PSYC 314 - Lecture 7

Describe the main features of the treatment and care context.
1. Anxiety and fear impact physiological systems and cause us to seek care (either through health behaviour or coping).
2. When we are sick we adopt the Sick Role, a certain set of rights, obligations, and expectations one gets when they are sick.
  1. This complicates things since people may take advantage of the rights the sick role gives and not make an effort to get better.
3. Illness brings secondary gains, such as sympathy or time off school/work.
4. The Social Context (Personal & Professional).

Summarize key factors in the use and misuse of health care services.
1. Using Health Services.
  1. A series of health and illness-related behaviours before using the healthcare system.
  2. Perception - detect or perceive symptoms. (Awareness).
  3. Interpretation - interpret symptoms as potentially threatening (Illness, injury, or disease is inferred).
  4. Decision - decide that medical attention or health care is needed (Intention is set).
2. Stages of Delay.
  1. Appraisal - time it takes to appraise a symptom as relevant to health.
  2. Illness - time between appraisal and deciding to seek out medical attention.
  3. Utilization - time between deciding to seek medical attention and actually getting it.
3. The Worried Well.
  1. The “worried well” refer to those who are unnecessarily anxious about their health (in the absence of a related diagnosis). They tend to misuse health services.
    1. Neuroticism is a significant predictor.
  2. Concerns about the worried well have remerged during COVID-19.
4. Lay Referral Network.
  1. Before people decide to seek medical attention for their symptoms, they typically get advice from friends, relatives, or co-workers (their “lay referral network”). These people may…
    1. Help interpret a symptom.
    2. Give advice about seeking care.
    3. Recommend a remedy.
    4. Recommend talking to someone else.
5. Going Online.
  1. Nearly 3/4 Canadians go online to find health related information, and over half use the internet to self diagnose.
6. Medical TV Shows.
  1. 80 recommendations were randomly selected from the Dr. Oz Show and The Doctors (each), which were then evaluated by experienced evidence reviewers.
  2. Approx. 1/3 to 1/2 of the recommendations made were based on good science.
Identify and provide examples of sociocultural factors using health services (I.e., gender, SES, indigenous identity, stigma).
1. Accessing Health Services.
  1. The majority of Canadians (15+) who need health care (over 70%) do not report any difficulties with access.
    1. What groups report more difficulties? Women, LGBTQIA+ individuals, Indigenous people, Immigrants, low-income Canadians, and those reporting poor or fair health.
  2. Canadians DO experience longer than average wait times and continue to perform below the international average in access to care (among rich developed nations).
    1. Even before the COVID-19 pandemic, Canada had the longest wait times for ER visits and non emergency surgeries out of 11 countries studied. Wait times have worsened since the pandemic.
2. How is gender related to use?
  1. Both women and gender-nonconforming people (trans, non-binary) report more difficulties accessing and using health services. Reasons could be:
    1. Stigma.
      1. I.e., belief that women make up or exaggerate their symptoms because they are hormonal and emotional rather than being taken seriously.
        Maybe because historically most research has been done on men.
    2. Women / people with uteruses use health services more frequently.
    3. Lack of physician training on reproductive + gender related health care.
    4. They more often report not feeling respected by doctors and nurses.
    5. They are also less likely to be adequately treated by doctors.
    6. Financial limitations (lower wages, unemployment).
3. How is SES related to use?
  1. Lower SES Canadians use medical services less than upper SES.
    1. Maybe due to barriers to accessing healthcare.
  2. Canadians with lower income and education who do use medical services make more doctor visits per year (as well as more ER visits) than higher SES Canadians.
  3. Low-income Canadians tend to have longer wait times in hospitals than their high income counterparts.
  4. Immigrants in Canada also report longer wait times than non-immigrants.
4. How are indigenous people affected?
  1. Language and culture have been cited as key barriers to accessing health care systems.
  2. Canada’s health care system is poorly equipped for addressing and accommodating the unique cultural needs of Indigenous people.
  3. Practitioners are also poorly educated on the social and economic determinants of Indigenous peoples’ health.
  4. Lack of transportation and childcare services, and a lack of services in the area are also factors.
  5. Also, racism, discrimination, and stigma interfere with willingness to seek treatment and contribute to health outcomes.
5. The Role of Stigma.
  1. Social stigma can also interfere with the use of health services.
  2. Stigma may arise due to belonging to a stigmatized group, being diagnosed with a stigmatized disease or disorder, or just being sick.
  3. Many healthcare professions tend to carry their prejudices into their workplace.
  4. Stigma has negative outcomes for what people think about a disease but also how it spreads.
6. People with Disabilities.
  1. People with disabilities (physical, cognitive) face numerous barriers to accessing healthcare; stigma is widespread.
  2. There persist many incorrect assumptions about health and health care needs.
  3. People with disabilities are often excluded from health care initiatives.
    1. I.e., they are left out of sexual health initiatives because of the assumption that they are not sexually active.
7. People with HIV/AIDS.
  1. Many diseases and illnesses are stigmatized, making things more difficult for patients.
  2. People with HIV might be afraid of judgment for being HIV positive.
    1. This may deter them from seeking out health services.
    2. This may make them uncomfortable with disclosure.
  3. Stigmas deter people away from educational resources and/or having conversations about HIV.
  4. People may be afraid to get tested out of the fear of potentially testing positive.
    1. HIV is wrongly associated with gay men (another stigmatized group).
Identify key factors in patient-provider interaction and communication.
1. Things that a patient can do that may be problematic or impede communication:
  1. Wait too long to see a doctor.
  2. Be a passive consumer (not listening).
  3. Insist procedures are unnecessary.
  4. Express too much concern.
  5. Describe symptoms inaccurately.
  6. Omit or falsify information.
    1. This may be due to stigmas and fear of disclosure.
    2. Social desirability; patients may want to seem “desirable” in front of the doctor.
  7. Insist on procedures, medications, or certifications that are unnecessary.
  8. Fail to follow recommendations.
2. Patients can be divided into two groups based on how much health information they want:
  1. Monitors: more concerned and worried about an issue.
    1. Monitors will seek information, I.e., people who do research outside the doctor’s office.
    2. To motivate monitors, provide messages that include detailed information about risks and strategies.
  2. Blunters: overwhelmed by threatening information.
    1. Blunters will avoid information.
    2. To motivate blunters, keep messages short, succinct, non-threatening, and in simple terms.
Compare doctor-centred and patient-centred communication.
1. Things that a practitioner can do that may be problematic or impede communication:
  1. Not listening to the patient.
  2. Focusing on the first problem mentioned.
  3. Asking only yes-no questions.
  4. Depersonalizing the patient (I.e., no eye contact, cold or neutral emotion).
  5. Using too much medical jargon.
  6. Using baby talk, elderspeak, or overly simplistic explanations.
2. Patient-Centred Communication - care providers try to see the problem and treatment as the patient does (empathy), and in so doing enlist the patient’s cooperation.

Explain the possible role of empathy in practitioner burnout.
1. Compassion Fatigue - emotional exhaustion due to frequent/difficult patients.
2. Burnout - condition that results from chronic work strain, involves 3 main components:
  1. Emotional exhaustion: no more capacity to be emotional with patients.
  2. Depersonalize: not seeing patients as people.
  3. Low sense of personal accomplishment.
3. There is actually more evidence of a negative correlation between empathy and burnout.
  1. Empathy can make work more meaningful; as people are empathetic, they feel less burnt out.
  2. Burnout causes a decline in empathy.
4. Hojat et al. recommends engaging in clinical empathy: understanding the inner experiences and perspectives of the patient as a separate individual, and communicating this to them.

Identify and describe key factors in patient satisfaction.
1. Patient Satisfaction.
  1. Several factors contribute to patient satisfaction in a care setting.
    1. Technical quality of the care.
    2. Quality of interaction with practitioner.
    3. Sense of autonomy and informed consent.
      1. I.e., perceived control.
    4. Wait times.
    5. Attitudes of health care professionals.
    6. Environment.
    7. Effectiveness / outcomes of a treatment.
    8. Coordination among healthcare professions.
      1. I.e., not having to repeat oneself.
2. Satisfaction in Canadian Hospitals.
  1. Canadian Institute for Health Information (CIHI) identified 3 key factors in patient satisfaction.
    1. Communication: listening carefully, explaining things effectively.
    2. Coordination and communication among care providers.
    3. Support and planning for leaving the hospital.
3. The Physical Space - single bed hospital rooms result in better physical and mental health outcomes for patients.
  1. Reduced risk of infection from others.
  2. Improved privacy.
  3. The exception to this is when someone shares a room with someone who is or has gone through the same thing.
    1. This is the only time that shared rooms are as good as single rooms.
  4. There are also benefits with having a window / view of nature in the room:
    1. Improves satisfaction and reduces anxiety / pain.

Explain the role of patient satisfaction in health outcomes.
1. Patient satisfaction has been correlated with:
  1. Reduced hypertension.
  2. Fewer complications after surgery.
  3. Reduced mortality.
  4. Improved patient compliance / adherence.
  5. Improved use of health services.

Define, provide examples of, and note concerns associated with CAM.
1. Alternative Health Services.
  1. Alternative medicine: any practice that has claims of health benefits but is not backed by science; used in place of conventional treatment.
    1. Complementary medicine: alternative medicine used in conjunction with conventional medical treatment.
    2. CAM: complementary and alternative medicine.
    3. Anytime ANYTHING makes scientific health claims without evidence to back it, it is an alternative treatment.
2. CAM can be classified into different types.
  1. Manipulative and body-based methods: massage therapies, chiropractic care, etc.
  2. Natural products: herbal products, vitamin and mineral supplements, and other dietary supplements.
  3. Mind-body interventions: yoga, meditation.
3. Other CAM Practices.
  1. Homeopathy - applying diluted substances that produce symptoms in healthy people like those the ill person has.
    1. I.e., “like” cures.
    2. Most homeopathic treatments are just water or salt.
    3. Homeopathy is no better than placebo.
  2. Some Traditional Chinese Medicine practices.
4. Concerns about CAM that have not been supported by science.
  1. Some CAM have harmful side effects.
  2. People are profiting from false claims about CAM effectiveness.
  3. People may forgo evidence-based treatment in favour of CAM.
Identify key factors that may lead people to use CAM.
1. An estimated 70% of Canadian adults use CAM, with natural products such as vitamin and mineral supplements being the most frequent.
2. Factors that lead to the use of CAM.
  1. Lack of a solution in conventional medicine.
  2. Less wait time, better communication.
  3. Better patient experience.
  4. People prefer to ingest things that they perceive as “natural.”
    1. I.e., plants over drugs.

Explain the placebo effect (including how placebos are used in RCTs) and identify key factors.
1. Placebo: any medical procedure that produces an effect in a patient because of what a patient expects and not because of its chemical / physical properties.
  1. Ranges from drugs to surgery to psychotherapy.
2. Every drug is assumed to have a placebo effect; how do we make sure that there is an effect beyond the placebo?
  1. We can run an experiment in which the control group gets a placebo so that anything different in the experimental group is attributed to the physical / chemical properties.
  2. Randomized Clinical Trials (RCTs) are designed to measure the efficacy of a drug under optimal conditions; typically using a control group.
    1. The placebo effect is especially problematic in RCTs, as it causes confusion about the underlying causes of any observed effects. If a new drug is observed to have an effect, it is unclear how much of that effect is due to the placebo effect, which is assumed to occur with any treatment.
    2. As such, a placebo effect must be created in the control group (by giving them a placebo - an inert substance). If a significantly greater effect is seen in the experimental group (compared to the placebo control group), we can assume it is due to the drug’s physical / chemical properties.
3. The shape, size, colour, taste, and quantity of a drug influences its effectiveness; the more a drug seems like a medicine, the more effective it will be.
  1. Green and blue pills are associated with sedative effects.
  2. Yellow and red are associated with stimulant effects.
  3. White pills are associated with pain meds.
  4. Capsules are considered more effective than tablets.
4. The more that a setting and / or practitioner looks like they fit (I.e., looks like a doctor and doctor’s office), there will be a stronger effect.
  1. Providers who exude warmth, confidence, and empathy get stronger placebo effects than do remote and formal providers.
  2. The provider’s faith in the treatment is another influence on the effectiveness.
5. Patients can actually KNOW that something is a placebo and still experience effects but ONLY if they are told that some people experience benefits.