230 RELATING TO PATIENTS
DECIDING TO CONSULT
People frequently experience symptoms but do not consult health services. Estimates
vary, but 50–75 per cent of the population experience one or more symptoms of ill
health over any 2-week period (Demers et al., 1980; Porter, 2004). Yet, as Porter
(2004) notes, about one-third of these people do nothing about their symptoms, about
one-third self-medicate using over-the-counter medications or use alternative therapies
and only about one-third consult their doctor. Thus, even when health care is free at
the point of delivery (as it is in the UK), there is far from a one-to-one correspondence
between symptoms and consultation. This is problematic because people who need
health care may not seek help and so worsen their prognosis and also because a
substantial proportion of those who do consult have only minor symptoms that do
not require medical intervention.
Why do people consult?
A number of consultation prompts have been identified (Porter, 2004; Zola, 1973).
Unsurprisingly, symptoms that persist, that are perceived to be serious and thought to
be amenable to treatment are more likely to lead to help seeking. Symptoms that
interfere with other goals, for example, by inhibiting activities or reducing attract -
iveness, are also more likely to lead to consultation. Advice from others is an important
additional trigger. Finally, ease of access to services and having time (e.g. away from
work or child care) also make consultation more likely. In a study of 1,210 people,
Berkanovic, Telesky and Reeder (1981) found that 64 per cent reported symptoms
over 1 year. The researchers employed multiple regression analyses to discover which
When you have completed this chapter you should be able to:- Discuss who is most likely to consult health care services (such as a family
doctor or general practitioner) and explain why. - Identify key correlates of patient adherence and discuss how adherence can be
maximized. - Describe key tasks that need to be completed during consultations with
patients. - Identify key components of patient-centred consultations and discuss the
findings of research into their effects on patients’ well-being and health. - Discuss the role of complementary therapies in health care.
- Define ‘placebo effects’ and explain how they occur.
- Discuss the needs of patients with long-term illnesses and illustrate the
contribution that psychological interventions can make to caring for these
patients.
LEARNING OUTCOMES