Psyc 365: Lecture 4

what are the Basic Models of Physician-Patient Interaction (Szasz and Hollender, 1956)?

1. Active-passive

2. Guidance-cooperation model

3. Mutual participation

Explain Active-passive from Basic Models of Physician-Patient Interaction ?

Situation in which patients are unable to participate in their care or make decisions because of their medical condition. Ex. severe injuries or coma

Explain Guidance-cooperation model from Basic Models of Physician-Patient Interaction ?

communication in which the patient seeks advice from the physician and answers the questions that are asked, but the physician is responsible for determining the diagnosis and treatment. Ex. sprained ankle or infection

Explain Mutual participation from Basic Models of Physician-Patient Interaction ?

the patient and physician make joint decisions about every aspect of care

• N.B. Care-seekers prefer being called patient to client

• Ideal relation between patient & doctors

• The typical physician-patient relationship is one in which the physician possesses a greater degree of power than the patient.

What are the 5 Communication patterns (Roter et al., 2000) ?

1. Narrowly biomedical - biomedical talk only, closed-ended medical questions and very little discussion of psychological issues

2. Expanded biomedical - biomedical talk with moderate levels of psychosocial exchange between physician and patient

3. Biopsychosocial - suggests that biological, psychological and social factors are all involved in any given state of health or illness.

4. Psychosocial - substantial psychosocial exchange between physician and patient. Current gold standard

5. Consumerist - the use of the physician as a consultant who answers questions rather than asking them.

What are the The Top 10 Physician Attributes Contributing to Patient Satisfaction in Rank Order ?

1. Always honest and direct

2. Listens to me

3. Encourages me to lead a healthier lifestyle

4. Does not judge; understands, supports

5. Someone I can stay with as I grow older

6. Tries to get to know me

7. Acts as a partner in maintaining health

8. Treats both serious and non-serious conditions

9. Attends to emotional and physical health

10. Can help with any problem

What are the 4 Factors in Physician-Patient Communication?

1. Information giving

2. Participation

3. General Patient Satisfaction

4. Malpractice Claims

Explain the Information giving Factor in Physician-Patient Communication?

Patients are generally dissatisfied-> want more information

Takes up 1 in 20 minutes of appointment

Explain the Participation Factor in Physician-Patient Communication?

More satisfaction and better recovery when patients get amount they want

Patient-physician mismatch can be harmful. Frequently result in an increase in the stress experienced by patients during medical procedures.

Explain the General Patient Satisfaction in Physician-Patient Communication?

Primarily a function of the quality of the physician-patient relationship

Non-verbal behaviours are more closely related to patient satisfaction than is verbal communication.

Explain the Malpractice Claims in Physician-Patient Communication?

Linked to patient dissatisfaction and poor patient-physician communication (e.g., information inadequacy, not listening, being dismissive, etc.)

Numbers are declining

What are Physician Behaviours Contributing to Faulty Communication?

• Inadequate rapport-setting.

• Interrupting too early.

• Use of medical jargon.

• Time factors

• when health care providers are aware that patients may not under baby talk and simplistic explanations

• patients and physicians do not always agree on the nature of the patient's chief complaint

What does research suggest to improve physician behaviours?

Some research suggests more patient satisfaction when: Longer visits, smaller patient volume

medical jargon

technical language used by a physician that is sometimes unintelligible to the patient.

Non-discrepant responses

• patient level.

when the physician responds to the patient's questions using the same sophistication of vocabulary that the patient uses.

Multilevel explanations

• educate patient.

explanations that use medical explanation using everyday language. health professionals may use medical jargon with their patients because they simply forget that their patients do not share the same medical vocabulary.

What are the Patient Behaviours Contributing to Faulty Communication?

• Patient deception. ~half withhold info from physicians for various reasons

• Lack of information seeking. most refrain from voicing questions or doubts

• Trouble Remembering. 60% cannot remember what physician said (sometimes because of anxiety)

What is social concordance in the context of patient-physician relationships?

Social concordance is based on similarity with respect to shared social characteristics.

What are examples of shared social characteristics that contribute to social concordance?

Ethnicity, gender, education, age.

Which type of patients prefer greater involvement in health-related decisions?

Healthier, younger, and better-educated patients.

What is the relationship between lower patient-physician social concordance and patient perceptions of care?

Lower patient-physician social concordance was associated with less favourable patient perceptions of care.

Do physicians provide more information to male or female patients?

Physicians provide more information and give more direct instruction to their male patients than to their female patients.

Compliance or adherence

The degree to which patients carry out the behaviours and treatments that physicians and other health professionals recommend.

Non-adherence

not following advice of health care professionals

Creative Non-adherence

intentional modification of recommended treatment

what are the Methods to measure patient adherence?

1. Ask health professional

2. Ask patient

3. Ask other people

4. Watch for appointment non-attendance

5. Count pills

6. Watch for treatment non-response

7. Examine biochemical evidence

what is the Frequency and Cost of Non-Adherence?

• Non-adherence rate

• Ranges from 25-50%

• Mostly medication non-adherence

  • Not filing prescriptions (due to costs, day-to-day changes in how one is feeling)

    • 80%+ not willing or unable to follow life-style changes

• Cost to Canadian~$ billions annually.

  • Ex. hospital spending, sick days, etc.

  • 5% of hospitalizations due to patient non-adherence

What factors predict adherence?

Illness and Characteristics of the Treatment regimen

-Changes in longstanding habits -Complexity and duration

-Side effects

-Obviousness of symptom(s)

-Patient characteristics (ex. age, gender, cultural background; mood/stress)

-Socioeconomic factors (e.g., cost of medications for seniors)

-Physician characteristics Ex. confidence in physician's abilities

-Physician-patient interaction

-Physician characteristics Ex. confidence in physician's abilities

-Physician-patient interaction: Poor communication

Improving Patient adherence

-Educational strategies Ex. package inserts, lectures, etc.

-Behavioural strategies: Prompts and reminders, Tailored regimen, Self-monitoring, Contingency contracting.

-Social and emotional support

Why is adherence important?

Consequences of not adhering to treatment recommendations: -20% of hospital admissions

-higher risk of developing health problems or of prolonging or worsening current disease

what are some Health-Related Resources Available on the Internet?

• Medical Articles and Reports

• Local services

• Health initiatives & health promotion

• Surveys

How to Assess the Quality of Health Info on the Internet?

Certain organizations provide "seals of approval" for health-related sites.

Advice to consumers:

1. On-line info cannot replace info received from health care practitioner

2. Put in work to discover the source of info

3. Demand quality assurances when buying

what are Implications for Patient-Physician Relationships?

• Patients are spending more time online.

• Physicians spend more time discussing info patients got from the Internet.

• Patients have different expectations of the health care system

• Patients and physicians may differ in their views on Internet info