Lecture_1_Doctor/Pt. Relationship I_Caring for Pts./Caring for Self Flashcards
Disease vs. Illness
Disease:
A disruption in normal biological functioning. Objective. Clinician-centered interviewing. “How do we cure?”
Focus = Curing
Illness:
A sense of dis-ease. Subjective sense of feeling sick in some way. Reflected in mood, affect & behavior. More pt. focused interviewing. “How do we do the process of healing?”
Focus = healing
A particular patient can have both, or one without the other. Emphasis will be different in each case.
Definition of Health
Health is NOT the absence of disease, rather, it is a process by which others maintain:
- A sense that life is comprehensible, manageable, and meaningful
- The ability to function in the face of changes within themselves and their relationship with their environment
One can consider themselves healthy in the face of disease. Ex. w/pt. having healthy outlook on life in the face of ALS disease
What is “Behavioral Medicine”?
The interdisciplinary field concerned with the development and integration of behavioral, psycho-social, and bio-medical science knowledge and techniques relevant to the understanding of health and illness, and the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation.
Importance:
-25% of primary care visits are behavioral in some sense
-50% of patients w/chronic issues have psycho-social problems that come with their disease
Relationship between structure & function in behavioral medicine:
The role mental and social structures play in shaping healthy behavior and people’s responses to illness:
-structures: personality, family, and institutional systems, cultural values, and religious and spiritual belief systems.
Famous behavioral medicine quote by Sir William Osler:
“it is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”
- know the pt. AND the disease
- health is in the mind
Why is behavioral medicine a resource for both patients & physicians?
Understanding the developmental psychological, social, cultural, and spiritual dimensions of human behavior will help:
- understand the factors that drive human behavior
- engage the pt. as an active, co-collaborator in treatment
- select effective treatment interventions
- formulate preventive health programs
- relate to pts. at a “human” level
- avoid personal burn out
(the last two are related, according to research)
Cultural Humility: foundation for cultural competence
A lifelong process of self-reflection and self-critique
-NOT mastery of different beliefs/practices
Developing a “respectful partnership” with each pt. through:
- pt. focused interviewing
- exploring similarities/differences between one’s own and a pts’ priorities, goals & capacities
- appreciation for different worldviews hewn from lived experience
Key elements to monitor when caring for pts:
- “consensus trance”
- guiding values & attitudes
- transference & counter-transference
- empathy
Definition of Consensus Trance:
“The sleep of everyday life”
-the state of trance induced by the environment to which we have become accustomed.
Definitions of Guiding Values
For any difficult conversation to be fruitful, the ground must be prepared with intention and compassion, and certain values must be in place:
- a demonstrated commitment to quality care
- trustworthy & timely communication (do what you say you’ll do)
- heart-centered listening & truth-telling
- a lack of denial
- proactive, ongoing decision-making (no “kicking the can down the road”)
Definitions of Transference vs. Counter-transference
Transference:
-reactions the PT. has to the clinician. (“attraction, hatred, etc.”)
Counter-transference:
-reactions the CLINICIAN has to the pt. (“I hate this pt.”)
The goal is NOT “no emotional reactivity”
Rather, monitor expression AND be aware, recognize, and analyze each type in order to use the information to better understand the pt. and facilitate treatment.
Definition of Empathy
The capacity to think and feel yourself into the inner life of another person.
A recognition of self in the other.
-we are more alike than different
An expansion of self to include the other
-not just trying to take another’s perspective, but trying to “walk in their shoes”
Benefits of empathy on clinical practice:
The EFFECTIVE and SATISFYING practice of the art & science of medicine hinges as much on the ability to connect with the SUBJECTIVE experience of pts., as it does with the evaluation of OBJECTIVE data.
Empathy is the chief means we possess to understand (from the inside out) the subjective world & experience of another person.
-learn to recognize what the pts’ world is like from the inside-out
To relate empathetically w/pts, you have to be well grounded
5 factors from David Myers’ research on happiness that contribute most to happiness and well-being:
- work/leisure experiences that lead to flow: “getting in the zone”
- finding meaning/purpose in religion/spirituality
- having relationships that provide social support
- being physically healthy
- community service/helping others
It’s NOT about:
- how much $ you make
- what you do/career type
- ability/disability
- intelligence
- children/family type
- appearance, age, cultural background
Gratitude boosters that help build resiliency:
- gratitude journal
- acts of altruism/kindness
- learning to forgive
- investing time & energy in friends & family
- taking care of your body, & developing strategies of coping w/stress & hardships
- gratitude visits (intentionally meeting w/and telling someone how they’ve contributed to your life
