Patient-Practitioner Relationship Studies

• The quality of the patient-practitioner relationship is related to the quality of interpersonal communication.
• McKinstry and Wang (1991) found that patients preferred male doctors in suits and ties, and female doctors in lab coats.
• 28% of patients were dissatisfied with doctors' attire.
• McKinlay and Ley (1988) found a positive correlation between time spent on the maternity ward and understanding of medical jargon.
• Patients may forget advice if it is full of jargon, complex, and the patient is stressed.

Evaluation of Patient-Practitioner Relationship Studies

• Doctors often incorrectly assume patients don't understand medical jargon, reducing the quality of the relationship.
• Increased understanding of verbal and non-verbal communication can improve the patient-practitioner relationship.
• Understanding can be improved by giving women a chance to demonstrate their understanding of advice.
• The research can be used to inform dress codes for male and female doctors.
• McKinlay's study used qualitative data, giving greater insight and improving the relationship.

Patient and Practitioner Diagnosis and Style

• Byrne and Long (1976) investigated doctor- and patient-centered styles in 2500 medical consultations.
• They identified 7 prescribing styles ranging from patient-stated to doctor-stated.
• Savage and Armstrong (1990) classified consultation styles into directing and sharing, based on 359 patients.
• Directing styles were associated with higher patient satisfaction due to better explanations.

Evaluation of Patient and Practitioner Diagnosis and Style

• There is a cultural bias because the findings represent a Western, individualistic culture.
• Medical consultations were recorded and coded into units for statistical analysis, drawing objective conclusions.
• Savage and Armstrong's independent groups design increased the reliability and validity of conclusions.

Practitioner Diagnosis: Type I and Type II Errors

• A Type I error is when the doctor incorrectly believes there is an illness/diagnosis, when in fact there is not.
• A Type II error occurs when the doctor incorrectly diagnoses the patient with no illness. -Errors are often present in original diagnostic tests/screenings as they are given to large populations due to their low cost.
• Robin and West (1992) found that the likelihood of committing errors increased when there was little patient self-disclosure.
• Safer et al (1979) investigated delaying treatment and identified appraisal delay, illness delay, and utilization delay.
• Appraisal delay is typically the longest at 4.2 days, while utilization delay is the shortest stage at 2.5 days.
• Barlow and Durand (2011) investigated hypochondriasis, finding it results from a trigger, apprehension, and increased focus on the body.
• Aleem and Ajarim (1995) investigated Munchausen syndrome, finding that it develops when patients pretend to be sick for attention.
• Child abuse and neglect may increase the likelihood of developing Munchausen syndrome.

Evaluation Types I and II Errors Studies

• Self-report measures rely on the accuracy and honesty of the respondents' memory and testimony.
• The sample size used by Safer et al was large, so the findings have large population validity.

Adherence to Medical Advice

• Non-adherence to medical advice can occur before, during, or after treatment, intentionally or unintentionally.
• Factors influencing adherence include the patient, treatment programmes, and health care provider.
• Non-adherence results in increased mortality and healthcare costs.
• Bulpitt (1994) stated that rational non-adherence occurs when the patient has rational justifications for non-adherence.
• Becker (1974) says that the Health Belief Model uses modifying factors to determine the likelihood of action.
• The Compliance Model (1974) includes the mother's psychological readiness to take action.
• Non-adherence can be measured by physiological tests, patient self-reporting, and monitoring progress.
• Regarding methods of measuring adherance, Riekart and Droter (1999) found significant bias in self-reporting
• Chung and Naya (2000) found pill counting to be a useful method of measuring adherence.
• Roth (1978) concluded that blood and urine samples were the most accurate measurement of adherence.
• Sherman et al (2000) found that pharmacy information was more accurate than doctors' judgments in repeat prescriptions.
• Ley (1988) suggest that the SIMPLE model can improve adherence via simplifying regimen characteristics.
• Yokley and Glenwick (1984) used money as an incentive and this improved practitioner style.
• Watt et al (2003) found that the Funhaler increased asthmatic children's adherence.

Evaluation of Adherence to Medical Advice Studies

• Becker's study operationalized adherence, increasing the validity of the findings.
• The findings may be culture-bound to Western, individualistic cultures.
• Self-report measures are quick but may be influenced by social desirability bias.
• Biochemical tests should be used in cases where the self-report measure is not in accordance with progress.

TrackCap

• The TrackCap, by Chung and Naya (2000), is a reliable, non-invasive method that can be used to establish usage patterns
• Useful because it can identify times in the day when patients are more likely to forget to take medication
• Yokley and Glenwich used longitudinal study so there was high temporal validity.
• However BPS ethical guidelines were breached because participants were deceived due to the nature of study

Pain

• Pain allows us to learn through conditioning, identify injuries, and limit activity. It can be explained physiologically, psychologically, or both through the Gate Theory.
• Acute pain is more painful, shorter, and appears more suddenly than chronic pain.
• Descartes stated that pain is perceived by the brain because of noxious event.
• Melzack (1965) stated that psychological gates can increase or decrease pain perception. Physical, emotional, and mental conditions can affect the gates
• Phantom limb pain occurs in 70% of amputees. Melzack suggested that the neuromatrix continues to respond to sensory stimuli from the lost limb.
• Most commonly, pain is measured through self-report.
• Intensity is measured through McGill Pain Questionnaire or observation, quality through deep and surface pain descriptions, and location through patients locating the pain's origin.
• The VAS (visual analogue scale) identifies intensity, while the McGill Pain Questionnaire (Melzack, 1975) measures sensory, affective, and evaluative aspects.
• Behavioural methods of assessment include the UAB Pain Behavioural Scale, measuring body language, mobility, and posture.
• Varni and Thompson (1987) suggested a paediatric Pain Questionnaire uses numbers, colours, and facial expressions.
• The Wong-Baker FACES scale uses 6 faces with numbers and expressions which symbolizing various degrees of pain.
• Surgery can be used to make lesions in areas of the brain affected by pain and there is pain relief medication i.e. biochemical methods such as painkillers used to create and inflammation relief
• Cognitive redefinition can help an individual achieve a more realistic perception of their pain.
• Morley, Shapiro and Biggs (2004) recommends attention diversion strategies like imagery, mindfulness, and discussing the patient's view on pain to alleviate its effect.
• Acupuncture and TENS stimulates releases endorphins and electrical stimulation in brain

Evalution of Pain

• A holistic approach effective as an explnation for pain and there is a real-life application of improves understanding via improved effectiveness of brain and nuerological pathways
• Gate Control Theory may lead to imagery development
• CBT is a useful way of managing pain that is non-invasive and does not depend on age.

Physiology of Stress

• Selye (1936) proposed the General Adaptation Syndrome (GAS): In the alarm reaction, the body immediatley reacts to the stressor; In the resistance stage, the body tried to resist through energy comsuption; And in the exhaustion stage the activity is triggered in the parasympathetic branch
• Animal studies support GAS' 3 stages, demonstrating the stress responses with exposed rats
• Acute stress: sensory nerouns sends information along hypothalamus. Hypothalamus then triggers the sympathic branch which promotes fight/flight
• Common effects of the acute stress reactions which includes release of adrenaline and Vasoconstriction
• Chronic stress: the HPA axis (Hypothalamic-pituitary-adrenal system), Produces more long-lasting effects. CRF (corticotropin releasing factor) results in more activity in pituatary gland which then releases stress hormome cortisol
• Early research on fight/flight can be guilty of beta bias because early lab mice used lab mice due to low hormones
• It reduces risk of young people's abandonmnet
• Stress: Improved treatments for Addison's Diease

Sources of Stress

• Sources of stress include life change. both positive and negative, may increase the need for physical psychological adaptaions
• There's a positive correlation between adaptation required and high levels of stress associated
• There is stress associated w/ life changing with LCU
• High stress levels will be seen in personel that experience highly stressful 6 months before deployment (1970)
• This means the higher the likelyhood of someone being ill
• It is important to account for individual circumstances because not all divorces are stressful for example
• Can't make assumptions: Life changes question validity as a source of stress becuase of its complex nature
• Research relies on correlational studies
• Cannot demonstrate "cause and effect relationoship". third variabile problem and hard to make casual conclusions
• Life changes
• Daily stress can be a greater effect on stress development
• It's made worse with financial ssues and health problems
• Each time we experience we go though primary appriasal and compare against secondary apprasial
• The scale used Kanner studies weather they were smaller source. Over 100% of participants completed a hassle scare
• Over researchers reported that daily troubles has positive relation more stressful than life changes.
• The "minor" trials were more stressful difficult to deal with and interact

Additional Considerations for Dailiy Hassles and Stressors

• Individuals daily interactions, like daily interactions, can have amplified/ overexaggerated effect from stressors.
• There could be different gender/ roles when applying this
• Researchers carried out daily/hasstles, carried our by Retrosepectively and rely on accuracy. More likely to have short memories and is comprimised

Workplace Stressors

• Workplace stress can have a relation to high workload and high control
• There can be more stress relating to disease as demonstrated by Bosmas
• Stress can also come from a Swsdish Imber production and the high the levels and responsibilties will lead to fatigue
• Maintaining controlled stress can be stressful but can also improve self-confidence.

Measuring Stress

• Measuring stress can be done via two self-report measures involving SRRS and the Hassles and Uplift Scale.
• SRRS is comprised of 43 items ranked with LCU and this is based of original sample form participants whom rated to with they had to adujst given the values
• The hassles scale was measured by knanner scale measuring the severtty
• This includes financial strains
• Third objective is by messuring physiological stress and the autonomic repsonse from electrodes attaching from middle fingers an increase in sweat results in greater conductance.
• There are signitifcant diffrences with taking global/ specifi approches when assessing stress. This is measured with Hasseles and Uplift Scale
• Some of theses scales can trigger validity as each participants understands them diffrently and can trigger a death