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 ).