Social science & medicine. Part E, Medical psychology最新文献

This study explores certain physician-patient psychosocial characteristics influencing medical decision-making about length of hospitalization and discharge medications in the hospitalized treatment of patients with chronic asthma. The physician's personal orientation toward the treatment of patients was operationalized as low or high physician sensitivity. Briefly, high sensitivity physicians treat their patients as whole persons while low sensitivity physicians treat them as instances of pulmonary pathology. Significant differences were observed between low and high sensitivity physicians in the number of discharge medications they wrote for both asthma and nonasthma medications and in the length of hospitalization of their patients. The patient's mode of coping with the illness was operationalized as low, moderate, or high levels of panic-fear symptomatology. Low panic-fear scores are characteristics of patients who tend to minimize their symptoms while high panic-fear scores are characteristics of patients who tend to emphasize their symptoms. Patients with extreme low or high panic-fear levels were reacted to quite differently by low and high sensitivity physicians. This affected decisions about discharge medications and length of hospitalization. In short, high sensitivity physicians prescribed less steroid medications to extreme low and high panic-fear patient groups and hospitalized them longer relative to the moderate panic-fear group. By comparison, low sensitivity physicians prescribed more steroid medications to the extreme patient groups and hospitalized them for shorter durations. A comprehensive and detailed understanding of the influences of physician characteristics on medical decision-making will require additional studies to assess specific individual differences in perceptual, cognitive, and affective capacities.

In research, as well as in daily practice, patient interviews and estimates by clinical staff are used to determine patients' adherence to drug regimens. The present study was undertaken to evaluate the accuracy of these methods in determining medication compliance among patients treated with pilocarpine to prevent visual loss from glaucoma. This was done by comparisons with objective and detailed information on self-medication behaviour obtained with a recording medication monitor. Results indicated that estimates by clinical staff were not useful in determining medication compliance. Patient interviews indentified 7 out of 16 patients who missed doses at least once a week. However, underreporting of missed doses was a major problem in determining medication compliance by interview. Of 73 patients interviewed, only 4% reported two or more missed doses during the past 7 days, whereas monitor records showed that 33% of the patients missed at least 2 doses, and 16% missed at least 6 doses, during the past week.

This paper compares the physician's associate (PA)-primary care physician (MD) relationship with that of the clinical psychologist (Ph.D.)-psychiatrist (MD) relationship. It explores the manifest and latent, explicit and implicit, instrumental and expressive, and conscious and unconscious issues which affect the division of labor within each of these professional pairs. The greater historical depth of the psychologist-psychiatrist relationship is explored to offer a perspective on the direction in which the professional identity of the PA is moving, and likewise that of the PA-MD relationship. In both cases, it is argued that the basis for the homeostasis of role complementarity is overdetermined by unconscious issues which role partners bring to the relationship.