Health Psychology: Patient-Provider Relations

The nature of patient-provider communications

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

“Issues” with other healthcare providers

• 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.

Nature of Patient-Provider Relations

• 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. 

Structure of the Healthcare Delivery System (in US; pretty same in the Philippines but not well-developed)

• 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

Provider behaviors that contribute to faulty communication

• 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

Patients’ contributions to faulty communication

• 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

Improving patient-provider communication

• 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.

The patient in the hospital setting

• 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.

Special issues in patient-provider relations

• 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.

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