Chapter 8/9 - Med Sociology Doctor-Patient Interaction- Dr. A

What are the "no's" of building rapport?

- showing disapproval embarrassment impatience boredom - condescension - stereotype - speaking ill to other people about pt

The ADA's Principles of Ethics and Professionalism Code, Section 4 covers ______

4) JUSTICE ("fairness") Duty to TX ppl fairly

_____ is how the clinician explains the symptoms, while an _____ is how the patient experiences it

Disease Illness

Barriers to communication, accuracy of information, consideration of findings are factors to consider when upholding the responsibility to ______

Do no harm

Is it possible to not have ANY bias?

Hell no!, Why? Bcc we have unique perspectives and experiences that shape our perception

We must avoid _____ questions

Leading

Commitment to professional competence is a _______ process

Lifelong Maintaining knowledge and skills

The original health maintenance organizations

Paid doctors on salary rather than fee-for service

Honesty and empowerment are important responsibilities in WHICH PRINCIPLE?

Patient autonomy

Maintainin* med knowledge, recognizing underlying conditions, etc are examples of a dentists role as a ___

Physician

Serving the interest of the pt, assuming altruistic behavior, and preventing market influences / social pressures form compromising are important responsibilities in WHICH PRINCIPLE?

Primacy of pt welfare

structural explanation

Riska's explanation that holds that barriers, such as a lack of mentors, keeps women from advancing to top positions in medicine

female

Sue Fisher found that many _______ patients were not satisfied with the explanations given them by their doctors - also stated that male physicians have a tendency to misdiagnose heart attacks as stomach or anxiety problems

T/F Almost all Americans over the age of 65 are eligible for Medicare

True

_____ are standards we use to measure beliefs / behaviors. _____ are attitudes or feelings that we attach to perceived differences.

Values Biases

Irish, Italian

Zola found that ______ patients tended to underestate their symptoms, whereas ________ patients tended to overstate them

middle, upper

________ and _______ class persons tend to be more consumer-oriented and active participants in the physician-patient encounter

lower-class

________-_____ persons tend to be more passive in dealing with doctors as authority figures and show a decreased sense of personal control over health matters

sexism

_________ may be most evident in the top posts in academic medicine where women physicians are rare due to the demanding career with motherhood

physicians

a ________ behavior is the most important factor endangering trust in the doctor-patient relationship

Today's applicants to medical school: a. are approximately 50% female. b. are approximately 25% racial minorities. c. have a high attrition rate once enrolled. d. are rejected at a rate of about 70%.

a. are approximately 50% female

Which of the following is a likely consequence of health care reform efforts in the United States? a. The number of students admitted into medical school will increase. b. Medical schools will devise new programs to encourage students to select a primary care field. c. Medical schools will have access to significantly greater sums of money for medical research.

b. Medical schools will devise new programs to encourage students to select a primary care field.

surgeons

besides ICU physicians, _________ are also known for trying to retain decision-making authority for themselves and to present information to their patients and their families that justifies action

The official accrediting agency for programs leading to the doctor of medicine degree is which of the following? a. American Medical Association, Educational Division b. American Board of Medicine c. Liaison Committee on Medical Education d. Department of Health and Human Services

c. Liaison Committee on Medical Education

"Detached concern" refers to which of the following? a. the emotional distance a physician must take from a patient due to the overwhelming amount of knowledge required to be a physician b. the emotional distance a physician must take from a patient as a student c. concern about the patient without excessive emotional involvement or over-identification

c. concern about the patient without excessive emotional involvement or over-identification

A study of medical students at an Israeli medical school found which of the following to be the greatest source of stress? a. great differences in age between the student and the patient b. inadequate educational preparation c. death of a child or young adult

c. death of a child or young adult

Which of the following accurately describes early medical education in the United States? a. involved little regulation b. was done primarily through apprenticeships c. varied considerably in terms of quality d. all of the above

d. all of the above

surgery, internal medicine, psychiatry

fill in the blanks, separated by a comma - Susan Hinge found that the top specialties such as _______ and ________ _________ were characterized as masculine, with traits like "toughness," "macho," and "demanding," while those as the bottom like family practice, pediatrics, and _________ were considered "soft" and feminine

upper, middle, lower, working

fill in the blanks, separated by a comma - doctors from ______ and _______ class backgrounds tend to communicate more information to their patients generally than doctors with ______ and ________ class origins

women, male

fill in the blanks, separated by a comma - some patients may perceive ________ physicians as less of an authority figure than ______ physicians

male, female

fill in the blanks, separated by a comma - when assessing their accomplishments: _______ doctors tend to speak only of their technical skills and choices of appropriate treatment, while _______ doctors stress their value to patients and did so using words like "help" and "care"

therapeutic

human cloning is characterized as either __________ (the cloning of human organs for transplantation in sick people) or _________ (the cloning of people themselves)

female doctors

it was found through a study that _______ _______ are more attentive to patient's comments and medical histories, especially those of women

Eliot Freidson

person that suggested that physicians tend to have bias in favor of finding illness in their patients

doctors

the ________ emphasis is on finding out what is medically wrong and doing something about it, so he or she can move on to the next patient

coronary heart disease

the diagnostic model of _________ _____ _______ held by physicians generally fits male symptoms better than females whose heart attacks can be masked by upset stomachs or anxiety symptoms not commonly seen in men with heart problems

biographical medicine, techno-medicine

the expanding reliance on new technologies has promoted a shift away from _________ ________, with its focus on the patient's oral account of his or her medical history, and instead to ____-______, involving the extensive use of advanced technology for testing, diagnosis, and the scientific determination of treatment in a more differentiated world of health care delivery

female physicians

the gender of physicians to tend to be more empathic and egalitarian in they relationships with patients, more respectful of concerns, and more responsive to patients psychosocial difficulties

third-party payers

the government in the case of Medicare and Medicaid, private health insurance companies, and managed care programs are all examples of ______-______ ______ intruding on the traditional doctor-patient relationship

sensitivity

the lack of male __________ to women patients was a major factor in the formation of the women's health movement to combat sexual discrimination in medicine

human genome project

the potential of gene therapy and genetically based drugs has yet to be realized, but the results of the _______ ________ _______ provides researchers with a map of the human genetic code

compliance

this requires comprehension by the patient and communication is the key for avoiding noncompliance

Examples of "commitment to honesty"

- full clear info before TX - clear and willing consent - allow for pt choice - explanation if any injury / error

guidance-cooperation model

- physician-patient interaction model that applies when the patient has an acute, often infectious illness, such as the flu or measles - patient knows what is going on and can cooperate with the physician by following his or her guidance in the matter, but the physician makes the decisions

activity-passivity model

- physician-patient interaction model that applies when the patient is seriously ill or being treated on an emergency basis in a state of relative helplessness , due to a severe injury or lack of consciousness - physician has full decision making power in the relationship

The ADA's Principles of Ethics and Professionalism Code, Section 1 covers ______ and Section 2 covers _____

1) PT AUTONOMY ("self governance") Aka respecting pt's right to self-determination and confidentiality 2) NONMALEFICENCE ("do no harm") Aka duty to refrain from harming the patient

The three fundamental principles of medical professionalism is______

1) primacy of pt welfare 2) pt autonomy 3) social justice

The ADA's Principles of Ethics and Professionalism Code, Section 3 covers ______

3) BENEFICENCE ("do good") Duty to promote pt welfare

The ADA's Principles of Ethics and Professionalism Code, Section 5 covers ______

5) VERACITY ("truthfulness") Duty to communicate truthfully

Acceptance comes from trained staff as well as _____ of all types of patients

Aesthetic work

Recognizing concerning signs, building trust with patients, etc are examples of the dentist's role as a ______

Caregiver

When planning findings, use clear and thorough ____, check for the patients _____, and determine _______

Communication, understanding, willingness to proceed / concerns / questions

To understand patient perspective, address the _____ component

Emotional Also bring up past diagnosis

The first important component of building a relationship with patients is through thr ______

First impression

As dentists we have commitments to _____, _____ of care, improving _____ to care, scientific _____, managing ____, _____ responsibilities,

Honesty Quality Access Knowledge COI (conflicts of interest) Professional

Blue cross and blue shield were founded to protect the financial security of

Hospitals and Doctors

Under community rating

Individual premiums are based on the average risk level of the community as a whole with a "group rate"

To build a trusting and supportive relationship, we must gather ____, offer ____, provide ____, and meet ______

Info, info, care, mutual goals

What is the affordable health care act?

Instead a real system it is an agglomeration of public and private health care insurers (such as Medicaid and Aetna), health care providers (such as doctors and nurses) , and health care settings ( hospitals and nursing homes),that function autonomously in often competing ways.

______ is the basis of medicine's contract with society

Medical Professionalism

The nonlexical component of speech is called ______ (ex: matching responses, modulating affect, changing language)

Paralanguage *use patient's language

The ______ is the core of clinical practice

Patient doctor relationship

Promoting justice, equitably distributing resources, and working to end discrimination are important roles of WHICH PRINCIPLE?

Principle of social justice

Trust is built through building ___

Rapport Acceptance of pt stories / demographics Ask about feelings Match them where they are (posture and language) to empathize with demeanor Remember details about patients

voluntaristic view

Riska's explanation that holds that women are socialized to follow stereotypical gender expectations and consequently tend to make occupational choices that fit those expectations

If the patient is a child, they are (NOT/STILL) the center if the encounter, and there are _____ relationship(s)

STILL TWO (you and child, and you and parent)

What are the "three perspectives"?

Sickness —-> social cultural Illness —-> patients perspectives symptoms Disease —-> practitioners perspective diagnosis pathology

internet

Taiwan study on the Internet vs face-to-face visits in a community hospital showing that the _______ users showed less confidence in doctors, less compliance with instructions, and a greater willingness to use alternative medicine than those who visited the doctor

Which country spends the most per capita on health care?

The U.S.

consumerism

a phenomena common in modern American society where people make educated decisions about the purchasing of health care plans and coverages based off of the mini-max principle

Which of the following statements accurately describes student reaction to stressors in medical school? a. There is a high level of distress; use of alcohol and other drugs increases and depression is not uncommon. b. While there are many stressors, medical students have largely been immune to these pressures; use of alcohol and other drugs declines during medical school and depression is very rare.

a. There is a high level of distress; use of alcohol and other drugs increases and depression is not uncommon.

In an analysis of medical school accounts written by medical students, Conrad found: a. a perception that the medical education process focuses primarily on disease rather than illness. b. a perception that the medical education process focuses primarily on humane and caring encounters between physicians and patients. c. a perception that the medical education process focuses equally on the technical and non-technical aspects of medical care.

a. a perception that the medical education process focuses primarily on disease rather than illness.

Medical residents: a. are legally able to practice medicine if under the supervision of a licensed physician. b. can practice medicine without supervision as long as they are working in a medical school hospital. c. are still in the observation stage of their training.

a. are legally able to practice medicine if under the supervision of a licensed physician.

Research on career choices of medical students has found: a. important changes in career choices during the education process. b. little change in career choices during the education process. c. no clear pattern in the stability of career choices during the education process.

a. important changes in career choices during the education process.

Research on abuse perceived by medical students has revealed which of the following? a. Few felt they had been abused during medical school. b. A large majority felt they had been abused during medical school. c. Most students are so detached from the faculty that there was little opportunity for abuse of students.

b. A large majority felt they had been abused during medical school.

Which of the following accurately describes the "evidence-based medicine" approach to medical education? a. It requires patients to give evidence of illness to physicians. b. It encourages physicians to select medical therapies that have been tested and shown to be effective. c. It encourages physicians to always ask for a second opinion.

b. It encourages physicians to select medical therapies that have been tested and shown to be effective.

Which of the following is true about medical education in China? a. Medical schools teach only traditional Chinese healing techniques. b. Medical schools teach only modern western healing techniques. c. Fewer years of medical education are required for those who offer only primary care. d. None of the above is correct.

c. Fewer years of medical education are required for those who offer only primary care.

Which of the following accurately describes the "problem-based learning" approach to medical education? a. was developed at Case Western Reserve University b. emphasizes the use of fact in learning c. emphasizes student problem solving d. both a and b

c. emphasizes student problem solving

Which of the following was a result of the Flexner Report? a. A homogeneous, university-based system of medical education emerged. b. A science-based medical education curriculum developed. c. Numerous colleges closed. d. All of the above occurred.

d. All of the above occurred.

doctor-patient

effectiveness of the _______-______ interaction depends upon the ability of the participants to understand each other through effective communication from the physician to the patient, and vis-versa

Which of the following were important obstacles to early efforts to reform medical education? a. overly personal relationships between physicians and patients b. dependence of medical professors on student fees c. distrust for the laboratory and lack of respect for experimental science d. little interest in medical research e. all of the above f. only b, c, and d

f. only b, c, and d

electronic support groups (ESGs)

groups that are forming among people with similar health needs who wish to share their experiences online and develop greater expertise

gene therapy

has a goal to treat or cure disease by giving patients healthy genes to replace defective ones, made possible from the sequencing of the human genome through the human genome project

The most basic element in any nation's health care system is ________________________________________.

how it provides and pays for health care

Havasupai Indians

in 2010, Arizona State University settled out of court with the _________ _______ after researchers from the school were found to have used DNA samples given by the tribe for diabetes research in other projects - the tribe members had signed a vague consent form giving permission for the use of their blood in medical or behavioral research, but both the spirit and intent of the agreement had been violated from the tribe's point of view

medical decision rule

is the notion that since the work of the physicians is for the good of the patient, physicians tend to impute illness to their patients rather than deny it and risk overlooking or missing it - Thomas Scheff

genetic testing

makes it possible to learn about someone's likely health future that even that person does not know

robotics and computer-guided imagery

may increase efficiency and precision in surgery and reduce the need for extensive hospitalization

mutual participation model

physician-patient interaction model that applies when the patient fully works together with the doctor to manage a chronic illness such as diabetes or heart problems

cloning

refers to making a precise genetic copy of a molecule, cell, plant, or animal

digital divide

survey that showed how the Internet had become a major source of health information creating a ______ ______ where women with high incomes and education were more likely to use the Internet for health information than those at the lower end of the social scale who lacked Internet access

computer information highways

the development of these connecting a patient's personal home computer to those of doctors, hospitals, drug companies, medical suppliers, health insurers, and medical databases will allow patients to obtain health information directly from their own computer rather than visiting a physician

sociology of genetics

the social use, control of information, risks, and ethics of genetic research has promoted the birth of a new field in medical sociology called

feminization

the term _________ has been used to indicate a female majority in medicine and as a term that signals the gradual decline of the status and autonomy of medical work when women enter a profession

social class

those patients who are similar to physicians in _______ ______ are more likely to share their communication style and communicate effectively with them

Oregon

what state claims that genes are naturally occurring organic matter and not something invented by humans?

women

who normally practices the following? - primary care - pediatrics - geriatrics - OBGYN

men

who normally practices the following? - surgery - sports medicine - internal medicine

ideal doctor-patient relationship

with a caring physician and trusting patient, this represents what type of relationship? - ended in the 1960s