Doctor-patient Relationship Flashcards
What is the most important factor in MD-patient relationship?
Ability to convey intrinsic interest esp in the initial encounter
It is the primary therapeutic instrument:
Doctor
The primary therapeutic focus:
Patient
3 ways of MD’s attitude towards patient:
Must identify with patient
Must be humble, caring & respectful
Believes the patient will teach him something
Aspects of MD-patient relationship, based on patient’s unconscious & conscious desires and to cooperate w/ therapist’s efforts to help him are under what?
Therapeutic alliance
The type of relationship that focuses on needs of both parties:
Social
Relationship when MD directs his clinical skills & experience towards evaluation & treatment of px’s problem:
Professional
Refers to the forces within the patient and the conscious/unconscious which opposes the purpose & goals of the therapeutic process:
Resistance
Give examples of resistance:
Tardiness Floor staring Avoid looking at therapist Hiding behind hands Sitting stiffly Not moving at all or moving incessantly Announcing that he has nothing to say
When the feelings are displaced onto therapist from unconscious representations of people important to the Px early in his childhood.
Transference
Feelings towards the therapist may be based on:
Two-fold bases
Reality
Transference
What the Px representa to therapist’s unconscious in terms of early significant figures:
Countertransference
The feeling towards the Px that stems from Px’s appearance, personality & character conflicts.
Reality
It is counterproductive, may be dehumanizing and is a confusing form of resistance:
Jargon & humor
The impediments to listening:
Anxiety Fatigue Impatience Inattentiveness Restlessness Daydreaming
4 MD-Px models:
Active-passive
Teacher-student
Mutual participation
Friendship model
The model that is dysfunctional and reflects psych problem in MD.
Friendship model
Model when the MD is taking control & Px is completely passive.
Active-passive
Model when the MD is paternalisitic and the Px is dependent & accepting:
Teacher-student
Model that shows equality, in which MD and Px require & depend on each other’s input:
Mutual participationt
T or F:In effective listening, one should avoid subtle verbal or non verbal expressions of disdain or judgement of Ox’s story even when content affects therapist’s sensibilities.
TRUE
T or F: The psychiatric and medical interview should be a systematic survey of subjective & objective aspect of illness.
TRUE
Other aspects of psychiatric interview are wide range of biological & psychosocial data, emotional rxns of the patient and interaction between Px and interviewer. Do these apply to medical interview as well?
No (medical interview is simply a systematic survey of subjective & objective aspect of illness)
Factors that may affect the interview:
Px's physical or emotional distress Cognitive capacities of Px Emotionally based biases of interviewer Situational factors Racial, ethnic & cultural factors
When asking for childhood and adulthood aspects such as educ history, relationship, social & sexual history, religion, you are asking about?
Personal history
Alcohol and drugs is under what history?
Psychiatric history
The psychiatric database involves:
Identifying data Chief complaint Reason for consultation History of present illness Psychiatry history Medical history Family history Personal history
Examples of MD’s emotional resources:
Intrinsic desire to help Ability to relate warmly Respect for self & others Value for human life Philosophy of life
Confidence, tolerance of perplexity, empathy, attitude towards sickness, sensitivity to suffering & ability to reorganize & confront different feelings are aspects of what?
MD’s emotional resources & standards of conduct
It is the matrix of the healing relationship:
Doctor-patient relationship
