Chapter Eight: Using Health Services

Healthcare Costs 2.4 trillion dollars; 18% of economy Medicare rising 2x rate of inflation Therefore, control = Medicare cuts ACA reduced 580 billion from Medicare – provider cuts mainly Depressed: #1 users of medical system Anxiety/Panic: #2 overuse Low SES: ER overuse and belief about care

Who uses healthcare? Not everybody who needs it uses it Not everyone who uses it needs it Not a rational system of use - Misused - Underused - Overused

Who feels sick? Individual differences Attentional differences Hypochondriacs believe normal bodily symptoms are indicators of illness Neurotic people either exaggerate symptoms or are more attentive to real symptoms Individual differences People who are focused on themselves are quicker to notice symptoms People with more distractions and who attend less to themselves experience fewer symptoms Attentional differences

Recognition of Symptoms Boring situations make people more attentive to symptoms Medical students’ disease: Students believing they are ill with the same illness about which they are studying Situational factors Stress-related physiological changes are misinterpreted as symptoms of illness Stress Affects perception about symptoms and perceived vulnerability to illness Mood

Irrational Judgement Common disorders are regarded as less serious Influenza/flu deaths? Unexpected symptoms are ignored and expected symptoms are amplified Delay treatment Treatment is sought only when the symptom: Affects a highly valued body part Causes pain

Commonsense Model of Illness Commonsense beliefs - Held by people about their symptoms and illnesses Result in organized illness representations Includes basic information about an illness Identity - Name of the illness Causes - Factors believed to have led to the illness

Cultural Expressions of Distress Culturally bound expressions of illness Examples: Ataque de Nervious (Hispanic): intense distress, seizure like, stress triggered Dhat Syndrome (S.Asian): impotence, fatigue,anx Khyal Cap: (Cambodian) “A wind attack suffocation”

Who treats us first? Family and friends who offer their own interpretations of symptoms way before the treatment is sought Advice is offered regarding: What the symptom means Advisability of seeking medical treatment Various home remedies

The Internet: knower of all things? Two-thirds of Internet users have used it to find health information Many physicians depend on it for the most up-to-date information on illnesses and treatments Problem?

Who Uses Health Services? Age - Infants and the elderly use it most frequently Gender Women use it more than men Pregnancy and childbirth account for it Women have better homeostatic mechanisms Men are expected to ignore pain and not give in to illness Gender Women use it more than men Pregnancy and childbirth account for it Women have better homeostatic mechanisms Women’s medical care is more fragmented Men are expected to to ignore pain and not give in to illness

Who Uses Health Services? Social class and culture - Lower social classes use it less than affluent ones Social psychological factors Individual’s attitudes and beliefs toward health services and symptoms Children learn how to use health services from their parents

Using Health Services for Emotional Disturbances Psychological complaints - Nonmedical complaints that stem from anxiety and depression People use health services for psychological complaints as: They are accompanied by physical symptoms Medical disorders are perceived to be more legitimate than psychological ones

Misuse Health Services for Emotional Disturbances Seeing Medical Doctor for Anxiety, Depressive, or Stress related symptoms Suicidality addressed in emergency rooms not psychologist’s offices They need to document their absence in order to collect wages at work

Delay Behavior Putting off seeking treatment for one or more potentially serious symptoms

Stages of Delay in Seeking Treatment for Symptoms Time taken to decide that a symptom is serious Appraisal delay Time between the recognition that a symptom implies an illness and the decision to seek treatment Illness delay Time between deciding to seek treatment and actually doing so Behavioral delay Time that elapses between the person’s calling for an appointment and his or her receiving appropriate medical care Medical delay

Causes of Delay Common among people: With no regular contact with a physician Who are phobic about medical services Symptoms that delay seeking treatment Those similar to a previous one that turned out to be minor Those that are easily accommodated

Causes of Delay Typical symptoms of a disorder are more likely to be treated Delay in taking recommended treatments Patients no longer feel any urgency about their condition Patients become alarmed by the symptoms and avoid thinking about them altogether

Causes of Delay Delay in the part of the health care practitioner Medical delay is likely when a patient deviates from the profile of the average person with a given disease