Transcript Medical Psychology 31.03.2011 - u

Medical Psychology
31.03.2011
The influences of gender and
age on health behaviors
Some determinants of the
success of communication with
the patient
► highest level of knowledge with
regards to the illness
► communication skills
► gender of the patient
► age of the person we are dealing
with
Analysis of gender problems in
medicine started in the 1970s
►questions of reproduction were central
as the result of the introduction of the
contraceptive pill
► Studies looking beyond reproduction
only appeared from the 1990s!
Diseases which occur more
frequently in women (LagroJanssen, 2007)
migraine, angina pectoris, multi-joint
inflammation, chronic obstructive lung
problems, intestinal inflammations,
chronic fatigue
90% of medically unexplained
symptoms (MUS) are reported by
women
(Mayou and Farmer, 2002)
Differences between men and
women in the case of MUS
► differences are not caused by
biological reasons
but rather differences in symptom
perception and
gender stereotypes of coping
(emotional coping is more
characteristic of women, and the
problem-centred approach of men) (de
Ridder, 2000).
Men
N
%
Women
Tiredness
598
36,9
Tiredness
1491
Back pain
385
23,7 Back pain
828
Coughing
365
22,5
Headache
746
30,6
Muscle stiffness
365
22,5 Muscle stiffness
669
27,4
Muscle pain
347
21,4
617
25,3
547
22,4
Muscle pain
%
61,1
33,9
Snuffles
336
Cold
302
18,6
Stiff joints
518
21,2
Headache
280
17,3
Pressure in head
501
20,5
Irritable bowel
273
16,8
Coughing
499
20,4
Tinnitus
257
20,7 Insomnia
N
15,8
Stiff joints
(Gijsbers van Wijk et al, 1999)
493
20,2
► women perceived the same symptoms
to be longer lasting and more severe.
► they sought expert help for their
perceived symptoms more frequently,
► in their case there is better correlation
between the reported symptoms and
behaviour
Who is healthier?
► women are more likely to suffer from
depression and minor somatic ailments
► men suffer from “more serious”
illnesses
► men are healthier for longer, but they
experience more severe ill health as
they age
(Verbrugge, 1989, Ross and Bird, 1994)
Study of illness behaviour
(Fletcher and Higginbotham, 2002)
► women receive more emotional
support and information from various
social networks during times of stress
► increased willingness to go to the
doctor with minor problems,
► they are less disturbed by a lower
level of control than men are
Be careful with generalizations!
► Prejudices can lead to the common
view that health related questions are
“women’s matters”
► Health care professionals may form
the attitude to take women’s complaints
less seriously or to minimise them.
What about men’s health?
► Prior to 1998 the scientific literature on
men’s health was limited to prostate
problems and testicular cancer
(Fletcher and Higginbotham, 2002).
► Men’s shorter life expectancy
relative to women is a global
phenomenon
This understanding drew attention to
particularly male health problems
Men’s health behaviour
► men utilise health services and
screenings less frequently
► they perceive symptoms of illness
later than women
► less concerned with illness
prevention, e.g. pay less attention to
their weight
(Gijsbers van Wijk et at, 1999).
Research in recent years links
differences in health behaviours with
views of masculinity and male
identity.
One of the key components of the traditional
’hegemonic’ masculinity is the refusal to care
for the body and worry about health
(Bunton and Crashaw, 2002).
The underlying – frequently unconscious –
classic male stereotypes:
men are “inherently” immune to illness and are
more tolerant of pain (Petersen, 1998).
Differences in symptom
presentation
► Lower level of “complaining” skills in
men.
► Emotional content in doctor-patient
communication is often less common for
men than for women.
► Men generally are prescribed sedatives,
anti-anxiety medication and
antidepressants less frequently than
women (Lee and Owens 2002).
► Expressions of emotion are also blocked in
men by the strong negative societal
prejudice against homosexuality
Stereotypes also suggest that a
“real man” takes on the risk
► Men suffer 3 times as many
accidents than women;
► incidences of both workplace and
traffic accidents are higher in their
case,
• as are acts of violence (Doyal 2001).
• even in childhood, 2x as many boys
die in accidents than girls (Lam et al
1999).
Preventive behaviour and
psychotherapy
► Men are less likely to take part in screenings
(Seymour-Smith et al, 2002).
► Boys are less likely than girls to be taken by
their parents to see a psychologist; this is
also the case for adult men (Jorm, 1994).
► Popular media strengthen the view that men
are “incapable” of looking after their own
health (Lyons and Willcott, 1999).
Women and men in the
therapeutic relationship
Nurses had to devise a treatment plan for male or
female patients with the same diagnosis and status.
► allocated less movement, pain relief and
emotional support for women than for men
(McDonald and Bridge, 1991).
Men were often given more post-operative pain
relief.
► Nurses described female patients less positively
– saw them as more demanding
nurses judged that the time they spent with female
patients was longer than that spent with the male
patients (Pittman, 1999, Foss and Sundby, 2003).
Communication with male
and female patients
(Foss and Sundby, 2003)
Hospital staff saw male patients’
behaviour as the norm.
Stated that
► women (especially older women)
presented more diffuse symptoms,
► were more circumstantial,
► communication with them took longer
► that hospital doctors did not have
time for “feminine” discussions.
Opinions of hospital staff based
on gender stereotypes (Foss and Sundby,
2003)
Time
requirement
Communication
Control and
power
Male patient
“problem-free”
Low
Specific, clear
Female patient
“demanding”
High
Unclear, uncertain,
circumspect
-Hands over control -Wants to supervise
-Asks little
-Asks for repeated
- Concentrates on information
one thing at a time -Worries about the future
Gender aspects of the
medical role
► Female doctors spend more time with their
patients;
► patients talk to them more
► emotional communication and the discussion of
psychosocial subjects are more characteristic of
women (Hall and Roter, 1998).
► Women doctors ask for patients’ opinion, or for
confirmation more frequently
► they show more non-verbal signs of interest
► they are less dominant during doctor-patient
consultation than their male counterparts ( Roter et al,
2002).
Despite all these differences,
research on this subject
has not shown
gender-based differences
in the choice of doctors!
Communication with elderly
patients is hindered by issues
associated with:
► age
► sensory (vision and hearing-related)
problems,
► loss of memory,
► slower information processing,
► diminishing competence in making life
decisions,
► loneliness
Typical beliefs and attitudes
of medical professionals
(Palmore, 1999)
►“Old people always know everything
better.”
►“Elderly people have been through a
lot.”
►“They need too much time.”
►“They are unsure when relating their
complaints.”
►“Oh, their relatives!”
Attitudes of 1st year
medical students
(Reuben et al, 1995)
Hypothetical decision test:
Students were much less likely to admit
an acutely ill 85-year-old woman to an
intensive care unit, intubate her, and
treat her aggressively than they were to
treat an acutely ill 10-year-old girl with
underlying chronic leukemia.
Restraining factors in the
treatment of elderly patients
(Bastiaens et al, 2007)
On the part of the doctor:
• lack of information or discussion
• not showing concern, is overly authoritative, does
not evoke trust
On the part of the patient:
• Mental problems (lack of understanding, memory)
• Low level of educational attainment
• Physical problems (vision, hearing, mobility
problems)
Positive factors in the
treatment of elderly patients
(Bastiaens et al, 2007)
On the part of the doctor:
• Wants to involve the patient (facilitates questions,
joint decision making)
• Appropriate training (geriatric specialism,
communication)
On the part of the patient:
• Willingness to participate, responsible attitude
• Individual traits (well-informed, expressive,
appropriate mental state)