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Chapter 9

PSYC 3170 Chapter Notes - Chapter 9: Pseudomedicine, Irritable Bowel Syndrome, Agreeableness


Department
Psychology
Course Code
PSYC 3170
Professor
Robert Muller
Chapter
9

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PSYCHOLOGY 3170
CHAPTER 9
Patient-Provider Relations
What is a Health Care Provider?
Although physicians continue to be the main providers of health care, Canadians are increasingly receiving
much of their primary care from individuals other than physicians
Nurses as Providers
Advanced practice nursing is an umbrella term given to registered nurses who have gone beyond the typical
2-4 years of basic training and who have responsibilities for patients
Nurse practitioner – a registered nurse (RN) who has additional education in health assessment, diagnoses, an
management of injuries and illness, and who can therefore order tests and prescribe drugs; affiliated with
physicians in private practices and also provide care across many settings
oTheir practice emphasizes health promotion and illness prevention
oMust often explain disorders and their origins, diagnoses, prognoses and treatments
Advanced practice nurses work both autonomously and collaboratively with other health care providers in
nursing outposts, community health centres, clinics, LT care facilities etc.
Nurses may also deliver advice remotely via telehealth services; telehealth – includes a variety of services
that use communication technology to connect people with health services
Physician Assistants as Providers
Physician assistants – skilled health care team members who perform a wide range of medical services;
supervised by physicians as part of an assistant team to complement health services
Their exact duties often vary by clinical setting but can include taking medical histories, conducting physical
examinations, diagnoses and treatment illness, ordering tests etc.
Although these tasks seem similar to that of physicians, physician assistants learn to know their limits and
seek guidance from their supervisor if necessary
They may become more popular in the future; only 300 working in health care settings now
Since medical practice has become increasingly complex, other professionals, such as physiotherapists, social
workers, nutritionists, occupational therapists, and psychologists have also become involved in specialized
care and are now often members of inter professional teams
Why is Patient-Provider Communication Important?
The quality of communication with a provider 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
People often judge quality of care by criteria that are irrelevant to its technical quality
Most of us are insufficiently knowledgeable about medicine and standards of practice to know whether we
have been treated well
We often judge technical quality on the basis of the manner in which care is delivered
A provider that engages in behaviours that are judged to be empathic and caring is often judged to be both
nice and competent, whereas a cool, aloof provider may be judged less favourably
Technical quality of care and the manner in which care is delivered are unrelated
Patient Consumerism
Another factor that may influence patient provider interaction is patients’ increasing desire and need to be
involved I the decisions that affect their health
Canadians wish to take a more active and less passive role in the decisions that affect their health
The increasing emphasis on maintaining and achieving good health in Western society has contributed to
patient consumerism in recent decades; patients have therefore become more proactive in managing their
health
Giving the patient a role in the development of the plan and how it will be enacted can help ensure
commitment to a treatment regimen
Lifestyle is a major cause of disability and illness; modifying lifestyle factors such as diet, smoking and
alcohol consumption must be done with the patient’s full initiative and cooperation if change it to be achieved
oPatients who regard their behaviour as under the control of providers instead of themselves are less
likely to adhere to lifestyle changes

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The Internet has also contributed to patients taking a more active role in their treatment; more than a third of
Canadians discuss what they find online about health with their provider
Finding appropriate info on the Internet may be a challenge
Patients often have considerable expertise about their illness, especially if it is a recurring or chronic problem
A patient will do better if this expertise is tapped and integrated into the treatment program
Setting
The medical office is an unlikely setting for effective communication; the average visit lasts 12-15 minutes
and when you are trying to explain your symptoms the physician will interrupt you before you get 23 seconds
into your comments
If you are ill, you must communicate this to another person, often a stranger; you must respond to specific
and direct questions and then be content to be poked and prodded
It is difficult to present your complaints effectively when on is in pain or has a fever and a patient’s ability to
be articulate may be reduced further by anxiety or embarrassment
The provider has the task of extracting significant info as quickly as possible from the patient; they are often
on a tight schedule
The patient’s ideas of which symptoms are important may not correspond to the provider’s knowledge, so
important signs may be overlooked
Structure of Health Care Delivery System
In Canada, primary health care providers are usually the first point of entry for individuals into our publicly
funded health care system
Primary health care facilitates and coordinates the provision of the services that are delivered to ensure
continuity of care if more specialized services are required
When secondary health care services are required, record of any necessary tests or procedures are passed
along to the referring primary care physician
One difficulty with this gatekeeper system is that receiving specialized care or tests necessarily requires an
initial referral from a physician
Even having a regular physician does not always ensure that needed medical care will be received in a timely
manner, due to high demand on the few physicians available
The long wait times to receive an initial consultation can be frustrating and stressful
Almost a quarter of Canadians report that they cant get in to see a doctor on the same day when they are sick
or need medical attention and more than a third report having to wait 6 or more days to get an appointment
with a doctor
Waiting and the factors that come along with it is a possible formula for dissatisfaction that may lead people
to consider seeking alternative means of dealing with their health issues
Changes in the Philosophy of Health Care Delivery
The physicians role is changing; the increasing acceptance of complementary and alternative 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
Responsibilities that once fell exclusively to physicians are now shared with other authorities
Holistic Health Movement and Health Care
Western medicine is increasingly incorporating Eastern medicine and non-traditional therapies
Philosophy of holistic health – the idea that health is a positive state to be actively achieved, not merely the
absence of disease – has gained a strong position in Western medicine
oAcknowledges psychological and spiritual influences on achieving health and it gives patients
responsibility for both achieving health and curing illness through their behaviours, attitudes and
spiritual beliefs
oEmphasizes health education, self help and self healing
Natural, low technology interventions and non-Western techniques of medical practice may be substituted for
or added to traditional care and include herbal medicine, acupuncture, massage, etc.
oReferred to as complementary and alternative medicine (CAM) – they are gaining popularity
among Canadians and treatment options
The biopsychosocial approach to health advocated by CAM use provides patients with a different way of
viewing their health
These changes alter the relationship between provider and patient, making it more open, equal and reciprocal
and potentially bringing emotional contact into the relationship between them
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CAM patients rate the quality of the interpersonal care and communication higher than do patients of
conventional medical practices
Provider Behaviours That Contribute to Faulty Communication
Not Listening
The reasons for not listening should be viewed within the context of the many obstacles that modern
physicians face, including having too little time to see too many patients
The consequence of provider efforts to manage the interaction not only prevents patients from discussing
their concerns but may also lead to loss of important info
Such info may be valuable not just for addressing the patients’ needs but also for helping to identify when
they may experiencing adverse reactions to certain prescribed drugs
Giving patients a chance to express their concerns and replying in an empathetic caring manner that
demonstrates that physicians are listening may therefore be one way to improve communication and enhance
patients’ perceptions of interactive quality
Use of Jargon
Studies reveal that patients understand relatively few of the complex terms that providers often use
In some cases, jargon filled explanations may be used to keep the patient from asking too many questions or
from discovering that the provider is not certain what the patient’s problem is
Long used medical jargon to impress gullible people;
More commonly, providers use of jargon may be a carryover form their technical training; they learn a
complex vocabulary for understanding illness and communicating them
oThey may find it hard to remember that the patient does not share this expertise
It may also stem from an inability to gauge what the patient will understand and an inability to figure out the
appropriate non technical explanation
Baby Talk
Because practitioners may underestimate what their patients will understand about an illness they may resort
to baby talk and simplistic explanations
Over simple explanations coupled with infantilizing baby talk can make the patient feel like a helpless child;
such behaviour can forestall questions
Elderspeak
A communication issue that is unfortunately common between health care workers and their patients;
includes using overly familiar terms like ‘dear’ and ‘sweetie’ to address elderly strangers
Similar to baby talk, elderspeak is an overly caring and infantilizing communication issue that sends the
message that elderly people are incompetent
Some evidence that it can negatively impact health; linked to increased probability of patients resisting care,
compared to normal communication, suggesting that elderspeak may create barriers to delivering needed
health care
Also reinforces negative age related stereotypes both for the person using it and for the target
Not only can this impact how the elderly feel about themselves which can negatively impact their health, but
it may also have long range health consequences for the person using elderspeak
Communication training may be able to reduce this problem and its consequences for both the patient and
provider
Stereotypes of Patients
Negative stereotypes of patients may contribute to problems in communication and subsequent treatment; eg:
First Nations are often stereotyped for being quite and passive or angry or drunk
oCan lead to social distancing in health care encounters
Health care providers may also hold stereotypes about patients based on their SES which can lead them to
discriminate against potential patients with low SES
When a person is seen by a provider of the same race or ethnicity, satisfaction with treatment tends to be
higher, underscoring the importance of increasing the number of minority physicians
Deal with it by ensuring that through its initiative called Diversity and Social Inclusion Health Care
oGuidelines designed to help health care professionals tailor health care so that it better meets the
social, cultural and linguistic needs of patients
Sexism is also a problem; male physicians and female patients do not always communicate well
oResearch suggests that in comparison with male physicians, female physicians generally conduct
longer visits, ask more questions, make more positive comments and show more nonverbal support
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