Dpr: Final Wk 11-12

Front 1

I am sorry can be potentially problematic for physicians for four reasons:

Back 1

i) Confusion with sympathy or even pity
ii) Shortcutting a deeper understanding
iii) Confusion with apologies
iv) It is changing the subject from the patient and family to physician.

Front 2

“I wish” expression of sympathy

Back 2

i) Physicians use it to align themselves with the patient and family. It allows the physician to be a on the same side with the patient/family and explore a deeper conversation.

Front 3

What are the patient interactive styles?

Back 3

1. Dependant/demanding
2. Orderly/controlled
3. Dramatic
4. Masochistic
5. Paranoid
6. Superior

Front 4

Dependent/demanding

Back 4

you are the only physician who has ever understood him or her.

i) Need special attention, massive reassurance, constant advice therefore:
(1) Specify limits of your contract with the patient
(2) Avoid making promises that you cannot keep
(3) Emphasize patient responsibility.
(4) Remind patient that time is limited
(5) Do not take credit for remission in the patient’s symptoms, because you will likely to be blamed for a relapse.

Front 5

Dramatic

Back 5

"The pain is the worst pain I have ever had”

i) Take a thorough clinical history in a respectful atmosphere while demonstrating that you are in charge.
ii) Focus on the how, not the why.
iii) Redirect inappropriate or uncomfortable questions
iv) Identify the strengths and feed them back

Front 6

Orderly/controlled

Back 6

punctual, take meds regularly, preoccupied with right and wrong answers

i) Take and orderly and systematic approach to the clinical interview providing frequent road markers.
ii) Explain things in detail
iii) Don’t leave any loose ends.
iv) Explain the purpose of each maneuver
v) Summarize frequently
vi) Take notes to indicate interest and thoroughness.
vii) Avoid mentioning any vague hypothesis, unusual aspects.
viii) If you don’t know, say so and plan a way to get the answer.

Front 7

Masochistic

Back 7

patient seem to be rejecting help as they present a history of continual suffering from disease, disappointment and other adversity.

i) Accept the patient’s pessimism with a descriptive statement: e.g. It sounds as though you don’t think there is much hope of getting better”

Front 8

Paranoid/Guarded

Back 8

patient is suspicious of health care professionals

i) Make a provocative statement and make sure not to contradict, argue or try to convince the patient otherwise.
ii) Don’t ignore patient’s suspicious attitudes.
iii) Check your understanding of the patient’s beliefs while indicating that you do not necessarily agree with them.

Front 9

Superior

Back 9

self-confidently, may appear smug, vain or even grandiose.
i) Acknowledge the patient’s point of view and avoid temptation to argue.