Seeking and Receiving Healthcare

How did the vaccine controversy arise?

- 1998 - Andrew mf Wakefield - published a study about 12 children who experienced the sudden onset of GI problems and autism related symptoms - parents or doctors of 8 of those 12 children stated that the symptoms started soon after the child received the measles, mumps, and rubella vaccination - children receive the first dose of this vaccine in their first 2 years - this also happens to be the age bracket where parents or doctors notice symptoms of autism in children - so, some parents would observe symptoms of autism develop around the same time as the vaccine - so they noticed a correlation, which made them concl it caused autism

Describe the study about ways to calm children before shots

- 4 -6 yo children who were about to get preschool shots = child paired w/ their parents, and then randomly assigned to a distraction group or a reassurance group - distraction group was asked to distract their child's attention away from the immunization procedure - parents of children in the reassurance group were asked to reduce their child's anxiety by reassuring them they had nothing to fear - results strongly favoured distraction group, with 3x as many children in the reassurance group needing physical restraint - those in the reassurance group showed more verbal fear than other children

Describe how personality traits contribute to illness behaviour w/ reference to Cohen's study?

- Cohen's study - investigators adminned a common cold virus to a group of healthy participants to see if participants w/ different personality traits would report symptoms differently - participants scoring high on neuroticism had high self reports of illness, whether or not objective evidence confirmed reports - also reported more symptoms than others, suggesting people high in this personality trait are more likely to complain of illness - people w/ higher neuroticism are more likely to seek med care than those w/ low neuroticism

Describe the ethnic factors in seeking healthcare?

- EuAmericans are more likely than other groups to report a visit to the physician - National Health and Nutrition Examination Survey looked at the reasons for these ehnic differences, comparing EuAmericans, AfAmericans and MexAmericans w/ Type2 diabetes on access and use of healthcare - ethnic differences appeared in health insurance coverage and common risk factors for diabetes and heart disease - ethnic differences in insurance coverage account for ethnic differences in use of health care - ethnic minorities, even in places that don't depend on priv health insurance, tend to show longer delays until diagnosis for cancer symptoms - ethnic minorities are more likely to experience discrimination in their lives, and those who perceive discrimination are less likely to use healthcare

Describe the healthcare barriers to those w/ and w/o insurance

- Insurance - finding a provider who will accept plan and the out of pocket cost of services -Uninsured - less likely to have a regular physician - more likely to have a chronic health problem - less likely to seek medical care because of the cost - reluctance causes issues for management of diseases - people w/ chronic disease and w/p health insurance have poorly controlled conditions, difficulty getting meds, more health crises, and a higher risk of mortality - may create a spillover effect, where those w/ insurance have higher costs and poorer quality of care

Describe the study looking at how labels are important to people identifying diseases?

- Leventhal - gave young adults a BP test, and assigned them to receive one of two results: high BP or normal BP - compared to the normal BP youth, those who received results labelled as high BP were more likely to report other symptoms related to hypertension - label made them report symptoms consistent w/ the diagnosis

How does culture play into the third component in the conceptualization process of conceptualizing a disease: determining causation?

- Study comparing Britons' and Taiwanese beliefs about heart disease - Britons were more likely to see heart disease as caused by lifestyle choices, whereas Taiwanese were more likely to see it as caused by worry and stress - someone who views heart disease as due to lifestyle will manage illness differently than those who view it as stress, so conceptualizations of disease causality will influence behaviour

What is modelling?

- a child seeing another one cope successfully with a similarly stressful procedure - modelling coupled with cognitive behavioural intervention and self talk reduced distress for children who were receiving painful treatments for leukemia - intervention was more successful than a drug treatment including Valium

What is seen by research to be the most useful kind of intervention for children in hospitals

- a review of interventions for children indicated multicomponent programs were generally more effective than single component programs: so providing info and teaching coping skills are important for children and parents when faced for hospitalization

How did Kasl and Cobb define the sick role behaviour?

- activities engaged in by people who believe themselves ill, for the purpose of getting well - happens after diagnposis

Did Wakefield's study actually show that the MMR vaccine caused autism among 8/12 children?

- already an issue with the small sample size - validity of the data has been called into investigation, and the study was retracted - epidemiological studies looked at this question, incl one examining over 500 000 children. None of these studies found any evidence that children who receive an MMR vacc show a higher risk for autism than those who do not - if Wakefield's study showed a valid assoc between vacc and autism, than a study of 500 000 should find the same association as well

What is the most important reason someone seeks medical care?

- anxiety concerning the condition, coping resources, and level of physical functioning -> NOT level of symptoms! - those w/ adequate resources to cope w/ symptoms and quality of lives is not too impaired do not seek medical care

What are convenient care clinics?

- basic health care providers - health care is given by physicians' assistants and nurse practitioners

What are excellent internet health resources?

- centre for advancing health website - National Institutes of Health

Describe the ways people think about diseases that vary from medical explanations

- children and college children show inaccurate and incomplete understandings of diseases when they describe diseases they have and how they became ill - in one study, college students thought that symptoms of the flu would be less serious if they contracted the virus from a lover rather than a hated person (lmao who?!!) - people may seek, or not seek, medical care based on incomplete and inaccurate beliefs about health and illness

What are the behaviours that patients like in physicians?

- confident - thorough - personable - humane - forthright - respectful - empathetic

Describe the use of alternative healthcare?

- considered alt because they provide alts to conventional med care - 1/3 of US people who seek conventional health care also use alt healthcare, and nearly everyone who uses alt health care also uses conventional health care - people use alt healthcare sometimes bc things like healers are part of a cultural tradition - recent growth in use has come from well-educated people who are dissatisfied w/ standard med care, and who hold attidues compatible w/ the alt care they seek = well-ed people are more likely to turn to alt med bc they can better pay for this care

what is the main problem w/ intervention strategies to reduce children's distress from hospitalization

- cost - trend is toward cost cutting, and all interventions add to medical care costs - some of these interventions may be effective if they reduce the need for additional care or decrease other expenses

Describe the limited access to medical care in the US

- costs of medical care prevent many from receiving proper treatment and care - more restricted in the US than other western countries bc most others have developed national health insurance or plans for universal coverage = most people cannot afford hospitalization and complex medical treatments - led to the rise and development of health insurance

Describe the third component in the conceptualization process of conceptualizing a disease: determination of cause

- determining causality is more part of a sick role than illness behaviour, because it usually occurs after a diagnosis has been made - attribution of causality for symptoms is an important factor of illness behaviour - if someone can attribute hand pain to having being hit by a basketball earlier, they won't consider possibility of bone cancer as part of the pain - attribution of causality is faulty - colds attributed to germs or weather, and cancer as caused by microwaves or God - people are less likely to see professional treatment for conditions they consider as being caused emotionally or spiritually - someone who views heart disease as due to lifestyle will manage illness differently than those who view it as stress, so conceptualizations of disease causality will influence behaviour (Taiwanese/Britons study)

Define the difference between disease and illness, and how it can prevent people from seeking proper healthcare?

- disease and illness are often used interchangeably - disease = process of physical damage in the body, which can exist even in the absence of a label or diagnosis - illness is the experience of being sick w/ a diagnosis of sickness - people can have a disease and not be ill (ie., undiagnosed hypertension, HIV, or cancer). may have the disease but appear "healthy" and unaware of their disease - they often overlap as well, when someone feels ill and has a diagnosis of a specific disease - people frequently experience symptoms, but these may or may not be part of a disease

What do the five beliefs in leventhal's model predict?

- distress - seeking of healthcare - disease management

Describe the fourth component in the conceptualization process of conceptualizing a disease: consequences of disease

- even though the consequences of a disease are implied by the diagnosis, an incorrect understanding of consequences can also have a huge impact on illness behaviour - diagnosis of cancer is = death sentence - some neglect healthcare because they believe themselves to be in a hopeless situation - women who find lump in breast will delay appointment w/ doctor bc they fear the consequences: surgery, loss of a breast, chemo, radiation etc.

Why would people consider the physician's gender when choosing one?

- female physicans are more likely to show the desired behaviour than males - meta-analyses show that female physicians were more patient centred, spent 10% time w/ their patients, employed more partnership behaviours, were more positive hwen communicating, engaged in more psychosocial counselling, asked more questions, used emotionally focused talk, and were evaluated more highly by patients - patients of female physicians were more likely to disclose info on their med symptoms and their psychological concern

How is Segall's formulation of rights and duties ideal, not realistic in the US?

- first right (making decisions about health related issues) does not extend to children and people living in poverty - exemption of sick person: meeting these expectations isn't always possible. many sick people neither stay home, nor go to hospital, but continue to go to work. People who are scared of losing their jobs are more likely to go to work when they are sick, but so do those who experience good work relationships and are dedicated to jobs - to be dependant on others: sick mothers often must continue to be responsible for their kids the three duties fall under obligation to do what is needed to get well goal of getting well applies more to acute than to chronic diseases, bc chronic disease patients will never be completely well. Presents a conflict for those w/ chronic diseases, bc they have difficulty accepting their condition as one of continuing disability, and believe their disease is a temporary state

How is the communication of the diagnosis important?

- if diagnosis is minor, patients may be relieved and not highly motivated to adhere to (or listen to) any instructions that may follow - if diagnosis is serious, patients may be anxious or frightened, and these feelings may interfere w/ concentration on subsequent medical device - this is very important, bc when patients do not receive info that they have requested, they feel less satisfied w/ physician and are less likely to comply w/ the advice they receive. If they feel physicians understand their reasons for seeking treatment, and that both agree about it, they are more likely to comply

How do physicians "gatekeep" health care?

- in the US and Western countries, people aren't officially ill until they get diagnosed, so physicians are the gatekeepers to further healthcare - they don't only determine disease by diagnoses, but sanction it by giving a diagnosis - person w/ symptoms is not the one who officially determines their health status

Describe the socioeconomic factors that play into seeking healthcare

- in the US, people in higher socioeconomic groups experience fewer symptoms and report a higher level of health than people at lower socioeconomic levels - when higher income people get sick, they are more likely to seek healthcare - poor people are overrepped in hospitals, indicating they are more likely than middle and higher income people to become seriously ill - those in lower socioeconomic groups tend to wait longer before seeking healthcare, making treatment more difficult, and hospitalization more likely - poor have less access to med care, have to travel longer to reach hospitals, and must wait longer once they arrive - poor people use healthcare less than wealthier people, and when they do, their illnesses are more severe

Describe the iBS study about the lay referral network

- in this study, about half of those who didn't seek medical care sought alternative care or the advice of someone with the same condition - so most people sought help, just not necessarily from a physician

Describe individual and workplace insurance in the US, and how there are barriers to healthcare for people w/o insurance in the US?

- individual - expensive - offers less coverage, esp for people w/ health problems Workplace - employment is an important factor to accessing medical care in the US, as this is less expensive and offers more coverage - people who are unemployed or whose job doesn't have benefits are uninsured, a situation describing about 11% of people in the US

Define health, and how it can prevent people from seeking proper healthcare?

- is health the absence of illness, or attainment of a positive state? - WHO defines health as positive physical, mental, and social well being, not the absence of disease or infirmity - this has little practical value to people trying to make decisions about whether to seek medical attention for symptoms (as we like to play it off)

Describe the study about how culture and ethnic background are primarily responsible for differences in seeking med care?

- it is NOT lack of knowledge! SET UP - questionnaires sent to a large, diverse group, which incl two clinical vignettes showing 1) people experiencing signs of chest pain and 2) people discovering a lump in their armpit - experimenters asked each participant to respond to chest pain and lump in terms of needing immediate care RESULTS - Black, female, and lower socioeconomic groups were at least as likely as those who were white, male, and from middle and upper class groups to make accurate responses to potential medical problems - poor Black women do not lack info about the potential health hazards of chest pain/lump, but they are more likely to lack resources to respond quickly to these symptoms

Why is the internet a common source of health info?

- it satisfies motivations like: - seeking a greater understanding of a health issue - getting a second opinion - seeking reassurance - overcoming difficulties in getting health info through other sources

List the two easily accessible sources people take to seek health care

- lay referral network - the internet

What can misinformation about a vaccine do?

- lead parents to forego vaccines - public then, is at an increased risk for contracting measles - for the measles, 90 - 95% of a population needs to be vaccinated in order for the population to avoid exposure to the disease - even small dec in vaccine rates can lead to outbreaks of a disease - outbreak of measles in a California amusement park was due to a single person who contracted measles overseas and transmitted it to unvaccinated people

Describe choosing a practitioner for those who don't have health insurance

- less likely to have a regular health care provider than those with insurance - people who don't have health insurance may receive care from convenient care clinics or hospital emergency rooms, even for chronic conditions

Does the internet provide accurate info about vaccines?

- less than half of the websites resulting from a google search of "is there a link between the MMR and autism" provided scientifically accurate answers to the question

Describe the study examining age and health care

- looked at patients who failed to realize that a delay in seeking health care could bring about more severe symptoms as well as increased chance of mortality - compared w/ younger and middle aged people, these older patients were more likely to: 1. attribute their symptoms to age 2. experience more severe and lengthy symptoms 3. attribute their symptoms to another disorder 4. have had previous experience w/ cardiac problems - thus, people may seek help less willingly if they view their symptoms as being part of aging

Describe the internet as a source of healthcare info

- majority of internet users in the US report using it to search for health info either for themselves or for others - women and those with higher education are more likely than others to use the internet for this purpose - public health researchers can use a sudden increase in searches about specific disease symptoms to reliably ID outbreaks of infectious diseases in near real time

What factors can make hospitalization a stressful experience?

- managed care has helped control costs through shorter hospital stays, it hasn't always been in the interest of the patient - technological medicine has become more prominent in patient care, and personal treatment by hospital staff is less so

What is the issue with seeking care in emergency rooms?

- may result in people receiving care only after their condition is the definition of an emergency - these patients are sicker than they might have been if they had easier access to care - seeking care from emergency rooms is more expensive and overburdens facilities, so it is dec in its ability to provide care for those w/ acute conditions

What are the challenges of using the internet for healthcare info?

- misinformation - distinguishing between trustworthy websites from those simply trying to sell health products - Wikipedia is used as a primary source of health info, but its info may not be as accurate as other sources

How can hospitals allow for some patient control?

- most hospitals let patients have a choice of foods, and provide tv REMOTES TO ALLOW THEM TO SELECT A PROGRAM

Why do patients receive a lack of information?

- not due to attempting to withhold it from them, but because of the hospital routine - an open exchange of info between patient and practitioner is hard to achieve in the hospitals, bc physicians spend only a brief amount of time talking to patients - info may be unavailable because they are running diagnostic tests - hospital staff might not explain the purpose or results of diagnostic testing, leaving patient without info and anxious - for efficiency of organization, uniform treatment and conformity to hospital routine are desirable, even though they deprive patients of info and control

Describe the factor of stigma in utilizing healthcare?

- not seeking help bc of stigma assoc w/ disease -stigma may occur for a disease bc a person is embarrassed about the condition, or about the manner they have contracted the condition - stigma delays health care seeking for conditions that may be a source of embarrassment: incontinence, STD's, etc. - may also prevent some people, particularly smokers, from seeking care for symptoms related to lung cancer

Describe the real life profile of Lance Armstrong

- overcame testicular cancer - won five Tour de France's - later confessed to using performance enhancing drugs, and his reputation was damaged irreparably, his victories stripped - one of his victories in 1996 concerned his fans - instead of pumping his fists in victory, he looked exhausted with bloodshot eyes and face flushed. Later, he dropped out of the Tour after only 5 days - confessed he did not feel well, losing energy, suffering from coughs and lower back pain - he attributed them to the flu or hard training season - told himself to suck it up - symptoms didn't improve, and when he developed a bad headache, thought it was alc induced, and as his vision got blurry, he attributed that to getting older - he began coughing up blood, and a physician friend said it may just be a cracked sinus - the next day, his testicle had swollen to the size of an orange, and this mf went on a training ride - he then finally went to the dr's bc he couldn't sit on the seat - learned he had Stage 3 testicular cancer - cancer had spread upwards to lungs, abdomen, and brain, and he had a 40% chance of survival - there was nothing like $, lack of access or anything to hold him back from seeking care, but athletes deny pains to finish their race/game all the damn time - he did survive, but had to undergo chemo and surgery on both testicles and the brain

Describe how training parents affects a child's response to needles

- parents who received training on how to reassure child expressed a high level of confidence they could reassure and calm their child - after immunization, the reassuring parents not only had problems helping them, but rated themselves as much more distressed than other parents did - parents' distress also increased the child's anxiety - reassurance does jack sh*t for parent or children

Describe the hospital patient role

- part of the sick role is being a patient and complying w/ rules of hospital and medical advice - person is part of a complex institution and assumes a role in it - role includes difficult aspects: being treated as a "nonperson", tolerating lack of info, and losing control of daily activities. Patients also experience waits, delays, and communication problems w/ staff as distressing, which decreases their satisfaction

How does the internet affect the patient-physician relationship?

- patients are more active in health care - internet may decrease physicians' authority and change the nature of the physician-patient relationship - when the patient brings info in that the physician views as accurate and relevant, then the relationship can benefit - when they bring info that is inaccurate/irrelevant, it can deteriorate the relationship and challenge the physician's authority - many patients are scared to bring up Internet health info out of fear of challenging the health provider - so, internet is an important source of health info, but patients who don't have access to accurate and relevant info may not be in as good a position to effectively use healthcare system

Why is poor verbal communication an important problem in healthcare?

- patients are sig less likelyt o follow a practitioner's med advice when the practitioner communicates poorly

What problems do people encounter in receiving medical care?

- paying for medical care - those w/o insurance often have limited access to healthcare - Medicare/Medicaid help people over 65 and poor people with access to healthcare, but many have problems finding a regular practitioner and receiving optimal healthcare - physicians might not have a lot of time to devote to a patient, which can create comm problems reducing patient satisfaction - comm problems incl: using med jargon unfamiliar to patient, and focusing on determining and describing a diagnosis than the patients fully describing concerns - hospital stay are shorter, but being in the hospital is difficult for all ages - person must conform to hospital procedures, including being treated as a nonperson, tolerating lack of info, losing control of daily activities - children are placed in unfamiliar enviros, separated from parents, undergo surgery or other painful med procedures - interventions help children and parents to navigate this experience and may ease distress, but cost limits the availability of these resources

What happens as a result of the loss of control patients have over their lives?

- people manifest heightened physiological responses and react on a physical level to uncontrollable stimulation more strongly than when they can assert control over their condition - it can decrease their ability to concentrate, and can increase tendency to report physical symptoms

What has resulted from the changes in hospitals over the past 30 years?

- 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

Describe the study about stigma and smokers in seeking healthcare?

- people who perceived greater stigma assoc w/ lung cancer waited longer to seek care for initial symptoms - this may be particularly problematic for smokers, who are less likely than non smokers to seek help for symptoms that might indicate lung cancer, possibly bc of fear of judgment from physicians or being blamed for the disease

Describe the second component in the conceptualization process of conceptualizing a disease: time line

- people's understanding of the time involved is not necessarily accurate, even though a diagnosis implies a time course of a disease - ppl w/ a chronic disorder view disease as acute and of short duration - ie., people w/ heart disease may see disease as heartburn - w/ most acute diseases, patient can expect a temporary disorder w/ a quick onset of symptoms, followed by treatment, a remission of symptoms, and then a cure - people who conceptualize their illness as acute manage their symptoms better! - scenario doesn't fit the majority of diseases, which are chronic and persist over a lifetime - ie., in diabetes study, the people who conceptualized it as acute managed their illness WORSE, bc they took meds only when acute symptoms were present - conceptualizing chronic disease w/ a time limit provide patient w/ psychological comfort (cancer patients -> acute illness = less distress)

Why don't physicians and patients speak the same langauge?

- physicians operate in a familiar territory; they know the subject matter, are comfortable w/ the physical surroundings, and are calm and relaxed with procedures that are routine - patients are unfamiliar with med terminology, distracted by the strange enviro, and distressed by anxiety, fear, or pain - they also literally may not speak the same language, and differences in native language present a major barrier to communication - even w/ interpreters, miscommunication may occur, and patients either fail to understand or remember sig portions of the info the doctors five them

What are the barriers to people w/ insurance in receiving care?

- policies fail to cover services like dental care, mental health services, and glasses, so people have to pay for these out of pocket, or forego services - if people have a catastrophic illness, coverage may be inadequate for many expenses, creating enormous medical costs - medical costs are the cause for over 60% of personal bankruptcies in the US

Where do people seek med info?

- prior to seeking med care and info from the health care system, people turn to other people and the internet - lay referral network: people's family and friends, who help interpret meaning of symptoms and suggest causes and cures - internet is a common source of health info, although the quality varies - when patients do find accurate and relevant health info, it benefits the patient-practitioner relationship - not all patients have access to health info through the internet, or are wary of bringing this info to practitioners

What are some effective ways to reduce stress on kids?

- providing children and parents with info about hospital procedures and equipment can be an effective way to decrease anxiety - distraction > reassurance - modelling

Describe the fifth component in the conceptualization process of conceptualizing a disease: controllability of disease

- refers to people's belief they can control course of illness by controlling treatment or disease - people who believe behaviours won't change course of disease are more distressed by illness and less likely to seek treatment than those who believe it will be effective - people who can control symptoms of disease w/o med consultation are also less likely to seek medical care

What are the benefits of a satisfying patient-practitioner relationship?

- satisfied patients are more likely to... - follow med advice - continue to use med services and obtain checkups - less likely to file complaints against practitioners

Why is hospitalization a source of stress for children?

- separation from parents - unfamiliar environment - diagnostic tests - administration of anaesthesia - immunizations - surgery - post op pain

At what point should a person seek medical care with symptoms?

- sneeze, painful shoulder, or a headache would not make someone go get med care, but persistent stomach pain would - errors in both directions happens - people who decide to go to the doctor when they are not really sick feel foolish, pay money for the visit, and lose credibility w/ people who know about the error, incl. the physician - if they choose not to seek it, they may get better, or they may get worse, and ignoring symptoms may make treatment more difficult and endanger their health, and even inc their risk of death - prudent action would be to chance the unnecessary visits

Why is social media a dangerous place for misinformation about vaccines?

- social media sites offer emotional accounts of personal experience for vaccines or autism, which often focuses on perceived harms of vaccines - personal stories and narratives are more engaging and powerful - regardless of accuracy - than drier, scientifically based information - so, for a parent searching for info about the mMR vaccine, the internet and media may be powerful sources of misinformation - people also seek out info that confirms their beliefs, so people are resistant to new info that contradicts their views

Can changing these five Leventhal beliefs improve the health outcome?

- study on asthma - these components can be useful targets for intervention - researchers sent some asthma patients periodic text messages informing patients of the ID, time line, cause, consequences and controllability of asthma - patients receiving texts reported more accurate beliefs about asthma and ability to manage conditions - useful to understand why some people behave not only in unhealthy ways, but can be used as targets for intervention to improve self management

According to Mechanic's list of reasons for healthcare seeking, why do people seek help?

- symptom characteristics alone aren't sufficient - if symptoms persist or are seen as severe, people are more likely to evaluate them as indicating a need for care - so, people seek care not on the basis of objective symptoms, but on the base of their interpretation of symptoms, highlighting the role that beliefs and perceptions play in seeking healthcare

What do personal factors include when seeking healthcare?

- the way people view their body - their level of stress - personality traits EX: IBS - IBS is characterized by pain, cramping, and constipation and diarrhea - stress makes condition worse - some people w/ IBS seek med treatment, others do not

Describe the US govt's solutions to the problem of providing med care for those who cannot pay?

- two programs: Medicare, Medicaid + State Children's Health Insurance Program MEDICARE - pays hospital expenses for most Am over 65, and few people in this age group are w/o hospitalization insurance - offers med insurance that those who participate may purchase for a monthly fee, but expenses like dental care etc. aren't covered MEDICAID - health care based on low income and physical problems, like disability or pregnancy - restrictions make poor people ineligible, only about half of people living in poverty receive coverage State Children's Health Insurance Program - children are eligible for health insurance

What can a lay referral network help a person do?

- understand meaning of symptoms, such as what its label, cause, and cure might be - can also prime a person's perception of symptoms - a woman who had chest pain would react quite differently if her family had a history of heart attacks compared to a history of heartburn - people in this network could advise against medical care, esp if they can recommend simple home remedies are recommend complementary and alternative treatments - social networks are often a first source of info and advice on health matters, but may not always encourage people to seek medical care

What are the two important factors in building successful practitioner-patient alliances?

- verbal communication - practitioner's personal characteristics

Describe the first component in the conceptualization process of conceptualizing a disease: identity of the disease

- very important to illness behaviour - those who ID symptoms as "heart attack" vs "heartburn" should and do act differently - the labelling that occurs in conjunction w/ symptoms may be critical in somebody seeking help, or ignoring symptoms - labels provide a framework to recognize and interpret symptoms (ie., Leventhal BP study) - people experience less emo arousal when they find a label indicating a minor problem - initially, they will adopt the least serious label fitting their symptoms, bc a label carries some prediction about symptoms and time course of the disease - if the symptoms and time course do not correspond to the expectation implied by the label, the person must relabel - tendency to interpret symptoms as indicating minor, rather than major problems is the source of optimistic self diagnoses

What kind of physician do people tend to follow the advice of?

- warm - caring - friendly - interested in welfare of patients - if they think the physician looks down on them or are disrespectful, patients won't follow their advice or keep med appointments - poor communication may have a particularly bad effect on adherence when the physician and patient are of different ethnic backgrounds

Describe how the main healthcare provider has changed over time

- when people get sick, they search out a healthcare provider - 19th century: physicians dominant med providers. most middle and upper class people in industrialized nations sought out the services of a physician - End of the 20th: med dominance began to decline, and other types of health care providers' popularity rose, like midwives, nurses, pharmacists, phys therapists, psychologists, osteopaths, chiros, dentists, nutritionists, herbal healers

When can communication problems arise in healthcare?

- when physicians ask patients to report on their symptoms but fail to listen to patients' concerns, interrupting stories within seconds - what constitutes a concern for a patient might not be essential to the diagnostic process, and the practitioner may be trying to elicit info relevant to a diagnosis - however, this behaviour may be misinterpreted as a lack of personal concern or overlooking what patients consider important symptoms

What does it mean to be a non-person?

- when someone is hospitalized, all but their illness becomes invisible, status is reduced to a nonperson - their identities are ignored, but their comments and questions may also be - hospital procedure is focused on the technical aspects of med care, ignoring patients' emotional needs, and leaves them less satisfied w/ their treatment than those who are treated as people, listened to, and informed about condition

Describe gender differences in terms of seeking treatment?

- women are more likely to use healthcare than men - women tend to report more body symptoms and distress than men - when asked about symptoms, men tend to only report life threatening situations like heart disease - women report these symptoms but also non life threatening symptoms, like those from joint disease - w/ the same level of symptoms, the fem gender role may make it easier for them to seek many sorts of assistance, whereas the male gender role teaches men to act strong and deny pain and discomfort - men are more likely to delay seeking healthcare for symptoms that might indicate cancer

Describe the selective discounting of symptoms due to stress

- women under high stress are judged as less likely to have a physical disease than men in the same circumstances - particularly true for male physicians who are less likely than female ones to recommend cardiac testing for women who complain of chest pain - tendency to discount symptoms might be important factor in the treatment of women who experience symptoms and for health care providers who hear their reports

Describe how age affects seeking healthcare treatment?

- young adults usually feel healthy and indestructible, so they show the greatest reluctance to see a health professional - as they age, they are more likely to seek healthcare, bc age is tied to both the development of physical symptoms and people's interpretation of them - as we age, we have to decide whether our symptoms are aging, or disease - people tend to interpret problems w/ a gradual onset and mild symptoms as resulting from age, but if they have a sudden onset and severe symptoms, they are considered more serious - ie., if older patients w/ symptoms of acute myocardial infarction can attribute these symptoms to age, they delay seeking healthcare

What do patients value when they are able to choose their physicians? What do they actually judge to determine this characteristic?

-technical competence since patients don't have any training they have difficulty judging technical competence, and so they base their judgements of it off the practioners personal characteristics

What are the five components in the conceptualization process of conceptualizing a disease?

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

List and describe the two stages of dealing with symptoms

1. Illness behaviour - activities undertaken by people who experience symptoms but haven't received a diagnosis - engage in illness behaviours to determine state of health and discover suitable remedies - Armstrong engaged in these behaviours when he made an appointment w/ a physician 2. Sick role behaviour - behaviour of people after the diagnosis, whether from a health care provider or through self diagnosis - engage in this behaviour to get well - Armstrong showed this when he underwent surgery and chemo,and recovered from his treatment DIAGNOSIS is the event that separates illness behaviour from sick role behaviour

What determines people's decision to seek professional care?

1. Personal factors 2. gender 3. age 4. socioeconomic, ethnic, and cultural factors 5. characteristics of symptoms 6. conceptualization of disease

List the four characteristics of symptoms that determine a person's responses to disease?

1. Visibility of the symptoms - how apparent the symptom is to person and others STUDY: a study of Mexican women who had symptoms of possible breast cancer, those whose symptoms were more visible were more likely to seek medical help - w/ diseases such as these, the condition may be worse and treatment options more limited once it is visible 2. Perceived severity of the symptoms - symptoms seen as severe would be more likely to prompt action than less severe symptoms - highlights the importance of personal perception, and distinguishes between perceived severity of symptom and jUDGMENT of severity by medical authorities STUDY: patients and physicians differ in their perceptions of severity of symptoms -> symptoms that patients perceive as serious produce greater concern and a stronger belief that treatment is needed, as a study on women seeking care after experiencing heart attack treatments shows - women who interpreted symptoms as indicative of heart problems sought care more quickly than those who thought their symptoms were another condition - perceived severity of symptoms > presence of symptoms 3. Extent to which a symptom interferes with a person's life - more incapacitated, more likely they will seek med care - IBS and overactive bladder study: those who seek med care report a poorer health quality of life than those who don't seek med care 4. Frequency and persistence of symptoms - conditions that people view as needing care are both severe and continuous, intermittent symptoms are less likely to generate illness behaviour - severe symptoms are most likely to prompt illness behaviour, but mild symptoms can motivate healthcare seeking if they persist

How has hospitals and the experience of being in the hospital changed over the past 30 years?

1. many types of surgery and tests that were formerly handled through hospitalizations are now performed on an outpatient basis 2. hospital stays have become shorter 3. an expanding array of tech is available for diagnosis and treatment 4. patients feel more free to voice their concerns to their physician

What are the three duties or responsibilities that Segall said the sick role concept includes?

1. the duty to maintain health along with the responsibility to get well 2. the duty to perform routine healthcare management 3. the duty to use a range of health care resources

What are three rights or privileges that Segall said the sick role concept includes?

1. the right to make decisions concerning health related issues 2. the right to be exempt from normal duties 3. the right to become dependent on others for assistance

Define neuroticism

A personality trait marked by tendency to experience negative emotional states

Why do questions about the safety of vaccines persist?

Explanation 1: Celebrities - some of the most outspoken anti vacc critics are celebs w/ high media exposure, like Jim Carrey and Jenny McCarthy Explanation 2: No Exact Cause - exact cause for autism is unknown, and no cure exists - when med research doesn't have answers, people look to the internet and social media for answers

Define lay referral network

The network of family and friends from whom a person may first seek medical information and advice

Define illness behaviour

Those activities undertaken by people who feel feel and wish to discover their state of health, as well as suitable remedies. Illness behavior precedes formal diagnosis

Define sick role

Those activities undertaken by people who have been diagnosed as sick that are directed at getting well

What is the goal of illness behaviour?

determine health status in the presence of symptoms people routinely feel symptoms assoc w/ disease, chest pain,s oreness, headaches - presence of symptoms are critical in seeking healthcare, but presence is not sufficient to go to the doctor -

What factors are related to seeking medical attention?

social, ethnic, demographic factors characteristics of their symptoms their concept of illness In deciding when they're ill, people consider 1) the obvious visibility of their symptoms 2) the perceived severity of their illness 3) the degree to which symptoms interfere with their lives 4) frequency and persistence of symptoms - once pople are diagnosed, they assume the sick role that involves relief from normal social/occupational responsibilities, and the duty to get better

Describe how stress is a personal factor in a person's readiness to seek care

those who experience a great deal of stress are more likely to seek health care than those under less stress, even w/ equal symptoms those experiencing current or ongoing stress are more likely to seek care when the symptoms are ambiguous people are less likely to view someone as having a disease if the person also complains about stress, as others perceive symptoms that coincide w/ stress as not real