Hospitalization

1
Hospitalization

• Depersonalization
• Needs of the system
• Needs of the care provider
• Taylor
• Good Patient Role
• Psychological reactance
• Bad Patient
• Control
• Illusion of control
• Decision-making

2
Stress and Surgery

• Janis (1958)
• Interviewed patients presurgery, classifying
  them
  
• Extreme fear
• Moderate fear
• No fear
• Who showed fewest postoperative problems?

3
Stress and Surgery

• 3 basic types of information may be given to
  patients awaiting surgery
  
• Sensory
• Procedural
• Coping
• Are they equally useful?

4
Models of the Physician-Patient Relationship

• Active-Passive Model
• patient is unable (due to medical condition) to
  participate in care and to make decisions
  regarding personal welfare
  
• Guidance-Cooperation Model
• physician assumes the majority of responsibility
  for diagnosis/treatment
  
• Pt answers questions that are asked but leaves
  the thinking/decisions to the MD
  

5
Models of the Physician-Patient Relationship

• Mutual Participation Model
• MD Pt make joint decisions about every aspect
  of care
  
• Represents the most effective physician-patient
  interchange that can occur
  
• Each brings his/her own point of view to the task
  of improving patients health

6
Models of the Physician-Patient Relationship

• Szasz Hollender (1956)
• Active-Passive Model
• Guidance-Cooperation Model
• Mutual Participation Model

Roter Hall (1992) Paternalism Consumerism De
fault
Mutuality
Roter, Stewart, Putman, Lipkin, Stiles, Inui
(1997) Narrowly Biomedical Expanded Biomedical

Biopsychosocial Psychosocial Consumerist
Ballard-Reisch (1990) Patient Abdication Patient
Autonomy
Collaborative Relationship Termination
7
Doctor Patient Relations, Ballard-Reisch (1990)

• Patient abdication
• -Doctor makes all decisions and patient
  relinquishes responsibility similar to
  guidance-cooperation model.
  
• Patient autonomy
• -All decisions ultimately rest with patient
• -this type of relationship does not have a
  corollary in Szrasz and Hollenders framework.
  
• Collaborative
• Doctor and Patient work together to achieve
  desired outcomes similar to the mutual
  participation model.
  
• Relationship termination
• Patient and physician part ways.

8
Doctor Patient Relations, Roter Hall (1992)

• Paternalistic Relationship
• -Physician has most control and patient has
  little
  
• -resembles patient abdication and
  guidance-cooperation models
  
• 2. Consumerist Relationship
• Patient wields the power because she or she is
  essentially buying a service an the physician
  generally acquiesces to patient demands. This is
  similar to the patient autonomy model.

9
Doctor Patient Relations, Roter Hall (1992)

• 3. Default Relationship
• Both parties are relatively uninvolved. Each
  does bare minimum required of him/her, and each
  is reluctant to take responsibility for outcomes
  
• 4. Mutual Relationship
• -Both doctor patient are highly invested in
  patient outcomes, and are actively involved in
  the medical interaction, from diagnosis to
  treatment decisions.
• -Similar to what Szasz and Hollender referred to
  as mutual participation model, and what
  Ballard-Reisch called a collaborative
  relationship.

10
Types of Communication, Roter et al.,(1997)

• Narrowly biomedical Interaction in which doctor
  spends most of the time asking closed-ended
  questions, using technical vocabulary
  
• Expanded biomedical Similar to the narrowly
  biomedical but there is some psychosocial
  discussion which occurs
  
• Biopsychosocial Approximately equal time is
  spent on biomedical and psychosocial topics.
  
• Psychosocial Mainly psychosocial in nature
• 5. Consumerist Patient asking and doctors
  answering questions