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30 Cards in this Set

  • Front
  • Back
Evidence for Lack of Communiction: 1) __ of mothers not told what was wrong with child. 2) __ did not get opportunity/encouraged to express greatest concern.
1) 1/5
2) 26&
Evidence for Lack of Communiction: 3) __ of patients not given information about diagnosis 4) __ spent giving any information 5) Little or no advice about __.
3) 75%; audiotapes used (no cause, symptoms, or prognosis explained)
4) Less than one minute
5) Litle or no advice (1974, before patient inserts on drugs)
Evidence for Lack of Communiction: 6)___ a taboo topic, Sidney study with 300 patients with term. cancer. 7) __ of physicians make sure their patients understand.
6) Life expectancy; 50% discussed life expec, 15% used numbers.
7) 12%
Why poor communication?
1) Not because __.
2) Communication not stressed?
1) patients do not want to talk to doctor; ex. risk of not using medication at all, patients want to know more than doctors appreciate.
2) Nationwide survey (Diag, prevent med, communic, ethical, cost consid, cult needs; 30% stated communic as most important, 35-45% said doctor is good/ excellent. Accurate?
Why poor communication?
3) Lack of communic skills? maybe: ___
3) 72% of doctors interrup patients after 23 sec, 28% could finish thoughs, 69% were interrup after 15 sec; nonverbal cues to hurry (mumbling while thinking); Jargon (54% unable to define malignant, respir, cardiac); some identified troublesome terms but still used.
Why poor communication?
4) Patients are timid: __
4) Fear of ignorance, 15% would speak up; don't ask questions (6% of time); study: men with prostate cancer, mental health, sexual dysfunc.
Why poor communication?
5) Lack of time: ___
6) Due to diff points of view?
5) Impact of managed care (visits below 10 min; small amount of time needed)
6) Maybe; nec tests vs. disrup to life; psy issues in cancer.
Who gives most information?
Who gets most information?
1) Physicians who earn less money (within a specific field), females; 2) white, college educ, higher incomes; women ask more ques; higher ses saw phys 7 min, middle 6 min, low 5.8 min.
Why is lack of communic such a problem?
1) Dr. might be 'left in the dark': a)__
b) Alternative Medicine
1) a) Prostate cancer patients' physicians unaware of side effects (50% exp bad symp, 25% of phy know)
b) 70% of study in breast cancer used as well, only 33% tell doctors (may interact, e.g. radiation) 33% of 15 men used alt medicine vs. 4% thought by doctor.
Why poor communication?
2) Doctor shopping
2) Change phy 50% due to relat/communic; 60% changed optomol due to poor communic; less chances to devel a rapport.
Why poor communication?
3) Law suits
4) Patient compliance
3) Study: direct relat between communic skills and suits (vs. technical skills) The relationship protects from suits from tech errors; contain med costs with less suits.
4) non comp 20-30% for short term (ex. medicine) 30-40% for preventative (vitamins) 50% for lifetime mediciation (includes not following direc); study: estimates from health care spec. (not accurate; patient reports (later, how are you taking); count pills, blood tests, comp chips.
Conseq of non-compliance
1) Recurrence of symptoms, overdose (prescribe more), misdiag (response to drug), further damage to doctor-patient rel, some drugs must be taken together.
What communication can do (better health outcomes): __
Post-operative pain (less pain and less medicine), shorter hospital stays, quicker recovery from surgery, lower blood pressure (if uninterrup), blood sugar control (for diabetics), perceived health status, daily func.
Proposed Solutions
Doctor: changes in medical training (pittsburg med schoool, depart for phy-patient communic), new testing for interv skills ($1000 for one-on-one in clin setting, vs. less empath), continuing educ, changes in body lang (ask open-ended ques, sit, patient the expert in exp), changes in office pract (write out ques, devel clear descrip, write down ans, ask ques).
Medical Training:
Med student (__)
Clerkship (__)
Intern (__)
Resident (__)
Chief Resident (__)
Attending Physician (__)
1) first two yrs, 2) next two yrs, 3) first yr med resident 4) after grad, choose spec, 2 to 12 yrs, teaching hospitals, intern first yr 5)oversee other res 6) oversee res
First Year Medical Student
Similar to undergrad science courses, count a little less than clin wk, med bio ethics, genetics, physio, neurosci, beh sciences.
Second Year Medical Student
Third Year: Clerkships
Fourth Year: Elective clerkships
1)Pharmocology, endocrine, clin med, women's health...
2) int med, surgerym psychiatry
3) Stress (sel resid, nat matching prog must go, residents over wked 80 hrs/wk; teaching hospitals up to date.
Pain: ___; single most common medical complaint.
Sensory and emotional discomfort.
Measuring Pain (subjectively)
1) Self reportL McGill Pain Questionnaire (MPQ, 1975)
2)Visual Analog Scale (VAS)
Still same theory, Melzak used pain terms in three categories: sensory component (shooting, burning; type), affective (emot reac, e.g. scary), evaluative (e.g. mild; degree); Overal eval (one to five) behvioral measures (qualit), 2) VASL no to worst pain.
Qualities of Pain
Organic vs. psychogenic (phy causes or mind); acute (beg and end; severity ranges) vs. chronic, contin vs. episodic (esp for chronic pain)
Perceiving Pain
1) Nociceptors
Film: phantom limb (spinal cord, cells cut from periphery: hypersensitivity; pain not nec starting in actual area.
1) Afferent neurons that carry pain messages (from periphery to brain); sensory (feeling of pain via neurons); 2) Referred pain (perceived somewhere else; ex. fingers corresp with brain, many receptors vs. back.
Early theories of Pain
1) Mechanist view (which tissues) 2) could not account for role of psy factors (ex. child birth pain reports)
Peripheral Nerve fibers involved in pain percep:
1) A-delta fibers: __
(Pain a balance from A-delta and c-fibers) 2) c-fibers: __
1) larger, myelinated fibers that transmit sharp, localized; fast-skin, mem.
2) small, unmyelinated nerve fibers that transmit dull, diffuse, or aching pain; slow all-bdy tissues; usu internal, difficult to localize.
1) Substance P = Pain
2) Enkephalins = Relief
1) Helps send pain message; excit for nerve fibres, stim nerve endings 2) related to opiate family; bind to pain recep to lessen pain by telling body to stop rel substance P, how to get more?
Periaqueductal Gray Area
1) Stimulate area and reduce pain 2) morphine may work by stimulating this area; surgery with only PAG stim, release of endorphins (body's natural morphine; some during high per of stress, higher pain thresholds).
1) Descending Neural Pathway
2) Gate Control Theory (Melack 1960s): __
1) Endorphins stimulate PAG from brain -> Spinal cord (rel enkephalins)->Inhibits substance P. 2) Described physio mech by which psy factors can affect the exp of pain; Neural gate in spinal cord can open and close thereby modulating pain. Transmission cells: excited (fire) or inhibitory messages to brain.
Three Factors Opening and Closing Gate:
1) Amt of activity/firing in pain fibers
2) Amt of activity in other peripheral fibers (counter irritation) 3) Messages from brain.
Conditions that Open Gate:
Conditions that Close Gate:
A. 1) Physicial (extent of injury, inaprop activity level) 2) Emotional (anxiety, tension, depression) 3) Mental (focusing on pain, boredom)
B. 1) Phy (medic, counter stim: heat, message), 2) Emotional (pos emot, relax, rest) 3) Mental (intense concen/distract, involvment/interest in activities
A) Four types of pain behaviors
B) Emotions, coping, and pain
A. 1) facial/audible expressiosns of distress 2) distorted ambulation or posture 3) negative affect (grouchiness), avoidance of activity (also measurements for pain). B. 1) Chronic pain is assoc with higher levels of anger, fear, sadness, anxiety, stress (which is the cause?)
Coping with Pain
1) MMPI scales 1-3
2) Neurotic Triad
1) Hypochondriasis (overpreoccup with pain) 2) Depression 3) Hysteria (psy conflicts converted into phys sym; ex. ulscers, blindness.
2) Combination of scales 1-3 of MMPI