ISMAIL SADEK

The Doctor-Patient Relationship

At the core of the practice of medicine The patient expects a good relationship as much as a cure

Dr-patient relationship itself becomes part of the therapeutic process

Establishing effective communication is the first step in establishing the essential alliance that will allow the doctor to help the patient.

The capacity to develop an effective relationship requires a complexities of human behavior and education in the techniques of talking and listening to people.

They need the skills of active listening, which means listening both to what they and the patient are saying and to the undercurrents of the unspoken feelings between them.

We should realize that communication between two people occurs on several levels at once:

what the person believes about himself;

what he wants others to believe about them;

and who the person really is.

Components of The Doctor-Patient Relationship

An effective relationship is characterized by good rapport.

Rapport is the spontaneous, conscious feeling of harmonious responsiveness that promotes the development of a constructive therapeutic alliance.

It implies an understanding and trust between the doctor and patient

Rapport

(1) Putting patients at ease; (2) Finding patients' pain and

expressing compassion; (3) Evaluating patients' insight and

becoming an ally; (4) Showing expertise; (5) Establishing authority as

physicians and therapists; (6) Balancing the roles of empathic

listener, expert, and authority.

Establishing Rapport

Intellectual understanding & Emotional understanding

Empathy is the capacity of a person to put himself into the psychological frame of reference of another and thereby understand his thinking, feeling, or behavior

By looking at the patient and adopting an appropriate posture

By indicating that you understand what is happening to him.

Empathy

Transference: the process of patients unconsciously attributing to their doctors aspects of important past relationships, especially those with their parents

Countertransference: when doctors unconsciously attributes to patients that come from the doctor’s past relationships

Disliking a PatientSexuality and the Physician

Transference &Countertransference

the questions a patient asks, the way in which news is conveyed and treatment recommendations are made.

A talented, sensitive physician will have different approaches with different patients and indeed may have different approaches with the same patient as time and medical circumstances vary.

Models of Interaction Between Doctor and Patient

The paternalistic modelThe informative modelThe interpretive modelThe deliberative model

“You’re paid to do what I tell you!!”

Patient controlled consultation

The autocratic modelIt is assumed that the Dr

knows bestDr will prescribe

treatment and patient is expected to comply without questioning

Withhold informationDoctor Takes on role of

“parent”Desirable in some

situations

The paternalistic model

The Dr dispenses informationWithout suggestionBut the choice is left wholly up to

the patientMay be appropriate for certain one-

time consultationsDr. Likely to be perceived as cold

and uncaring

The informative model

To make recommendations that take into account the unique characteristics of an individual patient

A sense of shared decision makingDr presents and discusses

alternatives, to find, with the patient’s participation, the one that is best

Consider criticism and alternative suggestions

The interpretive model

Dr acts as a friend, or counselor to the patientNot just by presenting informationBut in actively advocating a particular course

of actionIs commonly used by Drs hoping to modify

injurious behavior, to stop smoking, or lose weight.

The deliberative model

Patient-related factorsDr-related factorsThe interview setting

Factors which influence Dr-Patient Communication

Physical symptomsPsychological factorsPrevious experienceCurrent experience

Patient-related factors

Training in communication skillsSelf-confidence in ability to

communicatePersonalityPsychological factors

Dr. -related factors

PrivacyComfortable surroundingsAn appropriate seating arrangement

The interview setting

Doctors do more talking than listening.

Doctors often ignore the patient’s emotional health.

Doctors underestimate the amount of information patients want.

Doctors who can’t communicate are more likely to end up in court.

SOME ERRORES

As your doctor, I will sacrifice everything in my personal life in order to fix what is broken in you.

Trust MeTell Me EverythingForgive MeRespect the boundariesWith that said, will you please get undressed now? We only have 4 minutes left.

The Doctor-Patient RelationshipThe Old Medicine

It's All About Collaboration.I am here to support you, guide you, offer you tools, and support your process, but I will not "fix" you - for I don't believe you are broken.You Can Heal YourselfI believe you already have within you the power to heal yourself. When we meet, just I will hold up the mirror for you. I'm Not Blaming You

The Doctor-Patient RelationshipNew Medicine

We Are EqualsI accept that my time is not more valuable than yours. As doctor and patient, we will respect each other's time.I Believe In YouWe Must Be Honest With Each OtherI Am Only HumanI'm Doing The Best I Can, And So

Are You

Interview Styles

Is based on a descriptive model of psychiatric disorders called the medical model

The official model supported by APA and WHO

Codified in DSM-IV-TR and ICD-10

Disorder-Centered Interviewing Styles

Is based on the introspective model, which emphasizes the individuality of the patient's experience

This model attends to the intrapsychic battle of conflicts

It is sensitive to the patient's educational, emotional, intellectual, and social background, the personality, and the individual symptom

Patient-Centered Interviewing Styles