Chapter Nine: Patients, Providers, and Treatments

1. Chapter Nine:Patients, Providers, and Treatments

2. Chapter Outline • Health care services • The nature of patient-provider communication • Results of poor patient-provider communication • Improving patient-provider communication and increasing adherence to treatment

3. Chapter Outline • The patient in the hospital setting • Interventions to increase information in hospital settings • The hospitalized child • Complementary and alternative medicine • CAM treatments • The placebo effect

4. Types of Health Care Providers

5. Patient Consumerism • Being presented with choices • Cooperating and participating in the development and enactment of the treatment plan • Having considerable expertise about their health problems

6. Types of Health Care Plans

7. Patient Dissatisfaction in Managed Care • Changing structure of the health care delivery system can undermine patient-provider communication • Results in colleague orientation • Patient-centered care: Providing patients with information • Involving them in decisions regarding care • Consideration of psychosocial issues

8. Nature of Patient-Provider Communication • Technical quality of care and the manner in which care is delivered are unrelated • Setting • Medical office is an unlikely setting for effective communication • Role of provider - Extract significant information quickly from the patient • Patient and provider are not always on the same page

9. Provider Behaviors that Contribute to Faulty Communication • Inattentiveness • Use of jargon • Baby talk • Nonperson treatment • Stereotypes of patients

10. Patients’ Contributions to Faulty Communication • Poor education and understanding • Patients' inability to present their complaints effectively • Ability to follow treatment guidelines declines due to old age • Neurotic patients exaggerate symptoms

11. Patient Attitudes Toward Symptoms • Misunderstanding the provider’s emphasis on factors that they consider to be incidental • Paying little attention • Believing that the provider has made an incorrect diagnosis

12. Interactive Aspects of the Communication Problem • Lack of opportunity for feedback to the provider • Difficulty in knowing when a relationship has been established with a patient • Learning is fostered more by positive than by negative feedback

13. Results of Poor Patient-Provider Communication • Dissatisfied patients • Less likely to comply with treatment recommendations • More likely to turn to alternative services that satisfy emotional rather than medical needs • Less likely to obtain medical checkups • More likely to change doctors and file formal complaints

14. Nonadherence to Treatment Regimens • Patients do not adopt the behaviors and treatments their providers recommend • Adherence rates vary depending on the treatment recommendations

15. Measuring Adherence • Asking patients about their adherence yields artificially high estimates • Researchers draw on indirect measures of adherence which can be biased

16. Good Communication • Adherence is highest in patients when: • Clear, jargon-free explanation is received • Instructions are asked to be repeated • Instructions are written down • Unclear recommendations are singled out and clarified • Instructions are repeated more than once

17. Treatment Regimen • Qualities of the treatment regimen influence adherence • Nonadherent patients cite excuses • Creative nonadherence: Modifying and supplementing a prescribed treatment regimen

18. Table 9.3 - Why do people sue?

19. Teaching Providers How to Communicate Training providers • Simple behaviors that are seen as warm and supportive • Nonverbal communication Training patients • Skills to elicit information from physicians • Thinking own questions ahead of time Probing for barriers to adherence • Barriers can be discovered by talking to the patient • Breaking advice into manageable subgoals that can be monitored • Rate of adherence increases if lifestyle changes are prescribed

20. Figure 9.2 - The Information-Motivation-Behavioral Skills Model of Health Behavior (Sources: Fisher & Fisher, 1992; Fisher, Fisher, Amico, & Harman, 2006; Fisher, Fisher, & Harman, 2003)

21. Patient in the Hospital Setting • Structure of the hospital • Depends on the health program under which care is delivered • Cure - Performing treatment action that has the potential to restore patients to good health • Care - Orientation of the nursing staff • Core - Ensuring the smooth functioning of the system

22. Role of Health Psychologists • Diagnosis of patients and assessment of patients’ level of functioning • Pre- and postsurgery preparation and pain control • Interventions to increase medication and treatment compliance • Teach appropriate self-care after discharge • Diagnose and treat psychological problems

23. Impact of Hospitalization on the Patient • Patients are required to entrust themselves completely to strangers in an uncertain environment • May result in problematic psychological symptoms

24. Interventions to Increase Information in Hospital Settings • Patients who have been prepared are: • Less emotionally distressed • Able to regain their functioning more quickly • Able to leave the hospital sooner

25. Hospitalized Child • Hospitalization can be hard on children • Environment can be lonely and isolating • May become socially withdrawn • Dependency fostered by bed rest and reliance on staff can lead to regression

26. Preparing Children for Medical Interventions • Children equally benefit with preparation as adults • Results in less problem behaviors • Parents can undertake preparation • Presence of parents during stressful medical procedures can be helpful

27. Complementary and Alternative Medicine(CAM) • Diverse group of therapies, products, and medical treatments • Represents a vast and unevaluated aspect of care • National Center for Complementary and Alternative Medicine (NCCAM) - Created to evaluate the usefulness and safety of CAM

28. Philosophical Origins of CAM • Holistic medicine: Approach to treatment that deals with the physical, psychological, and spiritual needs of the person • Traditional Chinese medicine • Based on the idea that a vital force qi flows throughout the body • Strives to affect the balance yin and yang

29. Philosophical Origins of CAM • Ayurvedic medicine - Goal is to balance among the body, mind, and spirit • Treatment - Use diet, exercise, massages, herbs, oils, spices, and various minerals • Homeopathy • Interprets disease and illness as caused by disturbances in a vital life force • Treatment - Use diluted preparations

30. Philosophical Origins of CAM • Naturopathy - Central tenet is that the body can heal itself through diet, exercise, sunlight, and fresh air

31. Dietary Supplements and Prayer • Dietary supplements - Contain nutrients in amounts that are as high or higher than levels recommended by the United States Institute of Medicine’s • Prayer - Spiritual beliefs have been tied to better health practices, health, and longer life

32. Acupuncture • Long, thin needles are inserted into designated areas of the body • Theoretically influence the areas in which a patient is experiencing a problem • Used to control pain • Triggers the release of endorphins which reduces the experience of pain

33. Yoga • Breathing techniques, posture, strengthening exercises, and meditation • Used to treat: • Chronic pain, bronchitis, symptoms associated with menopause • Mental and physical ailments related to stress, including anxiety and depression • Cancer-related fatigue

34. Hypnosis • State of relaxation which can alone help reduce stress and discomfort • Effects of hypnosis may be due to the composite effects of: • Relaxation • Reinterpretation • Distraction • Drugs

35. Meditation • Variety of therapies that focus and control attention • Helpful for managing pain • Effective treatment for certain functional disorders

36. Guided Imagery • Meditative procedure that has been used to control discomfort related to illness and treatment • Patient is instructed to conjure up a picture that he or she holds in mind during the experience of discomfort • Induces relaxation

37. Chiropractic Medicine and Osteopathy • Chiropractic medicine: Performing adjustments on the spine and joints to correct misalignments • Believed to prevent and cure illness • Osteopathy - Draws on the body’s ability to heal itself • Osteopath seeks to facilitate healing using manual and manipulative therapy

38. Massage • Manipulation of soft tissue • Reduces stress and is believed to boost immune functioning • Flushes waste out of the system • Used to control stress and pain

39. Who Uses CAM? • People who are not successfully treated by traditional medicine • People who face delays in receiving medical care and cannot afford high costs of medical care • Used more by white people than by minorities

40. Evaluation of CAM • Difficult because they are highly individualized • Importance of CAM is derived from the fact that many people use it • Integrative medicine: Combination of alternative medicine with conventional medicine

41. The Placebo Effect • Placebo: Medical procedure that produces an effect in a patient because of its therapeutic intent • Included in many effective treatments

42. Provider Behavior and Placebo Effects • Effectiveness of a placebo varies depending on: • How a provider treats the patient • How much the provider seems to believe in the treatment • Effects are strengthened when the provider gives reassurance to the patient that the condition will improve

43. Patient Characteristics and Placebo Effects • People who show stronger placebo effects are those who: • Have a high need for approval • Have low self-esteem and are persuadable • Are anxious

44. Situational Determinants of Placebo Effects • Setting that is similar to medical formality • Shape, size, color, taste, and quantity of the placebo • Treatment regimens that seem medical and include precise instructions

45. Social Norms and Placebo Effects • Placebo effect is facilitated by norms that surround treatment regimens • Expected way in which treatment will be enacted • Placebos are effective because people believe that drugs work

46. Double-Blind Experiment • One group of patients are given a drug to cure a disease or alleviate symptoms and another group is given a placebo • Measure of the drug’s effectiveness - Difference between the effectiveness of the drug and the effectiveness of the placebo