Soc 140 midterm

What was Ofri’s goal(s) in telling the stories of Mr. Amadou, Morgan Amanda, Ms. Garza, Marija and Tracey Pratt?

To illustrate how communication shapes diagnosis, treatment, and patient experience and show real-world consequences of miscommunication

Characterize Mr. Amadou

Language and cultural barriers

Characterize Morgan Amanda

Engaged, asks questions, challenges doctors

Characterize Ms. Garza

Passive patient, doesn’t speak up

Characterize Marija

Miscommunication between doctors lead to conflicting advice

Characterize Tracey Pratt

“Noncompliant” or assertive; stands up to physician

What was Ofri’s book called?

What patients say what doctors hear

what was Ofri’s main argument in chapters 1-2?

communication as diagnostic tool'; early patient-physician dynamics

what was Ofri’s main argument in chapter 3?

miscommunication consequences (Marija)

what was Ofri’s main argument in chapter 4?

Roter coding, interaction styles (biomedical vs consumerist visits)

what was Ofri’s main argument in chapter 5?

Patient assertiveness (Tracey Pratt)

what was Ofri’s main argument in chapter 6?

Pain communication; explanation reduces perceived pain

what was Ofri’s main argument in chapter 7?

Summarizes patterns; attentive listening and patient engagement critical

explain how research methods like surveys or interviews differ from coding interactions

• Surveys/interviews: Self-reported; reflect perceptions or recall, may be biased

• Coding interactions: Observational; classifies real conversation behaviors

How does Ofri describe Roter Coding?

systematically codes doctor–patient talk into categories: biomedical, psychosocial, consumerist, etc. (Ofri Ch.4)

What did it mean to be a patient in the 1800s?

• Low physician authority; patients had more control

• Limited tools, poor treatments, physicians not highly respected

How did things change for physicians and patients in the 1900s?

• Physicians gained cultural authority, became trusted experts

• Patients increasingly dependent

What was meant by the Golden Age of Medicine?

Doctors were gatekeepers of knowledge and treatmentHo

How did gatekeeping change from the 1800s to the 1900s in medicine?

• 1800s: Patients controlled access (limited options, family remedies)

• 1900s: Physicians controlled access, treatments, and legitimacy

What was the main type of communication between doctors and patients in the early period?

Paternalistic, physician-centered communication, where the doctor made most decisions and patients were expected to comply.

How did doctor-patient communication change over time?

By the mid- to late-20th century, communication became more patient-centered with shared decision-making. In modern times, interactions include engaged patients who negotiate care and some consumerist behaviors, where patients actively request treatments.

what was an engaged patient? how is it different from a difficult patient? (remember Morgan Amanda in ch.2)

• Engaged: Ask questions, challenge, collaborate (Morgan Amanda)

• Difficult: Label for patients who challenge authority; may overlap with “engaged”

How did physicians’ cultural authority change?

• Increased in early 1900s through education, specialization, institutional power

how did physicians achieve legitimacy and patient dependence?

Exclusivity of knowledge, control over treatment, patient reliance

what were Korsch & Negrete investigating in their article?

Communication gaps between doctors and parents; how miscommunication affects care

Based on the doctor-patient communication video, why was Korsch interested in communication?

Effective treatment requires understanding patient concerns

How did people react to Korsch’s work as discussed in class?

Some resistance from medical community; highlighted need for communication training

what big changes led to the reduction in physicians’ authority and when?

Patient rights, civil rights, social movements, internet, access to information (in mid-late 20th century)

what led to increases in patient agency?

Direct-to-consumer advertising, online resources, social awareness

What did Kravitz find in his study of direct to consumer advertising discussed in class?

Kravitz found that advertising increased patient questions, engagement, and treatment requests

what is health literacy?

Ability to find, understand, evaluate, and act on health information

what is shared decision making?

Collaborative process where patients and physicians jointly make treatment decisions

how does the internet affect medical visits?

• Increases patient knowledge but can spread misinformation (“Dr. Google”)

• Patients more empowered, sometimes challenge physician authority

what was Stevensen’s study about?

Studied patient expectations and communication, and how that affects treatment adherence

what was the goal of Nayyar’s dead wrong book?

Examine how misinformation spreads, how it interacts with engaged patients, and public health consequences

what did the chapter of Nayyar’s dead wrong book (chs. 1-5, 10) argue?

Case studies of misinformation; illustrates dangers of false knowledge and challenges in correcting it

How did Nayyar’s case study in Dead Wrong support the authors’ argument?

Misinformation undermines public health; engaged patients can still make poor decisions if misinformed

what is the relationship between misinformation and engaged patients?

• Engaged patients seek info and ask questions, but misinformation can mislead them

• Patient empowerment + misinformation = risk of poor decision-making

who was Alexander Fleming

Discovered penicillin in 1928.

what did A.F. contribute to research on bacteria and resistance?

Found first widely used antibiotic and highlighted the potential for resistance escalation.

what did A.F. warn about bacteria resistance?

Warned that bacterial resistance could emerge if antibiotics were misused (overprescribed, underdosed, or incomplete courses).

how are antibiotic misused?

• Prescribing antibiotics for viral infections (like colds or flu).

• Patients demanding antibiotics even when not necessary.

• Incomplete courses or taking leftover antibiotics.

• Overuse in agriculture (livestock feed).

What antibiotics are used to treat?

Bacterial infections (strep throat, pneumonia, bacterial skin infections, etc.)

what CAN’T Antibiotics treat?

Viral infections (flu, colds, most upper respiratory infections).

what do we learn about bacterial resistance when we look at it globally?

• Resistance is a worldwide problem; bacteria do not respect borders.

• Misuse and overuse in one country can affect bacterial populations globally.

• International coordination is necessary for monitoring, stewardship, and research.

what is bacterial resistance?

Bacteria evolve mechanisms to survive exposure to antibiotics.

why is bacterial resistance a problem?

Makes infections harder to treat, increases morbidity/mortality, and can render common infections deadly.

how do patients affect the treatment of upper respiratory illnesses?

• Patients often expect antibiotics, even for viral infections.

• Their requests, symptoms description, and insistence shape physician prescribing behavior.

• Physicians negotiate, educate, or acquiesce depending on perceived pressure.

what kind of dilemma do physicians face when deciding whether to prescribe antibiotics for viral infection?

• Desire to avoid unnecessary antibiotics vs. pressure to satisfy patient and maintain satisfaction/relationship.

• Risk of resistance vs. immediate patient satisfaction.

what are the main practices that patients rely on that shape treatment outcomes and physician practices for addressing them?

• Candidate diagnosis: Patients hint or suggest what they think is wrong.

• Resistance: Patients question or challenge treatment (e.g., refusing to accept “no antibiotics”).

• Requesting: Explicitly asking for specific medication.

what are physicians’ practices for addressing main practices patients rely on?

• Candidate diagnosis – presenting a range of possible diagnoses and treatments to frame expectations and educate the patient.

• Foreshadowing / anticipatory guidance – explaining why certain treatments (like antibiotics) may not be necessary, before the patient requests them.

• Affirmative presentation of treatment – clearly explaining why the recommended treatment is safe and effective, which can reduce patient resistance.

• Education and explanation – teaching the patient about the illness (viral vs bacterial, natural course, self-care) to increase understanding and compliance.

phases of medical care where patient practices show

• Opening / history-taking: Patients present concerns, candidate diagnoses.

• Examination / treatment negotiation: Resistance and requesting happen during discussion of care.

• Closing: Education and agreement on treatment plans.

in the Stivers chapter, what are the reasons for studying pediatrics?

• Parents influence treatment more than adult patients do.

• High rates of antibiotic prescription in children, especially for upper respiratory infections.

• Pediatric visits provide a controlled environment to study social interactions.

what are the two main issues that pediatricians and parents orient to in the visits?

• Treatability: Will the illness respond to treatment (e.g., antibiotics)?

• Legitimacy: Are the child’s symptoms real, serious, and warrant medical intervention?

In the vide Race Against Resistance, what happened to Tori?

Her skin infection did not respond to antibiotics due to bacterial resistance.

from the video and lecture, what are two ways people are approaching the problem of antibiotics not working in the video?

From the video and lecture, why is it particularly hard to develop new antibiotics?

• High cost and low financial incentive for pharmaceutical companies.

• Bacteria quickly develop resistance, shortening the effective lifespan of new drugs.

• Scientific difficulty: hard to find compounds that kill bacteria without harming humans.

what does the video on Opioids argue about who is responsible for the problem?

Multiple actors share responsibility — pharmaceutical companies, physicians, regulatory agencies, and patients.

what does Lembke argue about who is responsible for the overprescribing of opioids problem?

Emphasizes physicians’ role in overprescribing, but also acknowledges systemic factors (pressure to treat pain, patient demand, marketing).

how is the videos argument about who is responsible for overprescribing opioids align with and differ from Lembke’s argument about who is responsible?

• Similarity: Both videos highlight systemic and individual contributions.

• Difference: Lembke focuses more on physician decision-making and the culture of prescribing.

In lecture how is responsibility for opioid problem discussed?

• Responsibility is framed as distributed across actors:

  • Pharmaceutical industry marketing

  • Patient expectations for pain relief

  • Healthcare system pressures

  • Physician training and cultural norms

what does chapters 1-5 in Lembke’s book argue?

Historical and systemic rise of opioid prescribing; marketing, pain as “5th vital sign,” and initial underestimation of addiction risks.

what does chapter 8 in Lembke’s book argue?

How physician-patient interactions shape ongoing dependence and challenges in tapering opioids.

what does chapter 10 in Lembke’s book argue?

Stories of patients and strategies for managing withdrawal; highlights complexity of addiction and treatment.

Why did physicians start prescribing more opioids when they did?

• Pain was increasingly framed as undertreated (“pain as the 5th vital sign”)

• Pharmaceutical companies promoted opioids as safe and non-addictive

• Regulatory emphasis on patient satisfaction and pain scores

• Patients increasingly demanded relief, creating social pressure

• Lack of awareness about addiction potential

Why does Lembke discuss Karen?

• Patient who became dependent on opioids after prescriptions for chronic pain.

• Her story illustrates the difficult balance between treating legitimate pain and avoiding overprescribing.

• Shows real-world consequences of cultural and systemic pressures on physicians.

Who was Jim (Lembke)?

Patient who developed severe addiction from prescribed opioids.

Why does Lembke tell Jim’s story?

• To show how prescription opioids can escalate to dependence

• To show the challenges of treatment and recovery

What does the outcome of Jim’s story tell us?

• Highlights addiction can occur even with initially legitimate prescriptions

• Illustrates need for careful prescribing, monitoring, and patient education

What is the relationship between heroin and prescription opioids?

• Prescription opioids can serve as a gateway to heroin or illicit opioid use

• Reducing access to prescription opioids without treatment options can increase heroin use

According to lecture, how are pitch and creaky voice used when talking about pain?

• High pitch, creaky or strained voice can signal suffering or urgency

• Physicians perceive these cues when assessing pain levels

Based on lecture, what are ways that physicians can successfully recommend treatment from pain without opioids?

• Explain expected course of pain

• Symptomatic treatment: NSAIDs, acetaminophen

• Physical therapy, behavioral therapy

• Clear communication about limits of opioids and alternatives

• Patient education and reassurance

What was the primary finding of the White et al study discussed in class?

• Physician perception of patient characteristics affects opioid prescribing

• Subtle biases and social cues influence whether patients receive opioids

what were the findings of the Buchbinder study what explored requests for pain in the ER?

• Patients who explicitly request opioids more likely to receive them

• Shows patient behavior directly shapes prescribing

why do we care about the opioid crisis in this class?

• Demonstrates how physician-patient communication shapes public health epidemics

• Shows link between interaction, cultural authority, patient expectations, and treatment outcomes

• Fits the course theme: social interactions affect treatment, over- or under-prescribing, and population-level health consequences