The patient-practitioner relationship: misusing health services

Psychology A2 · Health Psychology. The idea in plain words, the rules to remember, the mistake to avoid and a worked example, written and checked by Mega Lecture.

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The idea

Some people use health services too little. Safer et al. (1979) interviewed patients in hospital clinic waiting rooms and split delay into three stages. Appraisal delay is the time taken to decide that a symptom means illness. Illness delay is the time from that point to deciding to seek medical help. Utilisation delay is the time from that decision to actually attending.

The health belief model gives another explanation: people delay when they feel at low risk, see the illness as mild, or see barriers as greater than benefits.

Others use services too much. In Munchausen syndrome a person fakes or causes symptoms to take the sick role. In malingering the person fakes symptoms for an external reward such as money.

Rules to remember

Total delay = appraisal delay + illness delay + utilisation delay.
Safer et al.: strong pain or bleeding shortened delay; worry about cost lengthened utilisation delay.
Health belief model: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action.
Munchausen syndrome: internal motive (attention and care as a patient). Malingering: external motive (money, time off, avoiding duty).
Essential features of Munchausen syndrome: pathological lying, moving from hospital to hospital, repeated feigned or self-caused illness.
Supporting features include many hospital stays, many scars, medical knowledge and a dramatic presentation.
Aleem and Ajarim (1995): case study of a young woman in Saudi Arabia whose repeated abscesses were found to be self-inflicted.

Common mistake

Students mix up illness delay and utilisation delay. Illness delay ends with the decision to seek help; utilisation delay starts with that decision and ends at the visit.

Worked example

Bilal has a cough for a month before he accepts he is ill. Two days later he decides to see a doctor, and he goes the next morning. Which stage of delay was longest?

Symptom to “I am ill” took a month: this is appraisal delay.
“I am ill” to “I need a doctor” took two days: this is illness delay.
Decision to visit took less than a day: this is utilisation delay.

Answer: Appraisal delay was the longest stage.

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