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Summary Cambridge International A Level Psychology - Heath.
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Cambridge International A Level Psychology - Heath. With these notes you'll have the necessary information to get an A+.
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By: Exam11 • 1 year ago
By: fathyia • 1 year ago
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Patient - practitioner relationshipPRACTITIONER AND PATIENT INTERPERSONAL SKILLS
interpersonal skills : the abilities we have (or don’t have) that allows us to communicate effectively with others.
NON-VERBAL COMMUNICATION (McKINSTRY & WANG) - looked at how acceptable patients found different styles of doctor’s
clothing and whether patients felt this influenced their respect for their opinion. Field experiment using interviews.
475 patients in five medical practices who were asked to look at 8 photographs and answer a few questions.
male female
white coat over formal suit; white coat over skirt and jumper
formal suite, white shirt and tie; skirt, blouse and woollen jumper
tweed jacket, informal shirt and tie; pink trousers, jumper and golden earrings.
cardigan, sports shirt and slacks;
jeans, short-sleeved shirt.
Participants underwent an interview, asking for opinions:
• Which doctor would they like seeing most for the first time?
• Would be more confident in the ability of one of these doctors
compared to the others (based on appearance)?
• Would be happy consulting any of them?
• Which doctor looked most like their doctor?
• Finally several closed questions about the doctor’s clothes
Results:
- most acceptable was men and female wearing a white
coat
- least acceptable was man in cardigan and woman in
trousers
- preferred female in a white lab coat, and in a smart skirt
and blouse
- 41% had more confidence in a formally dressed doctor
strengths weaknesses
- application to everyday life as it showed the importance - reductionist as there are other factors which could affect
of appearance and first impressions in developing first impressions and confidence like doctor’s ability e.g.
patients' confidence in doctors. facial expressions.
- representative and generalizable sample as there were - low ecological validity as pictures can’t show real-life
475 in total situations and the people in them weren’t moving/real.
- field experiment so controlled IV and DV which reduces - cultural bias as the study was in scotland, thus results
extraneous variables thus increases validity can’t be generalised to other countries because it is
unknown whether findings are just due to the culture.
- high ecological validity as conducted in waiting rooms
- 5 men vs 3 women → If a female doctor’s photograph in
- quantitative data gathered meaning it could not be a formal suit would have been included, the likelihood of
affected by subjectivity. This increases reliability. patients preferring the female doctor in a white lab coat
may have been lower.
- standardisation of using the same pictures for all ppts,
therefore there was consistency. - subjective data from participants which could be affected
by demand characteristics and social desirability bias
- demand characteristics were reduced as patients who
said they do not find the doctor’s clothing important gave
discriminatory scores anyway.
,VERBAL COMMUNICATION (McKINLAY) - aimed to assess understanding of 13 technical terms in a maternity ward. 81 randomly
selected women were divided into utilisers and under-utilisers. An interview was conducted about their understanding of
terms. They were informed they were trying to find out if doctors use words that patients don’t understand (not test).
→ example of words used: antibiotic, breech, navel, purgative, rhesus.
Results:
- terms were understood by less than 40% of the women.
- utilisers (or women who already had a child) had a better understanding than under-users
- ‘navel’ and ‘rhesus’ were found to be less understood by users of maternity services.
- women had a far better understanding than the doctors expected, the only exception being ‘purgative’.
Conclusions: Health workers and doctors use medical language to look more knowledgeable, important and keep the
conversations brief. On the other hand, women are afraid to ask questions if they don’t comprehend a word because they
don’t want to look stupid and uneducated.
strengths weaknesses
- ecologically valid and mundane realism as the study was - unethical as even though confidentiality was kept, the
conducted in a real setting and real terms were used. health service was disrupted and the women might have
Therefore, the results are more likely to be realistic. felt distressed having to admit that they did not know what
the words meant.
- application to everyday life as results could help doctors
increase their communication with patients and - cultural bias as it only included lower-class women in a
encourage them to ask questions if they don’t understand. British maternity ward. Therefore, the results cannot be
applied to men, women in other countries and people of
- double-blind technique reduces experimenter bias, this other social classes (low generalisability).
increases validity and reliability of the study
Doctors had actually underestimated the amount of
- random sample is representative to the population
people that would understand the terms. which begs the
question: why did the doctors use such jargon if they did
not expect the patients to understand it in the first place?
II VERBAL COMMUNICATION (LEY) - investigated the amount of information remembered by patients after a consultation.
Patients were asked what they could recall about the information given by the doctor and was then compared with what
was actually said.
Results:
- patients remembered 55% of the information given.
- they remembered the first thing they were told (primacy effect)
- they remembered information that had been categorised
- they remembered more if they had medical knowledge.
To reduce amount forgotten: categorisation, summarising, repetition, clarity and the use of diagrams, state key info first.
strengths weaknesses
- application to everyday life as this led to development of - ungeneralizable as the study was conducted in a
manuals for doctors on how to communicate with patients, specific place; therefore, the results cannot be applied to
leading to 70% increase in recall. other patients and doctors in other parts of the world.
- ecological validity as study used real patients/doctors for - social desirability as the patients may have not told the
real illnesses, so results are realistic and reliable. researchers everything they recalled because of the fear
of being judged if they got it wrong or their diagnosis. This
may have altered the results, thus reduced validity.
, PRACTITIONER AND PATIENT DIAGNOSIS AND STYLE
PRACTITIONER STYLE (BYRNE & LONG) - analysed 2500 recorded consultations and distinguished first between ‘diagnostic
phase’ and a ‘prescribing phase’. Then distinguished between a doctor-centred style and patient-centred style.
Byrne and Long outlined 6 phases that construct most of the consultation processes:
1. establishing a relationship with the patient
2. (attempts to) discovery of attendance reason
3. verbal and/or physical examination conducted
4. doctor or doctor-patient or patient consider the possible condition
5. doctor (sometimes patient) outlines treatment or further investigation
6. end of the consultation
Doctor-centred styles consist of questions with short answers and no consideration of the patient's suggestion of other
possible problems. Patient-centred included open questions with opportunities for detailed answers, allowing more
information to be assessed by the doctor. The doctor tended to avoid jargons making the communication more
understandable for the patient; they also let patients take part in decision making.
Field experiment on style (savage & armstrong)
200 participants. Randomly assigned to either directing or sharing style. They measured patient satisfaction and whether
they felt they had been helped right after the consultation and after one week.
Directing style of consultation reported higher levels of satisfaction. Particularly true for those with a physical problem and
those receiving a prescription.
Concluded that style does influence satisfaction in some types of consultations (patients with physical problems and
those receiving a prescription).
The consultation process consisted of 5 key parts:
directing sharing
Judgement on “This is a serious problem” or “I don’t think this is a “Why do you think this has happened?”
the consultation serious problem”
Diagnosis “You’re suffering from…” “What do you think is wrong?”
Treatment “It is essential that you take this medicine” “What have you tried to do to help so far?” or “I think
this medicine would be helpful; would you be prepared
to take it?”
Prognosis “You will be better in … days” “What do any of these symptoms or problems mean to
you?”
Follow-up and “Come and see me in … days” or “I don’t need to “Are there any other problems?” or “When would you
closure see you again for this problem” like to come and see me again?”
Results: Directed style group reported more ‘satisfaction with doctor’s explanation’ and with ‘own understanding of the
problem’ as well as more likely to report they were ‘greatly helped’. However, both groups were highly satisfied.
strengths weaknesses
- field experiment means controlled IV and DV - cultural bias as conducted in london, reduces
generalisability to other cities
- random sampling ensures there was no bias in choosing
and ensures objectivity, increasing validity and it is - the study may not take individual differences into
representative to population. account because the results were averaged, therefore
they cannot be generalised to everyone.
- ecological validity as the study was carried out in a real
setting with real patients. - demand characteristics as the participants may have put
the same information in the second questionnaire
- patients gave consent to participate in the study, because they might have felt like they had to in order to
meaning that it was ethical. please the researchers and not criticise their doctor.
- use of structured questionnaires means the study is
replicable and reliable
, • Wide age range of participants used (200)
• Quantitative data collected so comparisons can be
made.
• Tested both at the time of the consultation and a week
later so can check that the participant still has the same
feelings about the consultation. This improves the validity
of the study.
• Useful to practitioners so they can use a directing style
while consulting those with a physical illness and/or where
a prescription is required.
• Satisfaction was measured using two measures so more
likely to achieve a valid and/or reliable result.
• Randomly allocated to conditions which increases
validity.
PRACTITIONER DIAGNOSIS - a doctor may get a diagnosis wrong because: doctor may have not listened to you; patient may
have left out key information; doctor may confuse with another illness with similar symptoms; illness may be new to the
doctor (may have not seen it before); doctor may forget to do a follow-up to observe the illness.
Type 1 error - declaring an illness when it does not exist. (saying they have cancer when they don’t).
Type 2 error - declaring a person is well when they are not. (saying they don’t have cancer when they do).
Screening - test done for patients without symptoms.
Testing - test done to investigate symptoms or possible abnormality found during screening.
DISCLOSURE OF INFORMATION (ROBINSON & WEST) - 69 patients attending a sexually transmitted disease centre were giving
information about symptoms in three ways: computerised interview, a paper questionnaire, or physician interview.
Participants were randomly allocated to the two conditions (paper and computer) and asked to indicate their case history.
Then they proceed to a medical consultation that also includes a physical examination. The data from the questionnaire
and computer were then compared to those from the doctor’s notes. The things compared were: nr of symptoms reported,
nr of previous visits to the GU clinic, nr of sexual partners in the last 12 weeks.
Results:
- more information was given to a computer (mean nr of sexual partners was indicated higher on the computer).
- paper and computer gave more information than the face to face consultation with the doctor.
Sarafino noted that it becomes difficult to communicate with patients when they:
- Want to criticise the doctor or become angry.
- Ignore what the doctors are asking or saying.
- Insist on taking more tests or on being prescribed medication they do not need.
- Want a certificate for an illness they do not have.
- Make sexual remarks towards the doctor.
strengths weaknesses
- application to everyday life as it encouraged the - ungeneralizable as the research was only carried out at
development of communication systems in hospitals to one clinic (cultural bias), making the results less
make patients more comfortable and make it easier to applicable to the entire population and less reliable.
reach a correct diagnosis.
- patients may have felt it to be useless to mention
- no demand characteristics as the research was carried everything to the doctors since they had just told the
out in a real hospital with real patients, doctors, meaning computer.
that the participants would not change their behaviour to
conform with the experiment.
- randomisation reduces demand characteristics
- field experiment means controlled IV and DV
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