Doctor-Patient Communication

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  1. Psychiatric Patient Help Seeking
    Stigma attached

    • -Moral weakness
    • -Lack of self-control
    • -Punishment for wrong-doing
    • Strong correlation between psychological
    • illness and physical illness
  2. Most
    malpractice claims occur because
    • because
    • the physician did not discuss problems with the pt and listen to the pt’s side
    • of the issue
  3. Transference Reactions, definition
    • Pt unconsciously attributing to physician aspects of importance from previous
    • relationships, especially those with parents or other authority figures
    • Positive and negative 
    • -Transference reactions can swing back and
    • forth from positive to negative**
  4. how Transference Reactions
    • -The longer and more involved the interaction, the more likely that transference
    • reactions occur
    • -The more psychologically disturbed the
    • pt, the more likely that transference reactions occur
    • -Things said by physicians may
    • be treated as much more important than from other people
  5. what is Counter-transference
    • Physician’s
    • reactions toward patients
    •    Can be mild like stereotyping someone when they walk in but seeing them as an
    • individual after a few minutes.  

    • Can result medical errors and/or medical
    • negligence in assessing the severity of illness or by not taking the time to
    • make an accurate diagnosis
  6. Necessary Conditions for Rapport –
    Therapeutic Alliance
    • The patient must PERCEIVE that the Dr is 
    • -genuine 
    • -has Unconditional positive regards 
    • -has Empathy
  7. Beginning the Interview
    • -Show interest in them
    • -Show respect
    • -Put them at ease
    • -Introduce yourself and use their name
    • -Start with an open question
  8. Interviewing techniques
    • -Open-ended questions
    • -Closed/Direct Questions 
    • -Clarification 
    • -Reflection– repeat or paraphrase patient’s statement
    • -Facilitation – encourage pt to elaborate on an answer
    • -Silence
    • -Confrontation/Challenge – call the pt’s attention to inconsistencies in
    • responses or body language
    • -Interpretation– stating something the pt may not be aware of
    • -Summation 
    • -Explanation
    • -Transition– moving to another subject because you have enough on the current subject
    • -Self-revelation/self-disclosure
    • -Positive Reinforcement 
    • -Validation – normalizing the pt’s experience
    • -Reassurance/Support – expresses interest
    • and concern
    • -Advice
  9. Ending the Interview
    • Use summarization
    • Patients usually remember best the first
    • and last things they hear

    • Put instructions in writing for best
    • adherence

    • If pt was given bad or shocking news, check
    • how they are doing, what they heard, and if they have some support resources
  10. Models of Interaction
    • -between Physician& Patinet:Paternalistic Model (Autocratic Model)
    • -Informative Model :Dr dispenses information
    • -Interpretive Model: Doctors know pt and something about their families, lives, etc., Shared decision-making
    • -Deliberative Model: Acts as a friend or counselor to the patient

  11. How to deal with Problem Patients

    -Calm, reassuring, accepting

    -Adeptly deflecting seductive advances
  12. How to deal with Problem Patients

    -Firm in establishing limits

    -Reassuring that needs are taken seriously
  13. How to deal with Problem Patients

    • -Setting limits
    • -Define appropriate and unacceptable behavior
    • -Treat with respect and care
    • -Help become responsible for their actions
  14. How to deal with Problem Patients

    Narcissistic خودشیفتگی
    • -Understand that arrogance is surface and that underneath, they feel inadequate and fear
    • that you will see through them
    • -Calm, even-tempered, understanding, non-defensive
    • -Build trust
  15. How to deal with Problem Patients

    • -Maintain respectful, non-defensive, formal approach
    • -Expressions of warmth may heighten suspicions
    • -Explain in detail every decision, planned procedure
  16. How to deal with Problem Patients

    • -Respect for privacy as appropriate
    • -More formal
  17. How to deal with Problem Patients

    • -Include them in own care
    • -Explain in detail
    • -Give choices
  18. How to deal with Problem Patients

    • -Do not encourage sick role
    • -Take complaints seriously
    • -Firm limits on availability
    • -Frequent, regularly scheduled appts
    • -May need to deal with family
  19. How to deal with Problem Patients

    • -Treat with respect
    • -Heightened sense of vigilance for malingering
    • -if violent, don’t see pt alone
    • -Firm limits on behavior and clear consequences stated up front
    • -Confront inappropriate behavior
Card Set:
Doctor-Patient Communication
2013-09-02 13:17:07

Doctor-Patient Communication
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