Hello again DLD,
I went a bit 'round the bend once again as I got lost in this juicy
piece of research. Hopefully these links are not too overwhelming but
feeling like I've just scratched the surface, I'd like to do some
extra followup next weekend and then will post as my final answer.
The research is a bit light on the pop psychology references and, good
golly, I'm sure they're out there. I'm never satisfied until I look
under every metaphorical rock for your information. This weekend's
research is primarily focused on a cross-section of physicians'
decision making processes/biases/attitudes and aspects of managed
care.
=================================================
PROVIDER RELATED VOCABULARY
(includes physicians, nurse practitioners/nurses,
physician assistants, psychiatrists/psychologists
=================================================
Somatoform Disorder:
http://www.arts.uwaterloo.ca/~smccabe/psych603/1996-97/hm_over.html
Chronic Fatigue Syndrome: Overcoming the Attitudinal Impasse
http://www.cfids-cab.org/Stein.pdf
Heuristics:
"Heuristics are rules of thumb people follow in order to make
judgements quickly and efficiently. People use judgemental heuristics
to deal with the large amount of social information with which we are
faced."
Illusory Correlation:
"Another type of judgmental heuristic is known as illusory
correlation, or the process by which people conclude that A and B
belong together." (i.e., fibromyalgia + psychiatric disorder)
http://sesd.sk.ca/psychology/Psych20/Ejournals/interactions_cognition.htm
Critical Paths
"Essential steps in the diagnosis and treatment of a condition or the
performance of a condition. They document a standard pattern of care
to be followed for each patient and are developed primarily as a
nursing tool specific to a healthcare organization and its unique
system. Synonyms for Care Paths: critical paths, practice
guidelines/parameters, clinical guidelines/protocols/algorithms, care
tracks, care maps, care process models, case care coordination,
collaborative case management plans, collaborative care tracks,
collaborative paths, coordinated care, minimum standards, patient
pathways, quality assurance triggers, reference guidelines, service
strategies, recovery routes, target tracks, standards of care,
standard treatment guidelines, total quality management, key
processes, anticipated recovery paths (Lumsdon and Hagland, 1993)."
Negative Bias
"Criteria from the original CFS case definition and biases in the
scoring and selection of psychiatric tests contributed to high levels
of psychiatric comorbidity with CFS. These findings might have
contributed to physician beliefs that CFS was a predominantly
psychiatric rather than medical disorder. In addition, flawed
epidemiologic research significantly underestimated the community
"true prevalence" of CFS. Relying on physician referrals for
generating cases failed to take into consideration the negative bias
of many physicians, and fewer referrals would be generated from those
physicians who were skeptical of the existence of this illness.
http://www.cfs-news.org/jason.htm
Gender Bias in Pain Amplification Disorders:
"If you're in health care you should be asking yourself, 'What biases
do I hold personally about how men and women respond to pain? Does it
influence my judgment?' " When providers become aware of stereotypes
they hold about women, Dr. Unruh adds, men benefit, too: "If women are
more likely to get psychological explanations for their pain, one
might think that's primarily a problem for women," she says. "But all
pain is a psychological experience. With women we pay attention to the
emotional component. With men, we may respond to that not nearly as
well, if at all."
http://www.fibromyalgiasupport.com/library/showarticle.cfm/ID/3690/T/CFIDS_FM/cat/pain
Cognitive Shortcuts:
"These results are not a sign of physician bias toward individuals
with psychiatric histories, (...) Rather, the findings suggest that
survey participants were probably using "cognitive shortcuts" to
determine disease probability, in this case by taking previous medical
history into account."
http://www.pslgroup.com/dg/178472.htm
Social Cognition:
"Focuses on the way in which our thoughts are affected by the
immediate social context, and in turn how our thoughts affect social
behaviour. The approach can be summarized as follows: people take
cognitive shortcuts such as stereotyping in order to minimize the
cognitive load and we develop schemata that represent our knowledge
about ourselves, others and our roles in the social world. Once
formed, schemas bias our judgment schemata become more complex and
organized over time and are harder to change.
Overconfidence, Hindsight, Base Rate Neglect:
Journal of Advanced Nursing
Volume 43 Issue 3 Page 230 - August 2003
"This paper's starting point is the recognition that, for the vast
majority of day-to-day clinical decision-making situations, the
'evidence' for decision-making is experiential knowledge. Moreover,
reliance on this knowledge base means that nurses must use cognitive
shortcuts or heuristics for handling information when making
decisions. These heuristics encourage systematic biases in
decision-makers and deviations from the normative rules of 'good'
decision-making.
Aims. The aim of the paper is to explore three common heuristics and
the biases that arise when handling complex information in clinical
decision-making (overconfidence, hindsight and base rate neglect) and,
in response to these biases, to illustrate some simple techniques for
reducing the negative influence of heuristics."
http://www.blackwell-synergy.com/links/doi/10.1046/j.1365-2648.2003.02705.x/abs
Bedside Rationing:
http://www.acponline.org/journals/annals/01mar98/realism.htm
Cognitive Tunnel Vision/Micawberism:
"cognitive tunnel vision -- where new data are coerced to fit a
pre-existing and incorrect view of the situation
micawberism' -- believing that everything will work out OK in the end,
despite all the contra-indications
http://www.cogs.susx.ac.uk/users/bend/doh/reporthtmlnode5.html"
"Cookbook" Medicine:
http://www.svmic.com/KnowledgeCenter/CIArticles/CI1997_08.html
Iatrogenic Diagnostic Algorithms:
Postgrad Med. 1997 Aug;102(2):161-2, 165-6, 171-2 passim. Related
Articles, Links
Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic
algorithms. Do some labels escalate illness in vulnerable patients?
Hadler NM.
"Contemporary medicine has the sophistication to identify the clinical
settings in which the hunt for a diagnosis can be harmful to a
patient's health. Which patients are best served by a prolonged search
for a cause? Why has the disease-illness paradigm backfired for so
many patients? Dr Hadler challenges readers to look at the difficult
questions linked with diagnostic labels that might teach patients to
stay sick."
http://tinyurl.com/ixf6 (redirect from Pub Med)
Health Services Research:
"Health services research is the multidisciplinary field of scientific
investigation that studies how social factors, financing systems,
organizational structures and processes, health technologies, and
personal behaviors affect access to health care, the quality and cost
of health care, and ultimately our health and well-being. Its research
domains are individuals, families, organizations, institutions,
communities, and populations."
http://www.academyhealth.org/about/whatishsr.htm
=============================
MANAGED CARE VOCABULARY*
=============================
Adverse Selection:
(also see "favorable selection," sometimes known as "cherry picking")
"Adverse selection occurs when a larger proportion of persons with
poorer health status enroll in specific plans or insurance options,
while a larger proportion of persons with better health status enroll
in other plans or insurance options. Plans with a subpopulation with
higher than average costs are adversely selected. Plans with a
subpopulation with lower than average costs are favorably selected."
Capitation: (Cap, Capped, Capitate, Base Capitation)
"Specified amount paid periodically to health provider for a group of
specified health services, regardless of quantity rendered. (...)
The method of payment in which the provider is paid a fixed amount for
each person served no matter what the actual number or nature of
services delivered. (...) Providers are not reimbursed for services
that exceed the allotted amount. The rate may be fixed for all members
or it can be adjusted for the age and gender of the member, based on
actuarial projections of medical utilization."
Carve-Outs
"Practice of excluding specific services from a managed care
organization's capitated rate. (...) Common carve outs include such
services as psychiatric, rehab, chemical dependency and ambulatory
services. Increasingly, oncology and cardiac services are being carved
out."
Chronic Care
"Long term care of individuals with longstanding, persistent diseases
or conditions. It includes care specific to the problem as well as
other measures to encourage self-care, to promote health, and to
prevent loss of function."
Health Care Decision Counseling:
"Services sometimes provided by insurance companies or employers, that
help individuals weigh the benefits, risks and costs of medical tests
and treatments. Unlike case management, health care decision
counseling is non-judgmental. The goal of health care decision
counseling is to help individuals make more informed choices about
their health and medical care needs, and to help them make decisions
that are right for the individual's unique set of circumstances."
Medical Informatics
"Medical informatics is the systematic study, or science, of the
identification, collection, storage, communication, retrieval, and
analysis of data about medical care services to improve decisions made
by physicians and managers of health care organizations."
Ombudsperson or Ombudsman:
"A person within a managed care organization or a person outside of
the health care system (such as an appointee of the state) who is
designated to receive and investigate complaints from beneficiaries
about quality of care, inability to access care, discrimination, and
other problems that beneficiaries may experience with their managed
care organization. This individual often functions as the
beneficiary's advocate in pursuing grievances or complaints about
denials of care or inappropriate care."
Peer Review
"The mechanism used by the medical staff to evaluate the quality of
total health care provided by the Managed Care Organization. The
evaluation covers how well services are performed by all health
personnel and how appropriate the services are to meet the patients'
needs. (...) Some consumers suspect that peer review is not true peer
review since both the providers and the reviewers often have personal
financial incentives to reduce or increase medical care. Nonetheless,
peer review is utilized in all managed care settings."
*Review of A-Z terms in managed care glossary:
http://www.pohly.com/terms.shtml
==============================
LINKS OF INTEREST
==============================
National Committee for Quality Assurance
http://hprc.ncqa.org/index.asp
Holistic Approach to ADD:
http://www.thomasarmstrong.com/articles/empower.htm
Interesting Stats 101:
"The cost of administering the plan varies from one HMO to another
with some plans showing administrative costs of over 30%. In the US,
physicians account for 14% of the health care dollar, pharmacy expense
19%, hospitals 42%. As recently reported in The Lancet, the chiefs of
seven large HMOs averaged $7 million each in cash and stock pay
packages per year. The average plan, averaging 15% administrative
overhead, therefore, uses much more of its income to pay
administrators than to pay physicians."
http://www.healthlibrary.com/reading/ethics/apr98/managed.htm
Improving Communication with Your Doctor: (example)
http://www.womensheartfoundation.org/content/HeartWellness/improve_doctor_patient_communication.asp
==================================
POP PSYCHOLOGY, WELTANSCHAUUNG,
PANOPLY, SCHOLARLY TEXTS, ETC.
==================================
Heuristics and Biases : The Psychology of Intuitive Judgment
by Thomas Gilovich (Editor), Dale Griffin (Editor), Daniel Kahneman
(Editor)
http://www.amazon.com/exec/obidos/tg/stores/detail/-/books/0521796792/reviews/103-5831894-5315051
Full Catastrophe Living: Using the Wisdom of Your Body and Mind to
Face Stress, Pain, and Illness
by Jon Kabat-Zinn, Thich Nhat Hanh (Preface), Joan Borysenko
http://www.amazon.com/exec/obidos/tg/detail/-/0385303122/qid=1059958537/sr=8-1/ref=sr_8_1/103-5831894-5315051?v=glance&s=books&n=507846
Mindfulness
by Ellen J. Langer
http://www.amazon.com/exec/obidos/ASIN/0201523418/qid=1059613396/sr=2-2/ref=sr_2_2/103-5831894-5315051
Brief Therapy:
Lasting Impressions
http://www.erickson-foundation.org/press/BriefTherapy/briefTherapy.htm
Making Medical Spending Decisions
The Law, Ethics, and Economics of Rationing Mechanisms
Mark A. Hall
http://www.oup-usa.org/toc/tc_0195092198.html
Crank me up or down, DLD, and feel free to get a second take on this
question. Consider me off the clock though; I just think whatever
you're up to is important work and I'm happy to contribute.
Your eveready researcher,
V |
