Chapter 7: Doctor-Patient Relationship. Health Attitude

• Health attitude


  The relationship between individuals and their own health
• Variations in health attitudes

  • Optimistic, unfair optimistic and careless
  • Fatalistic attitude to health
  • Pessimistic attitude to hypochondriac commitment to own health
  • Realistic attitude towards health
• Optimistic, unfair optimistic and careless attitude


  Individuals are typically optimistic, outgoing, and enjoy the pleasures of life. They do not allocate much attention toward monitoring or analyzing their bodily functions, convinced of their perfect state.
• Fatalistic attitude to health

  An example of displacement as a defense mechanism - "It's out of my hands and in the hands of a higher power." Their fatalism is often linked to religious prejudices or lack of trust in medicine.
• Pessimistic attitude to hypochondriac commitment to own health

  Individuals tend to anticipate negative events, not just related to their health, but in general. They frequently observe themselves, noticing even the slightest bodily sensations and overvaluing them, searching for explanations.
• Realistic attitude towards health


  The realistic person can manage their health, which is well within their capabilities and control. By understanding the strengths and weaknesses of their body, individuals can evaluate limitations and manageable strains.
• Person Centered Medicine


  Approach that places the patient's personality, psychosocial context, attitudes, needs, and beliefs at the center of medical care.
• Dimensions of the relationship between personality and illness

  • Personality change in disease due to somatic disease itself
  • The degradation and disintegration of the individual as a result of the disease
  • Pathological response of the individual to changes in their illness
  • The challenges of daily living, specifically those related to combating the disease itself
  • Pathological personality development
• Reaction of the patient in hospitalization

  The advice of hospitalization can evoke mixed emotions in patients, particularly in cases of no prior experience of hospitalization. Separation from family and familiar surroundings, including the convenience and comfort of one's home, can be distressing for patients.
• Mental experiences of the patient during the hospital stay

  • Initial phase: Natural psychological experiences, involving sensory symptoms including pain and bodily discomfort in addition to emotional reactions of fear and nervousness
  • Next phase: Organizing one's volition to endure the pain and discomfort associated with numerous demanding research, medical procedures (varying in terms of invasiveness), and surgical interventions
• Disease as a biopsychosocial phenomenon

  The disease is a "harmful dysfunction" associated with pain, suffering and disrupted relationships. It encompasses cognitive aspects, experiential aspects, and behavioral aspects.
• Classical conditioning


  The behavioural response is learned through an association between a conditioned and an unconditioned stimuli, while the unconditioned stimulus is usually designed to satisfy basic (instinctual) needs.
• Operant conditioning (Instrumental conditioning)

  Based on the principle of reward and punishment, this process encompasses the incorporation of an instrumental stimulus to the conditioned stimulus.
• Illness as a pattern of behaviour


  Absorbed during childhood through instrumental conditioning. Children are 'conditioned' by their parents through trial and error (punishment and reward) on how they 'should' react when they are ill.
• Insight or awareness of illness


  • Intellectual insight (the patient understands and interprets the fact of the illness on a cognitive level)
  • True insight (emotional processing of the reality of the illness and active participation in overcoming it)
• Criteria for normal (adaptive) responses to illness

  • Proportionality
  • Timeliness
  • Appropriateness of the adaptive response
• Abnormal responses to illness deviate from one or more of the criteria for normal (adaptive) responses
• Experience of illness


  Attitudes to illness can range from normal and realistic experiences of life changes, anxiety, and uncertainty to pathological due to the intensity and/or inadequacy of emotional experiences.
• Stimulus


  e.g. sound
• Insight/Awareness of illness


  Also called nosognosia, refers to the patient's understanding and emotional processing of their illness
• Types of insight


  • Intellectual insight
  • True insight
• Normal (adaptive) responses to illness

  • Proportionality
  • Timeliness
  • Appropriateness of the adaptive response
• Abnormal responses to illness


  Deviate from one or more of the criteria for normal responses
• Attitudes to illness


  Can range from normal and realistic to pathological due to intensity and/or inadequacy of emotional experiences
• Personality types based on patient's attitude towards illness

  • People who are afraid but believe in healing
  • People who ignore or underestimate the disease
  • People who treat illness with indifference or are ashamed
  • People who "escape" into the disease
• Main task of medical staff

  Support the patient's attitude to the disease to become realistic
• Hypochondriac patients


  Need more explanation and reassurance from psychiatrist to distinguish neurotic/anxiety manifestations from actual physical disease
• Fatalistic attitude to treatment


  Patients are skeptical of recommended treatment and may not follow it
• Internal image of the disease

  Reflection of the disease in the patient's experience, contrasted with the external (clinical) image
• Aspects of perceived illness

  • Sensitive (cognitive image)
  • Emotional (fear, anxiety, hope)
  • Rational, informative (knowledge and assessment)
• Anosognosia


  Non-recognition or remaining ignorant of one's own illness, a psychological defense mechanism
• Patterns of illness behaviour

  • Balanced, calm and patient
  • Agitated, anxious
  • Uncommunicative, "shut down"
  • Denial of disease
  • Passive-aggressive, irritable and hostile
  • Regressive
• Pursuit of primary and secondary benefits

  Patients may intentionally worsen symptoms to extend hospital stay or resist leaving due to benefits received
• Abnormal illness behavior syndromes

  • Hypochondriasis
  • Hysteria/Dissociative conversion disorder
  • Simulation/Aggravation/De-aggravation/Dissimulation
  • Munchausen syndrome
  • Munchausen syndrome by proxy