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Behaviour science and their importance in health

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1. introduction to behavioral sciences

  1. 1. 1
  2. 2. Muhammad Asif Sami 2 INTRODUCTION TO BEHAVIORAL SCIENCES
  3. 3. Objectives  Behavioral Sciences and their importance in health  Bio-Psycho-Social Model of Healthcare  Desirable attitudes  Correlation of brain, mind and Behavioral Sciences  Role of a doctor 3
  4. 4. What is behavioral sciences  behavioral sciences deal with the study of human behavior using principles of psychology, sociology and anthropology in conditions of health and disease 4
  5. 5.  Amongst the behavioral sciences, psychology contributes to the study of human mind and the role played by its various functions such as emotions, thoughts, cognitions, motivations perceptions, and intelligence in maintaining health or causing disease, and how the development of personality takes place. 5
  6. 6. Behavioral Sciences and their importance in health Another major influence on human behavior is the role played by the family, the society or the community. The study of sociology as one of the behavioral sciences help the doctor to understand the influence of society and its various units and institutions on the processes of health and how they can change to cause disease. The role of family, gender issues, social classes, socioeconomic circumstances, housing, employment, social supports and social policies in maintaining health or causing disease is studied in this domain 6
  7. 7.  medical anthropology. It is the study of evolutionary effect on history, racial classification, geographic distribution of human race, and effects on health issues, sign and symptoms of diseases.  It also involves the study of culture methods of dealing with diseases and other distressing events of people’s lives. Which disease is to be stigmatized and which is to be kept secret, which is to be dealt with be the faith healers is largely determined by the anthropological influences on a culture.  Understanding the health belief model, attitudes of a society and the role culture assigns to a sick person are essential elements the highlight the importance of anthropology for a health professional. 7
  8. 8.  In essence, the behavioral sciences add to disciplines of anatomy, physiology, and biochemistry as basic sciences to support the study of holistic medicine. While the former three teach about the body.  Psychology educates the physician about the mind, and sociology and anthropology illustrate the evolution of human spirit and the factors that constantly influence it. 8
  9. 9. 9
  10. 10. Desirable attitudes 10
  11. 11. BIO PSYCHO-SOCIAL MODEL  The biopsychosocial model is a broad view that attributes disease outcome to the intricate, variable interaction of biological factors (genetic, biochemical, etc), psychological factors (mood, personality, behavior, etc.), and social factors (cultural, familial, socioeconomic, medical, etc.).  The biopsychosocial model counters the biomedical model, which attributes disease to roughly only biological factors, such as viruses, genes, or somatic abnormalities. The bio psycho-social model applies to disciplines ranging from medicine to psychology to sociology; its novelty, acceptance, and prevalence vary across disciplines and across cultures 11
  12. 12. 12
  13. 13. 13
  14. 14. Correlation of brain mind and behavioural sciences 14
  15. 15. Correlation of brain mind and behavioural sciences 15
  16. 16. Role of a Doctor:  Step – 1: Seating and Setting: (Environment)  Exclusivity The environment where bad news is being broken can have serious repercussions on the outcome of the interview. Patient’s mistrust and antagonism may simply result from a poorly chosen location. Therefore it is worth trying to find a private room where doctor and patient can focus on the subject attentively. 16
  17. 17.  Involvement of significant others Some patients like to have family members or friends around them when they receive bad news. If there are more than few people supporting the patient, ask one person to act as representative. This gives patient support and alleviates some stress from the doctor in the face of an emotionally charged interview. 17
  18. 18.  Seating arrangements It is advisable that interview takes place with both the doctor and the patient comfortably and respectfully seated next to each other, preferably at a distance of an arm’s length. The arrangement should never impart an intimidating image of the doctor. Instead, it should provide an appropriate setting for discussions and any emotional outbursts or ventilation of feelings that may arise. 18
  19. 19.  Be attentive and calm Most doctors feel anxious when breaking bad news and it is worth spending some time to eliminate any signals that may suggest our own anxieties. Maintain eye contact and show your attention. If the patient starts to cry, try shifting your gaze because nobody likes to be watched while crying. This should however be done with sensitivity and must never send a signal that you do not really care about the patient’s feelings. 19
  20. 20.  Listening mode Silence and repetition of last few words that the patient has said, are two communication skills that will send across the message that you are listening well.  Availability If you have appointments to keep, give your patient a clear indication of your time constraints but make yourself available to the patient for all his queries and doubts, for the duration that you are with him on her. 20
  21. 21. Step – 2: Patient’s Perception The principle involved in this step is “before you tell, ask”. Before you break the bad news to the patient, try to establish as accurately as possible the patient’s perception of his or her medical condition. Obtaining this information depends on your own communication style. As your patient responds to your questions take note of the language and vocabulary that he is using and be sure to use the same vocabulary in your sentences. 21
  22. 22.  This alignment is very important as it helps you assess the gap between patient’s expectations and actual medical condition. If the patient is in denial, try not to confront him in the first interview, as denial is an unconscious defense mechanism that facilitates coping. 22
  23. 23. Step - 3: Invitation  Although most patients want to know all about their illness but assumption toward that should be avoided.  Obtaining clear permission, respects the patient’s right to know or not to know.  Some examples to address this are: “Are you the kind of person who likes to know all the details about what’s going on?” , “How much information would you like me to give you about your diagnosis and treatment?” , “Would you like me to give you details about what is going on or would you prefer I tell you about the treatments I am prescribing to you?”. 23
  24. 24. Step – 4: Knowledge  Before you break bad news, give your patient a warning of some sort to help him prepare for himself e.g. “Unfortunately I have some bad news to tell you Mr. X” or “I am sorry to have to tell you…” When giving your patient bad news, use the same language that he uses.  This aligning is very important if you want to maintain a therapeutic relationship with the patient. 24
  25. 25.  Avoid scientific and technical language. Even the most well informed patients find technical terms difficult to comprehend in that state of emotional confusion.  Give information in small bits and clarify whether he understands what you have said so far, e.g. “Do you understand what I mean” or “Is this making sense so far”. As emotions and reactions arise during the interview, acknowledge them and respond to them. 25
  26. 26. Step – 5: Empathy  For most doctors responding to our patients’ emotions is one of the most difficult parts while breaking the bad news.  In our effort to alleviate our own discomfort, it is advisable to withhold certain information or give a more hopeful picture than it actually is. Although these tactics may help in short term they would seriously undermine all your efforts in the long run. 26
  27. 27.  It is much more useful and therapeutic to acknowledge that patient’s emotions as they arise and address them. The technique that is most useful is termed as empathic response.  In emphatic response one needs to listen and identify the emotion and then respond by showing that you understand the emotional expression of the patient. Combining the empathic response and the exploratory response then validating the patient’s feelings, reassures the patient that you understand the human side of the medical issue and that you have a respect for his feelings. 27
  28. 28. Step – 6: Summarize  Before the discussion ends, sum up the information in a short summary of all that has been discussed and give your patient opportunity to voice any major concerns or questions. 28
  29. 29. Step – 7: Plan of Action  You and your patient should go away from the interview with a clear plan for the next steps that need to be taken and the role you both would play, in the management of the issues. 29
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Behaviour science and their importance in health

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