1. introduction to behavioral sciences

Muhammad Asif Sami
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INTRODUCTION TO BEHAVIORAL SCIENCES

Objectives
 Behavioral Sciences and their importance in health
 Bio-Psycho-Social Model of Healthcare
 Desirable attitudes
 Correlation of brain, mind and Behavioral Sciences
 Role of a doctor
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What is behavioral sciences
 behavioral sciences deal with the study of human
behavior using principles of psychology, sociology and
anthropology in conditions of health and disease
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 Amongst the behavioral sciences, psychology contributes to the study of
human mind and the role played by its various functions such as emotions,
thoughts, cognitions, motivations perceptions, and intelligence in
maintaining health or causing disease, and how the development of
personality takes place.
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Behavioral Sciences and their
importance in health
Another major influence on human behavior is the role played by the
family, the society or the community.
The study of sociology as one of the behavioral sciences help the doctor to
understand the influence of society and its various units and institutions
on the processes of health and how they can change to cause disease.
The role of family, gender issues, social classes, socioeconomic
circumstances, housing, employment, social supports and social policies
in maintaining health or causing disease is studied in this domain
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 medical anthropology. It is the study of evolutionary effect on history, racial
classification, geographic distribution of human race, and effects on health issues,
sign and symptoms of diseases.
 It also involves the study of culture methods of dealing with diseases and other
distressing events of people’s lives. Which disease is to be stigmatized and which
is to be kept secret, which is to be dealt with be the faith healers is largely
determined by the anthropological influences on a culture.
 Understanding the health belief model, attitudes of a society and the role culture
assigns to a sick person are essential elements the highlight the importance of
anthropology for a health professional.
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 In essence, the behavioral sciences add to disciplines of anatomy,
physiology, and biochemistry as basic sciences to support the study of
holistic medicine. While the former three teach about the body.
 Psychology educates the physician about the mind, and sociology and
anthropology illustrate the evolution of human spirit and the factors that
constantly influence it.
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BIO PSYCHO-SOCIAL MODEL
 The biopsychosocial model is a broad view that attributes disease
outcome to the intricate, variable interaction of biological
factors (genetic, biochemical, etc), psychological factors (mood,
personality, behavior, etc.), and social factors (cultural, familial,
socioeconomic, medical, etc.).
 The biopsychosocial model counters the biomedical model, which
attributes disease to roughly only biological factors, such as viruses,
genes, or somatic abnormalities. The bio psycho-social model applies to
disciplines ranging from medicine to psychology to sociology; its novelty,
acceptance, and prevalence vary across disciplines and across cultures
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Correlation of brain mind and
behavioural sciences
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Correlation of brain mind and behavioural sciences
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Role of a Doctor:
 Step – 1: Seating and Setting: (Environment)
 Exclusivity
The environment where bad news is being broken can have
serious repercussions on the outcome of the interview.
Patient’s mistrust and antagonism may simply result from a
poorly chosen location. Therefore it is worth trying to find a
private room where doctor and patient can focus on the
subject attentively.
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 Involvement of significant others
Some patients like to have family members or friends around
them when they receive bad news. If there are more than few
people supporting the patient, ask one person to act as
representative. This gives patient support and alleviates some
stress from the doctor in the face of an emotionally charged
interview.
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 Seating arrangements
It is advisable that interview takes place with both the doctor and
the patient comfortably and respectfully seated next to each other,
preferably at a distance of an arm’s length.
The arrangement should never impart an intimidating image of the
doctor. Instead, it should provide an appropriate setting for
discussions and any emotional outbursts or ventilation of feelings
that may arise.
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 Be attentive and calm
Most doctors feel anxious when breaking bad news and it is worth spending some
time to eliminate any signals that may suggest our own anxieties.
Maintain eye contact and show your attention. If the patient starts to cry, try
shifting your gaze because nobody likes to be watched while crying.
This should however be done with sensitivity and must never send a signal that you
do not really care about the patient’s feelings.
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 Listening mode
Silence and repetition of last few words that the
patient has said, are two communication
skills that will send across the message that
you are listening well.
 Availability
If you have appointments to keep, give your
patient a clear indication of your time
constraints but make yourself available to
the patient for all his queries and doubts, for
the duration that you are with him on her.
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Step – 2: Patient’s Perception
The principle involved in this step is “before you tell, ask”. Before
you break the bad news to the patient, try to establish as
accurately as possible the patient’s perception of his or her
medical condition.
Obtaining this information depends on your own
communication style. As your patient responds to your
questions take note of the language and vocabulary that he is
using and be sure to use the same vocabulary in your
sentences.
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 This alignment is very important as it helps you
assess the gap between patient’s expectations and
actual medical condition. If the patient is in denial,
try not to confront him in the first interview, as
denial is an unconscious defense mechanism that
facilitates coping.
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Step - 3: Invitation
 Although most patients want to know all about their illness but
assumption toward that should be avoided.
 Obtaining clear permission, respects the patient’s right to know or not to
know.
 Some examples to address this are: “Are you the kind of person who likes
to know all the details about what’s going on?” , “How much information
would you like me to give you about your diagnosis and treatment?” ,
“Would you like me to give you details about what is going on or would
you prefer I tell you about the treatments I am prescribing to you?”.
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Step – 4: Knowledge
 Before you break bad news, give your patient a warning of
some sort to help him prepare for himself e.g.
“Unfortunately I have some bad news to tell you Mr. X” or “I
am sorry to have to tell you…” When giving your patient bad
news, use the same language that he uses.
 This aligning is very important if you want to maintain a
therapeutic relationship with the patient.
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 Avoid scientific and technical language. Even the most well informed
patients find technical terms difficult to comprehend in that state of
emotional confusion.
 Give information in small bits and clarify whether he understands what
you have said so far, e.g. “Do you understand what I mean” or “Is this
making sense so far”. As emotions and reactions arise during the
interview, acknowledge them and respond to them.
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Step – 5: Empathy
 For most doctors responding to our patients’ emotions is one of the most
difficult parts while breaking the bad news.
 In our effort to alleviate our own discomfort, it is advisable to withhold
certain information or give a more hopeful picture than it actually is.
Although these tactics may help in short term they would seriously
undermine all your efforts in the long run.
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 It is much more useful and therapeutic to acknowledge that
patient’s emotions as they arise and address them. The
technique that is most useful is termed as empathic
response.
 In emphatic response one needs to listen and identify the
emotion and then respond by showing that you understand
the emotional expression of the patient. Combining the
empathic response and the exploratory response then
validating the patient’s feelings, reassures the patient that
you understand the human side of the medical issue and that
you have a respect for his feelings.
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Step – 6: Summarize
 Before the discussion ends, sum up the information
in a short summary of all that has been discussed and
give your patient opportunity to voice any major
concerns or questions.
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Step – 7: Plan of Action
 You and your patient should go away from the
interview with a clear plan for the next steps that
need to be taken and the role you both would play,
in the management of the issues.
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1. introduction to behavioral sciences

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1. introduction to behavioral sciences