All Title Author
Keywords Abstract

Physical Health Examinations in a Psychiatric Setting: The Interactions between Medical Doctor and Patients

DOI: 10.4236/aasoci.2018.81005, PP. 76-93

Keywords: Mental Illness, Physical Health Care, Stigma, Integrated Health Care, Interpersonal Interaction

Full-Text   Cite this paper   Add to My Lib


The purpose of this article is to shed light on the possible stigmatization during a physical health examination in a psychiatric setting and explore the medical doctor and patients’ perceptions of such an integrated care model. This is a qualitative case study using semi-structured interviews and observations. Empirical findings are analyzed using the theory of stigma in order to explore the role of stigmatization in an integrated care setting. The analysis finds three main themes: 1) The advantages of a safe and familiar setting, 2) To be treated as a human being—not an illness, 3) Interpersonal communication with mutual understanding can reduce stigmatization. The results show that stigmatization does occur at some points. However, both patients and the medical doctor think that the integrated care setting contributes to a successful physical health examination. This is due to the location as well as interpersonal aspects.


[1]  Ammentorp, J., Sabroe, S., Kofoed, P. E., & Mainz, J. (2009). Effects of a Communication Course for Clinicians on Parents’ Perception of Care—A Randomized Controlled Trial. Scandinavian Journal of Caring Science, 23, 506-517.
[2]  Bellamy, C. D. H., Flanagan, E., Costa, M., O’Connell-Bonarrigo, M., Tana Le, T., Guy, K., & Steiner, J. L. (2016). Barriers and Facilitators of Healthcare for People with Mental Illness: Why Integrated Patient Centered Healthcare Is Necessary. Issues in Mental Health Nursing, 37, 421-428.
[3]  Bernard, H. R. (2011). Research Methods in Anthropology Qualitative and Quantitative Approaches (5th ed.). Blue Ridge Summit: AltaMira Press.
[4]  Blikkenberg, S., & Vendsborg, P. (2011). Oplevelse af Fordomme Og Diskriminering. In P. Vendsbo, S. Blikkenberg, K. Kistrup, A. Lindhart, & M. Nordentoft (Eds.), Domt pa forhand (1st ed., pp. 47-65). Kobenhavn: Psykiatrifonden.
[5]  Blumer, H. (1969). Symbolic Interactionism: Perspective and Method (1st ed.). London: University of California Press.
[6]  Borba, C. P. C., DePadilla, L., McCarty, F. A., Von Esenwein, S. A., Druss, B. G., & Sterk, C. E. (2012). A Qualitative Study Examining the Perceived Barriers and Facilitators to Medical Healthcare Services among Women with a Serious Mental Illness. Women’s Health Issues, 22, 217-224.
[7]  Bryant, A., & Charmaz, K. (2014). Grounded Theory in Historical Perspective: An Epistemological Account. In the SAGE Handbook of Grounded Theory (pp. 31-57).
[8]  Charmaz, K. (2001). Qualitative Interview and Grounded Theory Analysis. In J. F. Gubrium & J. A. Holstein (Eds.), Handbook of Interview Research: Context and Method (1st ed., pp. 675-695). Thousand Oaks: SAGE Publications.
[9]  Coffey, A., & Atkinson, P. (1996). Making Sense of Qualitative Data: Complementary Research Strategies. Thousand Oaks: Sage Publications.
[10]  Creswell, J. W. (2013). Qualitative Inquiry and Research Design. Choosing among Five Approaches (3rd ed.). Thousand Oaks: SAGE Publications.
[11]  Crotty, M. (1998). The Foundation of Social Research. Meaning and Perspective in the Research Process (1st ed.). London: Sage Publications.
[12]  De Hert, M., Cohen, D., Bobes, J., Cetkovich-Bakmas, M., Leucht, S., Ndetei, D. M., & Correll, C. U. (2011). Physical Illness in Patients with Severe Mental Disorders. II. Barriers to Care, Monitoring and Treatment Guidelines, Plus Recommendations at the System and Individual Level. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 10, 138-151.
[13]  Ewart, S. B., Bocking, J., Happell, B., Platania-Phung, C., & Stanton, R. (2016). Mental Health Consumer Experiences and Strategies When Seeking Physical Health Care: A Focus Group Study. Global Qualitative Nursing Research, 3.
[14]  Flick, U. (2009). An Introduction to Qualitative Research (4th ed.). London: SAGE Publications Ltd.
[15]  Flyvbjerg, B. (2011). Case Study. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage Handbook of Qualitative Research (1st ed., pp. 301-316). Thousand Oaks: SAGE Publications.
[16]  Goffman, E. (1963). Stigma. Notes on the Management of Spoiled Identity. London: Penguin Books.
[17]  Goffman, E. (2005). Interaction Ritual: Essays in Face-to-Face Behaviour. American Sociological Review, New Brunswick: Transaction Publishers.
[18]  Hardy, S., Deane, K., & Gray, R. (2012). The Northampton Physical Health and Wellbeing Project: The Views of Patients with Severe Mental Illness about Their Physical Health Check. Mental Health in Family Medicine, 9, 233.
[19]  Hassan, I., Mccabe, R., & Priebe, S. (2007). Professional-Patient Communication in the Treatment of Mental Illness: A Review. Communication & Medicine, 4, 141-152.
[20]  Horsfall, J., Cleary, M., & Hunt, G. E. (2010). Stigma in Mental Health: Clients and Professionals. Issues in Mental Health Nursing, 31, 450-455.
[21]  Hospital, A. M., Hospital, A. M., Ong, L. M. L., de Haes, J. C. J. M., Hoos, A. M., & Lammes, F. B. (1995). Doctor-Patient Communication: A Review of the Literature. Social Science & Medicine, 40, 903-918.
[22]  Israel, M. (2015). Research Ethics and Integrity for Social Scientists: Beyond Regulatory Compliance (2nd ed.). London: SAGE Publications.
[23]  Jacobsen, C. B., Martin, H. M., Andersen, S. L., Christensen, R. N., & Bengtsson, S. (2010). Stigma og psykiske lidelser. Kobenhavn.
[24]  Kolbæk, P., Schioth, E., Aagaard, J., & Munk-Jorgensen, P. (2014). Follow-Up Interventions in Persons with Schizophrenia and Metabolic Syndrome. Australian & New Zealand Journal of Psychiatry, 48, 1059-1060.
[25]  Lawrence, D., & Kisely, S. (2010). Inequalities in Healthcare Provision for People with Severe Mental Illness. Journal of Psychopharmacology, 24, 61-68.
[26]  Lawrence, D., Hancock, K. J., & Kisely, S. (2013). The Gap in Life Expectancy from Preventable Physical Illness in Psychiatric Patients in Western Australia: Retrospective Analysis of Population Based Registers. BMJ, 346, 1.
[27]  Lester, H., Tritter, J. Q., & Sorohan, H. (2005). Patients’ and Health Professionals’ Views on Primary Care for People with Serious Mental Illness: Focus Group Study. British Medical Journal, 330, 1122-1126.
[28]  Link, B. G., & Phelan, J. C. (2001). Conceptualizing Stigma. Annual Review of Sociology, 27, 363-385.
[29]  Mainz, J., Sloth, A., & Kjol-bye, M. (2014). De mange aktorer og deres samarbejde. [The Many Actors and Their Cooperation.] In P Jorgensen, & C. Thomsen (Eds.), Fysisk helbred blandt psykisk syge (1st ed., pp. 227-237). Kobenhavn: FADL’s forlag.
[30]  Maj, M. (2009). Physical Health Care in Persons with Severe Mental Illness: A Public Health and Ethical Priority. World Psychiatry, 8, 1-2.
[31]  Mik-Meyer, N., & Jarvinen, M. (2005). Indledning: Kvalitative metoder i et interaktionistisk perspektiv. In N. Mik-Meyer & M. Jarvinen (Eds.), Kvalitative metoder i et interaktionistisk perspektiv (1st ed., pp. 9-24). Kobenhavn: Hans Reitzels Forlag.
[32]  Ministeriet for Sundhed og Forebyggelse (2014). Bekendtgorelse af sundhedsloven. [Executive Order of the Health Law.] Copenhagen.
[33]  Mitchell, A., Malone, D., & Doebbeling, C. (2009). Quality of Medical Care for People with and without Comorbid Mental Illness and Substance Misuse: Systematic Review of Comparative Studies. The British Journal of Psychiatry, 194, 491-499.
[34]  Muntingh, A. D. T., van der, F.-C., Van Marwijk, H. W. J., Spinhoven, P., Assendelft, W. J. J., de Waal, M. W., Van Balkom, A. J. L. M. et al. (2009). Collaborative Stepped Care for Anxiety Disorders in Primary Care: Aims and Design of a Randomized Controlled Trial. BMC Health Services Research, 9, 159.
[35]  Nordentoft, M., Wahlbeck, K., Hallgren, J., Westman, J., Osby, U., Alinaghizadeh, H., Burne, T. et al. (2013). Excess Mortality, Causes of Death and Life Expectancy in 270,770 Patients with Recent Onset of Mental Disorders in Denmark, Finland and Sweden. PLoS ONE, 8, e55176.
[36]  Pitman, A. L., Osborn, D. P. J., Wright, C. A., Nazareth, I., & King, M. B. (2011). Cardiovascular Screening of People with Severe Mental Illness in England: Views of Service Users and Providers. Psychiatric Services, 62, 1338.
[37]  Region Hovedstaden (2015). Sundhedsaftale 2015-2018. [Health Agreement 2015-2018.] Copenhagen.
[38]  Roberts, S. H., & Bailey, J. E. (2011). Incentives and Barriers to Lifestyle Interventions for People with Severe Mental Illness: A Narrative Synthesis of Quantitative, Qualitative and Mixed Methods Studies. Journal of Advanced Nursing, 67, 690-708.
[39]  Robson, D., & Gray, R. (2007). Serious Mental Illness and Physical Health Problems: A Discussion Paper. International Journal of Nursing Studies, 44, 457-466.
[40]  Shuel, F., White, J., Jones, M., & Grey, R. (2010). Using the Serious Mental Illness Health Improvement Profile [HIP] to Identify Physical Problems in a Cohort of Community Patients: A Pragmatic Case Series Evaluation. International Journal of Nursing Studies, 47, 136-145.
[41]  Sikker Psykiatri (2016). Projekt Sikker Psykiatri fortsætter til 2017. [Project Safe Psychiatry continues until 2017.]
[42]  Silverman, J., & Kinnersley, P. (2010). Doctors’non-Verbal Behaviour in Consultations: Look at the Patient before You Look at the Computer. British Journal of General Practice, 60, 76-78.
[43]  Smith, R. A. (2007). Language of the Lost: An Explication of Stigma Communication. Communication Theory, 17, 462-485.
[44]  Smith, R. A., Quesnell, M., & Zhu, X. (2016). Stigma and Health/Risk Communication. Oxford Res. Encycl. Commun., Oxford: Oxford University Press.
[45]  Sowers, W., Arbuckle, M., & Shoyinka, S. (2016). Recommendations for Primary Care Provided by Psychiatrists. Community Mental Health Journal, 52, 379-386.
[46]  Sundhedsstyrelsen (2009). National Strategi for Psykiatri. [National Strategy for Psychiatry.] Copenha-gen.
[47]  Thornicroft, G., Rose, D., & Kassam, A. (2007). Discrimination in Health Care against People with Mental Illness. International Review of Psychiatry, 19, 113-122.
[48]  Tranter, S., Irvine, F., & Collins, E. (2012). Innovations Aimed at Improving the Physical Health of the Seriously Mentally Ill: An Integrative Review. Journal of Clinical Nursing, 21, 1199-1214.
[49]  Van Den Tillaart, S., Kurtz, D., & Cash, P. (2009). Powerlessness, Marginalized Identity, and Silencing of Health Concerns: Voiced Realities of Women Living with a Mental Health Diagnosis. International Journal of Mental Health Nursing, 18, 153-163.
[50]  van Hasselt, F. M., Thier, C. S. M., van Rijswijk, E., & Loonen, A. J. M. (2014). Is Somatic Health Screening in Patients with Severe Mental Illness of Added Value? Perspectives in Psychiatric Care, 50, 186-192.
[51]  Vreeland, B. (2007). Bridging the Gap between Mental and Physical Health: A Multidisciplinary Approach. Journal of Clinical Psychiatry, 68, 26-33.
[52]  Wahl, O. F. (2012). Stigma as a Barrier to Recovery from Mental Illness. Trends in Cognitive Sciences, 16, 9-10.
[53]  Wright, C. A., Osborn, D. P. J., Nazareth, I., & King, M. B. (2006). Prevention of Coronary Heart Disease in People with Severe Mental Illnesses: A Qualitative Study of Patient and Professionals’ Preferences for Care. BMC Psychiatry, 6, 16.
[54]  Yin, R. K. (2009). Case Study Research. Design and Methods (4th ed.). Thousand Oaks, CA: SAGE Publications, Inc.
[55]  Yin, R. K. (2016). Qualitative Research from Start to Finish (2nd ed.). New York, NY: Guilford Publications.


comments powered by Disqus