© 2012 McGraw-Hill Companies, Inc. All rights reserved.McGraw-Hill/Irwin© 2012 McGraw-Hill Companies, Inc. All rights reserved. Health Psychology 8 th edition Shelley E. Taylor Chapter Nine: Patient-Provider Relations

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-2 What is a Health Care Provider? Nurses as providers: - advanced-practice nurses: - nurse-practitioners - nurse midwives - clinical nurse specialists - nurse anesthetists Physicians’ Assistants as providers: - perform many routine health care tasks

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-3 Patient-Provider Communication Judging quality of care: - the manner in which care is delivered is used as the criteria Patient consumerism: - patients have a desire to be involved in decisions that affect their health - t o convince a patient to follow a treatment plan requires the patient’s cooperation - patients often have considerable expertise about their health problems

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-4 Patient-Provider Communication (cont.) The setting: - the medical office is an unlikely setting for effective communication Structure of the health care delivery system: - private, fee-for-service care - Health Maintenance Organizations (HMOs) - Preferred-Provider Organizations (PPOs)

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-5 Patient-Provider Communication (cont.) - Patient dissatisfaction in managed care: - provider not always overly concerned with patient satisfaction - some evidence that quality of care has eroded - HMOS and patient care - DRGs and patient care: - Diagnostic-Related Group (DRG): - a classification scheme that determines the nature and length of treatment for particular disorders - DRGs have positive and negative effects on care

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-6 Patient-Provider Communication (cont.) Changes in the philosophy of health care delivery: - physician’s role is changing - patients must assume more responsibility Holistic health movement and health care: - health is a positive state to be actively achieved - Western medicine incorporating Eastern approaches - Greater emotional contact between patient and provider

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-7 Patient-Provider Communication (cont.) Provider behaviors that contribute to faulty communication: - inattentiveness - use of jargon - baby talk - nonperson treatment - stereotypes of patients

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-8 Patient-Provider Communication (cont.) Patient contributions to faulty communication: - patient characteristics - patient knowledge - patient attitudes toward symptoms

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-9 Patient-Provider Communication (cont.) Interactive aspects of the communication problem: - providers rarely receive feedback - when a patient doesn’t return: - the treatment may have led to a cure - the patient may have gotten worse and gone elsewhere - the treatment may have failed, but the patient got better anyway - the patient may have died *Feedback is essential for the providers

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-10 Results of Poor Patient-Provider Communication Nonadherence to treatment regimens: - nonadherence: - patients do not adopt the behaviors and treatments their providers recommend - estimates range from 15% to 93% of patients do not heed their physician’s advice

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-11 Results of Poor Patient-Provider Communication (cont.) Measuring adherence to treatment regimens: - yields unreliable and artificially high estimates Causes of adherence: - good communication - treatment regimen - creative nonadherence

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-12 Results of Poor Patient-Provider Communication (cont.) Malpractice litigation: - malpractice suits have exploded over the past decades because of: - increases in technical complexity - administrative complexity - incompetence and negligence - poor communication

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-13 Improving Patient-Provider Communication Teaching providers how to communicate: - training providers: - “patient-centered communication” improves patient-provider dialogue - nonverbal communication skills - practice communication skills

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-14 Improving Patient-Provider Communication (cont.) Teaching patients how to communicate: - training patients: - teaching patients skills for eliciting information from physicians - thinking up one’s own questions or perceiving that physicians are open to questions improves communication during office visits

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-15 Improving Patient-Provider Communication (cont.) Probing for Barriers to Adherence: - look for effective combination of information, motivation, and behavioral skills Health care institution interventions - reduce wait time

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-16 The Patient in the Hospital Setting More than 35million people admitted yearly to nearly 6,000 hospitals in the U.S. - structure of the hospital: - depends on the health program - Cure, Care and Core: Cure – physician’s responsibility Care – nursing staff Core – administration of the hospital

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-17 The Patient in the Hospital Setting (cont.) Functioning of the hospital: - occupational segregation in the hospital is high - nosocomial infection – infection that results from exposure to disease in the hospital setting - hospital workers, especially physicians, likely to break rules designed to control infection

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-18 The Patient in the Hospital Setting (cont.) Recent changes in hospitalization: - alternatives to traditional hospital services Cost-cutting pressures: - hospitals have vacancy rates as high as 70% - almost half of U.S. hospitals are part of a multihospital system Role of psychologists: - hospitals psychologists doubled in 10 years

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-19 The Patient in the Hospital Setting (cont.) Impact of hospitalization on the patient: - patients arrive at hospital with anxiety - hospital patients show problematic psychological symptoms - patients are given a road map of procedures they can expect

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-20 Interventions to Increase Information in Hospital Settings Landmark study – Janis (1958) - fearful patients are too absorbed with their pre-operative fears to process preparatory information adequately - patients with moderate fears were able to develop realistic expectations of what post-surgery would be *Preparation for patients is very beneficial

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-21 The Hospitalized Child Anxiety: - not all adverse reactions can be attributed entirely to “separation anxiety” - a warm, nurturant relationship with a caregiver can offset some of the adverse effects of hospitalization for children - mother need not be the person who provides that relationship

© 2012 McGraw-Hill Companies, Inc. All rights reserved.9-22 The Hospitalized Child (cont.) Preparing children for medical interventions: - conscious sedation - distraction for managing pain and discomfort - exposing children to modeling film - coping skills preparation - explaining their illness and treatment - encouraging children to be vigilant copers of stress instead of avoidant copers - parental support but not necessarily parental presence