2.6: Perceptions

David Featherston

Perception of health care provision

Patients and carers reported that health care professionals:

Often do not listen or ask the patient and his/her carers their views or perspectives
Often have little knowledge of community resources available to support the person, largely because they continue to work within their own narrow frame of reference and service provision
Rarely work from a position of identifying the patients’ strengths and current capacities
Need to be more collaborative with patients, carers and particularly each other.⁽¹⁾

The findings of a workforce skills project reported considerable discrepancies between the quality and content of care that the health service perceived that they were offering and the experiences of patients and carers.⁽¹⁾ The following is a quote from this project’s Consumer and Carer survey and supports the findings of Lawn and Battersby. When asked to describe their experience of working in collaboration with a psychiatrist one respondent answered:

"A disaster! She did not listen to me (the carer). She thought she was doing brilliantly. All the time not being listened to, not getting to talk to the psychiatrist, and not being given strategies for managing behaviours."

In response to the question ‘In your experience, what do you think psychiatrists see as the key elements or principles of chronic condition self-management?’, 54% of consumers and carers perceive that psychiatrists see the key principle as medication for the patient; that is the prescription of drugs based on a diagnosis of the condition.

Other findings from the project research which identify discrepancies between consumer/carer and psychiatrist, are displayed in the tables. It should be recognised in this instance that the psychiatrists surveyed were not linked with the consumers/carers interviewed.

Consumer	Psychiatrist
I have a self-management plan.	I provide a self-management care plan to assist the consumer to manage their condition.
40%	59%

Carer	Psychiatrist
A health professional has actively involved me in the development of a self-management care plan.	I actively involve the carer in the development of a self-management care plan.
25%	58%

Reflective exercise

Please reflect on the following questions and write down your thoughts.

authors_comments

Why do some patients feel ‘not listened to’?

Including but not limited to psychiatrists will often listen for diagnostic information rather than the concerns of the patient, style of questioning does not provide opportunities for the patient to speak freely, patients do not always get the answers that they want to questions, time limitations, lack of eye contact, body language, the psychiatrist taking actions that do not take the patients concerns into consideration, non-collaborative or patient-centred consultation, The psychiatrist may focus mainly on medication management rather than the life issues concerning the person, their partner/spouse and family. The psychiatrist may not deal with underlying psychological issues using psychotherapy skills, leaving the patient frustrated.

Why do some carers feel ‘not listened to’?

Including but not limited to no access to consultations, not asked questions, no opportunity to speak, not part of self-management process, statements made are not considered/implemented, not always taken seriously, don’t receive the support that they need.

What factors contribute to the patient not feeling empowered or willing to take responsibility for their own care? Consider this question from the point of view of you, the patient and the setting of the consultation.

Including but not limited to lack of trust in the patient-psychiatrist relationship, psychiatrist is too dominant in consultations, perception by the patient of lack of interest by the psychiatrist, not enough reassurance, support and positive reinforcement, interruptions to consultations, not allowing the patient to be involved in decision-making (the patient should feel some ownership to decisions made), not having an easy to follow self-management care plan, problems have not been clearly outlined, patient goals are not clearly stated / too challenging / not challenging enough, fear by patient, the patient lacks the appropriate skills to self-manage their condition.

In what ways can you help a patient to tell you what their main problem is from their point of view?

Including but not limited to develop a trusting relationship, positive body language, reassurance and support to the patient, show empathy, ask open ended questions, allow the patient’s point of view to guide the conversation particularly at the conclusion of the visit, address questions of daily living

Research

The attached articles by Scott Miller provide additional insight into perception.

Reference

Lawn S, Battersby MW. Skills for person-centred care: health professionals supporting chronic condition prevention and self-management in D’Cruz HM, Jacobs SW, Schoo A. Knowledge-in-practice in the caring professions: Multi-disciplinary perspectives. Ashgate Publishing Ltd, England, 2009.

Continue to Module 2.7: Resources for Self-management Support

2.6: Perceptions

Perception of health care provision

Reflective exercise

Research

Reference

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Project support

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