Chapter 9

Question 1

specialized functions of practitioners (and pros/cons of this)

Answer 1

• Because different services require vast amounts of knowledge, professionals specialize in one area
• • Ex. GPs, pediatrics, cardiology, neurosurgeons, dermatologists, gynecologists, psychiatrists, etc.
• Advantage: patients receive greatest amount of expertise available for each health problem
• Disadvantage: specialists don’t always communicate with each other about a patient, and may only work with patients briefly -> impersonal

Question 2

office-based and in-patient treatment

Answer 2

• GP’s office: receive treatment or be referred to specialists or hospitals
• Hospitals: in-patient treatment; treat people with serious illnesses who require medical attention either continuously or involving complex equipment
• Nursing homes: in-patient care for those who need long-term medical and personal care; typically the elderly
• People are now relying less on inpatient care because it’s so expensive -> using outpatient or home healthcare services instead

Question 3

Canadian Healthcare System (and how it differs from other countries)

Answer 3

• Healthcare costs are paid for by Canada’s publicly funded health insurance program (Medicare)
• • Regulated on a province-by-province basis -> funded health services differ throughout the country (ex. Fertility treatments funded in QB, but nowhere else)
• Canada is only country whose universal healthcare system doesn’t cover prescription drugs; vision and dental care not covered either -> often covered by private insurance plans
• Issues involving access to care and long wait times for hospital care, surgeries, or seeing specialists
• Other countries also have universal healthcare (ex. Australia, Germany, Sweden), but some don’t (ex. USA), and countries differ in what their universal healthcare system covers

Question 4

Factors that impact perception of symptoms

Answer 4

• Individual differences: Some people have more symptoms than others, higher pain tolerance, and pay more attention to internal states than others -> heightened awareness of body sensations
• Competing environmental stimuli: High degrees of environmental stimuli (ex. Exciting, overwhelming sensory info) can reduce ability to pay attention to internal stimuli
• Psychosocial influences: perception of body sensations can be influenced by cognitive, social, and emotional factors (ex. Placebo effect, or nocebo effect – perceiving side effects not actually caused by the drug)
• Gender and sociocultural differences: Reporting of symptoms varies by cultural group (ex. Asians report more physical symptoms with psychological bases, black individuals delay treatment longer, etc.); women have lower pain tolerance than men

Question 5

how to people interpret and respond to symptoms?

Answer 5

• Making correct decisions to seek medical care often relates to prior experience of similar problems (but sometimes it can lead to incorrect interpretations too)
• We create “commonsense models” or cognitive representations of illnesses based on experience and what we read about illnesses
• Fear can act as a motivator to seek treatment, or make you avoid treatment
• Can be influenced by a lay referral network (nonpractitioners who provide info – ie. Your friend telling you you should get that rash checked out)

Question 6

4 elements of creating a “commonsense model”

Answer 6

• Illness identity (name and symptoms)
• Causes and underlying pathology (how one gets the disease)
• Timeline (prognosis)
• Consequences (seriousness and outcomes)

Question 7

who uses health services?

Answer 7

• People with health risks like obesity use healthcare more than others
• Age and gender: children and the elderly use physicians more; females use physicians more
• Sociocultural factors: Advantaged groups use physicians more; Aboriginal people, recent immigrants, and people with low SES use physicians less (feel less susceptible to disease, have less access to physicians, language barrier may be in effect)

Question 8

factors influencing why people use, don’t use, or delay using health services

Answer 8

• Iatrogenic conditions: developing health problems as a result of medical treatment -> can lead to a distrust of physicians that reduces use of health services
• Patients can also lose trust in physicians if they feel stigmatized or fear breach of confidentiality
• Health belief model: perceived threat of illness must be high, and the perceived benefits of getting treatment must outweigh the perceived barriers or doing so in order to seek treatment out
• Social and emotional factors and seeking medical care: people with depression/low energy, who are embarrassed, or who are male tend to avoid medical care; people who are fearful or experience “sanctioning” (when friend insists they get treatment) more likely to seek care quickly (unless they’re afraid of the pain of treatment)
• Treatment delay: time between a patient first noticing symptoms and seeking medical care

Question 9

3 stages of treatment delay

Answer 9

• Appraisal delay: am I sick? Sped up if there’s severe pain/bleeding
• Illness delay: do I need professional care? Sped up if symptoms are unfamiliar
• Utilization delay: is that care worth the costs? Sped up if not concerned about cost, or felt like they could successfully be treated

Question 10

Complementary vs. Alternative medicine

Answer 10

• Complementary medicine: methods used along with conventional treatments
• Alternative medicine: used in place of conventional treatments

Question 11

4 main types of Complimentary and Alternative Medicine (CAM)

Answer 11

• Manipulative/body-based methods (ex. Massage therapy)
• Natural products (ex. Supplements and herbs)
• Mind-body interventions (ex. Progressive muscle relaxation)
• Other CAM practices (ex. Energy fields, homeopathy, traditional Chinese medicine, etc.)

Question 12

2 types of problematic health service usage

Answer 12

• People who over-use health services
• • Ex. Hypochondriacs: interpret real but benign bodily sensations as symptoms of illness; worry excessively about health, and make frequent medical complaints; have high levels of neuroticism
• People who have real health issues that medical technology cannot detect
• • Ex. People with Chronic Fatigue Syndrome

Question 13

factors that influence patient-practitioner relationship

Answer 13

• patient preferences for participation in medical care
• practitioner’s behaviour and style
• patient’s behaviour and style

Question 14

factors that influence patient-practitioner relationship: patient’s preferences for participation

Answer 14

• a mismatch can lead to discomfort and wanting to switch doctors
• women and younger adults tend to want to be more involved and learn more info about their illness

Question 15

factors that influence patient-practitioner relationship: practitioner’s behaviour and style

Answer 15

• Doctor-centered: brief exchanges requiring brief answers, focusing on first problem person mentioned
• Patient-centered: asking more open-ended questions, allow patient to provide more information, avoid medical jargon -> preferred and make more effective diagnoses
• People prefer doctors who are competent but also sensitive, warm, and concerned

Question 16

factors that influence patient-practitioner relationship: patient’s behaviour and style

Answer 16

Doctors dislike patients who don’t follow their treatments, wait too long before contacting them, insist on unnecessary treatments/procedures, make sexually suggestive remarks, or are vague/unclear when describing their symptoms -> these can lead to less effective relationship, and quality of care can suffer

Question 17

adherence vs. compliance

Answer 17

• Adherence: the degree to which patients carry out treatments; suggests collaborative nature of treatment
• Compliance: the degree to which patients carry out treatments; suggests reluctantly obeying

Question 18

the non-adherence problem

Answer 18

• Patients may fail to adhere to various aspects of medical advice (ie. Recommendations for meds, diet)
• Patients may violate advice in different ways (ie. Not following recommended dose, discontinuing meds before they’re supposed to)
• Average rate of nonadherence is about 40%

Question 19

characteristics that influence non-adherence

Answer 19

• Illness or regimen: changing long-standing habits, doing complex regimens, long durations of regimens, high costs, and negative side effects reduce adherence
• Person:
• • Age, gender, and socio-cultural factors can influence (ie. Young patients less likely to follow, Aboriginal patients may be less likely, etc.)
• • Psychosocial aspects: ex. Health belief model; Affected by cognitive and emotional factors, as well as social support and self-efficacy
• Interactions between patient and doctor

Question 20

rational non-adherence

Answer 20

not adhering to a treatment regimen for valid reasons (ex. If medication gives them serious side effects)

Question 21

how can patient-practitioner interactions affect adherence?

Answer 21

• Communication/directions may be unclear and leave too much to the patient’s (often incorrect) interpretation
• Practitioners with patient-centered style increase adherence
• Practitioners seen as a culturally insensitive by patients reduce adherence

Question 22

why is it important to increase adherence?

Answer 22

because nonadherence increases risk of developing new health problems or worsening current ones -> higher mortality rate

Question 23

ways to improve adherence

Answer 23

• Improving physician’s communication skills (ie. Through brief workshops that teach doctors how to simplify instructions, having patients repeat them, providing written instructions, etc.)
• Interventions directed at patients: have patient explicitly state they will comply, send follow-ups/reminders, motivational interviewing, ensuring social support, tailoring regimen, self-monitoring, behavioural contracting

Question 24

chronic care model and its 6 elements

Answer 24

• Chronic Care Model: uses 6 methods to promote primary prevention
• • Organization of care: healthcare system prioritizes primary prevention (like identifying smokers and helping them quit)
• • Clinical information systems: having regularly-updated, easily accessible data in client’s files
• • Delivery-system design: physicians initiate preventive interventions (ex. Counselling for stopping smoking) carried out by non-physicians
• • Decision support: providing staff with guidelines, training, and reminders to identify clients who need intervention
• • Self-management support: providing info and referrals to clients and their families to help them recognize the need for prevention
• • Community resources: making use of self-help organizations and supporting public health programs

Question 25

medical students' disease

Answer 25

as med students learn more about diseases, 2/3 of them incorrectly believe they have one

Question 26

mass psychogenic illness

Answer 26

widespread symptom perception across individuals without any medical basis (usually starts after a strange odor or seeing someone pass out -> chain reaction)