Health Psychology (4)

1. Health Psychology (4) Christine L. Whitley

2. After studying Chapter 2and 3, students should • State the four basic premises of medical care Understand the issues surrounding disclosure of information within the medical setting • outline the ways in which technological advances have changed the way we communicate during medical encounters • Be familiar with the three basic models of physician-patient relationships and the variations of these models • Know the three basic components of the medical care visit, and what occurs during each segment • Be familiar with structured frameworks that foster the collaborative process Be able to list the elements that complicate medical interactions • Know the most common consequences of imprecise communication • Understand the strategies that patients can use to improve the quality of the communication with their physicians and health care practitioners • Be able to identify specific nonverbal cues that are often used by patients and practitioners • Be able to summarize the important elements of good bedside manner • Know the three factors that comprise the construct of empathy • Understand how self-fulfilling prophecies and optimism can influence medical outcomes • Be able to summarize the average differences between male and female physicians, and between older and younger physicians

3. Premises of medical care; Cassell Communication • 1. Doctors treat patients, not diseases • 2. The body has the last word • 3. All medical care glows through the physician-patient relationship • 4. Spoken language is medicine’s most important tool The patient's well-being is what ultimately matters, not just the diagnosis

4. Communication can bring doctor and patient to a mutual understanding about the patient’s illness and an agreement about how to approach it • 1. Each person’s communication’s skills are important • 2. each person’s views and beliefs about the illness are important • Patients are more satisfied when communication with physicians is good

5. Technology and communication Technological communication vs. natural communication? Medical information available on the internet. Globalization of the data-based researches Telesurgery: the surgeon is in one place and the patient in another place, and the team practice under the supervision of the surgeon More… but better? More media = more knowledge needed = more responsibilities!

6. Disclosure of information is one important philosophical viewpoint • 1. Some patients want all of the information related to their illness; others prefer to play a more passive role, receiving less information. • 2. Some physicians believe that patients should know the details of their illness and prognosis, others believe that some things should be kept from the patient. • 3. research shows that most patients want to be involved in their own care

7. 3 Models of the physician-patient relationship • 1. Active-passive • 2. Guidance-cooperation • 3. Mutual participation Variations: Ballard-Reish: patient abdication, patient autonomy, collaborative, and relationship termination Roter and Hall: paternalism, consumerism, default, and mutuality

8. Active-passive model: Full responsibility rests with the physician, and the patient is the passive recipient of care

9. Guidance-cooperation Interaction in which major responsibility rests with the physician, but the patient does contribute information that the doctor can use

10. Mutual participation Describes interaction in which physician and patient share responsibility, collaborating in the decision-making process

11. Medical care visit: 3 parts • History • Open-ended, closed-ended, or focused questions • Attention to the medical jargon • Natural communication lost in training? • Physical examination • Separation between the patient and the physician • Recommendations • Attention to the medical jargon • Expectations on the diagnosis and treatment plan • Collaborative choices: responsibility, autonomy, satisfaction, observation of outcomes, structures • Decision trees, and PREPARED • Reassurance from the physician P: Procedure (treatment) R: Reason E: Expectations P: Probability A: Alternatives R: Risks E: Expenses D: Decision

12. If only we could communicate…

13. Things that complicate medical interactions: • 1. Time constraints place limits on both patients and their doctors • 2. Patients’ anxiety about illness can interfere with effective communication • 3. Differences in the perspectives of patients and practitioners may result in communication difficulties • 4. Jargon complicates verbal interchange between practitioners and patients

14. Interview: Sources of Motivation • Biological factors: needs for food, water and proper temperatures • Emotional factors: panic, fear, anger, love and hatred • Cognitive factors: perceptions, beliefs about yourself, and expectations about others • Social factors: parents, teachers, siblings, friends and television

15. First Impressions • Schemas about people shape first impressions of them. • This impression influences later perceptions of their behavior and one’s reactions to it. • First impressions: • Are formed quickly. • Usually change slowly. • Typically have a long-lasting influence.

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17. Nonverbal communication • Posture • Hand gesture • Facial expression and eye contact • Voice quality • Personal appearance

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34. We don’t need subtitles, do we?

36. Types of Attributions • Internal Attribution: The behavior is due to characteristics of the person. • External Attribution: The behavior is due to aspects of the situation.

37. Biases in Attributions • Fundamental Attribution Error: The tendency to overattribute the behavior of others to internal factors. • Actor-Observer Bias: The tendency to attribute one’s own behavior to external factors, especially when the behavior is inappropriate or inadequate. • Self-Serving Bias: The tendency to take personal credit for success but blame external causes for failure.

38. Shoulder shrug • Sign of submission

39. Hand-to-face gesture • You are not convincing your audience…

40. Crossed-Arms-on-Chest • He is not coming out and you are not coming in

41. Thumbs • Displays confident, authoritative attitudes

42. Show me where you look and I can tell you what you are thinking about… Recalling a picture left Recalling a sound Recalling a feeling Talking to oneself right

43. Setting arrangements • The corner position: friendly, casual conversation

44. Setting arrangements • The cooperative position: working together

45. Setting arrangements • The competitive defensive position

46. Setting arrangements • The independent position: don’t want to get involved

47. Consequences of imprecise communication • Patients may become confused and more apprehensive about their illness • Patients are less likely to adhere when the importance of, and directions for, adherence are not emphasized ( - health outcomes) • Patients are less satisfied with the medical care that they receive

48. Can patients improve the quality of communication? • More assertive and direct in question-asking and can correct things their physicians may have misunderstood • Various strategies can help the patients to remember

49. EMPATHY • Being sensitive to another individual’s changing feelings and “connecting” emotionally to that person; understanding another’s private perceptions

50. Remember to listen, express and communicate your needs and emotions Ex. When you watch TV, I am concerned because knowing how much time this class requires I need to be sure that you know how to organize your time. Therefore I would really appreciate to know that you will spend enough time on your homework to be successful in the class. 1) Describe the situation without your perception or opinion involved. Describe the facts, the setting and the actions of others. 2) Link the situation with your feelings. Remember, they are your and cannot be shared without being expressed in one way or another. 3) Explain the need that you currently want to be satisfied. 4) Make a realistic and concrete demand. Accept that a demand can be answered by YES or NO! Starting with the other person’s feeling I know that when you watch TV you feel relaxed because you can be relieved from the pressure of others’ expectations. I know that you would like me not to mention your homework when you are relaxing. However, when you are watching TV, I am concerned…