o Taking care of family members results in delay  Patient delay: Period btwn one’s 1 awareness of a symptom &  Shorter delay: o Least likely to delay treatment are those in the treatment for that symptom 1. Appraisal delay greatest pain o Time it takes an indiv to decide if a symptom is o Those who are trustful of others are less likely to serious (sign of illness) delay 2. Illness delay o Time btwn recognition of a symptom (one is ill) & How Does Hospitalization Impact the Patient? deciding to seek medical care  ~ 2.8 million ppl are admitted to Canadian hospitals each year  Hospitalizations have decreased over the last 12 years 3. Bhvr’al delay o More outpatient visits o More day surgery 4. Incorporating prevention & health promotion o Ppl refered to other places o Work together to enable patient to take required steps to o Staying in the hospital for surgery recovery has control & improve health decreased – can recover at home 5. Enhancing the patient-physician relationship o Build rapport Structure of Canadian Hospitals 6. Being realistic  How do hospitals receive funding if we do not pay for services o Physicians must recognize their own limits directly?  Ex. Can only see a certain amt of patients in a o Funded thru annual budgets negotiated w provincial or day to give them each enough patient-centred territorial ministries of health or regional health board care or authority o Both physician & patient have limits  How are hospitals organized? o Administration at the top, physicians, nurses and Role of Psychologists technicians as employees  1982: 1 full-time Psychologist per 131 hospital beds in Canada o Different goals:  1999: 1 for every 51 beds  To cure (physician) o # of psychologists increased in hospitals  To care for (nursing staff)  Psychologists have become more autonomous since 80’s;  To maintain the core (administration) given their own departments in hospitals o Communication patterns & hierarchy (occupational o Participate in patient diagnosis & determine level of segregation) fn’ing  Nosocomial infections: infection results from exposure to o Involved in pre- and post-surgery care, pain control disease in a hospital setting (ex. Anxiety), treatment compliance, and bhvr’al o Affect 250,000 Canadians every year programs such as self-care o Results in death for several thousand  Top 3 units in a hospital that psychologists are involved in: pain, eating disorders, cancer  How are hospitals organized? o This is beginning to change due to the rise in chronic Ex. illness (ex. heart disease, diabetes, etc) o Outpatient: o Ex. Preparation for own death of the death of a loved  A person who goes to the hospital for a procedure one or test but does not stay overnight  inpatient = stays overnight, 24hr surveillance byThe Impact of Hospitalization on the PATIENT stafff  When admitted to hospital: o Day care patient: o patients stay in an impersonal room  A person who goes to the hospital for a procedure o regimented schedule or test that is more involved than a routine test &  ex. Eating schedule, no control over which foods does not stay overnight given  ex. chemo daycare o invasion of privacy o Day surgery: o have no control  surgery that does not require the patient to stay in the hospital  White coat hypertension: elevated bp only when it is  ex. implant tubes in ears to treat recurring measured in the doctor’s office infections  Psychological symptoms: anxiety, nervousness, fear, depression, insomnia Patient-Centered Care  Need to integrate the conventional understanding of disease w  “Hospital patient role”: The patient is expected to be each patient’s unique experience of illness cooperative, dependent, and helpful w/o demanding excessive  Total-person approach to patient problems attention  Change over past years o Despite the fact that the “good” patient is the type most  6 interconnected components: appreciated by staff, the patient who fully takes on 1. Exploring both the disease & illness experience the patient roles is not necessarily well-adjusted or o What the patient believes is wrong, feelings about being satisfied. ill, impact of illness on their daily fn’ing, how they believe the physician should proceed  Reactance: the non-compliant bhvrs & attitudes of patients o Effected aspects of the patient’s life who perceive hospital rules and regimens to be unacceptable 2. Understanding the whole person challenges to their freedom o Patient’s disease & the experience of illness in the context o Attempts to regain control of pat
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