DEPARTMENT OF BEHAVIORAL SCIENCES
LECTURE SIX
HEALTH PSYCHOLOGY
content
Perceiving and interpreting symptoms
Barriers to effective use of health services
Patient-practioners relationship
Compliance and adherence
Perceiving symptoms
■ Symptoms perception is determined by both individual differences in
attention to ones body and by transitory situational factors that
influence the direction of ones attention.
■ When attention is directed outwards as by vigorous physical activities or
highly distractive environment, symptoms are less likely to be noticed.
■ Other factors determine perception may include
■ Individual personality differences: some individual characters are
more likely to perceive threat and notice symptoms than others e.g.
hypochondriacs and neuroticism also affects perception of symptoms.
■ Cultural differences
Perceiving symptoms
■ Cultural differences: there are reliable cultural differences in how
quick and what kind of symptoms are recognized
(kirmeyeandyoung.1998)
■ Attentional differences : attentional difference depends on people
are so much focused on themselves (their bodies, their emotions and
their reactions in general).are quicker to notice symptoms than people
who are focused boering jobs, socially isolated work outside homes
etc.
■ Situational factors :situational factors influence whether a person
will recognize a symptom e.g. a boring situation makes people more
attentive to symptoms than an interesting situation does. A symptom
is more likely to be perceived more on a day a person at home than
fully engaged in an activity.
Perceiving symptoms
■ Stress: stress aggravates the experience of symptoms ,people who
are under stress may believe that they are more vulnerable to illness
and so attend more closely to their bodies. Financial constraints,
disruption in relationships and other stressors lead to people believe
they are ill.
■ Mood: mood influences self-appraised health .people who are
positive mood rate themselves as more healthy ,report fewer illness
related memories and report more symptoms and more pessimistic
that any action they take would relieve their symptoms and perceive
themselves more vulnerable to future illness.
Interpretation of symptoms
■ Interpretation of symptoms is influenced by two major factors
■ Prior to experience: people who are experienced with a medical
condition estimate the prevalence of symptoms to be greater and
often regard it as less seriousness than those with no history.
■ Expectations: people may ignore symptoms they least expect than
those they do expect e.g. women who expect their menstrual periods
close may interpreted otherwise vague sources of discomfort as
premenstrual symptoms and those whose periods are several days
away may ignore the same symptoms.
Barriers to Effective Health Care Services
■ Without good health, it's difficult to enjoy the rest of what life has to
offer. That's why keeping yourself healthy or getting healthier should
be one of your top priorities. However, not all of us are able to access
healthcare effectively. It largely depends on where we live and who we
are.
financial resources. For people with high-deductible health plans or
those living in countries where they need to pay for healthcare out of
pocket, the issue of money is a very real one.
The inability of a clinic or hospital to gather enough supplies to deliver
proper medical treatment.
Barriers to Effective Health
Care Services
• Culture and believes spiritual or religious beliefs
• Unmet health needs
• Delays in receiving appropriate care
• Inability to get preventive services
• Hospitalizations that could have been prevented
The Doctor-Patient Relationship and Behaviour
Hippocrates viewed the physician as 'captain of the
ship'
and the patient as someone to take orders
patients are individual human beings with
problems that all to often transcend their
physical complaints.
The patient are not „cases” or „admissions” or
„diseases”
Why Does It Matter
• The patient-physician relationship is fundamental for providing and
receiving excellent care ,To the healing process, to improved
outcomes .
Therefore, it is important to understand what elements comprise the
relationship and identify those that make it "good, "because of the
rapidly changing environment that characterizes health care today,
we need to understand what physicians and patients must do to
protect and nurture the relationship.
Four Prototypes of Doctor-Patient Relationship
•Paternalism
•Consumerism
•Mutuality
•Default
Paternalism
• Traditional form of doctor-patient relationship
• Doctor takes on role of parent
• Doctor is the expert and patient expected to cooperate
• Tightly controlled interviewing style aimed at reaching an organic diagnosis
• Passive patient and a dominant doctor
• Focus is on care, rather than autonomy
The Paternalistic Approach
If I’ve told you once I told you
1,000 times, stop smoking!!”
The Paternalistic Approach advantages
•The supportive nature of paternalism appears to be
important when patients are very sick at their most
vulnerable
•Relief from the burden of worry is curative in itself, and
the trust and confident implied by this model allows
doctor to perform “medical magic
Mutuality
• The optimal doctor-patient relationship model
• This model views neither the patient nor the physician as standing aside
• Each of participants brings strengths and resources to the relationship
• Based on the communication between doctors and patients
• Patients need to define their problems in an open and full manner
• The patient has right to seek care elsewhere when demands are not satisfactorily met.
• Physicians need to work with the patient to articulate the problem and refine the
request
• The physician’s right to withdraw services formally from a patient if he or she feels it is
impossible to satisfy the patient’s demand
Advantages
• Patients can fully understand what problem they are coping with through physicians’
help
• Physicians can entirely know patient’s value
• Decisions can easily be made from a mutual and collaborative relationship
DISADVANTAGES
• Physicians do not know what certain degree should they reach in communication
.Is the patient capable of making the important therapeutic .
Consumerism
• we can simplify the complicated relationship with “buyer and seller” relationship, is it good or bad?
What is your opinion?
• The patient can challenge to unilateral decision making by physicians in reaching diagnosis and
working out treatment plans
• Reversing the very basic nature of the power relationship.
• PATIENT:
• Health shoppers so consumer behavior
• Cost-consciousness
• Information seeking
• Exercising independent judgment
• DOCTOR :Health care providers
• Technical consultant
Default
• When patient and physician expectation are at odds, or when the need for change in
the relationship cannot be negotiated, the relationship may come to a dysfunction
standstill.
Patient Centred consultation style
• Dr is less authoritarian , encourages patients to express their own feelings and
concerns , empathic , listen more than talk .
• Dr use open end questioning , show interest in psycho-social aspect of patient’s
illness
Length of Consultation
Average 8 minutes
Makes patient centred consultation styles more difficult.
Doctor-patient relationship in the past
• Paternalism Because physicians in the past were people who have higher social
status
• “doctor” was seen as a sacred occupation which saved people’s lives the advices
given by doctors were seen as paramount mandate.
• Doctor-patient relationship at present
• Consumerism and mutuality
• Patients nowadays have higher education and better economic status
• The concept of patient’s autonomy
• The ability to question doctors
Principal elements that are essential to the relationship:
1-COMMUNICATION
2-OFFICE EXPERIENCE
3-HOSPITAL EXPERIENCE
4-EDUCATION
5-INTEGRATION
6-DECISION-MAKING
7-OUTCOMES
Communication and Treatment
Advice reassurance and support from the doctor can have a significant effect on
recovery
• Seven Essential Elements in Physician-Patient Communication
• Build the doctor-patient relationship
• Open the discussion
• Gather information
• Understand the patient’s perspective
• Share information
• Reach agreement on problems and plans
• Provide closure
GNonverbal skills
gath
• Attentive and interested body posture
• Facial expression
• Appropriate eye contact
• Touch
Who are “difficult” patients?
What characteristics make a patient “difficult”?
• Mental health disorders
• Multiple symptoms
• Chronic pain
• Functional impairment
• Unmet expectations
• Lower satisfaction with care
• High users of health care services
Conclusion
• Relationship between patients and doctors are often unstated, and thy are
dynamic
• As conditions change, the kind of relationship that works best for a patient
may change
• Doctors and patients should choose a “relationship fit”
• effectiveness of the patient-physician relationship directly relates to health
outcomes.
An integrated approach to information gathering.
Seeking to identify physical psychological and social factors
Will likely to produce a better outcome of health care.
Compliance and Adherence
■Adherence
“The degree to which the person’s behavior corresponds with the
agreed recommendations from a health care provider.”
(World health organization)
Why adherence matters
Results of failure to adhere to prescribed medications:
Increased hospitalization
Poor health outcomes
Increased costs
Decreased quality of life
Patient death
Why don’t patients adhere
Complex therapies
Side Effects
Failure to understand the need for the medication
High out-of-pocket costs
Non Adherence
This simply means failure of a patient to follow medical instructions
and advice
EXAMPLES:
• Patient does not take his or her medicine at all
• Improper dosages are taken
• The medicine is taken along with un-prescribed drugs (including
traditional medicine). This can lead to adverse interactions.
• Not following advice on nutrition e.g. during pregnancy and lactation
FACTORS AFFECTING NONADHERENCE
• Personality of the patient e.g. some patients like to “rebel against authority”, denial
of disease
• Poor quality of doctor-patient interaction
• Cognitive factors e.g. forgetting, unclear instructions, too complex medications,
careless
• Uncomfortable side effects
• Drugs are too expensive (patient tries to “stretch” the medicine by skipping a dose)
• Patient frustration with being dependent on drug
• “Testing” by the patient
• Food taboos and beliefs – sickness, pregnancy, lactation, menstruation
Steps to improve non adherence
• Give clear and simple instructions
• Better doctor-patient communication and interaction (emphasize, repeat, be specific, etc.)
• Simplify the regimen if possible
• Prescribe cheaper generic drugs in place of expensive, branded drugs
• Inform patient about possible side effects
• Change the medication if severe side effects
• Explain about taking antibiotics properly
• Get family members to monitor adherence
• Doctor can also monitor adherence
• Deal with food taboos and beliefs
Remember
Partial adherence is better than total nonadherence
Important to educate patients about taking antibiotics properly i.e.
take the entire course
Be especially careful when prescribing to children, the elderly, and
the immunocompromised
Look out for serious side effects, adverse reactions and adverse
interactions!
■ THANK YOU FOR LISTENING.
