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PSYC 3170 (151)
Chapter 9

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PSYC 3170
Gerry Goldberg

-Starts with the story of a person who goes to a physician and has to wait for an hour and only gets 5 minutes of doctor with no medication suggested, just told to take over the counter medicines and fluids…leads the patient to thing why they bothered to come to the doctor. - Long waits, insensitivity, apparently faulty diagnoses and treatments that have no effect are the stuff of these indignant stories. -This chapter will talk about the following issues. 1) Why patient provider communication is important. 2) The nature of the patient-provider communication and the factors that erode it. 3) Consequences of poor communication, including noncompliance with treatment and use of alternative health care. Finally, the efforts to improve patient provider communication. - Refer to physician as provider because Canadians receive their primary care from individuals other than physicians too like nurse practitioner etc. - Nurses as providers are advanced practiced nurses who have gone beyond the four years of nursing education, Nurse practitioner is a RN who has additional info in health assessments, diagnoses, and management of injuries and illness, who can send orders and prescribe drugs. Also should be able to explain origins of disorders. Even if not a nurse practitioner, nurses have an important role in medicine as they give treatment instructions and screen patients before they see the doctor. NP can work with or without a collaboration of a physician. - Physicians supervise physician assistant, this role was introduced to overcome the shortage of physicians. Their duties are similar to a physicainc but are taught to know their limits and seek guidance from physicians. They can take medical histories, conduct physical examinations, diagnoses, treatment, ordering and interpreting tests, writing prescriptions and assisting in surgeries. - Why is patient-provider communication important? Criticisms of provider talk about volumes of jargon, little feedback and depersonalized care. People are usually not very knowledgeable about medicine and hence judge the provider by his manners and how nice he is, even though the technical quality and manner in which care delivered are unrelated. -Cause of the increasing emphasis on health, patients are becoming more involved in their health issues and want to be involved in the decisions that providers make about their health as compared to earlier times where providers were given the full authority. Also, since lifestyle like smoking etc is a major cause of health disorders, patient’s imitative is necessary to overcome the problem and hence communication is becoming more necessary. Studies show that patients know more about their condition and if patient’s expertise or opinion integrated in treatment, they recover better. - Setting of the medical office is also a constraint between patient provider communication since the patient has been waiting for long and gets to talk only a bit when the provider interrupts cuz he has more patients in line and is trying to make more effective use of time, some the symptoms that patient’s think are important the provider might not and may overlook the important signs. - The Canadian health care system which requires to see a physician first who then refers the patient to a specialist requires long wait to see a specialist and can be frustrating, affects them negatively and increases anxiety and stress. Also can lead the patient to consider alternative means of dealing with their health issues. - Rising of other health care providers and use of complementary and alternative therapies decrease the dominance and authorities what physicians once had and responsibility of physicians now shared with other health care providers is changing physicians role. - The idea that health is a holistic, is a positive state to be actively achieved and not merely the absence of disease lead patient towards other treatment options like curing illness through behaviors, attitudes and spiritual belief and techniques like acupuncture massage, psychic diagnosis, dance therapy are complementary alternative medicine therapies (CAM) which all require emotional contact. These changes also alter provider patient relationship also requiring more emotional contact and communication. - Providers Behaviours That Contribute to Faulty Communication: 1) Not listening 2) Use of jargon 3) Baby talk 4) Non person Treatment 5) Strereotypes of Patients. - . Not listening: The provider interrupts the patients explanation right after18 secs of patient explaining their problem. This can erode the communication between patient and provider and may also lead to loss of imp information. - Use of jargon: The use of jargon and technical language is another important factor in poor communication. Patients only understand a few complex terms that providers use. Sometimes its used to keep the patient from asking too many questions or to impress people with their knowledge. On the other hand, the providers use the technical language in their professional life and an inability to figure out what the patient will understand. - Baby Talk: The provider may also underestimate what the patient will understand about an illness and its treatment, may lead them to simplistic explanations and baby talk, which can make the people feel like a helpless child. - Nonperson Treatment: This is the depersonalization of a patient and makes the patient feel that they are not there and ignore them during a treatment, in order to keep the patient quite so the provider is able to concentrate eg, during a surgery. It would be disturbing for a provider to do the job if the patient keeps fussing and asking unnecessary questions. However, this greatly reduces the patient’s attitude towards the provider, visit and their condition as well. - Stereotypes of Patients: Communication can be eroded the provider encounter a patient or disease that they would prefer not to treat. For example first nation people are stereotyped as ‘quite and passive’ or ‘angry’ or even ‘drunk’, which can lead to social distancing. Patient of the provider with the same race and ethnicity gets more satisfied. Negative perceptions have seen by provider in elderly patients and females as well, since they conduct longer visits, ask more questions and show more nonverbal support. Physicians also prefer acutely ill patients over chronically ill patients as hey have answer questions and deal with prognosis. - Patient’s Contributions to Faulty Communication: 1)Patient Characteristics 2) Patient’s Knowledge 3) Patient Attitudes toward Symptoms - Patient Characteristics: Patients might not understand important details about the illness or treatment. Neurotic patients may exaggerate their symptoms and compromise a physician’s ability to determine the seriousness of a patient’s conditions. Also, during physicals visit patients are anxious which makes it harder to retain all the information. Can be solved by focusing directly on patient’s concerns. - Patient Knowledge: Some patients are unable to understand even simple info about their case They may also be class based, socio-linguistics that contribute to poor communication. As people age, their medical problems increase but their ability to present their complaints and understand treatment guidelines also increases. Use of internet is decreasing this problem, however internet is not so common with low class or older people. - Patients Attitudes towards Symptoms:Patients find some symptoms important about their illness which the proiver wont as the provider concentrates n the underlying severity of the illness where as patient is more concerned about the pain and symptoms that interfere with their activities. Patients may misunderstand the provider’s emphasis on factors that they consider to be incidental and pay little attention when vital info is being told and might believe that the provider made an incorrect diagnosis. Patients don’t give enough info, might be embarrassed about some health history (having an abortion), and may fear asking questions. Example of a guy who was embarrassed to go the doctor cause had a lump in his groin, thought it was cancer but when finally went to a surgeon, it turned out to be hernia but the patient thought the surgeon was hiding the cancer info from him so the patient doesn’t freak out. However, only after the successful surgery for hernia did he believe that the surgeon was actually right. - Interactive Aspects of the Communication Problem: Since providers don’t receive feedback, rarely learn about the results of the communication. Never knows for sure that once the patient leaves, if they got cured by the treatment given by the provider or went out somewhere else to seek advice or may have died. Also if the patient does get treated wont come back or if dissatisfied patients wont complain directly, might just change the provider. Learning promoted by positive feedback than negative, providers don’t usually receive a lot of feedback so don’t learn a lot about their communication with patients and when they do receive feedback, its negative feedback which they are not sure how to change or what to do instead. - Results of poor patient provider communication can lead the patient to not use health care services anymore and switch to CAM therapies
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