PATIENT PRACTITIONER RELATIONSHIP
a) PP interpersonal skills
non-verbal communications (McKinstry and Wang, 1991)
- Doctor’s clothing
- 475 patients from Scotland
- Interviewed about their opinions on 8 photographs of doctors wearing different attires
(formal and informal)
- They were asked which doctors they would be the happiest seeing for the first time (0-5) and
which doctors are they confident in their ability based on their appearance
- Results: Older patients and those in higher social class preferred traditionally dressed
doctors. Patients prefer formally dressed doctors.
- The way practitioner dress matters to their performance
verbal communications (McKinlay, 1975)
- investigated on communication barriers between patients and doctors.
- Conducted a pilot study into the words which doctors used in a Scottish maternity hospital.
- Participants- lower class women were interviewed to test their understanding of 13 regularly
used medical words such as “protein” and “antibiotic”.
- A scale was used which ranged from A (not understand at all) to D (understand pretty well).
- Results: On average, each term was understood by LESS than 40% of women.
Verbal communication (Ley, 1988)
- Find out how well patients remember about medical information given by their doctors.
- Patients were interviewed and were asked to repeat what the doctors told them to do.
- This was then compared to what was actually said to them.
- Results: patients had a good recall of the first thing told and that they remembered more to
information that has been categorized.
- Forgetfulness is linked to factors such as age and medical knowledge
- Ley suggested that a practitioners should use simple language and state the key information
first
b) patient and practitioner diagnosis and style
practitioner style: doctor and patient-centred (Byrne and Long)
- Carried out a study analyzing PP interactions by observing around 2500 tapes of medical
consultations in several countries
- They found that practitioners use one of two styles, either doctor centered, and patient
centered.
- Doctor centered are focused on giving CLOSED questions and ignores other problems
patients might have.
- Patient centered focused on OPEN questions and doctors allow patients to participate in
decision making.
practitioner style: doctor and patient centered (Savage and Armstrong)
- Compare directing and sharing styles on patients' satisfaction.
- 359 patients from London were randomized to either directing or sharing style of diagnosis.
- Patient’s satisfaction was measured by how effective the practitioner’s help was to them.
, - Results: patients were more satisfied with the doctor centered style of diagnosis and that it
was considered to be more effective.
practitioner diagnosis: type I and type II errors
- Doctors can accidentally make errors when diagnosing patients.
- 2 types of errors;
- Type 1 occurs when doctors diagnose a person as ill when in fact they are actually healthy.
- Type 2 error is when doctors diagnose a person as well but they are actually ill.
disclosure of information (Robinson and West)
- Investigated if people would be more likely to reveal their symptoms and undesirable
behaviors to a computer or paper questionnaires.
- 69 Patients were recruited from the genitourinary clinic and they were randomly assigned to
either computer condition or paper interview.
- They were asked to complete their case histories and had medical examination afterwards.
- They then had a face-to-face consultation with a doctor.
- Results: patients revealed more information about their symptoms and undesirable
behaviors to the computer than to the doctor.
c) misusing health services
delay in seeking treatment (Safer, 1979)
- Safer investigated the factors that influenced patients delay in seeking medical attention.
- study was conducted in 4 clinics in a large inner-city hospital.
- Patients who were waiting for their doctor was approached by interviewers and they were
asked if they were going to tell the doctor about a new symptom.
- They will be selected if they were going to tell.
- 93 patients were interviewed about their health behavior leading up to their current illness
and their reactions to the symptoms.
- Safer identified 3 stages of delay; appraisal delay, illness delay and utilization delay.
misuse: hypochondriasis (Barlow and Durand, 1995)
- Hypochondriasis is defined as the persistent fear of serious medical illness.
- People with this disorder believe minor symptoms as a sign of illness with negative outcome.
- Barlow and Durand took an account of a patient named Gail with this disorder.
- Gail came to the clinic, complaining of anxiety and stress and the doctors observed and
noted down her behavior.
- It soon became clear that her major concerns were about her health.
- For example, breathlessness was an independing heart attack to her.
- She stopped going to the clinic after a few years as she become convinced her concerns
were excessive, but her fears did not go away.
Munchausen syndrome (Aleem and Ajarim, 1995)
- Munchausen syndrome is when people intentionally produce or pretend to have
psychological and physical symptoms of illness to seek attention and play the sick role.
- They may spend years going from one doctor to another while pretending to have an illness.
- Aleem and Ajarim was a case study of a 22-year-old female who attended a hospital in Saudi
Arabia.
- The case was about a patient who injected her breast with a syringe full of faecal material.
a) PP interpersonal skills
non-verbal communications (McKinstry and Wang, 1991)
- Doctor’s clothing
- 475 patients from Scotland
- Interviewed about their opinions on 8 photographs of doctors wearing different attires
(formal and informal)
- They were asked which doctors they would be the happiest seeing for the first time (0-5) and
which doctors are they confident in their ability based on their appearance
- Results: Older patients and those in higher social class preferred traditionally dressed
doctors. Patients prefer formally dressed doctors.
- The way practitioner dress matters to their performance
verbal communications (McKinlay, 1975)
- investigated on communication barriers between patients and doctors.
- Conducted a pilot study into the words which doctors used in a Scottish maternity hospital.
- Participants- lower class women were interviewed to test their understanding of 13 regularly
used medical words such as “protein” and “antibiotic”.
- A scale was used which ranged from A (not understand at all) to D (understand pretty well).
- Results: On average, each term was understood by LESS than 40% of women.
Verbal communication (Ley, 1988)
- Find out how well patients remember about medical information given by their doctors.
- Patients were interviewed and were asked to repeat what the doctors told them to do.
- This was then compared to what was actually said to them.
- Results: patients had a good recall of the first thing told and that they remembered more to
information that has been categorized.
- Forgetfulness is linked to factors such as age and medical knowledge
- Ley suggested that a practitioners should use simple language and state the key information
first
b) patient and practitioner diagnosis and style
practitioner style: doctor and patient-centred (Byrne and Long)
- Carried out a study analyzing PP interactions by observing around 2500 tapes of medical
consultations in several countries
- They found that practitioners use one of two styles, either doctor centered, and patient
centered.
- Doctor centered are focused on giving CLOSED questions and ignores other problems
patients might have.
- Patient centered focused on OPEN questions and doctors allow patients to participate in
decision making.
practitioner style: doctor and patient centered (Savage and Armstrong)
- Compare directing and sharing styles on patients' satisfaction.
- 359 patients from London were randomized to either directing or sharing style of diagnosis.
- Patient’s satisfaction was measured by how effective the practitioner’s help was to them.
, - Results: patients were more satisfied with the doctor centered style of diagnosis and that it
was considered to be more effective.
practitioner diagnosis: type I and type II errors
- Doctors can accidentally make errors when diagnosing patients.
- 2 types of errors;
- Type 1 occurs when doctors diagnose a person as ill when in fact they are actually healthy.
- Type 2 error is when doctors diagnose a person as well but they are actually ill.
disclosure of information (Robinson and West)
- Investigated if people would be more likely to reveal their symptoms and undesirable
behaviors to a computer or paper questionnaires.
- 69 Patients were recruited from the genitourinary clinic and they were randomly assigned to
either computer condition or paper interview.
- They were asked to complete their case histories and had medical examination afterwards.
- They then had a face-to-face consultation with a doctor.
- Results: patients revealed more information about their symptoms and undesirable
behaviors to the computer than to the doctor.
c) misusing health services
delay in seeking treatment (Safer, 1979)
- Safer investigated the factors that influenced patients delay in seeking medical attention.
- study was conducted in 4 clinics in a large inner-city hospital.
- Patients who were waiting for their doctor was approached by interviewers and they were
asked if they were going to tell the doctor about a new symptom.
- They will be selected if they were going to tell.
- 93 patients were interviewed about their health behavior leading up to their current illness
and their reactions to the symptoms.
- Safer identified 3 stages of delay; appraisal delay, illness delay and utilization delay.
misuse: hypochondriasis (Barlow and Durand, 1995)
- Hypochondriasis is defined as the persistent fear of serious medical illness.
- People with this disorder believe minor symptoms as a sign of illness with negative outcome.
- Barlow and Durand took an account of a patient named Gail with this disorder.
- Gail came to the clinic, complaining of anxiety and stress and the doctors observed and
noted down her behavior.
- It soon became clear that her major concerns were about her health.
- For example, breathlessness was an independing heart attack to her.
- She stopped going to the clinic after a few years as she become convinced her concerns
were excessive, but her fears did not go away.
Munchausen syndrome (Aleem and Ajarim, 1995)
- Munchausen syndrome is when people intentionally produce or pretend to have
psychological and physical symptoms of illness to seek attention and play the sick role.
- They may spend years going from one doctor to another while pretending to have an illness.
- Aleem and Ajarim was a case study of a 22-year-old female who attended a hospital in Saudi
Arabia.
- The case was about a patient who injected her breast with a syringe full of faecal material.
