Health Communication HSC4022 Midterm Review

What are the 5 characteristics of stigma mentioned in the chapter? Can you apply them to a particular person i.e. someone in a wheel chair? Ch. 8

1. labeling, 2. stereotyping, 3. separation, 4. status loss and discrimination, and 5. power differential. This can be applied to specific people i.e. someone in a wheelchair- discriminated in physical activity and labeled as unhealthy.

How long do Physicians typically allow patients to talk before interrupting them? Ch.3

14 seconds on average.

What is a cohort? What is a cohort effect? Ch.2

A Cohort is a group of people. The Cohort Effect is the population of people put into groups based on date of birth rather than identified by age.

What is stigma? Ch.8

A social construct defined as an undesirable differentness, an adverse reaction to the perception of a negatively evaluated difference.

What is ageism? Ch.2

Ageism is discrimination based on a person's age. Paradox of aging: we dislike old people as a group but love individual old people.

How is aging defined? Chronological v. Biological age: Ch.2

Aging is defined as the passing of time for an individual. This is inevitable chronological change in age from year to year. Biological age is the internal age of our bodies vital organs, and takes into account lifestyle choices such as diet, exercise, sleeping habits, and genetics.

How does the biomedicalization of aging impact patients ability to refuse medical intervention? (Bio. of Aging)

Biomedicalization of conditions impacts patients ability and right to refuse medical intervention, because of the biotechnology of medicine that is now seen as routine when oftentimes there is a less invasive solution.

What are microaggressions? How can language be used to reframe microagressions? Ch. 8

Brief, interpersonal expressions of disgust, distrust, or dislike of the identity of another person because of individual characteristics i.e. body size, race, gender, sexual orientation, etc. Language can be used to reframe microagressions through sharing personal experiences through story. Storytelling acts as resistance discourse because it helps us better understand someone else's experience. Wh

How does the prodigy cultural arts program attempt to "empower participants through self-discovery and expression?"

By incorporating art healing with medicine, anger and aggression is lowered in children living in high-crime communities, and gives them an outlet for their emotions and allows them to express their emotions and therefore find themselves along the way.

Why is it difficult for physicians to revise or change a patients original discussion? (Hoofbeats)

Calls their judgement into question, can lead to patient safety errors and untold hours, weeks or months of uncertainty etc.

What are some of the factors that contribute to communication problems between Doctors and Patients? Ch. 3

Doctors are seen as unapproachable and "scary" because of the amount of knowledge they have. Oftentimes the Dr.'s credentials sway people to not ask questions or challenge a diagnosis.

Patient-Centered care focuses on changing the power relationship between Doctor and patient. What factors might complicate power-sharing between Dr.'s and patients? Ch.3

Doctors have selective perception, resistance to patients stories (bias based on gender, age, ethnicity, etc.,) and rely on observations, treatments, and vitals, also called measurements. This can cause disconnect as the patient does not feel as if they are permitted to question their knowledge.

Some people believe that clean needle exchange programs for injection drug users enables drug use, but the data from pilot projects show several advantages to such programs- what are they?

Emphasized the health, social, and economic aspects of substance use rather than drug consumption and or punitive measures. Lowers death rates from using proper sterile measures.

Explain the Ethnocultural/Familial layer of meaning: Ch.1 (culturally sensitive model of health communication)

Ethnocultural/Familial: incorporates the cultural traditions, customs, rituals, and values that 1. form patterns of everyday living, expression, and social interaction, and 2. are often learned through the family.

Explain how the culturally sensitive model of health communication can cause a person who uses drugs to become a patient at the Institutional/Professional layer, and criminal (sociopolitical layer). Ch.1

Ex: Because of tax cuts in mental health services, there are 60% of adults that go untreated in a given year, replacing hospital beds with jail cells, homeless shelters, and coffins. (Institutional/Professional) Ex: Addiction conjures stereotypes of deviant individuals engaged in high-risk behaviors, although substance use disorder affects a wide spectrum of demographics. Minorities living in poverty generally have access to fewer or lower-quality treatment options.

How has the biomedicalization of aging affected medical interventions among older patients? (Bio. of aging)

Focuses on the extension of life and not always on the QOL. Once medical intervention in late life becomes available and reasonably effective, it becomes the routine choice. Patients and families do not see "no intervention" as a choice.

What does the term "biomedicalization" mean? (Bio. of Aging)

Further integrating medicine as it signifies new forms of biotechnology even through their complex processes. Sometimes a simpler options is available.

How should physicians approach the care of patients such as these, when they present with legal and social problems in addition to serious medical problems? (Case 15)

Have documented evidence of a personal relationship between Patient and Physician, in order to become adequate stewards of patient's values and preferences.

What did John Dewey mean when he said that "art serves both intrinsic and instrumental purposes?" Ch. 6

He said the experience of art is intrinsically valuable insofar as it fosters a heightened sensory absorption with present circumstances, attentiveness to relationships in which people are engaged, and a greater depth of insight that fosters new possibilities.

How has the fact that older peoples lives are routinely extended by medical interventions affected family life and caregiving? (Bio. of aging)

Higher demand of geriatric care and hospitality services as families are burdened of taking care of their family member at old age which requires time and interventions which is costly as demands increase.

Explain the Ideological layer of meaning: Ch.1 (culturally sensitive model of health communication)

Ideological: comprises the core values, philosophical "truths" and ethical underpinnings of society. i.e. pervasive myths contribute to social and internalized stigma that frame the experiences of individuals living w/ certain illnesses.

Explain the Institutional/Professional layer of meaning: Ch.1 (culturally sensitive model of health communication)

Institutional/Professional: involves the organization of health-care and related services, as well as professional understandings of health problems and issues. i.e. tax cuts affecting services provided.

Explain the Interpersonal layer of meaning: Ch.1 (culturally sensitive model of health communication)

Interpersonal: focuses on the dynamics of style, intimacy, emotion, and roles played out in human interactions. i.e. expected behavior, however we all act different to the behavior.

When making medical decisions, are there differences between allocating scarce resources such as organs versus surgeons' time and expertise? (Case 15)

It is said that surgeons time and expertise can be of assistance when allocating scarce resources such as time and expertise.

What is an affective error?

Letting personal feelings about a patient affect

What is Narrative Medicine? What physician/scholar is primarily associated with these ideas? (Narrative Medicine Case)

Medicine practiced with the narrative competence to recognize, absorb, interpret, be moved by, and act on stories of illness. Rita Charon MD, PhD is primarily associated with these narrative ideas.

What is the main reason that Doctors are sued for malpractice? Ch. 3

Miscommunication

What are some of the advantages of "medicalizing" a condition or a human experience? (Bio. of Aging)

More resources for the specific condition/ human experience than previously; de-stigmatizing of the condition or human experience, etc.

Is obesity in America an epidemic? Or the results of changing the labels for various Body Mass Index (BMI) categories? Or something else? Ch. 8

Obesity has said to be "medicalized" and considered to be a medical diagnosis. BMI is biased because it does not take gender, age, muscle mass, etc. into account.

How might you explain the fact that most of us love our grandparents and older relatives but think negatively of older people in general? Ch.2

Oftentimes people over the age of 65 are seen as declining in health, productivity, mobility, etc. Also the general consensus and stigma about older people is that they are ignorant and rude. However, grandparents are family and we love them.

One of the difficulties is explained in Larry Browning's work on "lists and stories." How does this help explain communication difficulties between doctors and patients? Ch.3

Patient: Storytelling is a natural way to convey information and make sense of the world. It shapes their interpretations and viewpoints. Doctor: was taught to interpret information into lists of indicated clinical action. They both have different angles of communication which creates barriers and miscommunication. Patient thinks doctors do not listen to them, and Doctors think patients provide too much unnecessary information for diagnosis and treatment.

Do patients have a "right" to medical treatment? Or is access to care a privilege? (Case 15)

Patients technically speaking have a right to health-care, however that does not mean that the access is universal. Access to care is in a socio-economic sense a privilege because if a person have a decent job, they will have access to decent health insurance which will allow quality health care.

What is meant by the heterogeneity of aging? Ch.2

People become more different over time, this is what we call Heterogeneity of aging. Who is more similar? A group of 21 year olds or a group of 81 year olds? (81 year olds)

Imagine you are a member of the ethics committee considering what to do in this patient's situation. What would you recommend? (Case 15)

Personally, I would recommend laying out all of the potential outcomes/repercussions of surgery, as well as what other options would be to combat the various infections he was contracting. If the patient insists on having the surgery, as a Doctor explain your concerns but it is ultimately the patient's decision in whatever course of treatment.

What is the relationship between aging and illness? Ch.2

Social beliefs about aging have implications for identity. Aging does not equal illness, aging does not equal cognitive decline. Illness and cognitive decline are the result of a disease process, not merely time passing.

Explain the Sociopolitical layer of meaning: Ch.1 (culturally sensitive model of health communication)

Sociopolitical: encompasses the politics surrounding primary social bases of power such as race, class, age, and gender.

Medicine as a scientific practice looks for generalizable patterns across groups of patients, narrative medicine focuses on the particulars of a patients experience/story. What tools are used to teach physicians how to listen to and interpret patients' stories? (Narrative Case)

Stereophonic Listening- hearing the body AND the person who inhabits it. Reconcile visual clues, clinical measures and the patient's story of their experience.

What is an attribution error? (How Dr.s think)

Tendency to diagnose based of physical qualities and factors, as well as personality, instead of considering the influence and situational factors for diagnosis. someone who is in ER who smells like alcohol and is treated as an alcoholic.

What patient situation was discussed in this case? (Hoofbeats Case Study)

The Availability Heuristic

Under what kinds of conditions might our access to medical care be appropriately limited? (Case 15)

The condition under which our access to medical care can be appropriately limited is when the patient realizes their "right" to say no to plan of treatment, and resort to a less invasive one i.e. suggested hip replacement- physical therapy/ pain management.

Explain the Culturally Sensitive Model of Communicating Health: Ch. 1

The culturally sensitive model of communicating consists of five complex layers of meaning that participants bring to their relationships and conversations about health and illness.

What is Occam's Razor? (hoofbeats)

The simplest most common diagnosis is the solution from doctors, but is not always the case. "Parsimony:" if one explanation fits case, thats the likely cause.

What is Health Communication? Ch.1

The symbolic process by which people individually and collectively understand and accommodate to health and illness.

What does the title of the case mean? "When you hear hoofbeats, expect horses, not zebras." How did that thinking pattern of physicians complicate patient care in this case? (Hoofbeats Case Study)

The title means the most common diagnosis is usually the most likely cause of medical problems. The thinking pattern of physicians complicated patient care in this case because the Doctor was following the "Availability Heuristic" which is the most striking and novel stay longer in the mind. (in this case, diagnosis)

What are some negative aspects of medicalization? (Bio. of Aging)

There is a stigma around conditions that have now been medicalized; takes away from the societal factors that may be contributing to the condition or human experience.

What is the two-challenge rule in health care? (Hoofbeats)

This is a rule designed to allow anyone to question any aspect of a patient's situation and to all a momentary halt to the proceedings in order to allow new information to better inform patient care and prevent patient safety errors. Nurses/Dr.'s/others have 2 free passes to question status quo without suffering adverse consequences.

What does it mean to have an aesthetic orientation to healthcare? Ch. 6

We do not reject or abandon normative, scientific, logics of mainstream care; however we join other practitioners and scholars. We adopt the aesthetic orientation to healthcare that positions creativity as a form of reasoning worthy of consideration alongside scientific logics.

Cause and Effect vs. Correlation: Is weight gain the cause of health problems or the result of health problems? Or do weight gain and certain health problems tend to be associated with one another without a clear cause/effect relationship? Ch. 8

Weight gain and certain health problems tend to be associated together without a clear cause and effect relationship. This is because of the stereotypes for people who are over-weight.

How does the culturally sensitive model of health communication impact our understanding of health and illness? give example on how this model is useful in understanding the implications of considering drug addiction and disease.

While all 5 layers operate simultaneously, one or more layers may predominate in conversation, and the layer that is salient at one point for one person may not be for another. ex: The differences in race, gender, age, education, socioeconomic status, and life expectancies can create distance, lack of understanding or shared meaning, and problematic communication when we consider matters of health and illness.

What is the paradox of emotions?

assuming others emotions based on their interpretation, and as a consequence assume that emotions are discrete events that can be recognized with some degree of accuracy which is not always the case. (No scientific evidence)

What is representative error? (How dr.'s think)

doctors thinking is guided by a prototype, so they fail to consider possibilities that contradict the prototype and thus attribute the symptoms to the wrong case. when they focus on the presence or absence of disease to make diagnosis and not look outside of the box.

What are some characteristics of people that might be viewed as stigma? Ch. 8

older, impaired, physical disabilities, language differences, culture, etc.

What patient situation was discussed in this class? (case 15- a patient's right to treatment.)

physician-centered model of care: patient's right to treatment