Health Psychology: Patient-Provider Relations

Who can be considered healthcare providers?

Advanced practice nursing:
  * Nurse practitioners – sees their own patients, provides routine medical care, prescribes treatment, monitors progress of chronically ill patients and sees walk-in patients (ALL UNDER THE SUPERVISION OF AN ATTENDING PHYSICIAN)
  * Certified nurse midwives
  * Clinical nurse specialists
    * Has specialties (surgical nurses, pedia, ICU, etc.)
  * Certified registered nurse anesthetists
    * Relatively new in the US, none in the Philippines
    * Can cover if there is shortage in anesthesiologists
Physician assistants
  * 2 year post-college program
  * 1st year courses are the same as medical students, 2nd year courses are Clinical Rotations with direct patient contact
  * requires at least 2 years of college and experience in health care before acceptance
  * Good alternative to med school because med school is expensive and too long
  * Didactic, lecture-based
  * Advantage: requires at least 2 years of college

Not popular in the Philippines
Redundancy of other health care professions such as psychiatrists, general practitioners, internists, etc.
Cannot practice on their own – needs to be “attached” to private medical practitioner
* Need someone to cosign med orders, etc.

Judging quality of care
  * Quality of care is often judged based on the MANNER IN WHICH CARE IS DELIVERED
    * How you deliver the diagnosis and how you establish rapport is important
  * If the provider is warm and/or friendly, patients often see them as “nice and competent”.
  * If provider is cold or aloof, patients see them as distant and incompetent.
  * Strike a balance between direct and gauge how straightforward you could be
Patient consumerism: Doctors are no longer seen as “all-knowing”; patients have increasingly adopted a consumerist or “patient as customer” attitude towards their health care.
Setting: Average visit lasts 12 to 15 minutes and patients are interrupted not even 23 seconds into their history.

Private, fee-for-service-care: paid for out of pocket by patient
* Usually called private patients
HMO (Health Maintenance Organization): employees and employers have an agreed upon monthly rate, and employees are entitled to use health services at either no cost or a greatly reduced rate. Employees/patients must be pre-approved in order to see a “within-network” specialist or non-emergency provider.
Preferred Provider Organizations: Network of doctors offers members a discounted rate, members do not need pre-approval to visit an in-network specialist

Overuse of jargon
Baby Talk
Nonperson treatment
* Instead of talking to the patient directly, the doctor will talk to the parents
Patient stereotypes: Black, Hispanic patients; Elderly, Sexism, Psychological symptoms
* Can come from both the patient and the healthcare providers

Patient characteristics: neuroticism, anxiety
* Neurotic: extremely pessimistic
* Highly anxious: they may project that anxiety unto you
Patient knowledge
* Explain why their side/knowledge is wrong and why your side is right
* Show concrete evidence to support your claim
Patient attitude towards symptoms: consider patient’s embarrassment, emphasis on symptoms that produce pain or limit movement
* Embarrassed: usually any kind of mental illness because of stigma (also cultural)
* pain/limited movement: harder to deal with

2-way training
  * Patients need to be able to express how they feel, their symptoms
  * Always take into consideration how you’re coming across
    * Can the patient understand you without dumbing it down?
Information-Motivation-Behavioral Skills Model of health behavior: One needs the right information, the motivation to adhere, and the skills to perform the behavior.

Cure: responsibility of the physician; goal is to restore patient to good health
Patient Care: orientation of the nursing staff; humanistic side of medicine; goal is not only to restore patient to good health, but also to help patient keep their emotional and physical states in balance.
Maintaining the Core of the hospital: responsibility of hospital administration; ensures smooth functioning of the system as well as the flow of resources, services, and personnel.

Burnout of providers
* More patients than providers
When the patient is a child – Best practice is to prepare BOTH the patient and their parents. Ensure the hospital environment is as caring as possible.