Week 6 – Consultation Behaviours and Patient Adherence
Content:
1. In an ideal world…
2. Experiencing ill-health symptoms
3. Adherence (following medical advice)
4. Getting well
Part 1: In an ideal world
In an ideal world, healing illness would be straightforward:
1st – experience symptoms
2nd – we would consult an expert
3rd – we would receive diagnosis
4th – we would follow medical advice
5th – we would get well
The question here is whether it is that simple? Clearly it is not. At each stage, there are factprs that
interfere with the process – with the decision to seek help.
Examples:
- ‘Am I ill? Is that a symptom?
- Is it worth worrying a doctor?
- I’m just getting old I’m expected to have health problems
- There are others needier than me, I’m not THAT ill.
From this, we realise that initiating consultation is a behavioural decision, so factors that get in the
way of other behavioural decision equally apply here.
Chandrasekara 2016
This
highlights
the factors
that
contribute
to people’s
intentions
to seek
help and
then
ultimately
to seek
help.
, Part 2: Experiencing Ill-health Symptoms
Behavioural decision making is complex process, so we see variance between people in their
consultation behvaiours. This has been referred to as the clinical ice berg effect – dotors only see
small proportion of poepl that would benefit from consultation.
We mut also consider structural factors:It Is hard to get a GP appointment in some areas than other
– Cowling et al., (2014) Access to general practice and visits to A&E from National Patient Survey
Data.
- Consequently, there is an 11% increase in ‘unplanned’ A&E attendances – so attending at
point of emergency between 2008 - 2013
- And consequently, there is 5.77 million A&E attendances that were a result of patient not
being able to access general practice
This is a problem as we know that early consultation and diagnosis is critical for the prognosis of
many major illnesses.
E.g: Dementia:
- Early diagnosis helps with uncertainty of symptom progression, helps them manage and plan
for future better
- Early access to medical and non-medical treatment can be beneficial
Unfortunately is has been estimated that more than 50% of cases of dementia aren’t recognised in
primary care (GPs) (Alzheimer’s Disease International (2011). This calls for accessible diagnostic care
services and treatment for those diagnosed.
E.g: Cancer
- early screening and diagnosis can detect cancerns at early stage or prevent cancer developing
But: a quarter of new cancer diagnosies are made folling an A&E visit – so quite late. 10% of people
with cancer see the GP more than 5 times before getting a diagnosis.
Implications:
- Doctors may be ill-prepped for identifying symptoms
- And some people may not take up screening opportunities.
Symptom Perception
What Ogden highlights for us is research that looks at thresholds that underpin symptoms
perception. 3 cognitive processes that underpin symptom perception:
- ‘Is it a symptom? Is it abnormal or normal?
- ‘Do I need help?’
- ‘Could a doctor help?’
There is considerable variability in how these questions are answered. An older person may see a
cough more readily as a symptom, compared to a younger person.
Content:
1. In an ideal world…
2. Experiencing ill-health symptoms
3. Adherence (following medical advice)
4. Getting well
Part 1: In an ideal world
In an ideal world, healing illness would be straightforward:
1st – experience symptoms
2nd – we would consult an expert
3rd – we would receive diagnosis
4th – we would follow medical advice
5th – we would get well
The question here is whether it is that simple? Clearly it is not. At each stage, there are factprs that
interfere with the process – with the decision to seek help.
Examples:
- ‘Am I ill? Is that a symptom?
- Is it worth worrying a doctor?
- I’m just getting old I’m expected to have health problems
- There are others needier than me, I’m not THAT ill.
From this, we realise that initiating consultation is a behavioural decision, so factors that get in the
way of other behavioural decision equally apply here.
Chandrasekara 2016
This
highlights
the factors
that
contribute
to people’s
intentions
to seek
help and
then
ultimately
to seek
help.
, Part 2: Experiencing Ill-health Symptoms
Behavioural decision making is complex process, so we see variance between people in their
consultation behvaiours. This has been referred to as the clinical ice berg effect – dotors only see
small proportion of poepl that would benefit from consultation.
We mut also consider structural factors:It Is hard to get a GP appointment in some areas than other
– Cowling et al., (2014) Access to general practice and visits to A&E from National Patient Survey
Data.
- Consequently, there is an 11% increase in ‘unplanned’ A&E attendances – so attending at
point of emergency between 2008 - 2013
- And consequently, there is 5.77 million A&E attendances that were a result of patient not
being able to access general practice
This is a problem as we know that early consultation and diagnosis is critical for the prognosis of
many major illnesses.
E.g: Dementia:
- Early diagnosis helps with uncertainty of symptom progression, helps them manage and plan
for future better
- Early access to medical and non-medical treatment can be beneficial
Unfortunately is has been estimated that more than 50% of cases of dementia aren’t recognised in
primary care (GPs) (Alzheimer’s Disease International (2011). This calls for accessible diagnostic care
services and treatment for those diagnosed.
E.g: Cancer
- early screening and diagnosis can detect cancerns at early stage or prevent cancer developing
But: a quarter of new cancer diagnosies are made folling an A&E visit – so quite late. 10% of people
with cancer see the GP more than 5 times before getting a diagnosis.
Implications:
- Doctors may be ill-prepped for identifying symptoms
- And some people may not take up screening opportunities.
Symptom Perception
What Ogden highlights for us is research that looks at thresholds that underpin symptoms
perception. 3 cognitive processes that underpin symptom perception:
- ‘Is it a symptom? Is it abnormal or normal?
- ‘Do I need help?’
- ‘Could a doctor help?’
There is considerable variability in how these questions are answered. An older person may see a
cough more readily as a symptom, compared to a younger person.
