HEALTH PROFESSIONALS’ BELIEFS
Early research regarded health professionals as experts and assumed that doctors with similar levels of knowledge and training would act in similar ways. But there is, in fact, considerable variability in different aspects of medical practice. For example, Anderson et al. (1983) reported that doctors differ in their diagnosis of asthma. Mapes (1980) suggested that they also vary considerably in terms of their prescribing behaviour, some doctors giving drugs to only 15 per cent of their patients and others offering prescriptions for up to 90 per cent. Bucknall, Morris and Mitchell (1986) reported significant variation in doctors’ measurement of blood pressure, and Marteau and Baum (1984) reported that doctors differ significantly in their treatment of diabetes. It is now generally accepted that health professionals may behave not just according to their education and training, but also according to their own ‘lay beliefs’. This means that any evaluation of the interaction between health professionals and patients should not only focus on the personal beliefs of the patient and the knowledge base of the professional, but also on the personal belief system of the professional.Beliefs that influence practice Research indicates that the following beliefs influence the development of a health professional’s original diagnosis.The nature of clinical problems If a health professional believes that illness is determined by biomedical factors (e.g. lesions, bacteria, viruses), they will develop a diagnosis that reflects this perspective. But a professional who places the emphasis on psychosocial factors may develop a different diagnosis. For example, if a patient reports feeling tired all the time, the first professional might point to anaemia as the cause, and the second to stress. The probability of the disease Health professionals also have different beliefs about how common a health problem is. For example, some doctors may regard childhood asthma as a common complaint and hypothesize that a child presenting with a cough has asthma. Another doctor who believes that childhood asthma is rare might not consider this diagnosis. The seriousness of the disease Health professionals are motivated to consider the ‘pay-off ’ in reaching a correct diagnosis, which is related to their beliefs about the seriousness and treatability of an illness. For example, if a child presents with abdominal pain, the professional may diagnose appendicitis, as this is a serious but treatable condition. In this case, the benefits of arriving at the correct diagnosis for this condition far outweigh the costs involved (such as time wasting) if the diagnosis is actually wrong. The patient The original diagnosis will also be influenced by the health professional’s exi ing knowledge of the patient, including medical history, degree of support at home, psychological state, and beliefs about why the patient came to see the doctor. Similar patients We know that stereotypes can confound a decision-making process . Yet without them, consultations between health professionals and patients would be extremely time consuming. Stereotypes reflect the process of ‘cognitive economy’. They play a central role in developing and testing a hypothesis and reaching a management decision. So a health professional will typically base their decision partly on factors such as how the patient looks/talks/walks, and whether they are
reminiscent of previous patients. Communicating beliefs to patients Health professionals’ own health-related beliefs may be communicated to patients. A study by McNeil et al. (1982) examined the effects of health professionals’ own language on patients’ choice of treatment. They found that patients are more likely to choose surgery if they are told it will ‘increase the probability of survival’ rather than ‘decrease the probability of death’. The phrasing of a question like this tends very much to reflect the beliefs of the individual doctor. So the results indicate that the subjective views of health professionals may be communicated to the patient, and subsequently influence the patient’s choice of treatment.
Early research regarded health professionals as experts and assumed that doctors with similar levels of knowledge and training would act in similar ways. But there is, in fact, considerable variability in different aspects of medical practice. For example, Anderson et al. (1983) reported that doctors differ in their diagnosis of asthma. Mapes (1980) suggested that they also vary considerably in terms of their prescribing behaviour, some doctors giving drugs to only 15 per cent of their patients and others offering prescriptions for up to 90 per cent. Bucknall, Morris and Mitchell (1986) reported significant variation in doctors’ measurement of blood pressure, and Marteau and Baum (1984) reported that doctors differ significantly in their treatment of diabetes. It is now generally accepted that health professionals may behave not just according to their education and training, but also according to their own ‘lay beliefs’. This means that any evaluation of the interaction between health professionals and patients should not only focus on the personal beliefs of the patient and the knowledge base of the professional, but also on the personal belief system of the professional.Beliefs that influence practice Research indicates that the following beliefs influence the development of a health professional’s original diagnosis.The nature of clinical problems If a health professional believes that illness is determined by biomedical factors (e.g. lesions, bacteria, viruses), they will develop a diagnosis that reflects this perspective. But a professional who places the emphasis on psychosocial factors may develop a different diagnosis. For example, if a patient reports feeling tired all the time, the first professional might point to anaemia as the cause, and the second to stress. The probability of the disease Health professionals also have different beliefs about how common a health problem is. For example, some doctors may regard childhood asthma as a common complaint and hypothesize that a child presenting with a cough has asthma. Another doctor who believes that childhood asthma is rare might not consider this diagnosis. The seriousness of the disease Health professionals are motivated to consider the ‘pay-off ’ in reaching a correct diagnosis, which is related to their beliefs about the seriousness and treatability of an illness. For example, if a child presents with abdominal pain, the professional may diagnose appendicitis, as this is a serious but treatable condition. In this case, the benefits of arriving at the correct diagnosis for this condition far outweigh the costs involved (such as time wasting) if the diagnosis is actually wrong. The patient The original diagnosis will also be influenced by the health professional’s exi ing knowledge of the patient, including medical history, degree of support at home, psychological state, and beliefs about why the patient came to see the doctor. Similar patients We know that stereotypes can confound a decision-making process . Yet without them, consultations between health professionals and patients would be extremely time consuming. Stereotypes reflect the process of ‘cognitive economy’. They play a central role in developing and testing a hypothesis and reaching a management decision. So a health professional will typically base their decision partly on factors such as how the patient looks/talks/walks, and whether they are
reminiscent of previous patients. Communicating beliefs to patients Health professionals’ own health-related beliefs may be communicated to patients. A study by McNeil et al. (1982) examined the effects of health professionals’ own language on patients’ choice of treatment. They found that patients are more likely to choose surgery if they are told it will ‘increase the probability of survival’ rather than ‘decrease the probability of death’. The phrasing of a question like this tends very much to reflect the beliefs of the individual doctor. So the results indicate that the subjective views of health professionals may be communicated to the patient, and subsequently influence the patient’s choice of treatment.
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