pp relationship

• When analysing markets, a range of assumptions are made about the rationality of economic agents involved in the transactions
• The Wealth of Nations was written

  1776
• Rational


  (in classical economic theory) economic agents are able to consider the outcome of their choices and recognise the net benefits of each one
• Rational agents will select the choice which presents the highest benefits
• Consumers act rationally by


  Maximising their utility
• Producers act rationally by


  Selling goods/services in a way that maximises their profits
• Workers act rationally by


  Balancing welfare at work with consideration of both pay and benefits
• Governments act rationally by


  Placing the interests of the people they serve first in order to maximise their welfare
• Groups assumed to act rationally


  • Consumers
  • Producers
  • Workers
  • Governments
• Rationality in classical economic theory is a flawed assumption as people usually don't act rationally
• Marginal utility


  The additional utility (satisfaction) gained from the consumption of an additional product
• If you add up marginal utility for each unit you get total utility
• Dependent variable


  Patient level of satisfaction
• Controlled variables


  • Random selection of patients; same doctor used throughout
• Sample


  200 randomly sampled patients (aged 16-75) from a London GP practice
• Procedure


  1. Participants were randomly allocated to the 'directed' or 'sharing' practitioner style

  2. The doctor also had prompts giving examples of directed and sharing styles of consultation

  3. At the end of the consultation, the participant completed a five-question questionnaire

  4. Participants received a second identical questionnaire to mail back one week later

  5. Researchers noted the length of consultation and demographics

  6. Ethics: participants gave consent for their appointments to be audio-recorded
• Application to everyday life

  By understanding which style of consultation works best, practitioners can adapt to suit individual patients. This may help with information disclosure, meaning more accurate diagnoses.
• Savage and Armstrong's (1990) research offers situational explanations for patient satisfaction increasing with either a sharing or a directed style. This ignores individual differences that could impact a patient's preference.
• Delay in seeking treatment

  According to the health belief model (HBM), people who feel threatened by their symptoms tend to see a practitioner more quickly, whereas those who view symptoms as no threat, delay or avoid seeking medical help.
• Health belief model


  1. The individual would have to assess their perceptions before going to treatment, understanding this assessment can lead to the understanding of treatment seeking delay

  2. Individuals firstly evaluated their susceptibility for the illness

  3. Another additional cognitive evaluation includes the seriousness of their health problem and how it can impact their lives

  4. Followed by their perceived benefits and barriers

  5. Modifying factors can finally influence their perception of threat, which include their demographics and cues to action
• Safer et al. (1979) investigated whether delay can be broken into different stages and factors, involving different decisions/processes.

  
• Appraisal delay


  Pain will decrease the delay, whereas googling/ researching symptoms would increase the delay.

  
• Illness delay


  New symptoms would decrease the delay, scared of a negative outcome – would increase the delay.

  
• Utilization delay


  Pain increased, delay decreases. If symptoms may be felt as incurable or cost is expensive that will increase the delay.

  
• Munchausen syndrome


  When people seek out excessive medical attention, often going from city to city to get a new diagnosis and new surgical intervention. It is not malingering, which is when a person feigns or exaggerates symptoms for an obvious gain or incentive.
• Essential features of Munchausen syndrome

  • Pathological lying (pseudologia fantastica)
  • Peregrination (travelling or wandering)
  • Recurrent feigned or simulated illness

  
• Aleem and Ajarim (1995) developed a list of diagnostic features of Munchausen syndrome

  
• Methodology of Aleem and Ajarim (1995)


  1. A 22-year-old female university student was referred to hospital with a possible case of immune deficiency or neutrophil disorder

  2. She was initially investigated at the age of 17 for menstrual cycle issues

  3. She developed symptoms of deep vein thrombosis; medication to treat this was ineffective

  4. She was admitted to hospital aged 22 with a painful swelling on her breast

  5. She told doctors of similar swellings previously over her abdominal wall which had required drainage at other hospitals multiple times - there were scars

  6. Later she had abscesses drained and doctors discovered suspicious bacteria in fluid
• Reductionism versus holism


  The health belief model explanation is holistic, considering multiple reasons. This makes it hard to isolate which variables have the strongest effect in delaying seeking treatment. it is also difficult to create effective interventions. Amore reductionist approach may be necessary, but it is often impossible to manipulate variables for practical and ethical reasons.
• Idiographic versus nomothetic


  An idiographic approach with rich in-depth information is appropriate in Aleem and Ajarim (1995) as Munchausen syndrome is relatively rare and generalising from small samples in a nomothetic manner may not be valid. Practitioners can decide whether findings may apply to their own clients.

  
• Hypochondriasis


  Persistent fear of having a serious medical illness. Often interpret normal symptoms/sensations as a sign of an illness with a negative outcome.
• Delay in seeking treatment (Safer, 1979)

  1. Appraisal stage

  2. Illness stage

  3. Utilisation stage

  
• Factors predicting length of delay in seeking treatment

  • Beliefs about symptoms and consequences
  • Physical experiences of the illness
  • Strategies used by the patient to resolve their own ailments

  
• A patient who has an old illness and believes there are possible severe consequences of the illness may delay seeking treatment
• Munchausen syndrome


  A psychological disorder where someone pretends to be ill or deliberately produces symptoms of illness in themselves
• Munchausen syndrome (Aleem and Ajarim, 1995)


  • 22 year old woman reported swelling on her body, had been seen numerous times in hospital since 17, nursing staff found a needle with faecal material
• Suspicions were raised by the hospital when it was felt that the ailments she had did not appear to have a physical cause
• The patient left the hospital when confronted after becoming very angry and did not return again
• Psychologists have discovered about the misuse of health services: delay in seeking treatment, hypochondriasis, Munchausen syndrome
• Stressful life events, especially those involving exposure to death or serious illness

  May be a precipitating factor in the onset of hypochondriasis