Deck 9: Patients, Providers, and Treatments

Question 1

Rita is trained in traditional nursing and also has received special training in primary care. She is affiliated with a group of private practice physicians, sees her own patients, and provides routine medical care, prescribes treatment, and emphasizes health promotion and illness prevention. Rita is a(n)

A) advanced practice nurse.
B) nurse practitioner.
C) physician assistant.
D) clinical nurse specialist.
E) physician.

Answer 1

nurse practitioner.

Question 2

Good communication between patient and provider leads to a vague sense of satisfaction, but does not improve adherence to treatments.

Answer 2

False

Question 3

Why do people use CAM, given that traditional health care is paid for under Canada's universal health care system, and for the most part CAM is not?

A) The people who use CAM tend to be higher in socio-economic status, making cost less of an issue.
B) Consultations with CAM providers tend to be longer and often take psychosocial aspects of the patient's life into account.
C) In many cases people are able to avoid the uncomfortable effects that conventional treatments produce.
D) The people who use CAM tend to be higher in socio-economic status, making cost less of an issue and consultations with CAM providers tend to be longer and often take psychosocial aspects of the patient's life into account.
E) All of these answers are correct.

Answer 3

All of these answers are correct.

Question 4

The placebo effect is solely caused by psychological expectations of improved health and alleviation of symptoms.

Question 5

The typical physician assistant program lasts two years.

Question 6

Unsatisfactory patient-provider interaction has been noted as a reason for using complementary and alternative medicine.

Question 7

Patient-centred communication is an important way to improve the patient-provider dialogue.

Question 8

The philosophy that health is a positive state to be actively achieved, not merely the absence of disease,

A) is not prevalent in Western medicine.
B) acknowledges physical and psychological influences but not spiritual influences on health.
C) is holistic health.
D) is a traditional therapy in Western medicine.
E) None of these answers are correct.

Question 9

Disclosure of complementary and alternative medicine use to physicians ranges from only 22 to 36 percent.

Question 10

The "gatekeepers" in Canada's medical system refer to specialists.

Question 11

The changing philosophy of health care delivery means that many physicians recognize that there are less intrusive alternatives to traditional medical management.

Question 12

According to the text, one of the changes in the philosophy of health care delivery that affects patient-provider relationships is

A) Western medicine's resistance to nontraditional therapies such as meditation and biofeedback.
B) in response to increased consumerism among patients, medical students become less egalitarian in their relationships with patients during the course of medical training.
C) that provider-patient relationships are becoming more egalitarian.
D) that a holistic view of health is not practical in Western society.
E) that a patient should not question or even discuss their care with their provider beyond what is necessary.

Question 13

According to the Canadian Institute for Health Information (2007), which of the following is/are true?

A) compared to five other industrialized nations, access to primary health care in Canada was second to lowest.
B) fewer than 5 percent of family physicians in Ontario are accepting new patients.
C) more than a third of Canadian patients who needed medical attention had to wait six or more days to get an appointment with a doctor.
D) 25 percent of patients felt that a long wait time affected them negatively.
E) over half of all the patients studied said they experienced worry, anxiety, and stress while waiting.

Question 14

When patients do not adopt the behaviours and treatments their providers recommend it is called non-adherence.

Question 15

According to research cited in the text regarding complementary and alternative medicine (CAM),

A) CAM is considered an integral part of conventional medical practice.
B) there are up to 300 different types of CAM.
C) 25 percent of Canadians have used at least one CAM in their lifetime.
D) the proportion of the general Canadian population that consults CAM providers is higher than those who use CAM on their own.
E) fewer Canadians are relying on CAM because of the prohibitive costs.

Question 16

Problems with the structure of health care delivery system in Canada include

A) specialized care requires a referral
B) many Canadians do not have a family physician
C) long wait times
D) specialized care requires a referral, not enough family physicians, and long wait times
E) not enough use of complementary and alternative medicine

Question 17

Telehealth

A) includes a variety of services that use communication technology to connect people with health services
B) helps to connect patients with doctors
C) is useful for advice and consultation but not diagnosing or treatment
D) always requires the patient to follow-up in person with their health care provider
E) is not an effective way to receive advice or treatment for an illness

Question 18

Adherence to treatment is substantially increased when providers are able to draw on their personal authority as high-status figures, as well as their power of medical authority.

Question 19

Most patients

A) are good judges of the technical quality of the medical care they receive.
B) consider medical treatment to be of high technical quality if the provider is nice.
C) feel that the technical quality of medical care is somewhat more important than the manner in which it is provided.
D) judge the quality of care by the amount of time they spend with a care provider.
E) do not associate quality of care with the manner it is received.

Question 20

The technical quality of medical care and the manner in which it is provided are

A) critical determinants of patient satisfaction.
B) both important factors in provider-patient communication.
C) important factors in doctor shopping.
D) unrelated.
E) critical determinants of patient satisfaction, despite being unrelated.

Question 21

Which of the following are often stereotyped as being quiet and passive?

A) First Nations patients.
B) acutely ill patients.
C) sicker patients.
D) patients with psychological disorders.
E) chronically ill patients.

Question 22

For short-term antibiotic regimens, an estimated _______________ fail to comply adequately.

A) one-quarter
B) one-third
C) one-fifth
D) three-quarters
E) one-eighth

Question 23

Adherence is higher in patients who are

A) anxious and vigilant.
B) satisfied with their provider.
C) younger, white, and female.
D) asked to change personal habits.
E) older

Question 24

Avoidant coping strategies on the part of patients are

A) associated with good adherence to treatment regimens.
B) associated with poor adherence to treatment regimens.
C) associated with creative non-adherence.
D) unrelated with adherence to treatment regimens.
E) are not related to non-adherence to treatment regimens.

Question 25

When patients do not adopt the recommended medical treatment, the result is termed

A) malingering.
B) reactance.
C) doctor shopping.
D) non-adherence.
E) transference.

Question 26

The study of 20 randomly chosen hospitals in Quebec found that patients with communication problems in the delivery of their care

A) were at greater risk for experiencing multiple preventable adverse events
B) were less likely to complain to the ministry
C) were more dissatisfied with the hospital staff
D) tended to suffer from relatively minor health problems
E) All of these answers are correct.

Question 27

Which of the following is a provider behaviour that interferes with provider-patient communication?

A) sexism
B) not listening
C) elderspeak
D) use of jargon
E) sexism, not listening, elderspeak, and use of jargon are all behaviours that interfere with provider-patient communication

Question 28

Overall adherence rates are poorest

A) for obtaining medical tests.
B) with complex self-care regimens.
C) when the advice is perceived as medical.
D) when the advice is vocational.
E) when patients have young children.

Question 29

When providers oversimplify terms for elderly patients, the result is

A) disturbing to patients and can have a significant effect on the quality of the patient-provider relationship.
B) the elderly patient is more able to understand.
C) the elderly patient feels like a helpless child.
D) a decrease in the rate of recovery.

Question 30

According to what the text says about the use of jargon, studies reveal that providers

A) accurately report that patients' knowledge of medical terms is quite low.
B) underestimate the level of their patients' understanding of medical terms.
C) overestimate the level of their patients' understanding of medical terms.
D) tend to blame themselves for their patients' lack of knowledge of medical terms.
E) tend to blame the internet for the patient's lack of knowledge of medical terms.

Question 31

Satisfaction with treatment tends to be higher when

A) a person is seen by a provider of the same race or ethnicity.
B) the physician acts worried about the patient's health.
C) the physician takes an authoritative stance.
D) the physician is older than the patient.
E) the physician is shy and reserved.

Question 32

The study by N' Chróin'n and colleagues (2011) found that although 72 percent of patients being discharged felt that they had a good understanding of their diagnoses,

A) one-half did not follow-through with their doctor's recommendations.
B) older patients and those with cognitive impairments were less likely to have a clear understanding.
C) younger patients were more likely to falsely report their level of comprehension.
D) compared to women, men were less likely to follow-through with their doctor's recommendation.
E) more than half of the patients studied sought a second opinion to clarify the original diagnosis.

Question 33

The greatest cause of non-adherence to treatment is

A) the patient's unsupportive home environment.
B) the patient's uncooperative personality.
C) faulty patient-provider communication.
D) the decreasing use of traditional health plans.
E) distrust of the medical system.

Question 34

Elderspeak

A) is similar to baby talk.
B) is an overly caring and infantilizing communication issue that sends the message that elderly people are incompetent.
C) have long-range health consequences for the person using elderspeak.
D) creates barriers between patient and provider.
E) All of these answers are correct.

Question 35

Which of the following medical suggestions would be MOST likely to show high rates of non-adherence?

A) "Take three tablets per day for five days."
B) "Please stop by the lab on your way out and have some blood drawn for a complete battery."
C) "Make sure you schedule a mammogram before your next appointment."
D) "Try to rest and take some annual leave from your job."
E) "Please bring a stool sample back to our office at your earliest convenience".

Question 36

Provider efforts to manage the patient-provider interaction

A) encourages patients to discuss their concerns.
B) can lead to loss of important information.
C) can help to identify when the patient may be experiencing adverse reactions to certain prescribed drugs.
D) can facilitate an accurate assessment of the level of patients' technical understanding.
E) can lead to malpractice suits in certain circumstances.

Question 37

For the most part, patients' estimates of their rates of adherence are

A) accurate.
B) artificially high.
C) artificially low.
D) reliable.
E) creative.

Question 38

One factor in patients' contribution to faulty communication is because patients

A) often respond to different cues than do providers and provide faulty cues about their true concerns.
B) are more concerned with their underlying illness than its symptoms than are providers.
C) present their most distressing symptoms clearly and precisely; most faulty communication occurs with minor symptoms.
D) have little difficulty interpreting and reporting their symptoms.
E) rely too heavily on misinformation on the internet.

Question 39

Patients do not disclose their use of complementary and alternative medicine CAM to their physicians because they

A) do not feel comfortable enough to discuss this with their physician.
B) believe that their physician does not need to know about their use of CAM.
C) because their physician did not explicitly ask them about CAM use.
D) expect a negative response from their physician.
E) All of the these are potential reasons why a patient may chose not to disclose the use of CAM to their physician.

Question 40

Qualities of the medical interaction that exacerbate communication problems include the fact that

A) providers receive little feedback from their patients.
B) patients are more likely to provide negative rather than positive feedback.
C) patients seldom provide feedback about the effectiveness of providers' communication.
D) many patients are relatively cautious with providers.
E) All of these answers are qualities of the medical interaction that exacerbate communication problems.

Question 41

According to a study of patient-provider communication skills conducted by Thompson, Nanni, and Schwankovsky (1990), patient satisfaction, perceptions of personal control, and patient question asking was highest in

A) women who listed questions before the visit.
B) women whose physicians encouraged the asking of questions.
C) women who listed questions before the visit and women whose physicians encouraged the asking of questions.
D) women who had done research on the internet before the visit.
E) women who had stronger personalities.

Question 42

Placebo effects vary according to

A) how a provider interacts with the patient.
B) how much a provider believes in the power of the placebo.
C) a provider's warmth, confidence, and empathy.
D) how a provider interacts with the patient, the provider's belief in the power of the placebo, and the provider's warmth, confidence, and empathy.
E) gender of the patient.

Question 43

Adherence to treatment is improved when providers

A) provide verbal rather than written instructions about treatment, dosage, and side effects.
B) ask patients about potential barriers to adherence.
C) use their personal authority to prescribe treatments rather than to simply urge patients to adhere.
D) involve the patient's spouse or partner.
E) take empathy training.

Question 44

Explain the causes of adherence and treatment non-adherence and discuss how non-adherence can be reduced.

Question 45

Placebo effects may be associated with

A) improvements in patients' medical conditions.
B) reductions in patients' anxiety.
C) increased release of endogenous opioids.
D) some of the same biological pathways that account for the effects of "real" treatments.
E) All of these are associated with the placebo effect.

Question 46

Creative non-adherence

A) seriously undermines a patient's health.
B) is unrelated to disease prototypes.
C) may be a patient's attempt to reassert control over their illness and its treatment.
D) is essentially when a patient lies to a doctor to avoid unpleasant treatments.
E) is an effective coping strategy.

Question 47

Of the following, which is NOT an important factor in increasing adherence to treatment?

A) modifying institutional procedures for following patients
B) presenting the treatment regimen clearly
C) increasing the skill of the practitioner in communicating with the patient
D) following up with the patient by phone or postcard
E) None of these answers are correct.

Question 48

Efforts to identify the personalities of physicians who communicate effectively have revealed that

A) there is no one reliable characteristic that predicts good communication skills.
B) interest in people is the only reliable indicator of physician sensitivity.
C) physicians scoring high on extraversion are effective communicators.
D) there are multiple reliable indicators of physician sensitivity.
E) physicians scoring high on extraversion are effective communicators and there are multiple reliable indicators of physician sensitivity.

Question 49

Explain the various types of health care providers.

Question 50

The presence of a placebo effect is reflected in the importance placed by the medical community on

A) double-blind studies.
B) prospective studies.
C) retrospective studies.
D) drug studies.
E) pilot studies.

Question 51

Communication skills training for physicians should include

A) a focus on patient-centred dialogue.
B) the effective use of nonverbal behaviours.
C) the use of simple rules of courtesy.
D) simple tactics that should become second nature.
E) patient-centred dialogue, the effective use of nonverbal behaviours, the simple rules of courtesy should all be included in communication skills training for physicians so that these things can become second nature.

Question 52

The best predictor of physician sensitivity is

A) extraversion.
B) technical competence.
C) an interest in people.
D) idealism.
E) gender.

Question 53

Researchers examining the links between the Big Five Factors and placebo responding has found that

A) people scoring low in agreeableness were more likely to experience placebo effects.
B) people scoring low in openness were more likely to experience placebo effects.
C) people scoring high in extraversion were more likely to experience placebo effects.
D) people scoring high in conscientiousness were more likely to experience placebo effects.
E) people scoring high in neuroticism were more likely to experience the placebo effects.

Question 54

How can patient-provider communication be improved?

Question 55

Which of the following is NOT associated with patient-centred communication?

A) it is an important way to improve the patient outcomes.
B) it enlists the patient directly in decisions about medical care.
C) it is especially effective with "difficult" patients, such as those who are high in anxiety.
D) it is well-suited for working with patients with more advanced communication deficits such as stroke survivors.
E) it is more dependent on the physician's gender.

Question 56

Explain the ways in which interventions that target health care providers' communication skills may be related to increased patient satisfaction and increased adherence.

Question 57

If both treatments are considered equally effective, in which of the following scenarios are you most likely to see a larger placebo response for Patient A over Patient B?

A) Patient A receives a vitamin pill; Patient B receives a vitamin injection
B) Patient A receives treatment from a new doctor at a clinic; Patient B receives treatment from her shaman (traditional healer)
C) Patient A takes a green stimulant pill; Patient B takes a red stimulant capsule
D) Patient A takes Buckley's Mixture cough syrup; Patient B takes a no name brand cough syrup
E) In none of these scenarios would patient A experience a larger placebo response over Patient B

Question 58

The placebo effect

A) accounted for much of the success of early medical treatments but is seldom an important aspect of modern medical care.
B) accounts for improvements in the patient's psychological state but is unrelated to actual physiological changes.
C) has been observed in both patients and providers.
D) is powerful but of short duration.
E) accounts for about 15 percent of a drug's effect.

Question 59

Discuss the factors that have contributed to patient consumerism and how patient consumerism has affected the patient-provider relationship.

Question 60

Which of the following is NOT one of the three steps your text lists as critical in adherence?

A) understanding the treatment regimen
B) satisfaction with the relationship and treatment regimen
C) deciding to adhere
D) self-efficacy
E) these are all critical in adherence

Question 61

Explain how health care providers might use the placebo effect to its best advantage.

Question 62

A friend is laughing about another friend's self-prescribed herbal remedies. He scoffs that the placebo effect is purely psychological, thus "all in your head." Explain the nature and effect of placebos, and why this statement is inaccurate.