Medical Malpractice Case

Medical Practice

• A patient is more likely to file a malpractice suit against a physician if they believe the doctor missed a diagnosis or have poor communication with the doctor.
• A patient's behavior when seeking medical care is influenced by their culture, previous experiences, physical and mental conditions, personality styles, and coping skills.

Seeking Medical Care

• Only about one-third of Americans with symptoms seek medical care, while most people self-medicate with over-the-counter medications and home management.
• Patients may fail to seek help due to stigma, but it is essential to seek help as there is a strong correlation between psychological illness and physical illness.

The "Sick Role"

• The "sick role" includes exemption from usual responsibilities and expectation of care by others, as well as working toward becoming healthy and cooperating with healthcare personnel.
• Critics argue that the sick role theory applies only to middle-class patients with acute physical illness and emphasizes the power of the physician.

Telling Patients the Truth

• Adult patients are generally told the complete truth about their diagnosis, management, and prognosis.
• Information must be given directly to the patient, and not relayed through relatives, unless the patient permits.

Special Situations

• Patients may be afraid to ask questions about embarrassing or fear-provoking issues, and physicians should ask about such issues openly and address them truthfully.
• Physicians have the primary responsibility for dealing with adherence issues and angry or complaining behavior by patients.

Adherence

• Adherence refers to the extent to which a patient follows the physician's recommendations.
• Patients need to recognize that their behavior or condition is problematic before they are motivated to change or seek medical care.
• The "Stages of Change" model refers to the point at which recognition and readiness to change occur.

Factors Affecting Adherence

• Adherence is not related to patient intelligence, education, sex, religion, race, socioeconomic status, or marital status.
• Adherence is most closely related to how well the patient likes the doctor.

The Clinical Interview

• Good physician-patient communication improves patient adherence to medical advice, detection of physical and psychological problems, and patient satisfaction.
• The physical setting for the interview should be private, with no obstacles between the physician and patient, and at eye level.
• The physician should establish trust and rapport with the patient, gather information, and educate the patient about the illness.
• The interview serves to obtain the patient's psychiatric history, including prior mental problems, drug and alcohol use, and sources of stress.

Interviewing Techniques

• Direct questions are used to elicit specific information quickly, while open-ended questions are more likely to aid in obtaining information about the patient.
• Open-ended questions give little structure to the patient and encourage them to speak freely.
• Examples of specific interviewing techniques are listed in Table 21.5.

Medical Practice

• A patient is more likely to file a malpractice suit against a physician if they believe the doctor missed a diagnosis or have poor communication with the doctor.
• A patient's behavior when seeking medical care is influenced by their culture, previous experiences, physical and mental conditions, personality styles, and coping skills.

Seeking Medical Care

• Only about one-third of Americans with symptoms seek medical care, while most people self-medicate with over-the-counter medications and home management.
• Patients may fail to seek help due to stigma, but it is essential to seek help as there is a strong correlation between psychological illness and physical illness.

The "Sick Role"

• The "sick role" includes exemption from usual responsibilities and expectation of care by others, as well as working toward becoming healthy and cooperating with healthcare personnel.
• Critics argue that the sick role theory applies only to middle-class patients with acute physical illness and emphasizes the power of the physician.

Telling Patients the Truth

• Adult patients are generally told the complete truth about their diagnosis, management, and prognosis.
• Information must be given directly to the patient, and not relayed through relatives, unless the patient permits.

Special Situations

• Patients may be afraid to ask questions about embarrassing or fear-provoking issues, and physicians should ask about such issues openly and address them truthfully.
• Physicians have the primary responsibility for dealing with adherence issues and angry or complaining behavior by patients.

Adherence

• Adherence refers to the extent to which a patient follows the physician's recommendations.
• Patients need to recognize that their behavior or condition is problematic before they are motivated to change or seek medical care.
• The "Stages of Change" model refers to the point at which recognition and readiness to change occur.

Factors Affecting Adherence

• Adherence is not related to patient intelligence, education, sex, religion, race, socioeconomic status, or marital status.
• Adherence is most closely related to how well the patient likes the doctor.

The Clinical Interview

• Good physician-patient communication improves patient adherence to medical advice, detection of physical and psychological problems, and patient satisfaction.
• The physical setting for the interview should be private, with no obstacles between the physician and patient, and at eye level.
• The physician should establish trust and rapport with the patient, gather information, and educate the patient about the illness.
• The interview serves to obtain the patient's psychiatric history, including prior mental problems, drug and alcohol use, and sources of stress.

Interviewing Techniques

• Direct questions are used to elicit specific information quickly, while open-ended questions are more likely to aid in obtaining information about the patient.
• Open-ended questions give little structure to the patient and encourage them to speak freely.
• Examples of specific interviewing techniques are listed in Table 21.5.