LIFE THREATENING ILLNESS BEHAVIOR

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LIFE THREATENING ILLNESS BEHAVIOR

• I. EMERGENCY ANY CONDITION THAT IN THE OPINION
  OF PATIENT REQUIRES IMMEDIATE MEDICAL ATTENTION.
  CONDITION EXISTS UNTIL PROVIDER DETERMINES THAT
  PATIENTS LIFE OR WELL-BEING IS NOT THREATENED.

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• A. EMERGENT CONDITION PATIENT REQUIRES IMMEDIATE
  MEDICAL ATTENTION. DELAY IS HARMFUL TO THE
  PATIENT DISORDER IS ACUTE AND POTENTIALLY
  THREATENS LIFE OR FUNCTION.

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• B. URGENT PATIENT REQUIRES MEDICAL ATTENTION
  WITHIN A FEW HOURS. IN DANGER IF NOT ATTENDED
  THE DISORDER IS ACUTE BUT NOT NECESSARILY SEVERE.

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• C. NON-URGENT PATIENT DOES NOT REQUIRE THE
  RESOURCES OF AN EMERGENCY DEPARTMENT. DISORDER
  IS MINOR OR NON-ACUTE. AMERICAN HOSPITAL
  ASSOCIATION

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• D. ISSUES RAISED IN THESE DEFINITIONS
• 1. DISCREPANCY BETWEEN LAY AND PROVIDER
  DEFINITIONS OF EMERGENCY
• 2. PROVIDERS CAN MAKE APPROPRIATE DETERMINATION

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• a. HOMOGENEOUS BODY OF SKILLS AND KNOWLEDGE
• b. TRIAGE
• c. PATIENT MISLEADS OR IS ATYPICAL
• 3. MISUSE OF EMERGENCY DEPARTMENT RESOURCES
• a. SCALPEL TO CHOP WOOD

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• b. TRIAGE TO OUT- PATIENT
• 4. NOT ADDRESSED E.D. IS SENSITIVE
  INDICATOR OF HEALTH CARE DELIVERY IN
  COMMUNITY

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• II E.D. UTILIZATION ISSUES
• A. ATTERBURY
• 1. PHYSICIANS UNAVAILABLE, E.D. IS
• 2. INCREASED MOBILITY
• a. LESS HOME BOUNDEDNESS, WORK FURTHER FROM
  HOME
• b. PHYSICAL MOBILITY AND ACCIDENTS

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• c. RESIDENTIAL MOBILITY, NO PERSONAL
  PHYSICIAN
• 3. MISTAKEN BELIEF THAT E.D. IS CHEAPER
• 4. PHYSICIANS ENCOURAGE PATIENTS TO MEET
  THEM AT E.D.
• a. DIAGNOSTIC RESOURCES IN E.D.

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• b. PHYSICIANS DEPENDENT ON E.D. TECHNOLOGY
• 5. DECREASED NUMBER OF PRIMARY CARE PRACTITIONERS
  AND INCREASED SPECIALIZATION MANAGED CARE MORE
  PRIMARY CARE AND GATEKEEPING

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• a. PATIENT DUMPING
• b. MAINTAIN PRACTICE ORGANIZATION
• 6. PATIENTS DO NOT WISH TO BOTHER PHYSICIAN FOR
  MINOR COMPLAINTS
• a. DOC IN BOX OR URGENT CARE CENTERS

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• 7. UNDER SERVED IN INNER CITIES
• a. CITY AND COUNTY E.D.
• b. LESS DISCRETIONARY TIME
• 8. INDUSTRY, SCHOOL, POLICE FIRE REFERRALS
  ENCOURAGE NON- WORK NON-SCHOOL USE

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• 8. AGE DISTRIBUTION SHIFT, MORE MORBIDITY
  AND ACUTE AND LIFE THREATENING CRISES
• 9. MEDICAL BREAK THROUGHS OBTAINED FROM
  E.D.
• 10. CONSUMER CONTROL PATIENT DECIDES WHEN
  AND WHAT

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• B. ROTH WHY NOT?
• 1. OPEN 24 HOURS EVERYDAY OF YEAR
• 2. NO APPOINTMENT
• 3. IF EMERGENT OR URGENT QUICK CARE
• 4. DIAGNOSIS AND TREATMENT RESOURCES
  AVAILABLE

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• 5. SPECIALISTS ON CALL
• 6. RELATIVELY QUICK IN- PATIENT ADMISSION
• 7. RATHER THAN ASK WHY GO TO E.D., BETTER
  TO ASK WHY GO ANY WHERE ELSE?

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• III. SITUATIONAL APPROACH TO LIFE THREATENING
  ILLNESS BEHAVIOR IMPETUS AND
  SITUATIONS
• A. EMERGENT AND URGENT CONDITIONS
• B. UNEQUIVOCAL HEALTH STATUS DEVIATION

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• C. HIGH PROBABILITY OF DEATH OR DISABILITY
  OVER TIME
• D. PRIMARY PROCESS CRISIS COPING EMERGED,
  BREAKING THROUGH COPING STRATEGY
• E. ROLE RELATIONSHIP ANOMIC

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• F. LAY OTHERS ACUTE LAY REFERRAL
• G. PHYSICIAN RELATIONSHIP
  ACTIVITY- PASSIVITY
• IV. ACUTE MYOCARDIAL INFARCTION A CONTEXT
• A. SITUATIONS OF HIGH MORBIDITY AND MORTALITY
  OVER TIME

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• B. THROMBOLYSIS IN AMI STROKE ANGIOPLASTY
• C. THREE STUDIES
• 1. SILVER SPRING, MD 262 HOSPITALIZED 138
  OUT-HOSPITAL DEATHS
• 2. COLUMBUS, OH 1102 SUSPECT AMI
• 3. OSU HOSPITAL 600 CARDIAC PATIENTS,
  PSYCHOSOCIAL, PROSPECTIVE COPING

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• D. PHASES OF LIFE THREATENING IB
• 1. PRODROMAL PHASE
• a. WARNING 50-70
• b. MR JOHNSON
• c. SOFT SIGNS SYMPTOMS
• d. WALKING SICK WORRIED WELL

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• e. MEDIAN DURATION 14.3 DAYS
• f. PRECIPITATE V.S. EVOLVING CRISIS
• 2. SELF-EVALUATION PHASE CARE SEEKING
  PATHS
• a. PERSONAL EXPERIENCE
• b. MR SHANKS
• c. DIRECT CONTROL

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• d. MEDIAN DURATION 59.7 MINUTES
• e. DEFINITION AND EVALUATION OF HARD SIGNS
  SYMPTOMS
• f. PRODROMAL SS AND NORMALIZATION
• g. PRE-EXISTING CHRONIC
• 1. ILLNESS CONTEXT

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• 2. EFFECT INTERVAL
• 3. CRYING WOLF
• h. SOCIAL PROPRIETY
• I. SOCIAL CONTEXT HOME V.S. OTHER LOCATION
• 3. LAY EVALUATION PHASE
• a. ILLNESS AS SOCIAL EXPERIENCE

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• b. MEDIAN DURATION 29.9 MINUTES
• c. DECISION TO SEEK CARE SOCIAL 93 IN
  COLUMBUS HAD PHASE
• 1. SPOUSE TOLD MOST FREQUENTLY
• 2. MALE PATIENT SLOW, FEMALE FASTEST POWER
• 3. NON-FAMILY MOVE FASTER

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• d. MR DEVINE
• e. ACUTE LAY REFERRAL DIMENSIONS
• 1. AN ASSURANCE OF A NEED FOR CARE
• a. USE RESOURCES PRUDENTLY
• b. PROPRIETY
• c. EMBARRASSMENT AND DISRUPTION

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• d. EXTENDED V.S. TRUNCATED
• 2. EVALUATIVE V.S. INSTRUMENTAL
  CONSULTATION
• f. INFLUENCE OF LAY OTHERS ON MEDICAL CARE

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• 4. MEDICAL EVALUATION PHASE
• a. 41 HAD MEP IN COLUMBUS
• b. MEDIAN DURATION 29.7 MINUTES
• c. GATEKEEPING
• 1. ROCK V.S. SIEVE, MR SAMUELS

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• d. MEDICAL CONTACTS SLOW
• e. MEDICAL ADVICE CONSULTATION SLOWEST
• f. SHORT WHEN M.D. INVOLVED
• h. AFTER OFFICE HOURS AND WEEKENDS CALLS
  SHORTEST

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• 1. WOMEN LESS LIKELY TO CALL NON-OFFICE HOURS
• i. SPECIALISTS SLOWEST
• j. SOCIAL PROPRIETY SELF PRESENTATION
  BEHAVIOR
• 5. HOSPITAL TRAVEL PHASE TIME OF DECISION
  TO TRAVEL TO ARRIVAL AT E.D.

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• a. MODE PRIVATE AUTO, CAB, AMBULANCE, EMS
• b. MEDIAN TRAVEL TIME 35.2 MINUTES, MODES EQUAL
• c. GATEKEEPER DISPATCHER
• 1. KEY WORDS CHEST PAIN, SOB, UNCONSCIOUS OR
  HEART ATTACK

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• d. SOCIAL PROPRIETY AND STICKINESS OF SOCIAL
  LIFE
• e. CALLING M.D. LESS LIKELY TO USE EMS
• 6. HOSPITAL EVALUATION PHASE
• a. FROM E.D. DOOR TO DEFINITIVE CARE SETTING
  AND DOOR TO NEEDLE

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• 1. EXCLUDING PRODROMAL, HEP IS LONGER THAN TOTAL
  TIME FROM ONSET TO E.D., 130.5 MINUTES V.S. 136.2
  MINUTES MEDIAN TIME
• b. WALLET BIOPSY AND TRIAGE

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• c. MOST TIME SPENT REGISTERING, LOCATING
  M.D., EVALUATION, DIAGNOSIS,
  TREATMENT, PREPARING BED AND
  TRANSPORTING
• d. SELF-PRESENTATION BEHAVIOR AND MORAL WORTH

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• e. CALLING M.D. FOR LEGITIMACY AND
  SUSPECTING PATIENT DUMPING
• 1. NON-URGENT PATIENT
• 2. G.O.M.E.R.S.

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• V. SUMMARY AND SYNTHESIS
• A. INTERRELATIONSHIP OF HEALTH AND ILLNESS
  BEHAVIORS
• B. MULTIPLE HEALTH AND ILLNESS BEHAVIORS
• 1. COMPLEXITY OF MANAGEMENT
• 2. WORK DEMANDS AND AGENTS

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• 3. ENGULFMENT
• 4. WORRIED WELL AND WALKING SICK
• a. POST-TRAUMATIC STRESS DISORDER
• b. CUMULATIVE ADVERSITY
• c. MALADAPTIVE COPING AND COMPLIANCE

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• C. MOST ARE SUCCESSFUL

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