Key Pfi References - Sem1

Front 1

Key Questions when hit by illness (Helman 2007) (7)

Back 1

What has happened?
Why has this happened?
Why now?
Why me?
What should I do/who should I turn to?
What if nothing is done?
How will this affect others?

Front 2

People ascribe a meaning to there story - there are internalising and externalising explanations. Externalising ones often take the form of a narrative or story.

Narratives can be culturally influenced and defined

Back 2

Young



Becker

Front 3

What is normal/abnormal and expected/unexpected and treatable/untreatable may defined by social class, education etc.

Back 3

Fox ('Regionville')

Lower social classes adopt a more 'functional' definition of health

Front 4

EMs
Consultation is 'a transaction between lay and medical EMs'

Back 4

Kleinman (1980)

Front 5

A successful consultation requires a consensus between the patient and doctor ('negotiation')

Back 5

Webb

Front 6

Culture is a lens transmitted from generation to generation

Back 6

Helman (2007)

Front 7

Lay people use medical jargon they perceive to understand in the wrong way (that study where they got the stomach wrong, thinking antibiotics work against viruses, didn't know the difference between a boyle and a spot etc.)

Back 7

BOYLE


Note: LAY terms about spirits and ghosts, hot and cold may be misinterpreted by doctors!

Front 8

For treatments to be acceptable to patients, it must make sense in terms of their EMs (especially when it's unpleasant and they feel fine at the moment)

UK non-compliance estimated to be 30%

Back 8

Helman (2007)

Front 9

Term for when one culture imposes their own cultural values on another

Back 9

Cultural counter-transference (Helman)

Front 10

Somatisation definition (state who came up with it)

Back 10

The translation of dysphoric affect to complaints of physical symptoms, and even illnesses (KLEINMAN)

Front 11

Who pointed this out:
Cancer seen as a monster that attacks you from within and destroys you
Heart disease metaphors much less dramatic, and more mechanical

Back 11

Weiss

Front 12

The metaphors peopele ascribe to their illnesses are a way of experiencing and expressing events - they are often a feature of sudent, traumatic events that interrupt the normal flow of human events and may contribute to the nocebo effect

Back 12

Becker

Front 13

3 levels of cultural behaviour (name and the levels)

Back 13

Hall's 'Primary level culture'
What people say they will do
What they actually do
The belief systems which underlies their behaviour

Front 14

EMs provide explanations for five principle aspects of illness. Who said this and what are they

Back 14

Helman 2007
Aetiology, timing of onset, pathophysiological process, natural history and severity

Front 15

Lay sources of information heavily impact illness beliefs and behaviour

Back 15

Greenhalgh 1998

Front 16

Nature used to be prized for its medicinal qualities (sanatoria) then it changed, but now again nature seen as the antidote to the invisible pollution and factory fumes

Back 16

Helman 2003

Front 17

Stories in medicine:
Storytelling as healing, healing as storytelling (argues medical sciences is at its base a complex form of storytelling)

Back 17

BRODY 2003

'Without a storehouse of case exemplars to draw upon, medicine could neither be taught nor practiced'

Front 18

Doctor should NOT assume the medical story IS the patient's story

Back 18

Hunter 1991

Front 19

Stories are an essential part as a means of perceiving how scientific knowledge (general) can be applied to the individual (paprticular)

Back 19

Hunter 1991

Front 20

The placebo illustrates the importance of the illness narrative in healing

Back 20

Brody 1980

Front 21

Illness experience needs to be given an explanation that the patient finds acceptable
The patient must perceive that she is surrounded by, and can rely upon, a group of caring individuals
patient must achieve a sense of mastery/control over the illenss

Back 21

Brody 1980

Front 22

ASSURING patients that the treatment will work, and transmitting positive messages about the diagnosis may result in twice the cure rate compared to noncomittal colleagues

Back 22

Thomas 87

'Sustained partnership'

Front 23

Attributes of causation are often linked to past transgressions in religious stories

Back 23

Brody 1980

Front 24

Even if there is no cure available, the ability to prognosticate accurately, to tell the story of the future of the illness, maintain a sense of control may, symbolically if not pharmacologiclaly, lead to enhanced healing

Back 24

Brody 1980

Front 25

Being a patient for a change can open the eyes of doctors

Back 25

Kirby prostate surgery (Guardian 2013)

Front 26

Giving the illness a name is comforting - it makes 'the thing' an existence apart from the person which can then be struggled against

Back 26

Brody

Front 27

Patients come to physicians with broken stories as much as with broken bones and broken bodies.

The successful outcome will demand the joint construction of the narrative

Back 27

Brody 1980

Front 28

If a patient agrees to quit smoking, but cannot construct for herself a coherent and convincing narrative of her future life without cigarettes, it is improbable she will quit

Back 28

Brody

Front 29

Characteristics of a story (and author)

Back 29

Greenhalgh
Runs through time
Requires a narrator and listener
Focuses on characters
Includes an emotional dimension
Has a plot and invites interpretation

Front 30

Do not think every problem has a story shaped solution. They should be used when they have the most 'added value'

Back 30

Greenhalgh