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Ch 8-10 Part 4 The Patient in the Treatment Setting.docx

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PSYC 3170
Joseph Baker

Part 4 The Patient in the Treatment Setting Chapter 8 Using Health Service How do we recognize and interpret symptoms? Individual difference and personality - Most frequent symptoms showing up among patients who convert their distress into physical symptoms are back pain, join pain, pain in extremities, headache, abdominal pain, allergies to particular food, CV symptoms - Women not more likely to men to report symptoms Older age report more symptoms than young people - - Neuroticism is pervasive dimension of personality marked by negative emotions, self- consciousness, concern for bodily process High on neuroticism recognize and report symptoms more quickly  - Depression linked to increase physical symptom but only when recalled retrospective - Anxiety increase report physical symptom for concurrent/momentary physical symptoms  Encoding + retrieval process distinct for anxiety and depression as depression is better retrieval of past symptoms and anxiety heightens encoding current symptoms Cultural Differences - Cultural variations in emotional responses associated with experience of troubling symptoms are responsible for observed differences - Comparative study of menopause symptoms in NA and Japanese women  Japanese more likely to report no symptoms  Maybe explains that menopause has different meaning  Also because Japanese are more healthy in daily activities Cultural difference is not only socio cultural difference in language and meaning as  well as biological variations in experience of symptoms associated with different lifestyle Situational Factors - In boring situation makes symptoms more attentive - Intense activity takes attention of symptoms away - Medical students’ disease: studying symptoms lead to recognition of own symptoms  Distress decrease after knowledge but then perception doesn’t Stress - Believe they more vulnerable to illness and attend more closely to their bodies - Interpret stress related physiological change like accelerated heartbeat, breathing and interpret these changes as symptoms of illness - Symptoms are real but perception and interpretation of meaning may be exaggerated with stress Mood - influence self-appraised health Those in positive mood rate themselves more healthy then those in negative mood who - perceive themselves as more vulnerable to future illness - Those diagnosed with illness but in positive mood report fewer/less serious symptoms Interpretation of Symptoms - Prior experience People with experience of medical condition estimate prevalence of symptom to be  greater and often regard the condition as less serious than those with no history of condition Symptom’s meaning influence by how common it is within person range of  acquaintance/culture  Highly prevalent risk factor are regarded less serious than rare (more widespread is reason for little significance) - Expectations  Neuroimaging reveal expecting symptoms activates brain areas associated with experience of symptoms and distracting oneself from symptoms reduce brain activity in symptom perception areas - Seriousness of symptoms Symptoms affecting highly value are more serious and require attention   Eyes more than trunk or things that affect mobility, chest, pain Cognitive Representation of Illness - Illness schemas  Illness representation or schemes: organized conceptions of illness acquired through media, personal experience, friends  Can be sketch to extensive, technical, complete  Five distinct components: identity (label, name), consequence (symptom and treatment and extent they believe illness has ramification of their life), cause (what gave rise to it), duration (expected length of time illness will last), cure (whether they believe it will be cured thru appropriate treatment) 3 models   Acute: specific viral agent in short duration with no LT consequence  Chronic: several factors like health habits, long duration, severe consequence  Cyclic: alternating period duration, either no or many symptoms - Lay referral network  Informal network who offer own interpretation of symptoms before any medical treatment is sough  Preferred mode of treatment, offer home remedies, first choice of action  Natural health products: Complementary therapies including relaxation, imagery, spiritual healing supposed  to work with rather than replace conventional treatment  Often people don’t reveal and makes hard for health care providers as conflict of treatment - Internet:  Women 2x more likely than men to find answer for health questions  Household with kids more likely than those without children  Young men 15-24 least likely to search out health information  Common search is for specific disease + health condition  Lifestyle info is next most frequent  Chronic health conditions are visit most often What predicts the use of health service? Age - Young and elderly use health care most frequent - Young children more likely experience unintentional injuries, children under 5 account for most emergency department visit than any other age group Illness and unintentional accident frequency and use of service decline in adolescent - - Late adulthood develop more chronic disease and condition and use of health service more frequent Gender - Women use health care system more than men - Reasons being women have better homeostatic mechanism than men do: report pain easier, experience temperature change faster, detect new smell faster - More sensitive to bodily sensation - Another explanation is social norm that men should be tough - Economic factor: women more part time worker thus don’t have to take time off work but at same time women have more economic hardship thus contribute to poorer health - Women also have less structured care: need to go to multiple place from general physician, gynecologist, breast cancer specialist where as men only need go for general practitioner for all preventive care Socio Economic Status - Lower SES less likely visit physician, those who do make 4 or more visit and more emergency visit and hospital admission than those with higher incomes Culture - Ethnic minority group more likely to visit physician but not specialist Aboriginal peoples, African/Caribbean origin no more likely to consult physician in - previous year than Caucasian - Ethnic minority much more likely to visit 4 more visit than non-minority and also less likely to visit specialist - Linguistic barrier influence use of health care service  Those who perceived less service available or adequate leads to wanting to use service less and rating future health as poorer  Providing linguistic minority with language appropriate health care service is way to increase appropriate use of health service Social Psychological Factors - Health belief model suggest 2 factors to which person will seek treatment Extent to which person perceive threat to health   Degree to which they believe particular health measure will be effective in reducing threat Those who raise in going doctor when symptoms likely to go see doctor more than those - who don’t go unless serious symptom was showing How are health service misused? - Either when people seek health service when medically non-significant or when they should seek treatment but doesn’t Several reason they seek physician care when it should be address by mental health - service  Stress and emotional response create number of physical symptoms and so during stressful times use health service more  Anxiety, depression, psychological disorder accompany physical symptoms  Lead to recurrent and prolong hospital stay People make mistake symptoms of mood disorder for legitimate medical problem   Limited access to mental specials also stigma attached - People who misuse:  Worried well: concern for physical and mental health perceive minor symptoms as serious and believe they should take care of own health  Committed to self-care leading to health service use  Somaticizes: individuals who express distress and conflict through bodily symptoms  Threat to self-esteem, convince themselves are physically ill  Psychiatric disorder continue to be under recognized and undertreated in primary care  Somatization and related hypochondriasis more interpersonal disorder than vigilance or misinterpretation of low level symptoms and seek assurance through medical attention  Medical service perceived more legitimate than psychological one  Man depressed find admitting he is ill then depress to miss work - Illness brings secondary gains: ability to rest, free from unpleasant task, taken care for by others, time off work - Individuals with legitimate medical may mistake themselves for psychological: - Possible for diagnosis as well: more common in female diagnosis than male Delay behavior - Waiting for more serious symptom before seeking treatment lead to high rate of death, disability - Appraisal delay: time takes individual to decide symptoms is serious - Illness delay: time between recognition to imply illness and decision to seek treatment - Behavioral delay: time between actually deciding to seek treatment and actually doing so Medical delay: time elapses between making appointment and receiving appropriate - medical care - Elderly less delayed than middle age - Delay more common in those without regular physician, those who seek treatment in repose to pain or are fearful for doctors - Link to those who are nonuser of service: health belief model to predict delay behavior: those who fail to seek treatment may be more likely to believe treatment will be painful ( high perceived barrier) and nothing can be done (low perceived efficacy of treatment ) - Symptoms and delaying:  those who have pervious symptoms that turn to be minor lead to future delays  if symptom is easily accommodate and doesn’t provoke alarm lead to delay - treatment delay  often treatment doesn’t last in one visit or other times patients are satisfied with first visit delay future - provider delay:  account for 15%, when appropriate test is not undertaken  mistaken blackout for simple disorder versus diabetes or brain tumor  more delay when patient deviates from profile: 25 year old with breast lump not likely to consider for breast cancer (symptoms for 45+) How does hospitalization impact the patient? - Structure of the hospital  Structure leads to segregation leads to communication problems Nosocomial infection: infection result from exposure to disease in hospital setting   Physician most likely to commit infraction and least likely corrected about hand washing, sterilization, waste control  Communication would lead to constructive way of better control - Increase in day surgery, health initiative leading to less hospitalization - Increase n general acute hospital and specialized hospital to treat children: Children hospital - Increase in psychologist from 1 to 131 to 1 to 51 patient beds  More involved in pre surgery and post-surgery preparation, pain control, intervention to increase medication and treatment compliance and behavioral programs to teach appropriate self-care following discharge  Diagnose and treat psychological problem than can complicate patient care Impact of hospitalization on the patient Admission usually long, makes patient anxious, increase anxiety while patient is expected - to be cooperative, dependent - Hospital usually makes convenience for staff rather than patients - Hospital care fragmented with 30 different staff passing through patient rooms, little time spend with patient - Insufficient info given to patient about procedures but hospital stays are shorter and discharged sooner Burnout - 3 components: emotional exhaustion, cynicism, low sense of efficacy - High turnover, workplace injuries, high absenteeism - Job insecurities - Not given enough time, issues they couldn’t do things well, need to work through breaks, physical demands - Higher rate of depression, greater chronic health like pain interfering with ability to perform work, emotional abuse - Particular problem with young nurse on job less than 2 years - Low job satisfaction, emotional exhaustion leading to cynicism, alteration in physiological and neuroendocrine functioning - Coping styles help, giving more time to discuss problems How can control be increased in hospital settings? - Interventions like providing extensive info for admitting process, day surgeries, procedure may help increase psychological control - Highly fearful patients generally remained fearful and anxious after surgery and showed more negative affects - Patient with little initial fear show unfavorable reactions after surgery became agree after - Moderately fear was most effective - Reason:  Fearful patient too absorbed with own fears to process preparatory info  Too little fear were insufficiently vigilant to understand and process the info effectively  Moderate fear were vigilant but not overwhelmed and develop realistic expectation and expect the reaction/sensation post-surgery - Those who well informed show better post-operative adjustment, less emotionally distressed and regain function more quickly - Video tape help for upcoming surgeries, post treatment partner also shows effect  Prepping as role model, providing info, seeing they came out alright Social impact is positive one  Chapter 9 Patient Provider Relations What is a health care provider? - Nurse practitioner: has additional education in health assessment, diagnoses, management of injuries and illness  Affiliated with physician in private practice and provide care in community settings, health center in hospital, nursing homes  Emphasize health promotion and illness prevention  Patient education fall to nurse: given treatment instruction and screen patients  Usually viewed as complement to physician  Teleheath is service using communication technology to connect people with health service - Physician assistant: skilled health care team members supervised by physician  takes medical history, conduct physical exam, diagnoses, treatment of illness, order test, write prescription, assist in surgery Why is patient provider communication important? - judging quality of care: adequacy of care judge to technical quality, manner it was delivered   want people that are warm, confident and friendly rather than cool and aloof or those who feel uncertain  reality the quality of care and manner delivered is unrelated - patient consumerism  patient desire and need to be involved in decision  patient are more proactive in managing health  giving them a role in development of plan help ensure commitment for cooperation and participation  modification of lifestyle patient with recurring disease become more expert  - setting  average visit is only 12-15 min less time to communicate and effectively discuss complaints  provider also have difficulty retrieving as many info as possible  patient may have different idea of which symptoms are important to present structure of health care delivery system -  receiving specialized care requires initial referral from physician  regular physician visit also doesn’t ensure adequate medical care Ontario has lowest physician to patient ratios in country less than 10% are  accepting new patients  Long wait times makes experience frustrating and stressful Increase in using CAM   Female, middle age, highly educator and greater number of health complaints that are chronic in nature compared to those who doesn’t use Cam  Even with additional cost as it has best combination of treatment, conventional, to maximize treatment benefits More consultation, longer consultation, less side effects, more symptom  relief and improved physical functioning, increase hope  Result of dissatisfaction of conventional care, repeated visit strengthen use, more ppl also born into culture of using - Holistic health movement and health care  Western medicine is increasingly incorporating eastern approach Idea that positive health care be achieved rather than just absence of disease   Gives responsibility of patient to achieve health, emphasis on health education, self-help, self-healing, natural low technology intervention with non-western technique of medical practices: herbal medicine, acupuncture, acupressure, massage, homeopathy, spiritual healing, dance therapy  Alteration of relationship, making provider and patient more equal and potentially bringing emotional contact into relationship  Shift to egalitarian relationship leading to greater symptom relief Providing behaviors that contribute to faulty communication - Not listening  Only 23% of patients has time to finish explanation of concerns before provider began process of diagnosis  69% had physician interrupt and directing patient toward particular disorder, with average time about 18-22 sec before interruption  Lead to loss of important importance: chest pain, shortness of breathe - Use of jargon  Sometimes used to keep patient from asking questions  Or used to prevent patient from knowing they unsure of effect  Carried over from technical training, forget that patient don’t share same expertise - Baby talk  Opposite of jargon, use of too simplistic explanation and patient feels helpless Elder speak -  Overly caring and infantilizing communication sending message elderly people are incompetent Demeaning, negative impact on health, reinforce negative age stereotype affecting  way elder thinks of themselves - Nonperson treatment  Depersonalization of patient used to keep patient quiet or sometimes unintentional as patient became focus of provider’s attention like object rather than person  Emotion communicated can have impact of patient’s attitude towards provider  When physician looked worried, patients more concerned, recall less info, perceive condition as worse than when physician looked not worried - Stereotypes of patients  Negative stereotypes usually when provider is of different ethnicity  Sexism: male physician and female patients don’t always communicate well, female physician seem conduct longer exams and ask more questions, make more positive comments and show more nonverbal support, also talk about preventive behaviors more than male physician Patient’s Contribution to Faulty Communication - Patients may not clearly understand diagnosis and affect adherence - Patient characteristics  Those high in neuroticism present exaggerated picture of their symptoms, when they are anxious their learning is impaired - Patient knowledge  Linguistic barriers, comprehension related to complicating their problem - Patient attitude toward symptoms  Patient respond to different cues about illness than practitioner placing emphasis on pain and those that interfere activities whereas provider more concerned with underlying illness and treatment  Leads to misleading information they give as to what they think is important, fear of asking questions, embarrass about history, assumption provider is giving wrong diagnosis or incompe
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