health services wk 12

health care service today

• patient consumerism - choices, self efficacy, engagement

patient and provider setting

patient:

• feel rushed, sick, anxious, low in status, uncertain

• feeling intimidated by high status professinal

• challenge: 

• •Language barrier

  •Anxious, neurotic patients

  •Exaggeration of symptoms

  •Poor health literacy

  •Especially among the less educated & elderly

  •Patient expectations about what should be treated (online sources)

provider

• tight schedule

• struggle to diagnose if paitients dont present most relvant symptoms

risk of:

•Inattentiveness; depersonalization

•Focus on diagnosis; emotional protection

•Baby talk or use of jargon

•Prevent questions from patients

•Hide uncertainty about diagnosis

•Stereotypes

•SES, race, gender, illness

Consequences of Poor Patient-Provider Communication

•Dissatisfying experience with health service providers increase stress & reduces willingness to use medical services in the future.

•

•Increases non-adherence or non-compliance to treatment…

•Assessed directly by asking patients if they adhered to treatments.

•OR indirectly by tracking number of follow-up or referral appointments kept.

•

•Dissatisfaction & non-adherence affect their disease process & likelihood of recovery.

Placebo Effect

any medical procedure that produces an effect—psychological or physiological—in the patient due to its therapeutic intent, not its specific chemical or physiological properties.

psychologically mediated effect that also triggers real changes in physiology.

belief / expectation —> dampened negative affect and stress physiology —> improvement 

nocebo effect

•when information about the potential adverse effects of a procedure, rather than the procedure itself, produces the adverse effects.

• psychologically (e.g., negative expectations & beliefs) & physiologically mediated (e.g., increase negative affect & activate stress systems).

Patient-Provider Communication & Placebo Effects

can enhace placebo effect:

(1) Creating symbolic value

•When patient-provider communication is clear, patients understand what is wrong & perceives that the provider is doing something about it.

•This understanding & perception is soothing; reduces negative affect and stress.

•

(2) Increasing treatment adherence

•When patient-provider communication is positive, it increases positive treatment beliefs and adherence, which facilitates placebo effects.

can also affect nocebo

histamine prick test with cream

administered a prick test and then created positive and negative expectations “ increase reaction or decrease reaction

physician characteristics - high or low warmth (friendliness and eye contact) or high or low competence (medical research student vs student doctor)

Nocebo effects (negative expectations) occurred, regardless of physician characteristics.(grey always increased)

Some placebo effects (positive expectations) occurred as long as the physician was high in competence or warmth.

Placebo effects were the strongest when the physician was high in both warmth & competence.

low competence and low warmth - same rate of reaction for negative expectation and positive expectations

Burnout in healthcare professionals

emotional burn out, low sense of efficacy, people not recognising thier work

costs:

• institutional - absenteesim, high job turnover

• personal - more irritability, lack of sleep, insomnia, drug and alchohol abuse, poor health, suicide

cause:

emotional exhaustion afecting cynism affecting low sense of efficacy

• hectic, fast paced

• expected to be constantly empathetic / be emphathetic by nature

• giving too much and not receiving support from friend and family

• •Low control, autonomy, (positive) feedback, perception of success

• surgeons: high stake complex jobs, fear of litigation,

Higher empathy among residents (trainees in a specialization) predicted higher likelihood of burnout (Lee et al., 2018).

Defensive Medicine

•Deviation from sound medical practice due to fear of medical malpractice.

•Obstetricians limit their practice to gynaecology & retire early.

•Orthopaedic surgeons avoid surgeries related to spinal injury.

•Physicians avoid patients with complex medical problems or are perceived as “litigious”.

•Physicians eliminate or avoid recommending procedures prone to complications.

Improving the healthcare sector

Medical doctor level:

Training good doctors

Reducing doctor burnout

Allowing doctors to do their jobs

institutional level:

ensuring sufficient and sustainable healthcare resources 

reducing healthcare worker burnout

improvng operations 

fair pay vs taxes