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Psych 365 Ch 7.docx

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PSYC 365
David Cox

Psych 365 Ch 7 (The Health Care Provider) • Physicians: o In past decade gone from surplus to shortage of physicians, and recently more physicians returned to Canada than left to practice in other countries o Choosing a career in medicine:  More perfectionist pppl choose to be doctors • Can be adaptive when associated w/striving for achievement, maladaptive when associated w/excessive concerns RE evaluation • Conscientiousness best personality related predictor of success in medical school, tho nothing predicts this success better than past academic performance o Medical School: primarily biomedical training (no psychosocial)  First year: huge workload, virtually impossible to learn everything presented, self confidence often plummets (tho few fail)  Second year: considered most stressful academically • Come to terms that you can’t know everything, begin to be more assertive and confident, ask questions that show they’re focusing on what is needed to know for patient’s sake (not for exam purposes) • Now feel financial strain, differentiation b/w friendships on the “inside” and “outside” (non med students) o Enjoy new elevated status but lonely  Third year: now start clinical experience and interact w/patients directly (expected to act like a physician tho they aren’t one yet) • See gap b/w text books and patient reports of symptoms (uncertainty) • Must accept that they’ll make mistakes, strike balance b/w clinical competence and unrealistic expectations of perfection • Challenge of getting sick (contagious disease exposure) • First encounters of critically ill ppl and need to develop coping strategies (humor, immerse self in work, realizing death doesn’t equal failure)  Fourth year: now socialization in medical community essentially complete, developed coping strategies (not so emotionally distant but not too close to suffer) • Compassion fatigue= lackof energy in health care professionals, esp nurses, who are constantly working in an environment where suffering is common  Residency: time during medical training that bridges the attainment of medical degree and establishment of practice • Learn specialties, typically b/w 2-5 years depending on specialty • Sudden increase in accountability and decrease in sleep • Can’t work more than 80 hours a week, more than 24 hours in a row, and must have a 10 hour rest b/w shifts • Physicians’ Emotional involvement in work: o A profession that requires very emotional conversations, very personal o Must learn to ctrl emotions, tho hard o Most med students learn to dehumanize ppl by thinking of them as body parts not ppl (one way to maintain ctrl), another is to use humor • Physicians and stress: o Responsibility causing great stress o Hard to balance seeing ppl asap and not rushing o Burnout= condition similar to compassion fatigue and includes symptoms of physical exhaustion, depersonalization of patients, and feelings of discouragement and low accomplishment  Best way to prevent this is to focus on one’s own well being throughout career (social life, spiritual needs, setting limits at work, maintaining positive outlook) o Fewer medical students deciding to be GPs- lifestyle (acceptable work hours), orientation to society (LT patient rlnshps), prestige, focus on in-hospital care, scope of patient problems  GPs feature overwork and underpay, less attractive  Guidelines for giving patients bad news, stressful on both parties  M and F physicians experience stress differently • Workload no predictor of psychological stress for women, instead manageability of hours/fit of schedule more a preditcot • F w/greater workplace discrimination and strain b/w work and family roles • F reporting higher degrees of job satisfaction than male counterparts, tho less than previous generation (mothers who were physicians) • F physicians more likely suicide than general pop, M physicians less likely o Tho suicide generally lower for women anyway, rates not that different  Uncertainty as a source of stress: • Clinical examinations and other diagnosis tests are imperfect and the Consequences of medical decisions are inherently uncertain at the decisive moment o Prognosis= prediction of how a medical condition will change in the future (very uncertain) o Ppl have a general belief about tha accuracy of medical science and they apply that belief regardless of the condition in question o Patient estimates of accuracy quite unrealistic, underestimate likelihood of false positive diagnoses • Tests differ in sensitivity and specificity o Sensitivity= ability of a test to identify correctly those who hav a particular disease o Specificity= ability ot a test to correctly id those who DON’T have a disease • More uncertainty of medical decision making for primary care physicians than specialist o Primary care physicians: GPs o Difs not b/c of skill but b/c physicians of all types solve probs thru pattern recognition, GPs see wider range so have far too many patterns to remember o Specialists see narrower range of symptoms o Despite this patients usually report more satisfaction w/GP than speciality (low continuity disease focused care)  Physician impairment: A state in which stress related symptoms interfere w/ability yo perform job • Substance abuse one of most troubling cause, no more prevalent but partly b/c of ease of access (more likely to suffer alone)
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