1. Patient-Practitioner Relationships
Health Psychology
Patient-Practitioner Relationships

2. Requirements Interpersonal skills Diagnosis and Style
Using and Misusing
Use either the first 4 studies OR the last 3 to illustrate the above ideas

3. Background COMMUNICATION Message sender – message – message receiver
Non verbal; assist, replace, signal attitude, signal emotion
Dress of dcotors
Taylor – doctors are not trained in communication
No agreement on good consultation; Sensitivity; Complicated
DiMatteo & DiNicola – basic courtesy
Ley – 28-41% dissatisfied with information given. Much forgotten or not understood. Patients lack awareness of body therefore explanations are meaningless (Boyle)
Doctor-centred/Patient-centred. Beckman & Frankel doctors interrupt patients. Edelmann compared styles, Benbasset, elderly people do not want patient-centred

4. Background 2 JUDGEMENTS/DECISIONS
Heuristics – rules for probabilities. Availability heuristic uses information available to make decision. Representative heuristic make judgements about individual based on whole group
Primacy effect of information given – immediate decision made based on early information and later information made to fit the decision
Risk – Marteau present information in positive frame and its more likely to be chosen (10% survival, 90% chance dying)
Long adjustments take place after serious diagnosis. Taylor – search for meaning, search for mastery, self-enhancement

5. Background 3 LAY CONSULTATION Asking others for advice
Scambler – 11 lay consultations for every doctors visit
Why doctors visit – persistence, critical incident (change), treatment expectation
McDoctors – assembly line, shopping mall

6. Background 4 DELAY HYPOCHONDRIASIS MUNCHAUSENS IATROGENICS
Appraisal (time to interpret)
Illness (realising and deciding)
Utilisation (deciding and turning up)
Character of patient (age, gender, culture)
Illness related factors (site of symptom, type, speed of development, embarrassment)
Health beliefs (susceptibility, examination)
HYPOCHONDRIASIS
Overly worried about health
MUNCHAUSENS
Excessive medical attention
By proxy
IATROGENICS
Doctor made illness

7. 3 Short Summaries
Communication between doctor and patient is an important aspect of healthcare. It is made difficult by many factors, including different experiences, expectations and style of language that health workers use compared to general public
Diagnosis is difficult to make because of varied ways illness shows up in people and varied ways individuals describe symptoms. Health workers make best use of available evidence but may also bring biases into the judgement process. Diagnoses are not always welcomed by the patient and there is a long process of adjustment to development of a chronic illness.
Our general experience of health workers is good, but it is also fair to say a significant number of patients have poor experience for a number of reasons. It is true that hospitals can make us sick and doctors can make the wrong diagnosis, but the cost-benefit analysis suggests healthcare in the UK contributes massively to increasing the length and enhancing the quality of life.

8. Patient-Practitioner Relationship – Study 1
Kessler et al
Who
1999
Symptom attribution and recognition of depression
305 (most women)
16-90y
8 doctors, 1 surgery
Informed
What
General health questionnaire (depression/anxiety) + symptom interpretation questionnaire (symptoms + 3 causes, categorised psychologising, somaticising, normalising)
Seen by GP; spot symptoms anxiety/depression
Results
Patients way of thinking about own health affects way they interact with GP and therefore diagnosis given
If previously diagnosed depressive likely to be misdiagnosed with it this time

9. Patient-Practitioner Relationship – Study 2
Schofield
Who
1997
Agreement on preparation for breast cancer treatment
164 patients
5 specialists, 140 nurses, 64 doctors
What
Sets of likert scales. Doctor should always do…doctors should never do (+ not sure)
1. How patients should be prepared – times, jargon, sensitivity
2. steps to prepare – type of information, when delivered, how
Results
High level agreement
Only video information and previous ways of coping vary in response
Doctors rated less guidelines as important
Agrees with hypothesis that doctors lack interpersonal skills

10. Patient-Practitioner Relationship – Study 3
Mooney
Who
2001
Predictors of satisfaction
345 patients
1 clinic
Informed
What
Questionnaire (used before) after visit, likert scale,
Transferred to scale to give score
Results
90% rated as very good or excellent satisfaction
Quality of interaction received higher rating than facilities/access to services
Interpersonal skills of doctor predictor of satisfaction

11. Patient-Practitioner Relationship – Study 4
Smucker
Who
1998
Practitioner self-confidence and patient outcome
Random 189 doctors & chiropractors
Informed
What
Correlation
Questionnaire. I lack knowledge…I know exactly what to do…I feel comfortable treating. Likert, 1 Strongly agree – 5 Strongly disagree. 4Q self confidence, 4Q attitudes, 2Q knowledge of progression acute-chronic
Contact details 1633 patients, telephone contact made after 1st visit & 2, 8, 12, 24 weeks after.
Confidence score compared to length of recovery
Results
Strong correlation self-confidence and attitude
Patient satisfaction higher for chiropractors than doctors
No correlation with length of recovery

12. Study 5 Bourhis Who What Results 1989
Communication in hospital setting
40 doctors, 40 nurses, 40 patients
What
Questionnaire about medical language and everyday language in a hospital. Part 1 about how much of each they used with the other groups. Part 2 about how much they thought other groups used with each other. Part 3 appropriateness scale for the use of the languages in each group. Part 4 background information and attitudes
Results
Doctors use ML to maintain status
Nurses will converge
Doctors say they use EL but not backed up by nurses or patients. Patients try to use ML if they know some. Doctors prefer patients to use EL. Nurses are communication brokers. EL is better for patients (all agreed) and ML leads to difficulties.
Courses in communication a good idea

13. Study 6 Savage et al Who What Results 1990
GP consulting style and satisfaction
Inner London practice
359 patients random – 200 used
What
Directed consultation – “you are suffering from… it is essential that…you should be better in…come and see me in…” OR sharing consultation “what do you think is wrong…would you like a prescription…are there other problems…when would you like to see me again…”
Tape recorded
Patients 2 questionnaires – one immediately one 1 week later assess satisfaction
Results
Overall high level satisfaction
Directed group – higher level
Higher level of satisfaction with explanation and more likely to report ‘greatly helped’
Style of consultation affects patient satisfaction & contradicts contemporary ideas about sharing decisions

14. Study 7 Safer et al Who What Results 1979 Determinants of delay
4 clinics, 1 hospital
Interviewer approached patients (new), questions 45 minutes. Black female nurse + white male undergraduate
93, ~44y, 60% black
What
When did first symptom occur…when decided il…when decided to seek help. Range of questions open/closed to discover factors contributing to decision
Results
Factors operate independently as no correlation (appraisal, illness, utilisation)
Mean delay 14.2 days
Appraisal variable – severe pain, reading about symptoms, bleeding. Pain and bleeding speeds up process, reading is passive monitoring
Illness variable – new symptom, negative consequences of illness, gender. Old symptoms delay more, negative imagery delay more, females delay more.
Utilisation variable – cost increases delay, pain decreases delay, belief in cure delay less long
Personal problems lead to a longer delay in all areas

15. General Review Reductionism Generalisation Determinism/Free will
All rely on numerical scales
Statistical analysis possible but excludes rich data
Generalisation
Smucker generalisable to rest of geographic area
Others use convenience samples so findings restricted
Determinism/Free will
Kessler; the diagnosing behaviour is influenced by attribution style of patient
Schofield; preparedness of patients determined by doctors
Usefulness
Implications, benefit health services
Kessler/Mooney suggest ways doctors need to be trained (attributional styles, interpersonal skills)
Schofield guidance on how to consult

16. Questions…
Describe what psychologists have discovered about the relationship between patients and practitioners (10)
Evaluate what psychologists have discovered about the relationships between patients and practitioners (16)
One colleague in a group practice finds the elderly patients prefer to go to her colleagues than make an appointment to see her. Suggest how she might change her behaviour to encourage more elderly patients to make appointments with her. Using your knowledge of psychology, give reasons for your answer (8)
Suggest an intervention that will encourage people not to delay seeking help when they have serious symptoms. Give reasons for the suggestion.
Describe one study of patient-practitioner interpersonal style (6)
Discuss ethics of research into patient-practitioner interactions (10)
Describe one piece of research into using health services (6)
Discuss usefulness of research into using health services (10)
Describe one piece of research into mis-using health services (6)
Discuss problems of researching mis-use of health services (10)