Psych Ch. 1 Dr-Pt Relationships

Front 1

RAPPORT

Back 1

spontaneous, conscious feeling of harmonious responsiveness that promotes development of constructive therapeutic relationship.

Front 2

MODELS OF INTERACTION

Back 2

•Paternalistic
•Informative
•Interpretive
•Deliberative

Front 3

BARRIERS TO RAPPORT

Back 3

•Remaining cold, aloof, “technical”
•Overplaying the power differential
•Being defensive or suspicious of patients in general (i.e. lawsuits)
•Making the patient feel rushed – “next!”
•Dismissing their insights or observations
•Not answering questions
•Not apologizing & explaining a long wait

Front 4

Establishing rapport requires physician to understand the individual’s:

Back 4

- psychosocial & economic influences
- mental status & attitude towards being ill

Front 5

6 Strategies for Developing Rapport

Back 5

•Put patient and interviewer at ease.
•Find patient’s pain and express compassion.
•Evaluate patient’s insight & become an ally
•Show expertise
•Establish authority as physician
•Balance roles of listener, expert and authority

Front 6

What is the Power Differential?

Back 6

•Physicians are powerful
•Patients must trust dr.'s knowledge & power to get better

Front 7

FIVE STAGES OF PATIENT ROLE

Back 7

•Experience symptoms- “Something is wrong with me.”
•Acknowledge sick role- “I am sick and need help.”
•Seek professional help- enter system
•Allow dependency - Transfer control to doctor and follow treatment plan
•Recover/Rehabilitate - Give up pt. role

Front 8

FIVE STAGES OF PATIENT ROLE will be influenced by:

Back 8

•Personality
•Cultural beliefs
•Societal influences
•family Influences

Front 9

How are PATIENTs EMPOWERed by RELATIONSHIP-CENTERED CARE?

Back 9

•to be a partner in own diagnosis, treatment & cure
•trust & collaboration between doctor & patient
•patient will be forthcoming about symptoms & possible causes
•patient will understand own illness, its causes & possible treatments
•a frank understanding of disease course & prognosis

Front 10

WHAT BUILDS A STRONG DOCTOR-PATIENT RELATIONSHIP?

Back 10

when patient believes the dr. listened to & understood the description of the problem &
both agree on the nature of the problem

Front 11

3 Functions of the Medical Interview

Back 11

1. Determine nature of problem.
2. Develop & maintain therapeutic relationship.
3. Communicate info & implement treatment plan.

Front 12

What is the objective of determining the nature of the problem?

Obj: to enable the MD to establish dx

Back 12

to enable dr. to establish dx

Front 13

What skills are needed to determine the nature of the problem?

Back 13

1) knowledge base of diseases, disorders from multiple conceptual domains
2) ability to elicit data, encourage pt. to tell their story
3) ability to perceive data from multiple sources at multiple levels
4) hypotheses generation and testing
5) develop therapeutic relationship

Front 14

What is the objective of developing and maintaining a therapeutic relationship?

Back 14

1. pt. willingly provides information,
2. relief from distress,
3. Pt./dr. satisfaction

Front 15

What skills are needed to develop and maintain a therapeutic relationship?

Back 15

1) define nature of relationship
2) allow pt. to tell story
3) hearing, bearing, tolerating pt.’s expression of painful feelings
4) appropriate and genuine interest, empathy, support
5) attend to pt. embarrassment, shame, humiliation
6) elicit pt.’s perspective
7) determine the nature of problem
8) communicate information & recommend tx.

Front 16

What is the objective of communicating information and implementing a treatment plan?

Back 16

Pt. understanding of illness, procedures, tx possibilities, &
consensus about them,
informed consent,
improve coping mechanisms & lifestyle changes

Front 17

What skills are needed to communicate info & implement a treatment plan?

Back 17

1) determining nature of problem
2) developing therapeutic relationship
3) est. pt./dr. perspectives, education, clinical negotiation

Front 18

How does a PSYCHIATRIC INTERVIEW differ from a MED-SURG INTERVIEW?

Back 18

•Stigma
•Communication may be difficult (ex. cognitive disorder)
•May need to obtain info from others
•Increased emphasis on observations of behavior

Front 19

What are Specific interview Techniques?

Back 19

–Reflection
–Facilitation
–Confrontational
–Clarification
–Interpretation
–Summation
–Positive Reinforcement w/ Reassurance

Front 20

Reflection

Back 20

-Specific interview Technique
-repeating/paraphrasing what patient said, in supportive manner
•Assures that you (dr.) heard correctly
•Empathy- you are listening & concerned
•Example: “The pain started 5 days ago?”

Front 21

Facilitation

Back 21

-Specific interview Technique
•Uh-huh syndrome
–Be careful with this one
–May become unnecessary habit
–Example: “Tell me more about that”

Front 22

Confrontational

Back 22

•Substance Abuse - required for treatment to work
•Example: “You say you feel fine, but you look as if you’re having trouble breathing”

Front 23

Clarification

Back 23

•Just checking on data
•Works well when using Summation

Front 24

Interpretation

Back 24

•Making a connection for patient that s/he was not aware of at the time.

Front 25

Summation

Back 25

•Briefly summarize
•Demonstrates to patient you fully understand
•Example: “Let me review what you’ve told me to this point. Your back started hurting 2 days ago when you picked up the laundry basket. The pain is in your lower back, it hasn’t responded to over-the-counter medications, and it has been getting worse.”

Front 26

Positive Reinforcement with Reassurance

Back 26

•Provides hope for the patient
•Vital for successful therapy

Front 27

What are IMPORTANT ISSUES in interviewing?

Back 27

-Time Management
–Arrangement of office
–Taking notes

Front 28

There is a higher degree of non-compliance with:

Back 28

•Patients who are asymptomatic
•Psychiatric patients

Front 29

Define Compliance

Back 29

degree to which a patient carries out the clinical recommendations of the treating physician.

Front 30

How many pts generally comply w/ tx?

Back 30

In general:
•1/3 of all patients comply with tx
•1/3 sometimes comply with certain aspects of tx
•1/3 never comply

Front 31

How to increase compliance?

Back 31

•Increases w/ explanation, non-punitive attitude, & emphasis on value of treatment
•Dr.-Pt relationship is key