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Patients, Dentists and Society

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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