How does intervention in health psychology take place? - Chapter 10

What does the medical consultation entail?

When someone has decided to seek help, he goes to a care provider who is keen to collect as much information as possible about the patient to inform their diagnosis and treatment decisions. This is necessary to properly monitor the course of the disease and to interfere where necessary. This consists of five phases:

1. Establishing a good relationship between the care provider and the patient.
2. Finding out the reason for the patient's attendance.
3. Doing a verbal or physical examination or both.
4. The doctor, or the doctor and the patient, or the patient, considers the condition.
5. The doctor considers further treatment or further investigation.

When someone makes a decision together with the specialist, it is important that the specialist pays attention to a number of elements to make the conversation as pleasant and effective as possible:

• Have a good knowledge of research or medical information and be able to communicate this to the patient.
• A good relationship with the patient.
• Find out the nature of the patient's problem.
• Get an understanding of the patient's understanding of his problem.
• Involve the patient in decision-making processes.
• Managing time so that the consultation does not appear rushed.

Who has the power?

In a conversation between patient and caregiver it may be that the patient is central or that the caregiver is central. In the first case, the patient and the caregiver make the decisions together, the specialist listens quietly to the patient, the patient actively participates in the conversation, both the caregiver and the patient provide as much relevant information as possible and both agree afterwards with the decisions taken.

When the counselor is at the center of a conversation, he or she has control of the conversation, introduces the topics and closes them when he knows enough, the specialist asks questions with the main objective of obtaining information that is relevant to the decisions that has to be made, the caregiver makes the decision and the patient accepts it passively. In the past decade there has been a gradual shift from professional-centered to patient-centered.

Most people prefer to make decisions together with their specialist. Unless they value their situation so much that they don't know what to do, don't know enough about the subject or don't want to think about it because it is too frightening. When an operation has cosmetic consequences, such as an operation against breast cancer, people are happy to decide together with the specialist or alone. Older people, women, those with a serious problem, educated people and people with an active coping style want to be involved in decision making. Patients are more satisfied, have more confidence in health care, and have improvements in their well-being if they are involved in the decision-making process. The process of shared decision making consists of three steps:

• Choice: refers to the step of making sure that patients know that there are reasonable treatment options.
• Option: refers to providing more detailed information about options.
• Decision: refers to supporting the work of considering preferences and deciding what is best.

Which factors influence the process of consultation?

• Type of care provider: the type of interaction between patient and care provider depends on the type of care provider. Nurses are known for the fact that you can easily talk to them and listen well. On the other hand, doctors would find it difficult to empathize emotionally with a patient.
• Gender: research shows that patients themselves tell more if they have a female social worker facing them. Women also seem to convey more empathy and appear more caring, which increases patient satisfaction with the interview. Men and women who had been treated more often with disrespect by a doctor indicated that this was due to the opposite sex.
• Culture and language: the best consultation takes place when patients see themselves as being equal to the health professional in terms of values ​​and spiritual beliefs. So ethnic equality also helps.
• Type of information: care providers have to be extremely careful with what they say when talking to patients. More than half of the population will not know a lot of definitions. Terms such as "tumor", "benign" and "prognosis" can cause anxiety in the patient. The way in which information is provided also influences the behavior and thoughts of patients. Information can be brought in a positive or negative way. If messages are delivered to patients in a certain way during an intervention, the impact of the messages must be tested in pilot studies.
• Factors of the patient: as a patient, it is important to think in advance which questions you want to ask. Write it down if necessary. During the conversation, unexpected things can happen or you can hear emotional things that make you forget half.
• Bad news conversation: having a bad news conversation is stressful for both the patient and the caregiver. It is important that the patient is first prepared for the fact that bad news is coming and that the care provider then does not wait too long with the news itself. After that, it is best for the counselor to sympathize and then switch to practical matters. It is also important to provide the patient with information on paper, so that he / she can read it again later. Chadha and Repanos (2006) found that 64% of surgeons in their research felt confident in their ability to break bad news. Results from Ford et al. (1996) indicate that most people felt that the majority of time was spent giving biomedical information with relatively little emphasis on empathic responses or acknowledgement of distress. A large proportion of care providers have never had adequate training in conducting bad news conversations. In studies where workshops were given to care providers, a significant percentage improved in a positive way.

What happens beyond consultation?

Medical decision-making

Health care decisions are influenced by a lot of factors. Decisions are influenced by colleagues, the limited time and the way in which care providers look at patients and healthcare themselves. Diagnosing a disease can be done in different ways:

• Hypothesis testing: hypotheses are made and tested.
• Recognizing a pattern: the symptoms are compared with prototypes of diseases.
• Opinion revision or heuristics and biases: this is probably the least reliable approach to making diagnosis. A decision is made on the basis of partial evidence as a result of using heuristics.

Usually, care providers make correct and accurate decisions. However, their decision-making may be prone to error, particularly when decisions are made by heuristics due to lack of time or when optimal information may noy be available. These heuristics are also known as 'rules of thumb'. This can lead to errors quickly. A few examples:

• Availability: if a certain illness receives a lot of (media) attention, it is thought that this illness is very common. It is possible that a doctor recognizes a symptom and immediately thinks of this disease.
• Representativeness: a group of symptoms is compared to prototype syndromes without taking into account the prevalence of the diseases.
• Potential pay-off or differing diagnoses: if the diagnosis is unclear, the diagnosis assigned may be the one that carries the least cost and most benefit for the individual.

Taking medication

A large number of treatments consist of taking medicines. Medication has to be taken at certain times, in a certain amount and you have to take food intake into account. It is not as easy as it seems. Taking drugs for the HIV disease is very complex. There are a lot of factors that prevent people from taking their medication, such as:

• Social factors: little social support or low education.
• Psychological factors: anxiety and depression.
• Treatment factors: treatment not understood, side effects, complex intake schedule, few improvements.

Maximising medication use

One factor that may increase the recommended medication schedule is to discuss all treatments with the patient. The patient feels involved and feels that he also has a choice. If there is agreement between the hop provider and the patient about the treatment, there is a good chance that the patient will follow the recommended schedule.

Speaking to a patient in the correct language increases the understanding of the patient. In addition, it is helpful if the patient is aware of the fact that he can ask questions. Offering patients a list of possible questions has proven to be effective. The consultations took longer and patients had less need for information.

As a social worker you have to take into account that people only remember part of all the information you give them. Especially the information that is given at the beginning and at the end of a conversation is remembered mostly. A possible solution is to give people the standard information on paper, so that they can read it again at home.

Continue to take medication

By ensuring that the medication schedule requires as little memory as possible, people will not soon forget to take their medication. Another procedure is to receive a reminder in the form of a phone call, mail or e-mail. People can become dependent on this. When this form of reminder stops, the medication is regularly forgotten.

Changing behavior

Taking medication does not require a huge amount of behavioral change. Other medical interventions require an individual to adjust his behavior. If many demands are made on the patient, a lot of people will drop out. Stopping smoking is one of the most difficult behaviors to adjust, due to the addictive aspect and the cues in the environment. The percentage of people who adhere to the 'stop smoking' advice is very low. Changes in exercise routines are moderate and decrease over time. Lack of motivation is an important reason for non-compliance. According to Petter et al. (2009), programs with the aim of increasing therapy compliance must be based on self-regulation or the health action process model. According to the ERIC database, a number of components are central to behavioral change programs:

• Self-control strategies.
• Relapse prevention.
• Motivational strategies.
• Make change habitual.