The historical context of the physician-patient relationship
The dynamics between physicians & patients in the 1950/60s can best be described in this way.
What are physicians as authoritarian and patients as passive?
This is the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions
What is health literacy?
This form of patient pressure prevents a doctor from closing the medical visit
What is resistance?
This is the #1 reason people visit their primary care physician
What is pain?
This Lembke character was a recovering alcoholic when he became addicted to the opioids he received while being hospitalized for a back injury.
Who is Jim?
These people started recording medical visits.
Who are Korsch, Byrne and Long?
These are the different models of shared decision-making
What are the paternalistic models, shared decision making models, and informed medical models?
In his 1945 Nobel Lecture, Alexander Fleming predicted that this would increase bacterial resistance
What is misuse of antibiotics?
This drug is a helpful tool for safely weaning patients off opioids without subjecting them to withdrawal symptoms.
What is suboxone?
This Ofri character could best be described as an engaged patient
Who is Morgan Amanda?
In the 19th century, physicians were regarded in this way.
What is poorly / not well respected?
This researcher finds that patients who bring up direct to consumer advertising during medical visits are more likely to receive (inappropriate) prescriptions from their doctors.
Who is Kravitz?
These are the two issues that patients orient to in doctor-parent interactions, per Stivers
What are treatability and legitimacy?
These organizations were key in the push to recognize pain treatment as a right for patients
What are pain societies?
This Lembke character helps characterize how pain and psychological differences have become medicalized, and thus, treatable with pills
Who is Karen?
These factors contributed to the social standing of physicians prior to the “golden age” of medicine.
What are minimal licensing and education requirements, lack of organization among members of the profession, competition with other types of practitioners (e.g., homeopaths)?
This was one of the main themes of Phase 2.
(Hint: Phase 2 is Encouraging Patients’ Agency)
What are patient rights as part of civil rights (all about “autonomy” and “consent”)?
These three strategies make up Stivers’ 3-prong communication strategy to combat patient pressure.
What are foreshadowing, affirmative counseling, and persuasion?
Heroin addiction most often starts from use of what?
What are prescription opioid medications?
In the video "Race against Resistance," two central characters had infections - one had a skin infection, and the other had an ear infection. What were their names, and why were their stories included?
Who are Tori and Kerry. Their stories show that patients can find themselves in serious danger or risk if they have an infection that is resistant to antibiotics.
These were the three main push-backs against physician authority in the mid 20th century.
What are: (1)Legal concerns reining doctors in, (2) health concerns with why physicians were failing (poor rates of adherence, return visits, and satisfaction), and (3) intermediaries wanting to reduce physician power?
Stevensen et al suggest that patients bring up the internet to do these actions.
What are:
-suggesting the possibility of a serious illness
-providing a warrant for treatment in cases in which they have been unable to find a solution
-advocating for or against proposed treatment/intervention
-Challenge physician medical authority to diagnose and recommend treatment
These are the ways patients/parents exert pressure on physicians.
(Hint: walk through how this comes up in each phase)
What is...
--> opening: Priming
--> problem presentation: Candidate diagnoses and other sorts of priming
--> verbal/physical exam: Nudging
--> diagnosis: resistance
--> treatment phase: resistance
This short, but very influential, letter pushed physicians from being too scared to prescribe opioids to prescribing too many
What is the New England Journal of Medicine letter
This Lembke character, along with other “thought leaders” employed by this industry, passed on harmful misconceptions about opioids to doctors.
(Hint: Two responses necessary!)
Who are Dr Portenoy and Big Pharma?