drjunewilliamscolsma : doctor-patient relationship and patient interview
TRANSCRIPT
Doctor-Patient Relationship and Initial
Patient Interview
Dr June Williams Colsman M.D. of Medicine
Some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.
Physician
Placebo Effect
Placebo Effect is a combination of a psychological expectation blended with a neuron chemical response that transforms an anticipated effect into a real effect
Placebo Response
At least 20-30 % of patients have been shown to respond to treatment with placeboPlacebo pain response can be blocked by naloxone which suggests it is mediated by the endogenous opioid system
Transference
Expectation, beliefs and emotional responses that the patient brings to the doctor-patient relationship based on important relationships in the patient’s past
Positive Transference
Patient views doctor as good and has confidence in his or her abilityCan lead to over idealization and tremendous disappointment when doctor can’t solve all problems or is not always available.
Negative Transference
Patient views doctor as harsh punitive parent or authoritative figure who doesn’t care about well being and patient may be non-compliant.
Patient with experience with untrustworthy parent may seek many consultations and may be provocative to doctors
Countertransference
Refers to doctor’s reaction towards patient based on their own earlier experienceDoctors can feel guilty when they are unable to help patientDoctor may have feelings towards patient who remind them of close relative or friend.
Models of Doctor Patient Relationship
Model Physic ian'sRole
Patient'sRole
Application Prototype
Activity-Passivity
AutocraticWarm/detachedDominant
Passive Critical care oracutePatient needsstrong figure
Parent-InfantParent-Child
Guidance-Cooperation
Warm/detachedMakes plansAdvisesInformative
Cooperatesbut may begivenchoices
Above but morelikely subacute,chronic care &minor illness
Parent-ChildParent-Adolescent
Mutual-Partic ipation
Usually warmDiscusses planInteractiveHelps patienthelp selfInterpretive
Patientusesexpert butis active inown careInteractive
Possible withmost of above-more likely inchronic careandpsychotherapy
Elements ofabove butmostlyAdult-Adult
Empathy
The ability to momentarily experience the the feelings of another person ( put yourself in another person’s place.Transiently experience feelings of the patient and use those feelings to gain understanding of the the patient’s subjective experienceCommunication of that understanding to the patient
Empathy -Components
Transiently experience feelings of the patient and use those feelings to gain understanding of the the patient’s subjective experienceCommunication of that understanding to the patient
Clinical Interview The Interview Process The Interview Process INE HRAA-VF- WAY5 To MAV WE mvF- WAY5TOMA14F- ~ WE RA.VF-
Clinical Interview
Be PoliteIntroduce yourself to patientMake the patient comfortableInitial Question-Invite the patient to tell you how he or she came to be in the hospital (chief complaint ).