Health and illness behavior and patient-practitioner relationships

doi:10.1016/0277-9536(92)90143-E

Social Science & Medicine

Volume 34, Issue 12, June 1992, Pages 1345-1350

https://doi.org/10.1016/0277-9536(92)90143-E Get rights and content

Abstract

Health is a product of culture and social structure. The routine organization and constraints of everyday settings shape our health. Socio-economic status is of major importance in determining exposure to disease risk and in shaping health and illness behavior responses. Lay explanations of illness affect illness appraisal, self-treatment, decisions to seek care and changes in daily regimen. Somatization of psychosocial stressors is a common concern in primary care systems throughout the world, and doctors are commonly frustrated by such patients. Somatizing patients are often enmeshed in environments of great psychosocial difficulty or are depressed, and many cultural and social factors affect how depression is expressed. Although depression has devastating disabling effects on patients, it is often neither recognized by doctors nor treated. But doctor-patient relationships are often the context for appropriate management of such problems, and how they are handled affect the future trajectory of illness and disability. Doctors' responses are conditioned by their attitudes, training, interviewing and psychosocial skills, and organizational and financial factors. Patient flow is an important intervening variable affecting the management of psychosocial difficulties and depression.

References (32)

D. Mechanic
The stability of health and illness behavior: results from a 16-year follow-up
Am. J. Publ. Hlth.
(1979)
D. Mechanic
Promoting health
Society
(1990)
T.F. O'Dea
The Mormons
(1957)
E.M. Kitagawa et al.
Differential Mortality in the United States: A Study in Socioeconomic Epidemiology
(1973)
J.C. Caldwell
Routes to low mortality in poor countries
Pop. Dev. Rev.
(1986)
A. Inkeles
Exploring Individual Modernity
(1983)
D. Mechanic
Socioeconomic status and health: An examination of underlying processes
J.L. Spaeth
Cognitive complexity: A dimension underlying the socioeconomic achievement process
D. Mechanic
The concept of illness behavior: culture, situation, and personal predisposition
Psychol. Med.
(1986)

M. Balint

The Doctor, His Patient and the Illness

(1957)

D. Mechanic

Correlates of physiciam utilization: Why do major multivariate studies of physician utilization find trivial psychosocial and organizational effects?

J. Hlth Soc. Behav.

(1979)

D. Mechanic

Medical sociology: Some tensions among theory, method and substance

J. Hlth Soc. Behav.

(1989)

J. Newhouse et al.

Some interim results from a controlled trial of cost-sharing in health insurance

N. Engl. J. Med.

(1981)

D. Mechanic

Illness behavior: An overview

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No evidence for marked ethnic differences in accuracy of self-reported diabetes, hypertension, and hypercholesterolemia
2007, Journal of Clinical Epidemiology
Citation Excerpt :
For example, problems may be caused by the low level of proficiency in the language of the host country or, in case of translating questions to the mother languages of ethnic minorities, by the lack of equivalent translations [18]. In addition, the way people experience and label diseases and symptoms differ across cultures and ethnic backgrounds [19]. As far as we know, no study has compared self-reported diabetes, hypertension, and hypercholesterolemia with both the medical record of the general practitioner (GP) and with clinical measurements.
To assess whether the accuracy of self-reported diabetes, hypertension, and hypercholesterolemia in high-risk groups differs according to ethnicity.
We analyzed data of 430 patients at high risk of cardiovascular disease from different ethnic origin, including Turkish, Surinamese, and Dutch. Risk factors based on self-reports were compared with data from medical records and with a gold standard based on clinical measurements. Proportions of concordance between self-reports and other methods and kappa statistics (κ) were determined by ethnicity.
Concordance between self-reports and other data sources was highest in diabetes and lowest for hypercholesterolemia. Agreement of self-reports was substantial to almost perfect for diabetes (κ: 0.84–0.76), substantial to moderate for hypertension (κ: 0.63–0.51), and moderate for hypercholesterolemia (κ: 0.55–0.48). There was no statistically significant association between ethnicity and concordance, except for self-reporting of diabetes among Surinamese vs. Dutch indigenous patients (odds ratio = 0.37; 95% confidence interval: 0.14–0.97).
There are no marked ethnic differences in the accuracy of self-reports of diabetes, hypertension, and hypercholesterolemia in high-risk populations. Larger studies including multiple ethnic groups are needed to confirm these findings.
Provider and patient perspectives regarding health care for war-related health concerns
2007, Patient Education and Counseling
To gain insight about Department of Defense providers’ and health care beneficiaries’ opinions regarding provider–patient communication of health care for post-deployment health concerns.
Thirty-five Department of Defense primary care providers and 14 military beneficiaries participated in focus groups at five military medical treatment facilities. We audiotaped, transcribed, and qualitatively analyzed semi-structured focus group interviews to determine attitudes and beliefs about war-related health concerns, symptoms, and health care quality.
Focus groups revealed important insights about provider and patient perspectives of communication and care in four general areas: physician–patient trust, validity of symptoms and concerns, exchange of health information, and barriers to care.
Provider–patient communication contributes to patient satisfaction with medical care; poor communication may contribute to decreased patient satisfaction and provider effectiveness. The military health care system poses several challenges to provider–patient communication: the dual nature of the provider's role, the occupational relationship between illness and health care, pre- and post-deployment issues, and continuity of care impact patient and provider perspectives. The prevalence of various beneficiary and provider concerns regarding health care communication requires further study, particularly for the severely wounded.
The quality of information exchanged and of the interpersonal relationship impact medical decision making, particularly in occupational health settings such as the military. Attention to these issues may improve patient outcomes including satisfaction, adherence, trust, health status, and quality of life.
Emotional reactivity and the overreport of somatic symptoms: Somatic sensitivity or negative reporting style?
2006, Journal of Psychosomatic Research
The purpose of this study is to examine the role of emotional reactivity (ER) in symptom reporting and conceptualize somatizing processes as a signal detection task. Emotional reactivity has been theorized to influence symptom reporting through somatic sensitivity as well as via a negative reporting style. We assess the degree to which these two competing theories about the role of ER are accurate within the signal detection framework.
We used a multimethod approach that included using both static and prospective self-reports as well as a signal detection task.
Results suggest that ER exerts its influence on somatization tendencies via a negatively biased reporting style and is not mediated by somatic sensitivity as suggested by the somatosensory amplification and the symptom perception hypothesis.
Emotional reactivity has yet to be associated with objective measures of somatic sensitivity. Until such an association is found, it is likely that ER influences symptom reports via negatively biased reporting.
Psychologic considerations in the management of oral surgical patients
2006, Oral and Maxillofacial Surgery Clinics of North America
Hypertension, diabetes, hypercholesterolemia, and their combinations increased health care utilization and decreased health status
2004, Journal of Clinical Epidemiology
Citation Excerpt :
Among individuals with hypercholesterolemia, additional risk factors were associated with increased likelihood of ER visits, hospitalizations, and with poorer health status but not more outpatient visits. Use of health care is dependent on the number and persistence of symptoms, symptom recognizability, the potential disability that the symptoms may lead to, and an individual's cultural and social understanding of the illness [15–18]. These are related to the individual's health condition, educational background, ethnicity, and sociodemographic characteristics.
For individuals with hypertension, diabetes, or hypercholesterolemia, the relative magnitude of cardiovascular risk factors and the effect of multiple risk factors remains controversial and both treatment practices and health care usage vary. We sought to determine the effect of hypertension, diabetes, hypercholesterolemia, and their combinations on health care utilization and health status through analysis of data from a large national survey.
We applied the Anderson model to a cross-sectional representative sample (n = 15,107) of the U.S. civilian, noninstitutionalized population (the 1996 Medical Expenditure Panel Survey).
For diabetes, additional risk factors did not increase the likelihood of emergency room (ER) visits or hospitalizations but were associated with increased outpatient visits and poorer health status. For hypertension, additional risk factors increased the likelihood of hospitalization (but not ER visits), the number of outpatient visits, and poorer health status. For hypercholesterolemia, additional risk factors were associated with increased likelihood of ER visits, hospitalizations, and poorer health status but not more outpatient visits. Diabetes had the largest effect on health care utilization and health status.
These findings re-emphasize the magnitude of diabetes as a major risk factor associated with increased ER visits, hospitalizations, outpatients visits, and lower health status.
Functional health literacy and the quality of physician-patient communication among diabetes patients
2004, Patient Education and Counseling
While patients with poor functional health literacy (FHL) have difficulties reading and comprehending written medical instructions, it is not known whether these patients also experience problems with other modes of communication, such as face-to-face encounters with primary care physicians. We enrolled 408 English- and Spanish-speaking diabetes patients to examine whether patients with inadequate FHL report worse communication than patients with adequate FHL. We assessed patients’ experiences of communication using sub-scales from the Interpersonal Processes of Care in Diverse Populations instrument. In multivariate models, patients with inadequate FHL, compared to patients with adequate FHL, were more likely to report worse communication in the domains of general clarity (adjusted odds ratio [AOR] 6.29, P<0.01), explanation of condition (AOR 4.85, P=0.03), and explanation of processes of care (AOR 2.70, P=0.03). Poor FHL appears to be a marker for oral communication problems, particularly in the technical, explanatory domains of clinician–patient dialogue. Research is needed to identify strategies to improve communication for this group of patients.

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^☆: Presented at the 25th anniversary of the Netherlands Institute of Primary Health Care.

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Health and illness behavior and patient-practitioner relationships☆

Abstract

The stability of health and illness behavior: results from a 16-year follow-up

Am. J. Publ. Hlth.

Promoting health

Society

The Mormons

Differential Mortality in the United States: A Study in Socioeconomic Epidemiology

Routes to low mortality in poor countries

Pop. Dev. Rev.

Exploring Individual Modernity

Socioeconomic status and health: An examination of underlying processes

Cognitive complexity: A dimension underlying the socioeconomic achievement process

The concept of illness behavior: culture, situation, and personal predisposition

Psychol. Med.

The Doctor, His Patient and the Illness

Correlates of physiciam utilization: Why do major multivariate studies of physician utilization find trivial psychosocial and organizational effects?

J. Hlth Soc. Behav.

Medical sociology: Some tensions among theory, method and substance

J. Hlth Soc. Behav.

Some interim results from a controlled trial of cost-sharing in health insurance

N. Engl. J. Med.

Illness behavior: An overview