Healthpsyfinala

Front 1

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.

Back 1

1) 1/5
2) 26&

Front 2

Evidence for Lack of Communiction: 3) __ of patients not given information about diagnosis 4) __ spent giving any information 5) Little or no advice about __.

Back 2

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)

Front 3

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.

Back 3

6) Life expectancy; 50% discussed life expec, 15% used numbers.
7) 12%

Front 4

Why poor communication?
1) Not because __.
2) Communication not stressed?

Back 4

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?

Front 5

Why poor communication?
3) Lack of communic skills? maybe: ___

Back 5

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.

Front 6

Why poor communication?
4) Patients are timid: __

Back 6

4) Fear of ignorance, 15% would speak up; don't ask questions (6% of time); study: men with prostate cancer, mental health, sexual dysfunc.

Front 7

Why poor communication?
5) Lack of time: ___
6) Due to diff points of view?

Back 7

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.

Front 8

Who gives most information?
Who gets most information?

Back 8

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.

Front 9

Why is lack of communic such a problem?
1) Dr. might be 'left in the dark': a)__
b) Alternative Medicine

Back 9

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.

Front 10

Why poor communication?
2) Doctor shopping

Back 10

2) Change phy 50% due to relat/communic; 60% changed optomol due to poor communic; less chances to devel a rapport.

Front 11

Why poor communication?
3) Law suits
4) Patient compliance

Back 11

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.

Front 12

Conseq of non-compliance

Back 12

1) Recurrence of symptoms, overdose (prescribe more), misdiag (response to drug), further damage to doctor-patient rel, some drugs must be taken together.

Front 13

What communication can do (better health outcomes): __

Back 13

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.

Front 14

Proposed Solutions

Back 14

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).

Front 15

Medical Training:
Med student (__)
Clerkship (__)
Intern (__)
Resident (__)
Chief Resident (__)
Attending Physician (__)

Back 15

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

Front 16

First Year Medical Student

Back 16

Similar to undergrad science courses, count a little less than clin wk, med bio ethics, genetics, physio, neurosci, beh sciences.

Front 17

Second Year Medical Student
Third Year: Clerkships
Fourth Year: Elective clerkships

Back 17

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.

Front 18

Pain: ___; single most common medical complaint.

Back 18

Sensory and emotional discomfort.

Front 19

Measuring Pain (subjectively)
1) Self reportL McGill Pain Questionnaire (MPQ, 1975)
2)Visual Analog Scale (VAS)

Back 19

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.

Front 20

Qualities of Pain

Back 20

Organic vs. psychogenic (phy causes or mind); acute (beg and end; severity ranges) vs. chronic, contin vs. episodic (esp for chronic pain)

Front 21

Perceiving Pain
1) Nociceptors
Film: phantom limb (spinal cord, cells cut from periphery: hypersensitivity; pain not nec starting in actual area.

Back 21

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.

Front 22

Early theories of Pain

Back 22

1) Mechanist view (which tissues) 2) could not account for role of psy factors (ex. child birth pain reports)

Front 23

Peripheral Nerve fibers involved in pain percep:
1) A-delta fibers: __
(Pain a balance from A-delta and c-fibers) 2) c-fibers: __

Back 23

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.

Front 24

Neurotransmitters
1) Substance P = Pain
2) Enkephalins = Relief

Back 24

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?

Front 25

Periaqueductal Gray Area

Back 25

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).

Front 26

1) Descending Neural Pathway
2) Gate Control Theory (Melack 1960s): __

Back 26

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.

Front 27

Three Factors Opening and Closing Gate:

Back 27

1) Amt of activity/firing in pain fibers
2) Amt of activity in other peripheral fibers (counter irritation) 3) Messages from brain.

Front 28

Conditions that Open Gate:
Conditions that Close Gate:

Back 28

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

Front 29

A) Four types of pain behaviors
B) Emotions, coping, and pain

Back 29

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?)

Front 30

Coping with Pain
1) MMPI scales 1-3
2) Neurotic Triad

Back 30

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