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UKCD CDE/BSC 814
Patients, Dentists and Society
| Question | Answer |
|---|---|
| Definition: Norm | standard of behavior, "floating set point", varies within people and within a person |
| Behavior: Norm | changing the fork to the right hand after cutting meat to eat with the left |
| Consequence: Norm | stigmatizing of other ways of doing the behavior: other ways of performing that behavior are considered "wrong" and the actor "bad/outsider" |
| Definition: Health Data Base | your total accumulated "knowledge/experience" (regardless of source) of all aspects of health |
| Behavior: Health Data Base | HCP "all knowing |
| Consequences: Health Data Base | never argue or question a HCP's opinion |
| Definition: Health Beliefs | a culture-specific integrated system of ideas and behaviors concerning your health, comes from health data base and stays in effect as long as HDB validates it |
| Behavior: Health Beliefs | "a woman loses a tooth for every child she bears"- rural young women bear children around the same age a lack of oral care catches up with you |
| Consequences: Health Beliefs | lack of concern about early tooth loss |
| Definition: "Normal" | what is perceived as routine/within expectations |
| Behavior: "Normal" | defining lower back pain during tobacco cutting season as "routine" and therefore not meriting care, because it is a common affliction in your community, not noticing the short incremental onset of a chronic illness because it becomes normal |
| Consequences: "Normal" | delay in seeking care for a potentially serious condition that is totally unrelated to tobacco cutting |
| Definition: Boundary Maintenance | judging a person's group membership by their behavior |
| Behavior: Boundary Maintenance | On a public bus, choosing to sit next to an individual who appears to share your standards of dress/speech/cleanliness |
| Consequences: Boundary maintenance | Gravitate toward people like ourselves and tend to marginalize/reject/exclude people who are different |
| Definition: Prediction | perception that you know what to expect |
| Behavior: Prediction | dentist invariably cause pain (dental anxiety/phobia) |
| Consequences: Prediction | acute stress/anxiety about a visit, avoidance of dentists |
| Definition: Illness | Socially-defined state of abnormal health |
| Behavior: Illness | "nerves" |
| Consequences: Illness | temporary cessation of routine activities, seeking of medical care the physician sees as unnecessary |
| Definition: Disease | bio medically defined state of abnormal health |
| Behavior: Disease | swollen, red gums indicate gingivitis |
| Consequences: Disease | seeking/receiving dental care |
| Three types of social control: | religion, law, medicine- more recently medicine has been removed because it doesn't blame the victim |
| Definition: Religion | sick because "sinned" |
| Behavior: Religion | seek religious absolution |
| Consequences: Religion | sickness if punishment=guilt |
| Definition: Law | sick because broke a law |
| Behavior: Law | tried by legal system |
| Consequences: Law | sick because broke a law=guilt |
| Definition: Medicine | sickness just happens |
| Behavior: Medicine | try to correct cause |
| Consequences: Medicine | get treatment-little or no guilt |
| Definition: Health Motivational Model: Threat | patient's perception of risk to own health posed by a symptom/behavior |
| Behavior: Health Motivational Model: Threat | perception that tooth loss is painful and unsightly and preventable |
| Consequences: Health Motivational Model: Threat | routine oral hygiene and seeking regular dental care resulting in good oral health |
| Definition: Health Motivational Model: Feasibility | patient's perception of likelihood of altering the course of health events |
| Behavior: Health Motivational Model: Feasibility | practicing good oral hygiene as a dental health maintenance measure |
| Consequences: Health Motivational Model: Feasibility | generally good oral health |
| Definition: Health Locus of Control: Internal | you are responsible for your basic health |
| Behavior: Health Locus of Control: Internal | brushing and flossing daily in order to retain teeth |
| Consequences: Health Locus of Control: Internal | healthier teeth and gums |
| Definition: Health Locus of Control: External | your health is beyond forces of your control |
| Behavior: Health Locus of Control: External | no consistent oral hygiene because you don't believe it matters in retaining your teeth |
| Consequences: Health Locus of Control: External | early loss of teeth |
| Resource Allocation | time energy money = access |
| Relationship between prediction, health beliefs and health data ase | Prediction--> Health Data Base--> Health Beliefs |
| Definition: Doctrine of Specific Etiology | for every non-traumatic condition one necessary and sufficient pathogen, aka Germ Theory est 1860, main data base was acute infectious diseases, wrong because each person's immune system varies, sufficent b/c pathogen might not be enough to cause disease |
| Behavior: Doctrine of Specific Etiology | seeking a single cause with a single specific fix |
| Consequences: Doctrine of Specific Etiology | treating the disease instead of the patient, looking for technical fix to the problem without considering the patient |
| Definition: Multi-causal model | considering every condition to be the result of a multitude of forces |
| Behavior: Multi-causal Model | considering context of patient when trying to correct a complex problem |
| Consequences: Multi-causal Model | taking into account the context of the patient in treatment planning |
| Definition: Socioeconomic Status | social status as defined by income and education |
| Behavior: Socioeconomic Status | one's access to health are is affected by one's economic status and educational background |
| Consequences: Socioeconomic Status | a patient of very limited economic means and little understanding of gum disease, not seeking care for early gum disease. This patient will likely come at point you consider too/very late in their disease process |
| Definition: General Susceptibility Theory | starting out life with reduced life chances due to poverty, poor education, poor health, etc prevent rising higher SES |
| Behavior: General Susceptibility Theory | children of the poor, especially urban poor, likely to live out their lives in similar poverty |
| Consequences: General Susceptibility Theory | one who believes this theory sees those in the lowest SES as victims of their surroundings |
| Pathways to Disparity | 1. SES deprivation 2. Toxic environment 3. Social/Physical Trauma 4. Target Marketing 5. Inadequate Health Care |
| Factors Contributing to current disparities in reported health states across social groups | 1. poverty 2. hazardous substances 3. trauma/harassment 4. alcohol, cigarettes etc. 5. little access |
| Current Disparities consequences in health care | significantly worse health indicators for lower SES/minority individuals |
| Preparation of a patient for a root canal | start with sensory because that's how people set their normal and are going to be aware of, age makes a difference, bulk of information should be sensory but give some technical |
| Information provided in addition to a prescription: | share sensory information and not biomedical mechanism |
| U.S. expectations of health care vs Developing countries expectations of health care | US- expect they will known what you have and how to fix it DC- lower expectations of the medical care |
| Marker of General health in a country | MU5, mortality under 5 |
| Definition: Cue Competition | the competition among sensory cues for our infinite attention ex kids fevers spiking in the night when there are less cues |
| Behavior: Cue Competition | cues that cannot compete for attention, ie mild symptom, cues can also jam processing and limit processed important cues |
| Consequences: Cue Competition | one can fail to notice and not process early mild symptons and wind up coming late for care, one can also be made comfortable by overloading cues |
| Definition: Differential Socialization of Male/Female Children "Little Boys Don't Cry Phenomenon | male and female children in the US are trained to respond differently to many sensory cues, especially pain and minor sensations. |
| Behavior: Differential Socialization of Male/Female Children "Little Boys Don't Cry Phenomenon | males tend to be embarrassed to report minor sensory variations, while women are encouraged to note and report them |
| Consequences: Differential Socialization of Male/Female Children "Little Boys Don't Cry Phenomenon | men tend to come for care later in a disease process than women, therefore, as a health professional you need to praise males for coming even when the symptoms are mild because it can prevent larger problems |
| Definition: Availability | likelihood of recall of a given label |
| Behavior: Availability | the more frequently used is a label, the more easily it comes to mind as a label |
| consequences: Availability | mislabeling conditions because of recent high frequency of a similar condition ex girl w/ meningitis being wrote off for a flu |
| Schachter's 3 principles of sensation attribution: | 1. a noticeable deviation from "normal" 2. seek reasonable explanation in immediate past activities 3. if you don't find a reasonable answer keep looking along culturally patterns lines of explanation |
| Schachter's 3 principles of sensation attribution: 1. a noticeable deviation from "normal" | you notice a feeling that is not normal for you, might ask spouse or friend if they have ever had it, may not be reported as it becomes "Normal" |
| Schachter's 3 principles of sensation attribution: 2. seek reasonable explanation in immediate past activities | thinking back over past day to find acause, if a cause is found the sensation will be considered normal until it gets worse or goes away, ex. after jogging considering all leg pain normal, people may begin to consider any symptoms as reasonable |
| Schachter's 3 principles of sensation attribution: 3. if you don't find a reasonable answer keep looking along culturally patterns lines of explanation | may think about other things poeple say may cause this new sensation, began a real search for a cause, not witchcraft if that is part of your culture, might finally cause one to seek care, not likely to resort to voodoo unless part of your culture |
| perception | limited in our brains due to a large amount of cues that have to compete for attention |
| Definition: Pain Sensation | the point at which an increment in stimulation gets labeled painful. |
| Behavior: Pain Sensation | this is slightly different point for every individual. Stress can significantly heighten a sense of pain. |
| Consequences: Pain Sensation | people will label a stimulus as painful differently from each other & differently depending attitude, Stress will make a stimulus as painful earlier, at lower intensity, at peace patient who normally needs very little numbing may need more when upset |
| Definition: Pain Distress or Suffering | the psychological distress caused by pain. how upset the pain makes us. |
| Behavior: Pain Distress or Suffering | at some level pain is not simply a sensation, but psychologically tormenting, stressful or frightening |
| Consequences: Pain Distress or Suffering | pain caused by removal of a tooth in a patient who values their appearance may cause more suffering and distress than another individual |
| Definition: Specific Transmission/Direct Line/Telephone Theory | the more forceful the physical assault to the body the more pain will be perceived in the brain |
| Behavior: Specific Transmission/Direct Line/Telephone Theory | strike your finger with a hammer hurts more than rapping the same finger on the edge of a counter |
| Consequences: Specific Transmission/Direct Line/Telephone Theory | an individual's report of pain sensation/distress should be directly proportional to the severity of physical damage, DOES NOT EXPLAIN STRESS INDUCED ANALGESIA |
| Definition: Stress- Induced Analgesia | temporary lack of pain sensation in a particularly badly damaged area of the body |
| Behavior: Stress- Induced Analgesia | I don't feel any pain in my machine-mangled arm but I can feel pain everywhere else if stimulated |
| Consequences: Stress- Induced Analgesia | explains lack of perception of pain in severely injured patients in ER or a VA |
| Definition: Gate- Control Theory | explains reduction of pain perception under extreme circumstances or after condition DOES NOT EXPLAIN PHANTOM LIMB PAIN |
| Behavior: Gate- Control Theory | individual doesn't feel what would appear to be an "appropriate" level of pain considering the wound |
| Consequences: Gate- Control Theory | patients who are under stress or very frightened will perceived heightened levels of pain while people who are conditioned to frequency pain ie professional athletes may perceive less pain than expecting |
| Definition: Phantom Limb Pain | pain in a body part that is no longer attached, starts at the extremity and moves towards the stump, can last years |
| Behavior: Phantom Limb Pain | complaining of pain in a foot that has been amputated |
| Consequences: Phantom Limb Pain | very real, not figment of imagination, local anesthetic is best way to prevent its occurrence |
| Definition: Neuromatrix Theory or Central Registry Theory | severe pain leaves a footprint in the brain and therefore can receive or generate "false pain signals" for body parts now removed |
| Behavior: Neuromatrix Theory or Central Registry Theory | phantom limb pain |
| Consequences: Neuromatrix Theory or Central Registry Theory | explains occurrence of phantom limb pain and tends to support the peripheral origin of pain |
| Definition: Endorphin | naturally occurring opiods |
| Behavior: Endorphin | close pain gates |
| Consequences: Endorphin | natural defense against painful stimuli, reduce the perception of pain |
| Definition: Guarding | not using some part of the body because of pain there |
| Behavior: Guarding | chewing on only one side of your mouth because you have a sore tooth on the other side |
| Consequences: Guarding | any long term use of guarding will cause overuse and damage somewhere else in the body/mouth, eg excessive wear on one side of the mouth, joint pain |
| Definition: Reinforcement Secondary Gains | positive reinforcement that accidently encourages unwanted behaviors |
| Behavior: Reinforcement Secondary Gains | enjoying the family's attention while you are being pampered while your broken jaw is healing, so not healing as quickly |
| Consequences: Reinforcement Secondary Gains | simply enjoying the state of being care for and fussed over might make the individual less enthusiastic about getting well and becoming fully independent again, this is common phenomenon among the elderly in our society because so many lonely elderly |
| Definition: Dosing to the mean | very individual, deciding what the "average" amount of pain medicine is for a given condition, and giving it to everyone with that condition |
| Behavior: Dosing to the mean | deciding that no one should need more than one injection to numb their jaw for a root canal |
| Consequences; Dosing to the mean | 50% of your root canal patients will be over "numbed" and 50% will be under medicated. Each patient has a unique pain experience. |
| Definition: Analgesia Administration: PRN (as needed) | as requested by the patient |
| Behavior: Analgesia Administration: PRN (as needed) | patient requests meds |
| Consequences: Analgesia Administration: PRN (as needed) | PCA patients use less pain medication and heal more quickly, have fewer complaints because they can predict and control when they are going to feel better and get relief |
| Definition: Analgesia Administration: PCA (patient controlled analgesia) | patient controlled pump |
| Behavior: Analgesia Administration: PCA (patient controlled analgesia) | patient activates the pump as they feels need |
| Consequences: Analgesia Administration: PCA (patient controlled analgesia) | PCA patients use less pain medication and heal more quickly, have fewer complaints because they can predict and control when they are going to feel better and get relief |
| Definition: Stigma | a negative attitude shared by a group about a characteristic or set of characteristics, impossible to be free of |
| Behavior: Stigma | looking down on patients with some "devalued" characteristics, eg. HIV+, poor, elderly, rural, disable, obese |
| Consequences: Stigma | b/c of proven negative impact of stigma on interactions, stigmatized patients do not receive optimal care at hands of a stigmatizing clinican, difficult for non stigmatizing clinician to render good care to a stigmatized patient, b/c they are defensive |
| Definition: Stigma Theories | one stigmatizing characteristic causes assumption of more |
| Behavior: Stigma Theories | an individual with one stigmatized characteristic is treated as though they have many additional ones, without any evidence |
| Consequences: Stigma Theories | an individual with stigmatized characteristics is automatically assumed to have other negative characteristics, and therefore not given optimal treatment |
| Definition: Discredited | an individual who harbors an invisible stigmatizing characteristic |
| Behavior: Discredited | the individual enters an interaction knowing that they have a hidden flaw that others stigmatize |
| Consequences: Discredited | during an interaction, the discreditable person must manage the flow of the communication so the flaw is not uncovered, reduces the efficiency and spontaneity of the interaction |
| Definition: Achieved Status | earning public stature by one's individual effort |
| Behavior: Achieved Status | eg earning a DDS owning a nice home being active in one's religious organization |
| Consequences: Achieved Status | symbols of achievement, especially money and physical robustness become very important to self-esteem, if one loses one of both of these self-esteem and depression can result |
| Definition: Ascribed Status | social characteristics with which one is born, that acquires through no effort on one's part |
| Behavior: Ascribed Status | in communities or societies where ascribed status is important, social mobility is difficult, b/c these characteristics are not changeable unless one leaves one's home community |
| Consequences: Ascribed Status | make certain that you offer all your patients the same quality, is not quantity of dental care regardless of their social standing |
| Definition: Criteria of Self-Esteem: Independence/ Monetary Productivity | the ability to live and move about independently with full physical function/ gainful employment |
| Behavior: Criteria of Self-Esteem: Independence/ Monetary Productivity | living without physical dependence on people or appliances/ having a job |
| Consequences: Criteria of Self-Esteem: Independence/ Monetary Productivity | the importance of these two factors as criteria for self esteem if that loss of one or both severely damages self esteem and can lead to serious depression, loss of vigor or health, as a family dentist may pick up on changes and talk about issues |
| Definition: Possible Selves | alternative life activities that one could imagine being content doing |
| Behavior: Possible Selves | if you don't make it into the profession you have chosen, having a back up plan for a different job you could enjoy |
| Examples of Stigma in our culture | teeth appearance, weight, elderly, unskilled work, HIV+ |
| Research about Stigmas | reveal that often the person with a stigma discredits themselves and provides non verbal skills that turns off the other person |
Created by:
wiechartm
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