PSYC 328 Chapter Notes - Chapter 9: Horsepower, Socalled, Therapeutic Relationship
PSYC328 Chapter 9 Notes
•People vilify and praise health care professionals.
•This contradictory attitude is because health is of high value to us; since everything we do depends on our health.
What is a Health Care Provider?
•Canadians increasingly receiving much of their primary care from individuals other than physicians, including nurse practi-
tioners and complimentary and alternative medicine providers
Nurses as Providers:
•“Advanced-practice nursing” refers to any registered nurse with more than 2 to 4 years of basic nurse education, and with
•Nurse practitioner: a registered nurse (RN) with additional education in health assessment, diagnoses, management of in-
•They can order tests or prescribe drugs.
•They are affiliated with physicians in private practice.
•They also provide care in community clinics, health centres, nursing homes, homecare settings.
•Advanced-practice nurses work both autonomously and collaboratively with other health care providers in nursing out-
posts, community health centres, emergency departments, clinics, specialty units, and long-term care facilities
•They emphasize health promotion and illness prevention by explaining:
•Disorders and their origins
•They screen patients before they see the physician.
•They work autonomously and with other providers.
•They have a complimentary role rather than replace other providers.
•They can deliver advice via Telehealth.
•Telehealth: use of info and communication technology to connect people with health services, such as advice, info, con-
sultation, diagnoses, treatment, family visiting using audiovisual conference.
Physician Assistants as Providers:
•Physician assistants: skilled health care team members who perform wide range of medical services
•They are supervised by physicians as part of a physician (assistant) team to complement health services
•Their duties are outlined in a practice agreement with the supervising physician and the facility
•Their duties vary but can be:
•Take medical history
•Conduct physical exams
•Diagnoses and treatment of illness
•Order and interpret tests
•They know their limits and seek guidance from their supervising physicians if necessary
•In Canada, the Canadian Forces is their main employer, but pilot programs are introducing physician assistants in facilities in
•Physician Assistant Education Master’s programs launched in 2008 to increase their numbers.
•First year of program: seminar education
•Second year: clinical training
Why is Patient-Provider Communication Important?
•Poor patient-provider communication has been tied to non-adherence to treatment and failing to disclose concurrent use of
•Criticisms of providers usually centre on volumes of jargon, little feedback, and depersonalized care
Judging Quality of Care:
•Quality of care is often judged by criteria irrelevant to technical quality, such as the manner in which the care was delivered.
•Warm, confident, friendly provider is judged nice and competent.
•Cool, aloof provider is judged incompetent and less favorably judged.
•If provider is uncertain about nature of the condition, satisfaction declines.
•But these are unrelated to technical quality of care.
•Patients have an increasing desire and need to be involved in the decisions that affect their health. this does not mean
that patients wish to be completely autonomous in their health-related decisions or that they necessarily want to have to pay
to get better treatments
•Physician’s authority used to be accepted without question, but now patients have consumerist attitudes to health care: Ca-
nadians choose a combination of different treatments/products and health care practitioners that they think are best.
•Change in attitude is due to society’s emphasis on achieving good health
•To convince patient to follow treatment regimen, giving patient a role in the planning will help their commitment.
•Lifestyle is major cause of illness/disability
•Patients who see their behaviour as under the control of the provider are less likely to change lifestyle
•So modifying lifestyle needs full patient cooperation
•Internet also encouraged active patient role by giving them an easily accessible second opinion
•38% of Canadians using the internet for health info, discuss what they find with their health care provider
•Info about surgery and alternative therapies are the most commonly discussed types of health information
•Internet is where patients can get a second opinion
•Patients have more knowledge on their specific case/illness if it is a chronic problem.
•Therefore better communication between patient-provider is important and the provider and patient’s behaviour
•The average visit in the practitioner’s office lasts from 12 to 15 minutes
•When trying to explain symptoms, they will interrupt before the 23rd second
•Must endure long wait for a short consultation
•Will get interrupted multiple times by provider
•Will be poked and prodded
•If very ill, maybe someone else has to respon for you
•May be anxious/embarrassed about symptoms
•Hard to articulate when in pain/fever
•Must extract significant info quickly
•Has tight schedule
•Over-the-counter remedies can mask/distort symptoms
•Patient’s idea of which symptoms are important might not be the same for provider
•This setting has many sources of strain.
Structure of Health Care Delivery System:
•Canadian health care has a gatekeeper system
•primary health care providers including physicians are usually the first point of entry for individuals into our publicly funded
health care system
•Primary health care providers facilitate provision of services and make sure care continues if specialized services are
•When secondary health care is needed a physician referral form is required from the primary health provider.
•3.5 million Canadians do not have access to a family physician so they must use walk-in clinics and emergency rooms.
•Even having a family doctor does not ensure getting access
•Patients go through long wait times.
•Almost 1/4 of Canadians weren’t able to see a doctor on the same day they were sick.
•More than 1/3 had to wait 6 or more days to get an appointment.
•The long wait for primary care creates negativity, prolonged pain, worry, stress, anxiety.
•The wait is even longer for specialized care. This drives people to try complementary and alternative medicine of deal-
ing with their condition.
•In Ontario, the majority have a family doctor but 1/2 had difficulty getting an appointment.
•Over 90% of people who had used complementary alternative medicine (CAM) said yes to the question that if they have diffi-
culty accessing a physician, they would use CAM again
Spotlight on Canadian Research Box 9.1 - Why Do People Use Complementary and Alternative Medicine?
•Complementary and alternative medicine (CAM): a diverse group of healing therapies not yet considered integral to con-
ventional medical practice.
•There are 300 different types of CAM
•The universal health care system doesn’t cover the costs of CAM
•Use of CAM continues to rise in developed nations
•3/4 of Canadians have used at least one CAM in their life and 54% had used CAM in the past year
•General population use of CAM is only 20%, but 57% for breast cancer patients
•Those who use CAM tend to be female, middle-aged, highly educated, with a lot of chronic health complaints and
also use a lot of conventional health services.
•Most chronic illnesses can only be managed, not cured and physician don’t like dealing with chronic illness is-
•Many conventional treatments have unpleasant side effects.
•CAM users are more proactive about their health.
•CAM providers give longer, more in depth consultations and consider psychosocial aspects of patient’s life
•CAM users also receive benefits beyond symptom relief
•A study showed that CAM users reported symptom relief, improved physical functioning, coping, em-
powerment, hope, etc.
•CAM users also made healthy lifestyle changes.
•Initial CAM use is usually be due to dissatisfaction with conventional care, but beliefs in more holistic/em-
powering health care will sustain CAM use.
•With increased use of CAM, some people may simply be raised in a family where CAM use is the norm.
Changes in the Philosophy of Health Care Delivery:
•The role of the physician is changing
•Use to be characterized by dominance and authority and this is changing due to the growing use of CAM and the rais-
ing number of women in the medical profession
•These changes promote more egalitarian attitudes among physicians, they also challenge the physicians' dominance,
autonomy and authority
•Responsibilities exclusive to physicians are now shared with other authorities, including other health care providers
Holistic Health Movement and Health Care:
•Western medicine is increasingly incorporating Eastern Approaches to medicine and nontraditional therapies such as meditation
•Holistic health: idea that health is a positive state to be actively achieved, not merely the absence of disease now new concept in
•Acknowledges psychological and spiritual influences on achieving health and curing illness through their behaviours, atti-
tudes and spiritual beliefs.
•It emphasizes health education, self-help, and self-healing
•CAM (complementary and alternative medicine): herbal medicine, acupuncture, massage, dance therapy, etc. can be added or
substituted for traditional care
•Gaining popularity among Canadians as treatment options and increasing the demand for acceptance among conventional
•The biopsychosocial approach to health advocated by CAM use provides patients with a very different way of viewing their health
•This change alters the provider-patient relationship. The latter becomes more open, equal and reciprocal.
•CAM patients rate the quality of their interpersonal care and communication higher than do patients of conventional medicine
•Therefore patient feels more empowered which was linked to greater symptom relief
Provider Behaviours That Contribute To Faulty Communication:
•Is a problematic behaviour
•Beckman and Frankel study (1984)
•Studied 74 office visits
•¼ of patients were able to finish their explanation
•Most of the patients were interrupted after 18-22 seconds
•Prevents patients from discussing their concerns which leads to a loss of important information
•Study: 31-45% of patients did not have their symptoms mentioned in physician’s notes
•31% with chest pain
•38% with shortness of breath
•45% with cough
•Some physicians are suggesting that less attention should be given to physician’s impression of patient symptoms, and more
attention be given to patients’ firsthand experience of their symptoms
Use of Jargon:
•Another important factor in poor communication