Posted by Marilyn Lawrence on January 25, 1998 at 10:04:05:
1. Patient-provider prototypes:
Paternalism- this area appears to include people of approximately 60 years and older.
They were raised to believe anything the provider said and not to question the provider's
knowledge. This patient is apt to be more compliant. In this age category, it seems there
is more acceptance of illness socially and more nurturing from family and friends.
Consumerism- this category I see as young professionals; lawyers, accountants, outside
of the medical profession having higher education, and a certain degree of authority and
power. They are used to having control. They also know they have a right to question
providers and have the resources to search for their own answers.
Mutuality- probably the best example is the one listed, health care workers. There is
usually a mutual respect between the two, the provider recognizing the knowledge of the
health care worker, and more of a willingness to "work together" when making decisions.
Default- people who must rely on Medicare or Medicaid. The provider has to provide
care under the conditions that are defined by the authorities. The patient has to accept this
treatment even if not pleased or satisfied, because they are unable to pay for the health
care otherwise. Both the provider and patient have less control which may lead to friction
between them. This can also lead to non-compliance on the patient's part, and a lack of
enthusiasm on the providers part.
2. All sources of health information can be good or bad, it depends on their reliability and
credibility. National organizations that have research to back up their claims are probably
the best. Organizations such as the American Heart Association or American Cancer
Society have the funds to support the research that can provide consumers with facts.
Some sources that can do more harm than good are the "hear-say" sources. They tend
to relate to the "experiences" of the patient rather that the facts of the "illness". This can
occur when stories are relayed such as the "He said that she said...when cousin Fred
had...Aunt Myrtle fainted when they...Grandpa (who was 96) died when they...etc.,etc,etc.
3. My "good" and "bad" patient experience will be of the same individual. Recently I was
assigned to care for a 50+ year old man. during his heart cath. The nurses who had been
caring for him told me he was grumpy, mean, non-compliant, etc., etc., etc., which
instantly put some dread in my mind as far as what I would encounter. I smiled at him and
introduced myself only to be greeted by a rather sour-looking, non-smiling face and I
thought, "Here we go". In the beginning I was very straight and professional but friendly
and encouraging at the same time. I quickly learned from his comments that: #1: he was
scared to death, #2: he was angry because his body had betrayed him by having a heart
attack, #3: he was realizing that he was not immortal, #4: he was used to being in control
of things and he was not. I kept at him and teased a little, gave him a little Versed (yea!),
and before long he was commenting how the procedure was not bad after all and we were
doing a great job and causing no pain.
As I took him to the recovery area, I squeezed his hand and wished him well. At this
point, he kept hold of my hand tightly and thanked me warmly. My "bad" patient of the
day turned out to be my "best" patient of the day and I felt good because I thought I just
might have made a little difference in the way he dealt with his illness.