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Chapter 5

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Psychology 2036A/B

Chapter 5 (Psych 2036) Seeking Medical Care • when a person seeks help is a function of the specific nature of symptoms experienced as well as of the person’s social and personal needs. • Type of symptom experienced: o Symptoms that are new, unexpected, painful, disruptive, highly visible, or that affect highly valued parts of the body – interpreted as more serious and are more likely to lead someone to medical care. o If recognizable from past, believed to be unimportant or explainable – it is ignored o If interferes with daily activities – medical care is usually sought o Attack highly visible part of the body (face or eyes) or important to one’s self identity (lump in women’s breast) – gain attention  medical care o Most quickly led someone to seek medical care - PAIN • Symptom recognition – major contributing factor to seeking medical care • Who seeks medical care: o Females more than males o The very old and those who are of higher socioeconomic status o Rural residents than urban dwellers – visit family physician; urban – consult specialists Delaying medical care • Delay in seeking diagnosis and treatment – linked to increases in morbidity and mortality of cancer patients. • Patient delay – the period between an individual’s first awareness of a symptom and treatment of that symptom. o total patient delay – occur in sequence of stages 1. Appraisal delay – the time it takes for a person to decide that a symptom is a sign of illness 2. Illness delay - the time between recognizing one is ill and deciding to seek medical care 3. Behavioural delay – the time that elapses between the decision to seek medical care and acting on this decision by making an appointment 4. Medical delay – (seheduling and treatment) the interval between making an appointment and first receiving medical care. Study by Safer, Tharps, Jackson, and Leventhal (1979): • Least delay – were in the greatest pain • Total delay – longer for patients who had other problems (marriage), older, and waited for symptoms to go away, read about the symptoms • Best predictor for illness delay – whether the person had a new symptom o Person likely to see an old symptom as normal and tolerate it for a long period until it goes away  then seek medical care Chapter 5 (Psych 2036) • People who believed they could not be cured  delayed treatment • Limitations: o Study included only person who actually sought medical care o Uses retrospective data  Prospective study – in which the participants maintain a diary of their symptoms and their appraisals of those symptoms – more effective way of studying delay behaviors • Studying cancer patients: o Delays in treatment for cancer have a significant influence on survival rates o Both high and low levels of fear are associated with longer delays in reporting breast cancer symptoms.  Fear: fear of doctors and hospitals, cancer, embarrasement, chemotherapy, disfigurement, pain, loss of femininity, and loos of control.  With little fear: think that it is unnecessary to seek medical advice o Trust: who are trustful of others are less likely to delay seeking care • Social influences: o Women believe that if they are diagnosed with breast cancer, their male partner will abandon them. • Age: o Have an effect on patient delay. o Older age is associated with longer symptom-reporting delay by breast cancer patients • Delay by providers do not seem to be associated with decreased survival in patients with breast cancer Physician-Patient Interaction Basic models of physician-patient interaction: • Thomas Szasz and March Hollender: o Active passive model: describes a relationship in which patients are unable to participate in their own care or to make decisions for their own welfare because of the severity of their medical conditions. o Guidance-cooperation model: applies when patients seek advice from the physician; the patient answers the questions physician asks about their symptoms but the physician is responsible for determining diagnosis and treatment. o Mutual-participation model: the patient has more responsibility than in other models; physician and patient make joint decision about every aspect of the care  “essentially foreign to medicine” • Active and assertiveness and active involvement on the part of the patient – precursors of an effective partnership with the physician Chapter 5 (Psych 2036) • Typical: model in which physician possesses a greater degree of power than the patient. • Roter and collegues: used audiotape analysis to describe communication patterns o Narrowly biomedical – characterized mainly by biomedical talk, closed- ended medical questions, and very little discussion of psychosocial issues. o Expanded biomedical – includes numerous closed-ended medical questions and moderate levels of biomedical and psychosocial exchange between the physician and patient. o Biophychosocial – suggests that biological, psychological, and social factors are all involved in any given state of health or illness; balance of psychosocial and biomedical communication o Psychosocial – includes substantial amount of psychosocial exchange between the physician and patient. o Consumerist – the use of the physician as a consultant who answers questions rather than asking them • Collaborative model or psychosocial pattern – is preferred by the patients • Least preferred – biomedical patterns • 10 attributes contributing to patient satisfaction in rank order: 1. Always honest and direct 2. Listens to me 3. Encourages me to lead healthier lifestyle 4. Does not judge; understands, supports 5. Someone I can stay with as I grow older 6. Tries to get to know me 7. Acts as partner in maintaining health 8. Treats both serious and non-serious conditions 9. Attends to emotional and physical health 10. Can help with any problem Physician-Patient Communication • Information giving: o Patient’s diagnosis, possible causes of the problem, and methods of treatment. o “patients tend to be more dissatisfied about the information they receive from their physicians about any aspect of medical care” o average: physician spent 1 minute giving information o physicians underestimate patients’desire for information o physician withhold information from patients – to protect from worry o patients who are elderly have less education or a poor prognosis receive less info from physician o patients wants to receive information about their medication and its side effects o providing info to patients: lowered blood pressure, less psychological distress and improvement of symptoms • Participation: Chapter 5 (Psych 2036) o Healthier, younger, and better-educated patients prefer greater involvement in health-related decisions o Lower class- more passive role o Patients who report a preference for an active role in their treatment tend to recover faster than those who prefer an inactive role • General Patient satisfaction o Considering the needs of the patient – physician’s role o Physician;s hurried manner, insensitivity, lack of responsiveness, apparently faulty diagnosis, or useless treatment. o Strong preference – warm and expressive emotional style physicians opposed to emotionally neutral o Nonverbal behaviors are closely related to patient satisfaction than is verbal communication • Patient satisfaction, communication, and malpractice claims o Most complaints – communication or relationship problems o Patients have preferences and physicians should know that o Good communication = patients satisfied with medical care o Lussier and Richard  Physician’s failng to prepare for meeting with patients  Appearing to rush through the physician-patient interview  Underestimating the seriousness of the symptoms patients report  Devaluing patient and family views. o “Recipe for litigation” – patient dissatisfaction + bad outcome o Levinson and collegues  No claims physicians: flow of the visit, laughed and used more humour, facilitated communication, encouraged patients to talk and spend more time with their patients  No differences bet
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