Fishbain David A, Bruns Daniel, Meyer Laura J, Lewis John E, Gao Jinrun, Disorbio John Mark
Departments of Psychiatry, Neurological Surgery, and Anesthesiology, Miller School of Medicine at University of Miami, Miami Veterans Administration Hospital, Miami, Florida, U.S.A.
Health Psychology Associates, Greeley, Colorado, U.S.A.
Pain Pract. 2015 Jul;15(6):518-29. doi: 10.1111/papr.12210. Epub 2014 Apr 28.
The belief in medical care entitlement has recently resulted in major changes in the medical system in the United States. The objectives of this study were the following: to compare endorsement of three medical entitlement beliefs (I deserve the best medical care no matter what the cost [BMC], I am entitled to all of the medical care I want at no charge [NC], I shouldn't have to wait to see my doctors [W]) in community nonpatients without pain (CNPWP), acute pain patients (APPs), and chronic pain patients (CPPs) and to develop predictor models for these beliefs in APPs and CPPs.
CNPWP, APPs, and CPPs were compared statistically for frequency of endorsement of each belief. All available variables were utilized in logistic regression models to predict each belief in APPs and CPPs. Those affirming/nonaffirming each belief were compared by t-test for affirmation of narcissism, dependency, and antisocial practices on three scales from established inventories.
CPPs were significantly more likely than APPs to endorse BMC. No other comparisons were significant. The logistic regression models identified variables that related to narcissism, anger, doctor dissatisfaction, depression, and anxiety, which entered the models for both APPs and CPPs for some beliefs. Those APPs and CPPs who affirmed the beliefs of NC and W were more likely than their counterparts to affirm antisocial practices, but not narcissism or dependency.
Patient medical entitlement beliefs may be related to some psychiatric/psychological issues.
对医疗保健权利的信念最近导致了美国医疗系统的重大变革。本研究的目的如下:比较社区无疼痛非患者(CNPWP)、急性疼痛患者(APPs)和慢性疼痛患者(CPPs)对三种医疗权利信念的认同程度(无论费用多少,我都应该得到最好的医疗护理[BMC];我有权免费获得所有我想要的医疗护理[NC];我不应该等待看医生[W]),并为APPs和CPPs中的这些信念建立预测模型。
对CNPWP、APPs和CPPs在每种信念认同频率上进行统计学比较。在逻辑回归模型中利用所有可用变量来预测APPs和CPPs中的每种信念。对每种信念持肯定/否定态度的人通过t检验,比较其在已建立量表上自恋、依赖和反社会行为方面的肯定程度。
CPPs比APPs更有可能认同BMC。其他比较均无显著差异。逻辑回归模型确定了与自恋、愤怒、对医生的不满、抑郁和焦虑相关的变量,这些变量在某些信念的模型中同时进入了APPs和CPPs的模型。那些认同NC和W信念的APPs和CPPs比不认同的人更有可能认同反社会行为,但不包括自恋或依赖行为。
患者的医疗权利信念可能与一些精神/心理问题有关。