Health Comm Final Exam

Explain the criticisms of provider-centered comm.

- People are more educated and involved in own health - Difficult to know patients' expectations - Could be counterproductive

How can medical mistakes be managed?

- Establish trust - Invite feedback - Respond to complaints and requests ASAP - Show empathy/care - Create realistic expectations - Put it in writing - Don't be shy about giving referrals - Don't forget the family - Own up to mistakes

Assumptions that are used when advocating more patient participation in the medical interview and in medical decision-making

- Partnership-building - Participative decision-making - Patient-centered medicine - Patient autonomy - Philosophy: interaction will become more symmetrical

Explain some common attitudes and misperceptions about organ donation

- A common fear that medical professionals would allow someone to die to use their organs or that their organs being sold on the underground market - Physicians who care for a patient are actually not involved in decisions about his or her organ donation. That is handled by an entirely different staff and medical team. - Organ donation will mar a deceased person's appearance such that the family cannot have an open casket - this is untrue

What are the advantages and disadvantages of support groups, both face-to-face, and virtual?

- Advantages: help feel not alone or abnormal, others can give first-hand information, can express empathy with others and receive empathic messages themselves. -Disadvantages: can become counterproductive, may begin to feel that nobody outside of the group understands them as well as they understand each other

What was the Flexner Report? What happened as a result of it?

- All but a few medical schools in the country were lax in their coverage of biology and other sciences. This report criticized medical schools for not offering more supervised, hands on experiences with patients. - Result: an audit of all medical schools, shut down two-thirds of US med schools (MUSC included). They found out that schools weren't teaching enough science.

Explain transcendent experiences

- Being able to go beyond what the immediate illness is and seeing it in a bigger purpose - Get beyond the every day and see you can help someone else and educate other people struggling with this

Effects of socioeconomic status on provider-patient communication

- Caregivers tend to offer less info/guidance to patients of low socioeconomic status - Patients of low socioeconomic status are less likely to feel confident reading health information/understanding health statistics - Positive correlation between patients with higher socioeconomic status and better provider-patient communication

Reasons for racial differences in medical care and responses to it

- Distrust: causing people to underutilize health services and doubt validity of medical advice - High risk of a certain disease, low knowledge of it - Limited access to advanced medical facilities - Patient-caregiver communication: prejudicial assumptions from doctors, etc.

Describe the power dynamics in the medical interview (talk time, interruptions, etc.).

- Doctor controlled, typically interrupt in 16-18 seconds of the patient speaking - Directives - doctor gives commands or instructions - Blocking - doctor shifts topic to avoid patient complaints and emotional disclosure), - Doorknob disclosures - concerns brought to attention of doctor as they are leaving the room

What factors contribute to a patient being, literally, patient and granting physicians power?

- Doctor knowledge/power - Patient compliance - Patronizing behavior

Describe the psychological impact of being a medical provider

- Emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. - May become depressed, experience low self-esteem, and leave their jobs or avoid certain tasks.

Psychological influences on caregivers

- Emotional preparedness: caregivers may not know how to respond emotionally to a patient concern due to never having experienced it themselves/simply not being prepared for a situation at hand - Mindfulness: awareness of one's self and others and a non judgmental respect for diversity - Confidence: caregiver may doubt their capacity to cure and understand the people they treat/wonder what gives them the right to make decisions - Satisfaction: feeling appreciated and proud of the work they do

What happens to a person when they are in crisis?

- Feel events are out of their control - In denial/panic

What are the characteristics of supportive listening?

- Focus on the other person - Remain neutral - Concentrate on feelings - Legitimize the other person's emotions - Summarize what you hear

What are some suggestions for delivering bad news?

- Foreshadow the disclosure - Talk in a quiet, private place - Be clear - Avoid medical jargon - Show genuine caring

What is HIPAA? Why did it develop?

- HIPAA provides patients increased access to their own medical records and regulates who else may see them. It developed due to outrages from people learning of health care providers have sold or carelessly leaked their "confidential" medical information to others. - To ensure that individuals would be able to maintain their health insurance between jobs. - To ensure the security and confidentiality of patient information/data.

Differences between Health as Organic and Health as Harmonic Balance perspectives

- Health as organic: health can be understood in terms of the presence or absence of physical indicators. - Harmonic balance: health is not simply the absence of physical signs of disease. Rather, it is a sense of overall well-being and equilibrium.

HIPPA provisions

- Health care clients must be insured of confidential environment - Clients around the country have the right to see their medical records and make changes - People who believe their medical privacy has been violated can register complaint. - Requires providers to adopt a standardized set of codes, train staff, appoint staff, etc.

Explain the Theory of Problematic Integration

- How we take problems and integrate them into our lives so that they don't appear to be problems anymore - Taking situations and making them part of our ongoing existence

What effective communication skills are advocated by the ACGME?

- Interpersonal communication - Teamwork - Leadership

What can a patient do to prepare for the medical interview? What is the first thing they should say during the history taking/presentation of complaint segment of the medical interview?

- Know their history, how long symptoms have been present - A patient should start with their 3 main concerns, ranked in order of importance

What can a person do to encourage another to express his/her emotions?

- Look for "affective moments" - opportunities to understand something important about the other person and his or her coping status - Give yourself a moment to reflect - Keep in mind that people benefit from talking openly and honestly - Don't minimize losses or get encourage them to cheer up - Acknowledge and respect emotions

What are reasons for patient noncooperation with the medical treatment plan?

- Medical recommendations may be impossible or impractical to carry out (may be unable to afford medications or may be physically incapable of performing suggested routines) - Unclear understanding - Culturally or personally unacceptable - Diagnosis seems incorrect - Treatment seems unneeded or unhelpful - Unpleasant side effects

What are the tenets of the Family and Medical Leave Act of 1993?

- People can take up to 12 weeks off work to care for ailing family members, medical care or childbirth - Must have worked at company for one year/an average of 25 hours per week - Only companies with at least 50 employees are obligated to provide medical/family leave

Phases of Development of Children's Conceptualization of Illness

- Pre-logical conceptualization phase (ages 2-6): children define illness as something caused by a tangible, external agent, such as a monster or the sun - Concrete- logical conceptualization phase (ages 7-10): children begin to differentiate between external causes, such as wind and cold, and internal manifestations, such as sneezing and talking funny - Formal-logical conceptualization phase (ages 11 and older): children are remarkably adept at envisioning the complex influence of agents they cannot readily see

Describe the "Voice of the Medicine."

- Primarily oriented to evidence, measurement, and precision. - This voice is characterized as controlled compassion and concern for accuracy.

Explain the campaign of Orthodox Medicine.

- Push for conventional practitioners to be legitimate guardians of peoples health - Folk medicine was not as popular; discredited - Orthodox/conventional doctor was the unquestionable authority - Doctors became "all knowing" and were not questioned by the less educated

What are the two goals of social support?

- Reduce uncertainty - Increase perceptions of control

Explain the characteristics of motivational interviewing.

- Respectful tone - Allow decision maker set the agenda - Gauge the decision maker interest - Explore ambivalence - Elicit-provide-elicit - Identify multiple options

Expectations connected to the sick role

- Sick person is exempt from "normal" social roles - Not held responsible for their condition - Must want to get better and be actively seeking medical advice/complying with treatment

What are the implications of Intersectionality Theory?

- Social position is not simply the sum total of different identities - It is infeasible to rank-order the variables that influence social position

What patient characteristics make being a patient difficult, especially in regard to self-advocacy?

- Speaking up for oneself - Lower education/literacy levels - Not being informed enough to ask q's

Suggestions for communicating with persons who have disabilities

- Talk directly to them, not to their caregiver - If sight impaired, identify yourself - If adult, treat as adult - Listen attentively if it is difficult to understand - If in wheelchair, get on eye level

Communication Accommodation Theory

- The view that individuals adjust their verbal communication to facilitate understanding. - We tend to communicate similarly to the people we are communicating with especially if we like them and if they are significant to us. We tend to accommodate to other people in our communication. - If someone is speaking loud, then we tend to speak loudly. If someone is speaking slowly, then we tend to speak slowly.

Explain the two models of social support effects

- Therapeutic communication: helps a person reduce uncertainty and/or increase perceptions of control regarding a disease or illness state. - Non-therapeutic communication: focused on some area other than a disease or illness state.

What are some recommendations for dealing with difficult patients?

- Treat complaints as opportunities to learn more - Invest in patient relationships - Show empathy - Display curiosity - Try a little humor - Empower team members to handle problems before they grow

Skills necessary for health literacy

- Understand the language, jargon, legal talk - Have access to reliable info - Interest in health info - Social skills - Hearing and vision - Understand how to apply the info - Be willing to put info to use

Suggestions for Public Health Care Professionals and Health Care Providers for meeting literacy challenges

- Watch your language (words like pandemic, influenza, etc can frighten/confuse rather than inform) - Use multiple formats (words, diagrams, videos) - Evaluate messages for effectiveness/cultural appropriateness - Focus on action (specific suggestions for health behavior) - Create shame-free environments - Gauge literacy levels

How do sex, gender, and family roles in cultures affect health and health communication

- Women are less likely to have health insurance/suffer more domestic violence - Men are less likely to seek treatment

What are some reasons medical mistakes occur?

-Ineffective communication: sloppy handwriting, forgotten or delayed instructions, busy shift changes resulting in little time to talk

What are the risks of social support to the provider?

1. Drainage of resources 2. More vulnerable to stress from one's own problems 3. Sense of obligation, frustration, or responsibility 4. Social contagion of depression 5. Negative self- and other- evaluations if one can't provide effective assistance 6. Considerable effort may equal anxiety

What are the risks of social support to the receiver?

1. Loss of positive face: desire to be like, accepted, and competent - Stigma associated with needing help - Negative self-evaluations 2. Loss of negative face: desire for autonomy and privacy - Feelings of obligation may require divulging undesirable information - Over dependence on others 3. Increased stress

What are the three requirements of informed consent?

1. Patient capacity/ competence 2. Adequate information 3. Make sure the pt understands the information

Explain Charmaz's stage model of identity management.

1. Supernormal identity: Determined not to let the illness stop them from being better than ever 2. Restored self: People are not quite as optimistic but typically deny that the illness has changed them 3. Contingent personal identity: People admit that they may not be able to do everything they could previously do and they begin to confront the consequences of a changed identity 4. Salvaged self: Represents the development of a transformed identity that integrates former aspects of self with current limitations

Three questions caregivers should ask patients when seeking to be culturally competent

1. What do you think is wrong? 2. What do you think caused your problem? 3. How do you cope with your condition?

Average reading level of American public

8th grade

What is Intersectionality Theory?

A person's social position emerges within the interface of micro-level personal identities (age, race, sexual orientation, etc) and macro-level sociocultural patterns (sexism, racism, power, resources, etc)

Compare and contrast the Paternalistic and the Consumer/Informative Models in regard to the following:

A. The role of the physician - Paternalistic: physician is patient's guardian - Consumer: physician is a technical expert who provides the patient with means to exercise control B. The duties of the physician - Paternalistic: determine the medical condition, determine what treatments are most likely to reduce pain, present the patient with info that will encourage consent - Consumer: inform the patient of the disease state, informs patient of the risk/benefit of treatment, informs the patient of uncertain knowledge C. The assumptions of the model - Paternalistic: there are shared objective criteria for determining what is best, physician can determine what is in patient's best interest with limited input for patient, physician is patient's guardian. - Consumer: patient's values are defined and known, physician has obligation to provide all available info, physician bases treatments on facts and patient values.

What are the types of social support?

Action-facilitating support - problem focused (instrumental support, take someone to see a doctor, listen, provide information) Nurturing support - emotion focused (esteem/social network support)

Advantages and drawbacks of teamwork

Advantages - multiple perspectives applied to a problem (enhances creativity/innovation), gives new opportunities for diverse employees to take part in decision making, reduces costly oversights that may occur when people are devoted to highly specialized task. Drawbacks - takes time, groupthink (an individual going along with ideas they would not normally support), competition/conflict among health professionals from different disciplines

What are the challenges and characteristics of End-of-life communication?

Challenges: -The emotional quality of this communication requires special skills from professionals involved. -physicians and medical students are often overstrained and avoid end-of-life discussions (often ambivalent) -Patient preferences are difficult to infer and have to be assessed explicitly and regularly. -structural barriers obstruct possible benefits. Characteristics: - Assess the patient's level of understanding about the disease and expectations for the future. - Know how much the patient wants to know - Avoid phrases and words that can be misconstrued - Mention availability of coordinated, symptom-directed services such as palliative care early, - Physicians should transition from curative to palliative therapy

Explain the characteristics of the Voice of the Lifeworld

Concerned with health and illnesses as they relate to everyday experiences.

Causes of burnout

Emotional exhaustion, depersonalization, a reduced sense of personal accomplishment, excessive workload

How does environment influence the communication in the medical interview?

Environments that soothe and uplift can lower stress, reduce pain, keep people's spirits up, and facilitate better communication.

Right-to-die arguments (for and against)

For: People may want to die to end suffering. Against: Those enduring pain and grief may not be in the state of mind to think things through in order to make end of life choices. It is wrong to commit suicide even if the person requests it because they may request death for the wrong reasons.

Theory of health as expanded consciousness

Health events are integral parts of life that provide opportunities for growth and change

Explain locus of control and health self-efficacy. How do they affect coping?

Internal locus of control - general belief that people can control their own destinies =higher health efficacy, handle health better, changed-oriented and hard work External locus of control - general belief that things are controlled by outside forces. = high self-efficiency, no motivation Health self-efficacy - when people believe they can manage their health successfully

What physician behaviors do patients particularly like? Dislike?

Like: doctors who listen, ask questions, keep them informed, take them seriously, provide take-home info Dislike: threaten dignity with invasion of privacy/disrespectful communication

Describe the effects and implications of medical socialization.

Makes them much more scientific/have less empathy. Have to do the residency process (80 hour weeks, do all the scutt works, always on call)

Compare and contrast the different methods of oversupporting

Over Helping - too much instrumental support can make someone feel like a child. As a result, they may become needlessly dependent, feel left out of activities, and stop believing in their own capabilities. Over Informing - (forcing information when they can't understand or accept it) It can stress them out more, so waiting can preserve hope and minimize confusion. Over Empathizing - person won't develop a diverse social network b/c others are seen as uncaring or ignorant. People are less likely to express themselves to listeners who may become upset

What are the criteria that define collaborative interpretations?

Proposes that health communication is most effective when patients actualize the roles of decision makers and problem solvers and caregivers.

The "outcomes" model

Seeks to minimize reliance on medicine and maximize importance of everyday health and fulfillment.

Health condition as social asset vs. social liability

Social asset: people whose "deformities" or "diseases" make them especially good at what they do/accepted by public Social liability: health conditions that society regards with fear or revulsion

Explain advance-care directives

States a person's preferred medical care before they become too ill to communicate

The "find it, fix it model"

Uses diagnostic tests to find problems and for using therapeutic interventions to fix the problems.

Reason for non adherence (voluntary and involuntary)

Voluntary - treatment does not match life situation of patient, treatment does not match values/knowledge of patient, power struggles Involuntary - communication disorders, lack of understanding, lack of information provided by caregiver