Chapter 3
How do we conceptualize disease? What are Leventhal's five components? Describe each
1. Identity of the disease 2. Time line (the time course of both disease and treatment) 3. Cause of the disease 4. Consequences of the disease 5. Controllability of the disease. Few laypeople are experts in physiology and medicine. Most people are largely ignorant of how their body works and how disease develops. People think about disease in ways that vary substantially from medical explanations. Both children and college students show inaccurate and incomplete understandings of diseases when they describe diseases they have and how they became ill. There are 5 components in the conceptualization process: 1. Identity of the disease, people who have identified their symptoms as "heart attack"will react differently than those who label the symptoms as "heartburn" Labels provide a framework within which people can recognize and interpret symptoms. People labeled high blood pressure as opposed to normal were more likely to subsequently report other symptoms related to hypertension. People experience less emotional arousal when they find a label that indicates a minor problem. They will initially adopt the least serious label that fits their symptoms. The tendency to interpret symptoms as indicating a minor rather than major problem is the source of many optimistic self-diagnoses. 2. Time-line. Even though a diagnosis usually implies the time course of a disease, people's understanding of the time involved in not necessarily accurate. People with a chronic disorder often view their disease as acute and of short duration. Heart disease may be seen as heartburn. Conceptualizing a chronic disease as time limited may provide patients with some psychological comfort; patients who conceptualize their cancer as chronic report greater distress than those who view the disease as an acute illness. 3. The third component in conceptualizing an illness is the determination of cause. Determining causality is more a facet of the sick role than of illness behavior because it usually occurs after a diagnosis has been made. But the attribution of causality for symptoms is an important factor in illness behavior. If a person can attribute the pain in his hand to a blow received the day before, he will not have to consider the possibility of bone cancer as the cause of pain. Attribution of causality, is often faulty, people may attribute cancer to the will of God, these conceptualizations have important implications for illness behavior. People are less likely to seek professional treatments for conditions they consider as having emotional or spiritual causes. Culture may also play a role in attributions of causes for diseases. 4. The consequences of a disease are the fourth component in Leventhal's description of illness. Even though the consequences of a disease are implied by the diagnosis, an incorrect understanding of the consequences can have a profound effect on illness behavior. Many people see cancer as a death sentence, some neglect health care because they believe themselves to be in a hopeless situation. Women who find a lump in their breast sometimes delay making an appointment with a doctor, not because they fail to recognize this symptom of cancer, but because they fear the possible consequences- surgery and possibly the loss of a breast, chemotherapy, etc. 5. The controllability of a disease refers to people's belief that they can control the course of their illness by controlling the treatment of the disease. People who believe that their behaviors will not change the course of a disease are more distressed by their illness and less likely to seek treatment than those who believe that treatment will be effective. People who are able to control the symptoms of their disease without medical consultation will be less likely to seek professional medical care.
Which conditions shape people's response to symptoms?
1. Personal Factors. 2. Gender 3. Age 4. Socioeconomic, ethnic, and cultural factors 5. Characteristics of the symptoms 6. concecptualization of disease
How do people use the internet to seek medical information? What can public researchers do with internet research statistics? Who is more likely to use the Internet for this purpose? What negative impact might internet searching have? Overall how does it impact people?
A majority of Internet users in the United States report using the Internet to search for health information for themselves. Women and those with higher education are more likely than others to use the internet for this purpose. In fact, public health researchers can use sudden increases in the number of Internet searches about specific disease symptoms to reliably identify outbreaks of infectious disease in near real time! Women and those with higher education are more likely to use the internet for this purpose. It opens a vast source of medical information and misinformation to the public. Patients who go to the web for information become more active in their health care, but this knowledge may decrease physicians'authority and change the nature of the physician patient relationship. Overall, patients who don't have access to accurate and relevant information may not be in as good position to be effective users of the medical system.
How can receiving medical care be fatal.
At least 44,000 and as many as 98,000 people die in U.S. hospitals every year as a result of medical errors. Meditation too, can be fatal. Prescription drugs, even when prescribed and taken properly account for between 76,000 and 137,000 deaths each year. The medical profession has achieved only limited progress toward solving the problem of medical errors.
How do patients choose a practitioner?
Beginning in the 19th century physicians become the dominant medical providers. Toward the end of the 20th century medical dominance began to decline and other types of health care providers' popularity rose. These include midwives, nurses, pharmasicts, psychologists and herbal healers
Malone has been in the hospital for two weeks due to injuries from an automobile crash. Because he is hospitalized, he does not have to work; he receives three healthy meals a day; and most of his normal, everyday decisions are made for him. In such circumstances, Malone will probably
Correct Answer experience more stress than usual
How do symptom characteristics influence when and how people look for help?
David Mechanic (1978) Listed four characteristics of the symptoms that determine people's response to disease. 1. The visibility of the symptom- how apparent the symptom is to the person and others. Many of Armstrong's symptoms were not visible to others, including his enlarged testes. Unfortunately, with many conditions the condition may be worse or treatment options may be limited once symptoms become visible. 2. Perceived severity of the symptom. According to Mechanic, symptoms seen as severe are more likely to prompt action than less severe symptoms. 3. Extent to which the symptom interferes with a person's life. The more incapacitated the person, the more likely he or she is to seek medical care. 4. 4.Frequency and persistence of the symptoms- conditions that people view as requiring care tend to be those that are both severe and continuous whereas intermittent symptoms are less likely to generate illness behavior. Even mild symptoms can motivate people to seek help if those symptoms persist. Symptom characteristics alone are not sufficient to prompt illness behavior. People seek care on the basis of their interpretation of their symptoms, which relates to each person's view of illness.
How do gender differences affect people's response to symptoms?
Gender plays a role in the decision to get treatment, women are more likely than men to use health care Women tend to report more body symptoms and distress than men. Gender roles teach men to act strong and deny pain and discomfort.
How did Alexander Segall (1998) expand the concept of The Sick Role. What are the three privileges? What are the three responsibilities?
He proposed that the sick role concept includes three rights or privileges and three duties or responsibilities. The privileges are (1) the right to make decisions concerning health-related issues, (2) the right to be exempt from normal duties, and (3) the right to become dependent on others for assistance. The responsibilities are (1) the duty to maintain health along with the responsibility to get well, (2) the duty to preform routine health care management and, (3) the duty to use a range of health care resources. Segall's formulation of rights and duties is an ideal-not a realistic-conception of sick role behavior in the United States.
What is alternative health care?
Health care which provides alternatives to conventional medical care. Almost a third of U.S. residents who seek conventional health care also use some form of alternative health care, and nearly everyone (96%) who uses alternative health care also uses conventional health care. The recent growth of alternative medicine has come mainly from well-educated people who are dissatisfied with standard medical care and who hold attitudes that are compatible with the alternative care they seek.
Which of these factors reflect a significant trend in the health care system during the past 30 years?
Hospitalized patients are more severely ill than they were 30 years ago.
How do personal factors affect people's response to symptoms? What are the three major factors? What isn't the most important reason somebody seeks medical care? Give an example
Includes: way of viewing their own body, level of stress, and their personality traits. With irritable bowel syndrome level of pain is not the most important reason somebody seeks medical care. Instead a personally seeks medical care because of anxiety concerning the condition, coping resources, and level of physical functioning. Those who have adequate resources to cope with the symptoms and feel that the qualities of their lives is not too impaired do not seek medical care Stress is another personal factor in people's readiness to seek care. People who experience a great deal of stress are more likely to seek health care than those under less stress, even with equal symptoms Those who experience current or ongoing stress are more likely to seek care when symptoms are ambiguous. Personality traits also contribute, participants who score high on neuroticism generally had high self-reports of illness whether or not objective evidence confirmed their reports. These people also reported more symptoms than other participants.
In conceptualizing most diseases, people tend to
Incorrect Response rely on family and friends to inform them of the severity of the disease.
How do people have limited access to medical care? What about people who are insured but experience a catastrophic illness? What percentage of bankruptcies are medical costs a cause for?
Individual insurance tends to be more expensive and to offer less coverage (than from job). In 2011 15% of people in the U.S. didn't have health insurance. Policies often fail to cover dental care, mental health service, and eyeglasses. People who are insured but experience a catastrophic illness, coverage may be inadequate for many expenses, creating enormous medical costs. Medical costs are the underlying cause for over 60% of all personal bankruptcies in the United States.
How have hospitals and the experience of being in a hospital change din the last 30 years?
Now many types of surgery andtests that were formerly handled through hospitalization are now performed on an outpatient basis. Second hospital stays have become shorter. Patients feel increasingly free to voice their concerns to their physician. As a result of these changes, people who are not severely ill are not likely to be hospitalized, and people who are admitted to a hospital are more severely ill than those admitted 30 years ago.
How does complaining about stress effect people's perception
Other people tend to perceive symptoms that coincide with stress as not real. This is especially true for women
Describe the hospital patient role What difficulties do patients face?
Part of the sick role is to be a patient, and part of being a patient is following the rules of a hospital and complying with medical advice. That role includes being treated as a "Non-erson"tolerating a lack of information, and losing control of daily activities. Patients find incidents such as waits, delays, and communications problems with staff distressing and such incidents decrease patients' satisfaction. Hospital procedure focuses on the technical aspects of medical care; it usually ignores patients'emotional needs and leaves them less satisfied with their treatment than patients who are treated as persons, listened to, and informed about their condition. The hospital staff may not explain the purpose or results of diagnostic testing, leaving the patient without information and filled with anxiety. Hospitalized patients are expected to conform submissively to the rules of the hospital and the orders of their doctor, thus relinquishing much control over their lives. Lack of control can decrease people's capacity to concentrate and can increase their tendency to report physical symptoms.
What do medicare and medicaid do?
Passed in 1965, Medicare pays hospital expense for Americans over the age of 65, and so few people in this age group are without hospitalization insurance. Medicaid provides health care based on low income and physical problems such as disability or pregnancy. These restrictions make many poor people ineligible, only about half of people living in poverty receive coverage through Medicaid. (2011)
Why is verbal communication important to practitioner-patient interaction?
Patients are significantly less likely to follow a practitioner's medical advice when the practitioner communicates poorly. Some practitioners interrupt their patients when they're describing their concerns. A concern for a patient may not be important to the diagnosis and the practitioner may be trying to get information that's relevant to making a diagnosis. Patient's may misinterpret the physician's behavior as a lack of personal concern or overlooking what patients consider important symptoms. When patients believe that physicians understand their reasons for seeking treatment and that both agree about treatment they are more likely to comply with medical advice.
Why do a practitioner's personal characteristics matter?
People are more likely to follow the advice of doctors they see as warm, caring, friendly, and interested in the welfare of patients. Two meta analyses covering 35 years of research found that female physicians were more patient centered, spent 10% more time with patients, employed more partnership behaviors, were more positive in their communication, engaged in more psycho-social counseling, asked more questions, and were evaluated more highly by patients than male physicians. Patients of female physicians were more likely to disclose more information about their medical symptoms as well as heir psychological concerns.
How do socioeconomic factors, ethnic factors and cultural factors effect people's response to health conditions?
People from different cultures and ethnic backgrounds have disparate ways of viewing illness and different patterns of seeking medical care. In the United States, people in higher socioeconomic groups experience fewer symptoms and report a higher level of health than people at lower socioeconomic levels. Higher income people are more likely to seek medical care. Regardless, poor people are over represented among people that are hospitalized, and they are the most likely to become seriously ill. People in lower socioeconomic groups are also more likely to wait longer before seeking health care, thus making treatment more difficult and hospitalization more likely. The poor have less access to medical care, have to travel longer to reach health care facilities that will offer them treatment and must wait longer once they reach those facilities. Poor people utilize medical less than wealthy people and when they do their illnesses tend to be more severe. Ethnic background effects health care as well, European Americans are more likely to report a visit to a physician. Ethnic differences appear in health insurance coverage as well in common risk factors for diabetes and heart disease. A study from the UK confirmed that ethnic background, not lack of knowledge are primarily responsible for differences in seeking medical care. It was indicated that people from all racial backgrounds were at least as likely as those who were male to understand how to respond to chest pain or a lump in the armpit. Poor Black women do not lack information about the potential hazards of chest pain or a lump, but they are more likely to lack the resources to respond quickly to these symptoms.
How has technological medicine impacted patients?
Personal treatment by the hospital has become less prominent, this can combine to make hospitalization a stressful experience. In addition understaffing and the challenges of monitoring complex technology and medication regimens have created an alarming number of medical mistakes.
How does hospitalization affect children?
Source of stress and anxiety, separation from parents, unfamiliar environment, diagnostic tests, administration of anesthesia, shots, surgery, and postoperative pain. Providing children and parents with information about hospital procedures and equipment can be an effective way to decrease anxiety. Pediatric hospitals often offer some type of preparation program for children. Reassuring a child is not an effective way to reduce fear in either the child or the parent, distracting a child's attention away from the immunization is much more effective. Parents who receive training on how to reassure their child expressed a high level of confidence that they could calm their child. Then after immunization, the reassuring parents not only had problems helping their children, but they also rated themselves as being more distressed tan did the other parents. Another strategy is modeling, seeing another child cope successfully with a similar stressful procedure. Combined with cognitive behavior intervention and self-talk reduced distress fro children who were receiving painful treatment for for leukemia.leukemia. Multicomponent problems are generally more effective than single component programs. Cost is the main problem with intervention strategies to reduce children's distress resulting from hospitalization for specific medical procedures.
What is illness behavior? Give an example
The activities undertaken by people who experience symptoms but who have not yet received a diagnosis. That is, illness behavior occurs before diagnosis People engage in illness behaviors to determine their state of health and to discover suitable remedies Lance Armstrong was engaging illness behavior when he sought the opinion of his friend, and when he finally made an appointment with a physician.
What is sick role behavior? Give an example
The behavior of people after a diagnosis, whether from a health care provider or through self-diagnosis. Lance exhibited sick role behavior when he underwent surgery and chemotherapy, kept medical appointments, and took a break from cycling
What is a diagnosis in terms of illness behavior and sick role behavior?
The event that separates illness behavior from sick-role behavior.
What is true of people who are uninsured?
They are less likely to have a regular physician, more likely to have a chronic health problem, and less likely to seek health care. In addition a high proportion of people without insurance may create a spillover effect in which those with insurance experience higher costs and poorer quality of care.
How do people without insurance receive treatment?
They often receive care from emergency rooms, meaning they don't seek care until it has already become an emergency. These patients are sicker than they might have been if they had easier access to care. Seeking care from emergency rooms is also more expensive and overburdens these facilities, decreasing their ability to provide care to those with acute conditions.
What is the Lay Referral Network? What effects can it have?
When Lance finally decided to seek advice about his symptoms, he did not immediately go to a specialist. Instead, he consulted his friends, one of whom happened to be a physician. The LRF is a network of family and friends who offer information and advice before any official medical treatment is south. Most people who seek health care do so as a result of prior conversations with friends and family about symptoms. In some cases, people in the lay referral network might advice against seeking medical care, particularly if they can recommend simple home remedies or recommend complementary and alternative treatments.
How does age affect people's response to symptoms?
Young adults sow the greatest reluctance to see a health professional, probably because they feel more indestructable. In general people tend to interpret problems with a gradual onset and mild symptoms as resulting from age, whereas they are more ready to see problems with a sudden onset and severe symptoms as being more serious
What are the benefits of positive practitioner-patient interaction?
satisfied patients are more likely to follow medical advice, more likely to continue to use medical services and obtain checkups and less likely to file complaints against their practitioners.
Whitney twisted her ankle. She believes that she should make an appointment to see a doctor, but all her friends tell her that her injury is not serious and it will heal itself without medical intervention. Whitney decides that her friends are right. Thus, Whitney's decision not to seek help is based on her
subjective norms.
Why is routine in hospitals desirable?
uniform treatment,even though they deprive patients of information and control. Hospitals have no insidious plot to deprive patients of their freedom but this occurs when hospitals impose their routine on their patients. To aid with this hospital often now allow patients some choice in foods and provide tv remote control.
