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Chapter 9

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PSYC 314
Frances Chen

← Learning Outcome 1: Define health care provider ← - physicians continue to be the main providers of health care ← - Canadians are receiving much more primary care from people other than physicians such as nurse practitioners, and complementary and alternative medicine providers ← ← Nurses as Providers ← - Advanced-practice nursing: • umbrella term given to RN’s that have studied beyond their undergrad and who have many responsibilities for patients. • Work autonomously and collaboratively with other health care providers in nursing outposts, community health centers, emergency departments, clinics, specialty units and long-term-care facilities • Role as professional nurses is to complement rather than replace other health care providers ← - Nurse Practitioner: • an RN who has additional education in health assessment, diagnoses, and management of injuries and illness, can order tests and prescribe drugs. • NP’s affiliated with physicians in private practice • Provide care across diverse settings, i.e. community clinics, health centres in hospital, nursing homes, home care settings • Emphasizes health promotion and illness prevention • NP’s must often explain disorders and origins, diagnoses, prognoses, and treatments. Frequently give treatment instructions or screen patients before they’re seen by physician. ← - Nurses may also deliver advice via teleheath services: • telehealth includes variety of services that use technology to connect people with health services • i.e. advice, information from nurse via telephone, consultation, diagnoses, treatment, family visiting using audiovideo conferencing ← ← Physician Assistants as Providers ← Physician assistants: • Skilled health care team members who perform wide range of medical services • PA’s are supervised by physicians as part of physician/physisicna assistant team to complement existing health care services. • Duties vary by clinical setting but can include taking medical histories, conducting physical exams, diagnoses, treatment of illness, ordering/interpreting tests, writing prescriptions, assisting in surgery. • PA’s taught to know their limits & seek guidance from their supervising physician as necessary. • PA’s may become more common in Canadian health care settings in near future. • McMaster and U of Manitoba introduced PA Ed. Master’s degree programs in 2008. Aim to provide training to increase the number pf PA’s to help alleviate some strain on health care system due to physician shortages • Two year program includes: seminary-driven education in first year then second year of clinically based training As medical practice has become increasingly complex, other professionals i.e. PT’s, physiologists, OT’s, nutritionists, socials workers become involved in specialized care and now commonly members of inter-professional teams that deliver health care in more comprehensive manner. Learning Outcome 2: Why is patient-provider communication important? - criticisms of providers: jargon, little feedback, depersonalized care - communication is important to patients - poor patient-provider communication has been tied to outcomes as problematic as non adherence to treatment recommendations and failing to disclose the concurrent use of alternative treatments and therapies. Judging Quality of Care - most people judge care by criteria that are irrelevant to its technical quality. We aren’t sufficiently knowledgeable about medicine and standards of practice to know whether we have been treated well. - If physician expresses uncertainty about the nature of the patients condition, patient satisfaction declines. - However quality of care and the manner in which care is delivered are unrelated Patient Consumerism - factor that heavily influence patient-provider interaction is patients increasing desire and need to be involved in the decisions that affect their health. - Canadians wish to take a more active and less passive role in the decision that affect health. Whereas, at one time physicians authority was accepted without question or complaint. Now patients have adopted consumerist attitudes towards their health care. - Canadians often choose combo of conventional and alternative health care practitioners or products that they feel will best treat their health issue - This change has come from several factors: • Increasing emphasis on maintaining and achieving good health in Western society  Patients are more proactive in managing their health  Physicians need full cooperation and participation for treatment plan  Modifying lifestyle factors (diet, smoking, alcohol consumption) must be done with the patients full initative and cooperation if change is to be achieved.  Patients who regard their behaviour as under the control of providers instead of themselves are less likely to adhere to lifestyle change • Internet o Searching for information about health o Among Canadians who use the internet for health info, more than a third, 38% discuss what they find with a health care provider o Info about surgery and alternative therapies are most common to be discussed o Can provide a second, easy and accessible way for a second opinion. • Patients knowledge on illness, especially if it is a recurring or chronic problem o Ex. Diabetic may have a better sense of how to control his or her own blood glucose level than does a physician unfamiliar with the particular case. ← - relationship between patient and provider is changing in ways that make better communication essential. ← Factors that erode communication : aspects of the office setting itself, changing nature of the health care delivery system, provider behaviors, patient behaviors, and qualities of the interaction. ← Setting ← - medical office is an unlikely setting for effective communication ← - average visit: 12 to 15 minutes ← - difficult to communicate symptoms in such short time frame, especially to stranger (if not regular physician) and if he/she interrupts AND if very sick ← - provider task: extract significant information from patient as quickly as possible ← ← Structure of Health Care Delivery System ← - in Canada primary health care providers are first point of entry for us into publicly funded health care system ← - 3.5 million Canadians do not have a regular family physician ← - long wait times for initial consultation for patients = frustrating ← - wait times drive people to consider seeking alternative means of dealing with their helath issues ← - study of primary care users in Ontario, found that although the majority had a family physician, almost half experienced difficulty getting an apt with their doctor in the past year. ← - they were asked if they would consider consulting with a complementary and alternative medicine practioner the next time they experienced difficulties seeing a physician and over 90% of those who had previously used CAM said yes. Almost 60% of those who hadn’t used CAM before said yes ← ← Changes in the Philosophy of Health Care Delivery ← - the increasing acceptance and use of CAM therapies and the rising number of women in the medical profession have changed what was once a very clear physician role characterized by dominance and authority. ← These changes promote more egalitarian attitudes among physicians, they also challenge the physicians dominance, autonomy and authority ← - responsibility that used to be solely physicians’ are now shared with other authorities including health care providers and patients. ← ← Holisitc Hleath Movement and Health Care ← - western med. Is increasingly incorporating Eastern approaches to medicine and nontraditional therapies, such as meditation and biofeedback ← - philosophy of holistic health: idea that health is a positive state to be actively achieved not merely the absence of disease has gained a strong foothold in Western medicine. ← Holistic health emphazised health education, self help and self-healing ← - CAM patient-provider relationship is more open, equal and reciprocal and potentially bringing emtoinal contact into the relationship between patient and provider. ← ← Provider behaivours that Contribute to Faulty Communications ← Not listening ← - problematic provider behaviour is not listening ← - consequence of provider efforts to manage the interaction not only prevents patients from discussion their concern but may also lead to loss of important information. ← Use of Jargon ← - use of jargon/technical language is an important factor in poor communication ← - why use jargon? Some cases it keeps patients from asking questions. Physicians have long used jargon to inpress gullible laymen. Sometimes it’s not on prupose. They learn medical terms to talk to other physicians on common ground and it may just carry over. ← Baby Talk ← - pracitioners may underestimate what their patients understand about an illness and its treatment they may estor to baby talk and simplistic explanations ← Elderspeak ← - common communication between patients and health care workers ← - using terms such as “Dear” and “sweetie” or “are we ready for our bath” ← - elderspeak is an overly carrying and infantilizing communication issue that sends the message that elderly people are incompetent. ← - potentially demeaning and can negatively impact health (some evidence_ ) ← Nonperson Treatment ← - depersonalization of the patient is another problem that impairs the quality of the patient-provider relationship. ← - may be employed intentially to try to keep the patent uqet while an exam, producer or test is being conducted ← may be used uninetnionally because patient (as object) has become the focus of the provider’s attention ← Stereotypes of Patients ← - negative stereotypes ← - ex. First nations people often stereotyped as being quiet and passive or angry and drunk. ← Leads to social distancing in health care encounters ← Patients Contributions to Faulty Communications ← - some patients may not clearly understand their diagnoses which can affect adherence to prescribed treatement especially after discharged from hospital ← - identifying characteristics of patients that increase the risk for poor communication is therefore important for finding solutions to improvce communication and ultimately the quality of their care. ← Patient Characteristics ← - several factors on patients part
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