Studying the decision to see a doctor. Review, critique, corrective

The Predisposition to File Claims: The Patient's Perspective

The past dozen years have witnessed an astounding rise in costs relating to the prevention and management of medical malpractice claims. Not surprisingly, a crisis of trust has also been building over the same period. Public interest in alternatives to traditional health care has increased as has the plethora of defensive medical procedures in hospitals. In addition, the past decade has seen the rise of such hospital professions as risk management, patient representation, quality assurance, and utilization review. The current high interest in “patient services” and “patient relations” is just that-current: a reflection of low priority until gathering crises made such interests relevant.

The cost crisis has led to both reactive and preventive behaviors on the part of hospital personnel. Reactive behaviors are those designed to respond to errors and claims after they occur. Examples are incident investigation, adjustment decisions, and insurance reserve manipulation. Preventive behaviors are designed to head off incidents before they occur, by identifying and reducing sources of clinical error, legal liability, and patient aggravation.

Integrating herbal medicine into mainstream healthcare in Ghana: clients' acceptability, perceptions and disclosure of use

Background

Although there are current efforts to integrate herbal medicine (HM) into mainstream healthcare in Ghana, there is paucity of empirical evidence on the acceptability and concurrent use of HM, in the formal health facilities in Ghana. This study sought to determine client perception, disclosure and acceptability of integrating herbal medicine in mainstream healthcare in Kumasi, Ghana.

Methods

A cross-sectional study was conducted from May to August, 2015. Five hundred patients presenting at the outpatient departments of Kumasi South, Suntreso and Tafo Government Hospitals in Kumasi were randomly selected. Interviews were conducted with the use of structured questionnaires. A logistic regression analysis, using backward selection, was conducted to determine the influence of socio-demographic and facility related factors on the odds of using HM at the facility. All statistical tests were two-sided and considered significant at a p-value of <0.05.

Results

Majority of the study respondents were females (64.8%) and the median age was 36 years. Less than half, 42.2%, of the respondents utilized HM services when they visited the health facility. Reasons for using HM at the facility level included ‘being effective’ (24.4%), ‘easy to access’ (25.3%) and ‘being comparatively cheaper’ (16%). About 86% never disclosed previous use of HM to their health care providers. Socio-economic status and perception of service provision influenced use of herbal medicines. Respondents who rated themselves wealthy had increased odds of using herbal medicines at the health facility as compared to those who rated themselves poor (OR = 4.9; 95%CI = 1.6–15.3).

Conclusion

This study shows that integration of herbal medicine is feasible and herbal medicines may be generally accepted as a formal source of healthcare in Ghana. The results of this study might serve as a basis for improvement and upscale of the herbal medicine integration programme in Ghana.

Electronic supplementary material

The online version of this article (10.1186/s12906-017-2025-4) contains supplementary material, which is available to authorized users.

Disability Statistics, What We Count and What It Tells Us

This paper begins with four reinterpretations about the prevalence, trends, temporality, and spread of disability. Together they lead to a different view of disability as quite pervasive in terms of sheer numbers, length of disability experience, and domains of life, as well as organ systems affected. The denial of this reality is related to our attempt to make disability "fixed" and "dichotomous," whereas it is better conceived of as "fluid" and "continuous." The costs of maintaining the former position are traced in notions of disability's "real" numbers and measurement, as well as in research, policy, and advocacy arenas. A redirection is suggested in terms of a more multidimensional approach and a purging of the inherent negative elements in current conceptions and measurement of disability.

Social sciences and medical humanities: the new focus of psychiatry

The clinical practice of psychiatry should incorporate a biopsychosocial model of illness, acknowledging both cultural and social influences on the patient’s experience. Medical humanities include a number of academic disciplines that complement the clinical practice of psychiatry. The medical profession, including psychiatry, has a social responsibility to study the psychosocial context within which people become ill and have to be treated. Although the biopsychosocial model of illness has strong theoretical foundations, its application in clinical practice is limited. A new approach would be to restructure medical student teaching to include medical humanities in the first year, and to share such education with other professions.

Spillover effects of an uninsured population

A lack of health insurance has long been associated with negative effects on individual and family health due to access barriers. However, we know little about how a lack of health insurance affects wider communities beyond health care. Based on in-depth interviews in two Los Angeles communities, we report how a lack of health insurance affects the functioning of religious institutions and schools from kindergarten to 12th grade. We find a negative spillover effect at the individual and institutional levels for schools experiencing greater absenteeism due to health insurance problems of pupils. However, we find that religious organizations are little affected by a lack of health insurance of adherents. Instead, churches offer health programs as a means to engage their communities. Besides documenting a negative and a positive spillover effect, we offer a conceptual framework for the qualitative study of health spillover effects and examine the policy implications of our findings.

Mapping patients' experiences from initial change in health to cancer diagnosis: a qualitative exploration of patient and system factors mediating this process

Delays in the diagnosis of cancer are common, and they are attributed to both patient and healthcare system factors. Minimizing such delays and improving early detection rates is a key goal of the new cancer reform strategy in England, in light of recent data showing that survival rates in the UK are low. The aim of this study was to explore the pathway from initial persistent change in health to diagnosis of cancer in a sample of patients from seven diagnostic groups in the UK and the factors mediating this process. Qualitative interviews with patients diagnosed with cancer were carried out. Seventy-five cancer patients discussed their pre-diagnosis experience as part of a broader exploration of their symptom experience for a larger study. Data were analysed by using content analysis and chart events. A broader range of mediating factors affecting and extending the patient pathway to diagnosis were reported in relation to lung, gastrointestinal and head and neck cancers and lymphoma, compared with breast, gynaecological and brain cancer patients. Many of the mediating factors were patient-related (e.g. misattribution of symptoms to common ailments, underestimation of the seriousness of the symptoms, self-medication or monitoring of symptoms, etc.). Primary care practitioner-factors were also prominent, including the exploration of firstly more common possibilities for treating the presenting symptoms without follow-up of persisting symptoms. Public health education about common cancer signs and symptoms, educational approaches in primary care to improve early diagnoses of cancer and updated guidelines for referral of suspected cancers should be enhanced before we can see any improvements in survival rates from cancer in the UK.

Consultation with the general practitioner triggered by advice from social network members

OBJECTIVE

To investigate whether advice from a person's social network triggers contact with the general practitioner (GP).

DESIGN

Case-crossover design comparing the frequency of advice given to seek medical attention in the period before contact with a GP and the frequency in matching control time periods for the same individual.

SETTING

Twenty-one Danish GPs working in single-handed practices.

SUBJECTS

322 patients, aged between 18 and 91 years, were interviewed by telephone after an unscheduled visit to their GP; 148 were interviewed again 3-6 months later.

MAIN OUTCOME AND MEASURES

The odds of individuals consulting their GP after receiving advice from network members in the period before they contacted their GP compared with the odds of those consulting their GP in the control period(s).

RESULTS

Being advised by others to seek medical attention increased the likelihood of seeking primary health care approximately fivefold--single men received advice significantly less frequently (7%) than women (18%) and cohabiting men (32%).

CONCLUSION

Advice from other social network members to seek medical attention is a frequent and influential cue prompting individuals to contact their GP.

Sociospatial knowledge networks: appraising community as place

This article introduces a new theory of geographical analysis, sociospatial knowledge networks, for examining and understanding the spatial aspects of health knowledge (i.e., exactly where health beliefs and knowledge coincide with other support in the community). We present an overview of the theory of sociospatial knowledge networks and an example of how it is being used to guide an ongoing ethnographic study of health beliefs, knowledge, and knowledge networks in a rural community of African Americans, Latinos, and European Americans at high risk for, but not diagnosed with, type 2 diabetes mellitus. We believe that the geographical approach to understanding health beliefs and knowledge and how people acquire health information presented here is one that could serve other communities and community health practitioners working to improve chronic disease outcomes in diverse local environments.

Developing socio-spatial knowledge networks: a qualitative methodology for chronic disease prevention

Chronic disease is a significant and costly social problem. The burden is even more pronounced in communities with high rates of a particular chronic disease. Assessment of health belief systems and the local geographies of health beliefs can assist community health planners to create cost-effective strategic intervention programs where populations are at high risk for chronic diseases. In this paper, we elaborate the concept of socio-spatial knowledge networks (SSKNs) and demonstrate that SSKNs can be useful in informing the design of health care prevention strategies. In our project, we demonstrate how to identify key socio-spatial information for intervention strategies which will prevent or delay the onset of a particular chronic disease, Type 2 diabetes. Our qualitative framework allows us to determine which sites might be best characterized as socio-spatial knowledge network nodes for sharing diabetes information and which sites might be less suited to such exchange. Our strategy explores cross-cultural similarities, differences, and overlap in a multi-ethnic rural North Carolina context through simple techniques such as mapping social networks and sites in which people share their knowledge and beliefs about diabetes. This geographical analysis allows us to examine exactly where health knowledge coincides with other social support, and where such resources may be improved in a particular community. Knowing precisely what people in a community understand about a chronic disease and its treatment or prevention and knowing where people go to share that information helps to (1) identify strategic locations within a community for future interventions and, (2) evaluate the effectiveness of existing interventions. The geographical approach presented here is one that can serve other communities and health practitioners who hope to improve chronic disease management in diverse local environments.

Evaluating mental health care reform: including the clinician, client, and family perspective

This article suggests one direction that theory building might take to develop a stronger conceptual foundation needed to test the effect on clients of reforms in the financing and organization of mental health care delivery systems. The authors recommend that health status outcomes be measured from three perspectives: the client, who can best report his or her own subjective experience of illness; the clinician, who is the best source of information about the client's disease; and the family, which is the best source of information about the effects on members' health status of caring for a mentally ill family member. The authors also recommend that measurement of health status should be multidimensional.

Why go see the doctor? Care goes from office to home as technology divorces function from geography

Two functions of home care, assistance to improve disabled and aged patients' mobility and function, and self-care that includes treatment, screening-monitoring, exercise assistance, and information exchange, are described, as are the technologies used for these functions. Social and economic pressures as well as professional rationales that expand the use of technologies at home are noted, as is their impact on the site of care and on the patient-doctor relationship.

[Does anginal pain influence the medical care-seeking behavior of patients in the prodromal phase prior to an acute myocardial infarction. Results of a post-infarction late potential study.]

The aim of the study was to determine the proportion of high-risk patients who received appropriate antianginal therapy in the prodromal phase prior to a myocardial infarction, as an indicator of medical care seeking behavior. To this end, 606 male infarct patients aged 29-65 years were retrospectively interviewed 17-21 days after acute myocardial infarct. It was found that 77% of all patients (465/606) suffered from anginal pain, but only 32% of the patients with angina pectoris were receiving antianginal therapy in the prodromal period before acute myocardial infarction. Patients not taking medication were significantly younger than those with antianginal medication; they were more often smokers; they were less often suffering from high blood pressure; they expressed more pronounced nonacceptance of the risk; their history of anginal pain was significantly shorter; and they belonged more often to the patient group with a first myocardial infarction. In stepwise logistic regression analysis, high blood pressure, older age and exhaustion were found to be associated with medical treatment before infarction in the patient group with first myocardial infarction. In patients with recurrent infarction, continued smoking and denial of the risk remained predictive of nonmedication.

Healers, deities, saints and doctors: elements for the analysis of medical systems

This article provides the basic elements for the discussion and analysis of medical systems and their inter-dependency, with special reference to Latin America and, in particular, to the Andean countries. In a culturally diverse and socially stratified population, such as in contemporary Latin America, medical systems constitute a social representation resulting from the historical relationship between autochtonous medical cultures and those from other latitudes. The impregnation of scientific and popular knowledge results not only in the incorporation (and often expropriation) of folk in professional or scientific medicine, but also in the increasing 'medicalisation' of popular and traditional therapeutic practices. The emergent 'popular' medical system draws from both the professional and folk models, and in its actual practice, integrates both popular beliefs and materia medica with elements drawn from popular religions and pre-Hispanic deities. The degree of competitiveness, co-operation or 'integration' among medical systems depends mainly on the asymmetrical distribution of power and resources, and is conditioned by the population's behaviour in the management of disease. Existing pluralist systems of health care reveal a valuable array of survival strategies, which far outreach the proposals for integration called for by official sectors. On the other hand, knowledge derived from traditional medicine can contribute to the development of new models of clinical practice and to the expansion of the conventional epidemiological model.

Patient reports of health status as predictors of physiologic health measures in chronic disease

Accurate assessment of health status and forecasting of risk for poor outcomes in chronic disease require a broad representation of health measures. To support this conclusion, the health of patients with diabetes (N = 73) and hypertension (N = 105) was assessed using measures of physical and role functioning, perceived health, and disease severity (blood sugar or diastolic blood pressure, respectively, for diabetes and hypertension). Health questionnaires measuring functional limitations, overall health rating, level of health concern, perceived susceptibility to illness, and number of health problems were administered at study enrollment. Laboratory tests for blood sugar (hemoglobin A1) and diastolic blood pressures were performed at enrollment and were repeated at a subsequent clinic visit, from 3 to 6 months later. Functional limitations correlated significantly with elevated blood sugar (r = 0.57) and blood pressure (r = 0.49) at study enrollment. Perceived poor health was not substantially related to either physiologic measure at enrollment. Using ordinary least squares regression, the best predictor of both blood sugar and blood pressure at follow-up was baseline blood sugar and blood pressure, respectively. However, both functional limitations and perceived poor health made significant and independent contributions to the prediction of blood sugar and blood pressure at follow-up. The results underscore the value of both health survey measures and clinical measures in studies of chronic disease.

Implicit models of illness

This study was designed to be an initial investigation of implicit models of illness, that is, the dimensional structure that organizes an individual's common-sense illness schema. Nurses, college students, and diabetics rated the qualities of two different diseases, one that was personally salient (i.e., flu or diabetes) and one with which they were familiar but did not have direct experience (i.e., cancer), on a 38-item Implicit Models of Illness Questionnaire (IMIQ). An exploratory factor analysis revealed a four-dimensional structure of illnesses composed of Seriousness, Personal Responsibility, Controllability, and Changeability. The stability of this four-dimensional model was established using confirmatory factor analysis to test the fit of this structure to the IMIQ data of another sample of subjects drawn from the same populations. The structure of this implicit model proved stable for judgments of different diseases and across groups of subjects, even though they differed in their physical-health status and occupational roles. The dimensions identified in the present study were compared to those described in other papers. Our dimensions seemed to be both personally and psychologically meaningful. The implications of this preliminary "generic" implicit illness model for future work in the field of health cognition are discussed.

What makes persons "patients" and patients "well?

The transitions from person to patient and back represent social decision points rather than boundaries determined by shifting biological equilibria, as doctors so often suppose. Moreover, host resistance to pathogenic agents is weakened by social stress and strengthened by social support. Thus, the efficiency and effectivenss of medical care will be improved if the clinician, in assessing patient problems, systematically inquires into the social determinants of the decision to seek help. The probability of resolving the patient's difficulties will be enhanced by targeting treatment measures at the social components of the illness experience as well as at the pathophysiology of the disease process.

Specificity of patients requests in the initial interview

The concept of the patient's request is described in detail in relation to a negotiated approach to conduct an initial interview in a walk-in clinic and in relation to other related concepts such as patient's goals. The verbalization of specific requests of 363 patients to the psychiatric walk-in clinic of a general hospital was investigated, using a structured pre-intake interview. Although a majority of the patients (69.5%) verbalized a specific request, it was significantly less than the percentage (93%) who endorsed at least one request on the Patient Request Form. Specificity was related to socialization in the mental patient role, conditions of entry into the mental health system, and presenting complaint, but not related to demographic measures. The nonspecific patient is likely to come to the clinic at the suggestion of someone else, to be new to the clinic, having no past treatment history, and having general or situational complaints. The implications of these results for the conduct of an initial interview using the negotiated approach were discussed.