8/12/2019 Psyc. 326 Lecture 5 10.7.13

1/21

Ch. 2 Continued

Psyc. 326October 7, 2013

8/12/2019 Psyc. 326 Lecture 5 10.7.13

2/21

Variations of Basic Models! Ballard-Reisch (1990)

! Patient Abdication! Patient Autonomy! Collaborative! Relationship Termination

8/12/2019 Psyc. 326 Lecture 5 10.7.13

3/21

Variations of Basic Models! Roter and Hall (1992)

! Paternalistic relationship! Consumerist relationship! Default relationship! Mutual relationship

8/12/2019 Psyc. 326 Lecture 5 10.7.13

4/21

Variations of Basic Models! Roter et al. (2007)

! Narrowly biomedical! Expanded biomedical! Biopsychosocial! Psychosocial! Consumerist

*These are categories of communication, not specificallyrelationship models. Read about these.*

8/12/2019 Psyc. 326 Lecture 5 10.7.13

5/21

Variations in Basic Models! Mutuality

! An element of the medical relationship that emphasizes the balanceof power

! Requires the recognition of mutual expertise! Pseudomutuality

! Paternalistic model ingrained

! Conflict! Conflict is, in some ways, inevitable! Disagreements can be good!

! Indicate presence of mutuality

8/12/2019 Psyc. 326 Lecture 5 10.7.13

6/21

8/12/2019 Psyc. 326 Lecture 5 10.7.13

7/21

History-Taking! Medical professional takes the patients medical history

! Previous symptoms?! Family history?! Hospitalizations?! Medications being taken?

! Patient tells the story of the illness! Types of questions

!

Closed-ended questions! Open-ended questions! Focused questions

8/12/2019 Psyc. 326 Lecture 5 10.7.13

8/21

History-Taking! Improvements:

! Medical jargon! Active listening

! Interest! Concern

! Specific goal is to find out both what is happening in this bodythe pathophysiology of the illnessas well as who thepatient is

8/12/2019 Psyc. 326 Lecture 5 10.7.13

9/21

Physical Examination! Discrepancy of power

! Embarrassment

8/12/2019 Psyc. 326 Lecture 5 10.7.13

10/21

8/12/2019 Psyc. 326 Lecture 5 10.7.13

11/21

Reassurance! Hopeful attitude! Reduce fear! Outcomes!

Especially important in chronic/terminal illness

8/12/2019 Psyc. 326 Lecture 5 10.7.13

12/21

Agency for Healthcare Research & Quality

! http://archive.ahrq.gov/qual/beprepared.htm ! Patients need to take time to prepare for medical visits and

keep track of responses from their doctors.

8/12/2019 Psyc. 326 Lecture 5 10.7.13

13/21

PREPARED! Procedure (or prescription)! Reason! Expectations!

Probability! Alternatives! Risks! Expenses! Decision

8/12/2019 Psyc. 326 Lecture 5 10.7.13

14/21

Street et al. (2009)! How does communication heal? Pathways linking clinician-patient

communication to health outcomes

Communication

Functions

ProximalOutcomes

IntermediateOutcomes

Patient HealthOutcomes

D i r e c t r o u t e

Indirect Route

8/12/2019 Psyc. 326 Lecture 5 10.7.13

15/21

Street (2009)! Major Finding: Communication most often isindirectly

related to health outcomes. Communication impactsproximal and intermediate factors which, in turn, influencehealth outcomes

CommunicationFunctions

ProximalOutcomes

IntermediateOutcomes

Patient HealthOutcomes

D i r e c t r o u t e

Indirect Route

8/12/2019 Psyc. 326 Lecture 5 10.7.13

16/21

Indirect routes from Doctor Communicationto Health

! Proximal factors! Understanding! Satisfaction! Clinician-patient agreement! Trust

! Intermediate factors! Access to care!

Quality medical decision! Commitment to treatment! Trust in the system

! Feeling known! Patient feels involved! Rapport! Motivation

! Social support! Self-care skills! Emotional management

8/12/2019 Psyc. 326 Lecture 5 10.7.13

17/21

C H A P T E R 3

O C T O B E R 7 , 2 0 1 3

Communication in the MedicalEncounter

8/12/2019 Psyc. 326 Lecture 5 10.7.13

18/21

Language, Communication and Culture

! Worlds Apart: A Four-Part Series on Cross-CulturalHealthcare! Trigger films: Follow patients and families faced with critical

medical decisions! Filmed in patients' homes, hospitals, communities

! By Maren Grainger-Monsen, MD, and Julia Haslett!

Stanford Center for Biomedical Ethics

8/12/2019 Psyc. 326 Lecture 5 10.7.13

19/21

About these film clips

! Examine both the patients' cultures and the cultureof medicine.

! Goal is to raise awareness about the role

sociocultural barriers play in HCP-patientcommunication! Need for provision of healthcare services for

culturally and ethnically diverse patients.

8/12/2019 Psyc. 326 Lecture 5 10.7.13

20/21

Trigger films

! Mohammad Kochi

8/12/2019 Psyc. 326 Lecture 5 10.7.13

21/21

Mohammad Kochi

! Devout Muslim from Afghanistan! Had surgery for stomach cancer! Refused chemotherapy! Feared that the kind of chemotherapy offered would

prevent him from observing daily prayer! What could have helped avoid misunderstandings?