Week 12 Patients and Doctors PDF

MED 104-Medical Psychology Doctors and Patients Dr Stelios Georgiades, AFBP’sS, C.Psychol, Professor of Clinical Psychology  Learning Objectives 1. Outline...

MED 104-Medical Psychology Doctors and Patients Dr Stelios Georgiades, AFBP’sS, C.Psychol, Professor of Clinical Psychology  Learning Objectives 1. Outline the impact of psychological principles in doctor patient contact and communication. The meeting between the patient and the doctor is in many ways the focal point of all medical practice. Many studies have investigated the nature of this interaction and its effects on the eventual outcome. These studies have provided some revealing insight into the behaviour of the doctor and patient during the process of consultation. Factors Influencing the Behaviour of patients and doctors The term “health related behaviour” is used to cover a wide variety of behaviours concerned with aspects of health and illness. It includes - daily behaviours with health implications (e.g., diet), - preventive behaviours (e.g., attending dental checks ups, screening), - risk avoidance (giving up smoking, limiting alcohol consumption) and - specific behaviours in relation to symptoms and illnesses (e.g., self-medication, seeking medical help, adhering to medical advice). One very striking characteristic of these behaviours is how much they vary from person to person. Why is that? A simple explanation is biological. This means that people seek medical help more than others because the ones that seek more help are the ones with the more severe symptoms. The evidence however, fails to support this explanation since there is very little evidence in the health status of attenders and non attenders at general practices. This indicates that there must be some other alternative explanation to this pattern of behaviour of patients.  Past Experiences – Negative experiences yield less attendance Health attitudes and Behaviour Examples: - the degree of interest in and concern with health - the belief of one’s susceptibility to a particular illness - beliefs about the severity of particular illness - beliefs about the benefits and costs of a particular health action - beliefs about the efficacy of a particular health action  Differences between doctors. Research shows that although all medical doctors have a common training there are consistent differences between doctors on their approach to patients. Studies showed that doctors are divided into two major categories: - Those who are primarily concerned with technical aspects of illness. - Those who are interested in psychosocial aspects of illness.  These two positions are not necessarily mutually exclusive but it seems that doctors fall into one of these two categories. Although is still unknown as to how these differences between doctors develop it seems that is a combination of individual personality characteristics which are either developed or supressed in medical school and subsequently during training. Communication and their effects The quality of medical care depends on the interaction of doctor and patient and there is abundant evidence showing that in current practice this interaction is disappointing to both parties. Complains from Patient’s Perspective. Lack of information Communication gap Poor recall Low Empathy Activity/Passivity Comments from Doctor’s Perspective. Low compliance Poor information Lack of Information: A very large proportion of patients complain that they are not given enough information by those who are treating them. Example: Patients want to know what is actually wrong with them and what will happen to them, in terms of the type of treatment and the sorts of changes that will occur. The question of giving explicit information about illness. Communication gap and lack of compliance A common problem area described is that of communication gap. This refers to information which passes to and from the patient but which is either not understood or understood in a different way by the doctor and the patient. Usage of technical jargon by doctors Patients flattered by the fact that high technical language is used but fail to understand Patients do not ask for further clarification out of fear that the doctor might think of them as being stupid. One of the major problems that usually arise as a result of communication gap is low compliance. This can be attributed to Poor recall of information/advice given due to the complexity of language used Failure to understand the doctor’s advice leads to reliance on the patient’s perception of severity of illness Good communication between doctor and patient often leads to high opinion of doctor and therefore high compliance whereas poor communication leads patients to have low opinion of doctor and hence poor compliance. Patient Interviewing Guidelines Opening the Interview Encouraging and prompting the patient Support and reassurance Showing empathy Throughout the interview there should be good non-verbal communication in the form of good eye contact, good physical distance, posture, gesture, voice, (tone rate and fluency of speech) body movement etc.