Describe what psychologists have discovered about patient and practitioner diagnosis and style.

Mark scheme

Marking points from the official mark scheme (Oct/Nov 2019). The mark or mark type is shown in brackets.

1. Patient practitioner diagnosis and style, including the following
2. • Practitioner style: doctor and patient-centred (Byrne and Long, 1976, Savage and Armstrong, 1990).
3. • Practitioner diagnosis: type I and type II errors.
4. • Disclosure of information (Robinson and West, 1992).
5. Doctor and patient-centred (Byrne and Long, 1976, Savage and Armstrong, 1990)
6. Byrne and Long analysed 2500 recordings of medical consultations in a variety of countries, including England and Australia. They discovered the two distinctive practitioner styles.
7. Features of the doctor-centred style:
8. • Doctor asked closed questions (patient could only answer 'yes' or 'no').
9. • Doctor ignored patients' attempts to elaborate on their answers.
10. • Doctor placed most focus on the first problem described by the patient.
11. • Doctor made links between symptoms and their diagnosis without discussion or alternatives.
12. • Everything was based on 'fact' rather than two-way communication.
13. • Impersonal atmosphere.
14. • Patient was overall passive during the consultation.
15. Features of the patient-centred style:
16. • Doctor asked open-ended questions.
17. • Patient was given chances to give descriptions and elaborate on answers.
18. • Doctor used less medical jargon; patient could understand diagnosis and treatment options.
19. • Patient had the chance to participate in decision-making.
20. • Personal atmosphere.
21. • Patient was very active during the consultation.
22. Savage and Armstrong (1990)
23. Savage and Armstrong compared a patient-centred style (sharing consultative process) with the doctor-centred style (traditional doctor-led process).
24. All the patients involved in the study reported that they were highly satisfied with the consultation.
25. However, straight after the consultation and one week later, it was found that they preferred the doctor-led style.
26. It is possible that this is due to people being more familiar with the traditional method; adjusting to a newer consultation style could take time for patients and their doctors.
27. Practitioner diagnosis: type I and type II errors
28. Type I error - well patient diagnosed as ill.
29. Type II error – ill patient diagnosed as well.
30. The Type I and II errors are also known as the 'false positive' and 'false negative', respectively.
31. [Note that Rosenhan reversed these definitions.]
32. Disclosure of information (Robinson and West, 1992)
33. Robinson and West conducted a study on patients at a genito-urinary clinic.
34. They discovered that the patients gave more information to a computer than to the doctor they met afterwards.
35. For example, they admitted to having more sexual partners and revealed more symptoms.
36. This suggests that computers can be used to help patients communicate more comfortably and openly.
37. Mark according to the levels of response descriptors in Table A.
38. Other appropriate responses should also be credited.
39. A range of issues could be used for evaluation here. These include:
40. • Named issue – Validity (probably around the data collection method used) e.g. self-report methods used in all three of the studies and collected primary data from the participants. It could be subjective, and also open to bias.
41. Type I and type II error rely on the self-report of the patients which can be inaccurate.
42. The doctor can also misinterpret the description of symptoms given by the patient.
43. Patients may not be honest, show demand characteristics, etc.
44. • Determinism.
45. • Reliability of data collection methods.
46. • Strengths and weaknesses of method and/or design.
47. • Sampling and generalisations.
48. • Situational/individual explanations.
49. • Ethics.
50. Mark according to the levels of response descriptors in Table B.
51. Other appropriate responses should also be credited.