Symptom perception refers to a conscious awareness of a symptom following unconscious information processing. Sensation refers to a bodily perception. A symptom reflects a negatively valenced interpretation of a sensation. A bodily complaint is the expression of a symptom.
Bodily signs are objective and verifiable. Illness symptoms are interpretation signs. Bodily complaints are subjective and self-reported.
Somatisation refers to the inclination to worry about somatic symptoms. In the general population, 20% experiences a somatic symptom that causes some level of worry at least once a month. Almost 20% - 50% of the symptoms reported to the GP remain medically unexplained (e.g. fatigue, impaired sleep, pain). People are not good at interpreting their physical state accurately.
There are four groups that exhibit distinct patterns of symptom reporting:
Somatic symptom disorder involves a person having a significant focus on physical symptoms that results in major distress and/or problems functioning. There are excessive thoughts, feelings and behaviours related to the physical symptoms. Illness anxiety disorder refers to excessively worrying that one is or may become seriously ill. There might be no physical symptoms.
There are different psychological factors that influence the perception and interpretation of symptoms:
Negative emotions are associated with an increased report of symptoms and associating symptoms with illness more often. Anxiety makes people hypervigilant and sensitive to threat. Misperception of symptoms leads to a delay in seeking help (1), overuse or underuse of healthcare services (2) and compromised treatment (3). This demonstrates the importance of education about symptom recognition.
Pathology and normal physiological variation provide somatic information. This can lead to symptom perception. There are several things that determine the attention and symptom perception:
The competition of cues model states that people report more symptoms when they are less distracted. Trait and state negative affect are associated with elevated symptom reporting. People who complain about psychological symptoms are also more likely to complain about physical symptoms. A higher expectancy of symptoms leads to more symptoms.
There is elevated symptom reporting and fatigue during exercise when confronted with own physiological response (e.g. breathing). The experienced shortness of breath after exercise in patients is determined by illness-specific perceptual-feedback (e.g. wheezing) but not by actual lung capacity.
Pain refers to a distressing experience that is associated with actual or potential tissue damage. It occurs in a social context and has different aspects to it. Nociception refers to the stimulation of peripheral pain receptors which sends messages to the central nervous system. Suffering refers to the perceived pain, distress and disability that can arise from pain and related factors.
Pain threshold refers to the point at which a stimulus becomes painful. This is similar for most people. Pain tolerance refers to the degree to which a painful stimulus can be tolerated. This varies widely between individuals. Acute pain refers to pain which is necessary to protect us from damage or infection. Chronic pain can lead to changes to the neural pathway of pain leading to the perception of pain even when there is no physical injury. The effects of chronic pain can be prevented by early intervention.
The gate theory of pain states that there is a synaptic gate between peripheral nerves and neurons in the spinal cord. Pain signals compete with other signals to get through the gate and the gate can be opened or closed by physical and psychological factors. This theory states that stimulating another body part during pain can reduce the perceived pain. The neuromatrix model of pain states that pain is the result of interacting neural networks with somatosensory, limbic and cognitive components.
Conditioning approaches focus on the role of operant conditioning in behavioural responses to pain. Cognitive-behavioural approaches focus on behavioural factors (e.g. operant conditioning) and individual factors (e.g. perceived pain). The fear-avoidance model states that when people catastrophize about pain, there is greater fear of pain (1), greater focus on pain (2) and restricted functioning (3). The functional-contextual approach focuses on processes and function of thoughts and behaviours rather than the content. This approach focuses on psychological flexibility and treatment is focused on improving functioning.
The communal coping model (CCM) looks at the relationship between pain and catastrophizing thoughts and behaviours. According to the model, some people are predisposed to deal with distress by catastrophizing. This is thought to communicate distress and is an attempt to increase social proximity and support from others. The social function of catastrophizing is the most important.
The placebo effect refers to improving due to the expectancy of improving. This effect is more powerful for conditions with psychological components and not effective for conditions with a clear biological basis (e.g. infections). The nocebo effect refers to people developing symptoms that fit their beliefs when they have not been exposed to a pathogen. Classical conditioning is important in the placebo and nocebo effect, meaning that the presentation of medication is important.
Illness representation refers to people’s organized sets of beliefs about the experience (1), impact (2), effect (3) and outcome of illness (4). The dimensions of illness representations are illness identity (1), timeline (2), cause (3), control (4) and consequences (5).
The self-regulation model of illness behaviour states that illness representations can affect the way a person copes with their symptoms. This means that people are less likely to adhere to treatment for an illness without symptoms. Self-management interventions refer to interventions which target a person’s beliefs and coping to help them manage their illness and treatment effectively.
There are gender differences in chronic conditions and disease and symptom reporting:
The medically unexplained symptoms and gender-specific symptoms are only a minor component of gender differences. Having multiple roles (e.g. work, family, children) has a protective effect.
The competition of cues model may explain part of the gender differences (e.g. women are more often in jobs that require repetitive labour). Negative affect could also explain part of the gender differences as women rate higher on negative affect and neuroticism. Women generally have a larger vocabulary regarding symptoms and more knowledge about disease, which could explain part of the gender differences. Biological explanations for gender differences in symptom reporting and disease include sensory differences (1), immune differences (2) and larger physiological variance (3).
Medically unexplained symptoms or functional symptoms refers to diagnosis based on self-reported symptoms with no diagnostic physiological test. The diagnosis is based on exclusion and there is no disease-specific treatment available. It is possible that differentiation between specific functional syndromes reflects the specialist’s tendency to focus on symptoms relevant to their speciality.
Functional symptoms are common, persistent and associated with significant distress (1), disability (2) and unnecessary expenditure of medical resources (3). The prevalence of emotional distress and disorders in patients who attend hospital with functional syndromes is higher than patients with comparable medical conditions.
It has substantial clinical and economic impact as it is disabling (1), there is high comorbidity with psychological disorders and elevated stress levels (2) and there is high medical consumption and costs (3).
There are several important points about functional syndromes:
The medical protocol regarding functional syndromes consists of discouraging medical testing (1) and emphasising recovery rather than cure (2). It appears as if antidepressants and psychotherapy are effective in the treatment of functional syndromes.
The number of functional complaints is related to past episodes of anxiety and depression. There is a link between functional somatic syndromes and altered functioning of the central nervous system. Dissatisfaction with medical care is common among patients with functional syndromes.
Functional symptoms are more common in women (1), people with a low socio-economic status (2) and people with a history of child abuse (2).
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Medical Psychology – Lecture 1 (UNIVERSITY OF AMSTERDAM)
There are three relevant fields for medical psychology:
Secondary interventions refer to intervention for people who already have a health condition but want to prevent this condition from getting worse.
The definition of health that is used determines who is seen as ill or healthy. A definition of health can be physical (1), subjective (2), behavioural (3), functional (4), psychosocial (5), social (6) and cultural (7). Health can be seen as a continuum. Medical treatment focuses on the illness side of health whereas health promotion techniques focus on the wellness side of health.
Accurate diagnoses are more likely if it is understood how people’s experience shape perception (1), reporting of symptoms (2) and help-seeking behaviour (3). Embodied cognition states that many aspects of cognition are influenced by the bodily state.
The medical model states that the cause of disease is determined by biological processes. This implies that the resolution of disease is also determined by biological processes. In clinical practice, this is seen as the medical doctor striving to restore biological perturbations to obtain an optimal equilibrium (e.g. depression is an imbalance of serotonin and curing depression is restoring the balance of serotonin).
Limitations of the medical model are no recognition of relevant psycho-social influences on disease (1) and there is no recognition of psychosocial dimensions of disease (2). There is a strict separation between bodily and mental functioning (i.e. dualism) and there is no consideration for non-somatic implications of disease (e.g. disease can make you depressed).
The medical model predicts that more medical expenditure will lead to a healthier population and lower mortality. There is a correlation between life expectancy and medical expenditure. However, multiple other factors influence life expectancy besides medical expenditure.
The biopsychosocial model incorporates biological, psychological and social factors. The external factors include the sociocultural environment (1), pathogenic stimuli (2) and treatment (3). The internal factors include personal history (1), psychosocial processes (2) and physiological and biochemical mechanisms (3). This model allows for a more complete understanding of the factors that can contribute to health or illness.
Limitations of the biopsychosocial model are that it is not always possible to address all illness-influencing factors (1) and the model uses circular causality while linear causality is needed for treatment planning (2).
Socio-economic status (1), general socio-political context (2), levels of gender equity (3), personality (4), ethnicity (5) and health behaviours (6)
.....read more Medical Psychology – Lecture 2 (UNIVERSITY OF AMSTERDAM)Symptom perception refers to a conscious awareness of a symptom following unconscious information processing. Sensation refers to a bodily perception. A symptom reflects a negatively valenced interpretation of a sensation. A bodily complaint is the expression of a symptom.
Bodily signs are objective and verifiable. Illness symptoms are interpretation signs. Bodily complaints are subjective and self-reported.
Somatisation refers to the inclination to worry about somatic symptoms. In the general population, 20% experiences a somatic symptom that causes some level of worry at least once a month. Almost 20% - 50% of the symptoms reported to the GP remain medically unexplained (e.g. fatigue, impaired sleep, pain). People are not good at interpreting their physical state accurately.
There are four groups that exhibit distinct patterns of symptom reporting:
Somatic symptom disorder involves a person having a significant focus on physical symptoms that results in major distress and/or problems functioning. There are excessive thoughts, feelings and behaviours related to the physical symptoms. Illness anxiety disorder refers to excessively worrying that one is or may become seriously ill. There might be no physical symptoms.
There are different psychological factors that influence the perception and interpretation of symptoms:
Negative emotions are associated with an increased report of symptoms and associating symptoms with illness more often. Anxiety makes people hypervigilant and sensitive to threat. Misperception of symptoms leads to a delay in seeking help (1), overuse or underuse of healthcare services (2) and compromised treatment (3). This demonstrates the importance of education about symptom recognition.
Pathology and normal physiological variation provide somatic information. This can lead to symptom perception. There are several things that
.....read more Medical Psychology – Lecture 3 (UNIVERSITY OF AMSTERDAM)Stress refers to a mentally or emotionally disruptive or disquieting influence or a state of tension or distress caused by such an influence. It can be a cause or a consequence. It can be defined as a negative emotional experience accompanied by predictable biochemical, physiological, cognitive and behavioural changes that are directed towards either altering the stressful event or accommodating its effects. This means that stress has a function.
There are three approaches to studying stress:
The stress response follows stress perception which follows the stressor. Stress as an evaluative process includes two steps:
The two appraisals happen very quickly. Stressful situations consist of control (1) and social evaluation (2). The less control, the more stressful a situation is. The amount of perceived control determines how stressful a situation is.
The social self-preservation theory states that threats to the social self engender a specific set of psychological and physiological reactions. This includes feelings of low social worth (e.g. shame) and an increase in cortisol. These reactions can occur in situations of social evaluation. The stress responses are determined by social context.
Acute stress can be induced by having people do complex tasks (1) and have an amplifying component (e.g. social evaluation) (2). Acute stress lasts for 5 minutes to 2 hours. The reactivity hypothesis states that exaggerated cardiovascular responses to acute stress are a risk factor for the development of cardiovascular disease.
The fight-or-flight response includes the sympathetic branch of the autonomic nervous system (i.e. fast, first-wave response). It also includes the endocrine pathways of the HPA axis (i.e. slow, second-wave response). The SNS prepares the body for immediate action by stimulating the adrenal medulla to produce adrenaline and noradrenaline. The HPA axis activates the hypothalamus to release corticotrophin which sets other endocrine events in motion. This eventually leads to the release of cortisol. Increased cortisol in the blood leads to immune suppression (1), gluconeogenesis (2), fat metabolism (3), adrenalin production (4), more and better fear memory (5) and worse declarative memory (6).
The presence of cortisol in the bloodstream stops the hypothalamus from producing cortisol, meaning that the cortisol levels will naturally go back to baseline levels. However, after a prolonged period of stress, the HPA axis can become dysregulated and this can lead to
.....read more Medical Psychology – Lecture 4 (UNIVERSITY OF AMSTERDAM)The main functions of the immune system are protection against infectious disease (1), promotion of tissue repair (2) and destruction of malignant transformations (3). Unwanted side effects of the immune system are tissue damage (1) and discomfort and sickness (2).
The lymphocytes are the B-cells (1), T-cells and NK-cells (3). The goal of B-cells is antibody production. Cytokines are hormones produced by immune cells that initiate the inflammatory response. They are the signal molecules of the immune system. Immune cells are the same as leukocytes. Antibodies are soluble antigen receptors
The immune response to infection consists of several steps:
The infection meets the inside of the body on mucosa surfaces. The skin has a mechanical barrier (1), has endogenous flora (2) and is a bit acidic (i.e. low pH) (3). The mucosa has a mechanical barrier (1), has endogenous flora (2) and has antimicrobial proteins (3).
There are other protective factors when the mechanical barrier of the skin are breached:
Phagocytic cells use pattern recognition receptors to detect pathogens.
Activation refers to cellular or molecular changes that initiate or facilitate an immune response. Antigen refers to any molecule that activates the immune system (i.e. antibody generator).
Antigen-presenting cells migrate to second lymphoid tissues via draining lymphatics. This is done to maximize the probability that a unique antigen will encounter its unique receptor. In the lymphoid organs, antigen is presented to local naïve lymphocytes. Distinct MHC molecules are associated with distinct groups of antigens and distinct immune responses. Upon activation, naïve lymphocytes start to divide and become antigen-eliminating effector cells. This makes the lymphocyte ready to tackle the infection.
The T-lymphocytes have the function of destruction of cancerous and virally infected cells. The T-helper cells take care of immune regulation via the release of cytokines. It does this by orchestrating the activity of the phagocytic cells and the activity of other leukocytes.
The functions of immunoglobins (i.e. antibody) are:
Adaptive immunity is mediated by lymphocytes. The B-cells and T-cells have adaptive immunity.
.....read more Medical Psychology – Lecture 5 (UNIVERSITY OF AMSTERDAM)Depression is associated with an increased risk of somatic disease (e.g. diabetes, cardiovascular disease, cancer). There are several factors that could explain the increased somatic comorbidity in people with depression:
An unhealthy lifestyle (1), pathophysiology (2), residual confounding (3), third factors (4) and iatrogenic effects (5) can be mediating factors for the effect of depression on the risk for cardiovascular disease. Iatrogenic effects refer to, for example, the pharmacological impact of antidepressants.
Antidepressants could explain the effects of depression on the risk of cardiovascular disease because antidepressants influence both sympathetic and parasympathetic activity.
Depression can be seen as a brain disease. There are differences on different levels in the brain:
Depression is related to the immune system, the autonomic nervous system and the HPA-axis. Dysregulation in these systems increases the risk of cardiovascular disease. It could lead to somatic changes which could play a role in the development of a depressive state.
There are different depression-related biological dysregulations:
The HPA axis enables reaction to stress. It uses the mobilization of stored energy (1), suppression of immune function (2) and facilitation of many processes of the central nervous system (3).
A chronic activation of the stress response leads to atrophy of hippocampal cells 1), reduced neurogenesis (2), reduced synaptic plasticity (3) and altered monoaminergic signalling (4). Depressed individuals tend to have increased cortisol levels. Higher levels of cortisol are associated with the onset of depression.
The sympathetic nervous system prepares the body for action (i.e. fight or flight). The parasympathetic nervous system regulates the resting state of the body. Antidepressants lead to a lower heart rate variability.
Increased pro-inflammatory cytokines appear to induce sickness behaviour. In depression, there may be a chronic inflammatory response. Transmission of stress induces inflammatory signals to the brain.
The cytokines and inflammatory markers influence monoamine metabolism (1), glutamate metabolism (2) and neuroplasticity (3). There can be an increase in glutamate because of inflammatory markers. Reduced metabolism can lead to the damage of neurons.
Higher levels of CRP at baseline predict depressive symptoms. The IL-6 pathway is upregulated in depression. Adipose tissue is a big source of inflammation. People with depression exhibit higher levels of inflammatory markers and obesity prevalence is higher in people with depression. The association between obesity and depression is bidirectional.
Oxidative stress is
.....read more Medical Psychology – Lecture 6 (UNIVERSITY OF AMSTERDAM)Personality refers to the particular combination of emotional, attitudinal and behavioural response patterns of an individual. It is broad as people behave consistently across situations. A trait is a stable characteristic. A state is temporary. Personality traits appear to influence exposure to health-relevant social circumstances rather than simply moderate reactions to other influences on health.
Cloninger Temperament and Character Inventory distinguish several temperaments (i.e. inherited traits):
There are also several character traits (i.e. shaped by the environment):
The Big Five Personality traits distinguish five different personality traits:
Neuroticism is associated with the presence of somatic complaints. It comprises anxiety (1), depressive symptoms (2), worry (3), anger (4), irritability (5), self-consciousness (6) and low self-esteem (7). It is often accompanied by distress.
The interpersonal approach to personality assumes an inherent association between personality and social circumstances. Intraindividual factors (e.g. goals; expectancies) guide overt social behaviour. This leads people to behave in a way that is consistent with these factors, leading to stability of reciprocal interaction patterns. Personality can influence the frequency (1), magnitude (2) and duration of exposure to stressors in daily life (3). It is also possible that personality influences health through the influence on health behaviours.
Optimism refers to the tendency to hold optimistic expectations about the future and this is associated with better health (1) and fewer complications (2). It is not the same as the absence of pessimism.
Hostility refers to the tendency to experience anger and hold cynical or suspicious beliefs. It is related to atherosclerosis, CHD and mortality. Hostility is associated with more all-cause mortality. Type A behaviour (i.e. hostility and dominance) is related to coronary heart disease. Hostility and anger lead to a larger cardiovascular and neuroendocrine response to stressors. These effects are stronger for the development of the disease than the course of the disease.
It is also possible that people with a type-A personality select more challenging tasks and evoke more competitive and antagonistic behaviour from others. Hostile individuals respond to stressors with larger and more prolonged heart rate (1), blood pressure
.....read more Medical Psychology – Lecture 7 (UNIVERSITY OF AMSTERDAM)The clinical manifestations of cardiovascular disease are a combination of the gradual increase in underlying risk factors and acute triggers. Anger is a risk factor for cardiovascular disease. The stages of progression of cardiovascular disease are gradual subclinical disease progression (1), vulnerable disease stage (2) and presentation of acute coronary syndromes (3).
There is systemic circulation (i.e. blood through the body due to the heart) and the pulmonary circulation (i.e. blood to the lungs). The heart is a pump. It pumps oxygenated blood out of the left ventricle and pumps used blood through the lumps via the right ventricle. It receives its own blood supply from coronary arteries.
There are several types of cardiovascular disease:
Myocardial ischemia develops when cardiac demand exceeds coronary blood supply to the heart muscle. Increases in central and autonomic nervous system activity are a common phenomenon that links acute psychologic, psychiatric and neurologic events to major cardiac pathologies. Myocardial infarction is associated with a higher prevalence of work, home and financial stress (1), major life events (2), lower locus of control (3) and more depression (4).
The gradual disease progression of cardiovascular disease is influenced by modifiable factors (e.g. hypertension, diabetes, smoking, psychosocial factors, weight) and unmodifiable factors (e.g. age, sex, genetics). The treatment of coronary heart disease involves coronary angioplasty (i.e. dotting) (1), a bypass (2) or thrombolysis (3).
There are three types of psychological risk factors for cardiovascular disease:
The acute factors are involved in the end-stage of the development of cardiovascular disease. The episodic and chronic factors are involved in the development of cardiovascular disease. Chronic risk factors are associated with increased reactivity to acute stressors and promote the risk of development of episodic risk factors.
Plaque activation rather than gradual disease progression may be primarily involved in the adverse risk associated with episodic risk factors. Episodic risk factors may not last long enough to initiate and sustain an atherosclerotic process.
The associations between psychological factors and disease progression depend on the nature of the underlying disease (i.e. severity). Most psychological risk factors for cardiovascular disease are sub-threshold (i.e. not meeting diagnostic criteria for psychological disorders). Elevated levels of general distress, subclinical depression and depression are risk factors
.....read more Medical Psychology – Lecture 9 (UNIVERSITY OF AMSTERDAM)Cancer-related fatigue refers to the subjective sense of physical, emotional and or cognitive tiredness, related to cancer or cancer treatment. The fatigue is not proportional to recent activity and interferes with usual functioning. It is a severe fatigue (1), chronic (2), leading to disability (3) and not explained by somatic illness or a psychiatric disorder (4).
Cancer-related fatigue negatively influences quality of life (1), functioning (2), work ability (3) and mental health (4). About a quarter of the patients experience fatigue after treatment.
The risk factors for cancer-related fatigue appear to not explain the persistence of fatigue over time. Higher levels of cancer-related fatigue are associated with:
The cognitive behavioural model of cancer-related fatigue states that fatigue is triggered by cancer but the fatigue is perpetuated by psychological factors. There are several perpetuating factors for cancer-related fatigue:
Cognitive behavioural therapy (CBT) appears to be effective in the treatment for cancer-related fatigue but the availability is limited. An online version of this treatment is expected to be less demanding for patients (1), more broadly available (2) and more time-efficient for therapists (3).
The cytokine hypothesis of cancer-related fatigue states that activation of pro-inflammatory cytokines in the periphery signals the brain, leading to fatigue and other behavioural changes. This could occur because tumours can produce pro-inflammatory cytokines (1), as a result of cancer treatment-related tissue damage (2) and psychological factors (3). Cancer may maintain or exacerbate inflammatory signalling after tumour removal.
Childhood trauma is a strong predictor of fatigue and is associated with inflammation and neurologic and neuroendocrine processes relevant to fatigue. It is associated with low-grade inflammation and an exaggerated inflammatory response to challenge. This could influence a patient’s baseline fatigue level.
Loneliness could influence fatigue through immune dysregulation. Individual differences in peripheral
.....read more Medical Psychology – Lecture 10 (UNIVERSITY OF AMSTERDAM)Type 1 diabetes consists of a loss of B-cells. There is a sudden onset and no prevention. It occurs early in life and there is a peak during puberty. It is life-long and requires insulin-therapy. This type of diabetes is not lifestyle-related.
Type 2 diabetes consists of a loss of B-cells and insulin resistance. It has a late and slow onset. It is related to obesity and occurs more often in older age. There is a strong risk factor in genetics and lifestyle. It is treated through diet (1), exercise (2), medication (3) and insulin therapy (4). This type of diabetes can be prevented by means of diet and exercise.
The goal of diabetes treatment is to avoid extreme blood glucose levels while maintaining quality of life. High blood glucose levels increases the risk of complications. There are several long-term complications of diabetes (e.g. atherosclerosis, foot amputations, hypertension).
Chronically heightened levels of glucose can damage mitochondria. This can promote inflammation and telomere shortening.
The impact of diabetes on the brain are mild cognitive decrements in longstanding type 1 diabetes. There is an increased risk for cognitive decline in type 2 diabetes. About a third of the patients have prolonged coping problems with diabetes. There is also an increased prevalence of emotional distress in somatic disease.
There are three aspects that need to be dealt with for people with diabetes:
Diabetes depends almost entirely on behavioural self-regulation which makes it more difficult to cope with the disease. There are seven self-management behaviours in diabetes:
There are diabetes-specific stressors:
There is a negative cycle leading to burnout in diabetes. The negative experiences lead to negative beliefs and attitudes about diabetes. This leads to negative emotions which, in turn, leads to giving up. This, again, leads to negative experiences. There are often coping and adaptation problems in diabetes.
Diabetes distress refers to emotional distress specific to the experience of living with and managing diabetes. This is higher in patients with complications and adolescents. Depression can appear similar to diabetes distress. However, diabetes is associated with an increased risk of depression. There is a bidirectional relationship between depression and diabetes.
Stress has neuro-hormonal effects which can be amplified and initiated by lifestyle factors. This influences the risk for diabetes type 2, which, in turn, influences the risk of
.....read more Medical Psychology – Lecture 11 (UNIVERSITY OF AMSTERDAM)The goals of medical communication are optimal health and improving quality of life. Medical communication has six functions:
The communication functions influence proximal outcomes (e.g. trust), which, in turn, influences intermediate outcomes (e.g. commitment to treatment). The intermediate outcomes influence the health outcomes. The communication functions also directly influence health outcomes.
Bird’s model of medical communication states that a medical interview has the functions of gathering biological and psychosocial data (1), responding to the patient’s emotions (2) and educating patients and influencing their behaviour (3). The three functions model states that the three functions of a medical interview are the need to determine and monitor the nature of the health problem (1), the need to develop, maintain and conclude the therapeutic relationship (2) and the need to carry out patient education and implementation of treatment plans (3). The framework for patient-centred communication states that the functions of a medical interview are fostering relationships (1), information exchange (2), making decisions (3), enabling self-management (4), responding to emotions (5) and managing uncertainty (6).
Trust, in physicians, refers to the optimistic acceptance of a vulnerable situation in which the patient believes the physician to care for his interests. It is a psychological need because of vulnerability and unavoidable in severe disease. It is associated with risk. There are several dimensions of trust:
There are several layers of interpersonal trust:
Non-verbally expressed uncertainty led to reduced trust. There is stronger overall trust for older patients. Patient’s trust is enhanced by emphasizing medical competence (1), honesty (2) and caring communication (3). Physicians can strengthen their patient’s trust in them with minimal adjustments to their
.....read more
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