HLTH 360 Chapter Notes - Chapter 4: Hospital Medicine, Type I And Type Ii Errors, Externals
SchoolUniversity of Waterloo
Course CodeHLTH 360
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Medical anthropologist - trained to critically examine the practice of medicine. Because of the large amounts of information
related to health care is present on the internet, well researched patients say that they deserve an equal say in decisions about
Online access to information often leads to an increase in a patient’s desire to have a more active role in decision-making.
Confusion about health-related information can and should be better integrated into consultations during office visits.
The author says that patients with more information about their conditions are more proactive but only if they have the right
information and only if they use it to engage in a productive dialogue with their doctors. Patients don’t necessarily need more
information but simplified information to jump start conversations with the doctors. It helps patients to ask better questions.
Online medical information can and will lead to better care, but only if patients bring in what they find and doctors react well
to it when they do.
Common sense model of illness behavior simply predicts that people will decide to seek professional medical advice when they
have appraised themselves as ill with painful, debilitating, or bothersome symptoms. This level of analysis is intrapersonal.
Responses to symptoms depend on salient meanings in the context of individuals’ social ecologies, as opposed to the nature of
Of the various steps taken to remedy the situation, the focus is to seek medical help and since this is an observable action taken
with respect to an illness, it is defined as “illness behavior”.
Individual’s illness needs to be legitimated by a GP and if/she is to have publically funded treatment and social support, the
general practitioner is the professional gatekeeper to illness.
Hospital medicine enjoys higher status than general practice. “Traditional Domain of the educated elite” –Royal College. The
difference in status further fits the characterization of the general practitioner as gatekeeper, since he or she permits access to
consultants if expert opinion is needed.
Main assumption of common sense model- decision to seek professional medical help is a rational outcome of processing
symptom-related information. Second- humans are motivated to preserve themselves and this determines what is rational.
When Schema is not organized, 2 reasons: to obtain symptomatic relief and to elaborate inadequate schema.
Predictions- There should be a correlation between appraised seriousness and the speed with which the decision is made.
Deciding to visit the GP and mistakes will be characterized by Type I errors (false alarms) since individuals want to be on the
Untreated majority- Illness iceberg. Help seeking seems to be more slowed by Type 2 errors than accelerated in the interest of
self-preservation. This challenges common sense.
Behavioral (Schedule) Delay- time between deciding to seek professional help and doing so.Treatment (utilization) delay- time
between seeking the professional and taking his or her advice.eg- women with gynecological cancer- mean delay-97 days.
Health Belief model- Health decisions best understood with reference to individual’s perceptions of the social environment,
which are rationally processed. Whether the person will carry out health behavior depends on perceived vulnerability to the
threat ,in turn depends on perceived susceptibility and the perceived severity. Second- Evaluation of the act based on perceived
benefits against perceived barriers to performing it. Eg- women delay seeking help for breast cancer coz fear mastectomy
Perceived vulnerability is likely to be relatively low when the man has little understanding of his symptoms.
Attitudes concern evaluation, schemata does not. Reasoned Action predicts that behavioral intent is created or caused by two
factors: our attitudes and our subjective norms. Eg- pain in testicles, visiting a doctor depends on attitude towards doctors,
visits. Subjective norms represent the thinker’s perceived social support for his or behavioral intention and are therefore social
psychological in nature.
The theory of planned behavioris a theory that links beliefs and behavior. Externals believe that what happens in chance(delay
seeking help), internals see themselves as having control.Multidimensional locus of control- Health may be attributed to three
sources: internal factors (such as self-determination of a healthy lifestyle), powerful others (such as one's doctor) or luck (which
is very dangerous as lifestyle advice will be ignored - these people are very difficult to help).
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