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Unlocking Balint & the ‘Drug Doctor’. Courtesy of Emma Hardwick GPR 2008. Michael Balint. Why is he important?. The Doctor, his Patient and the Illness Understanding the physical, psychological, social aspects of the consultation Balint groups A doctor’s apostolic function
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Unlocking Balint & the ‘Drug Doctor’ Courtesy of Emma Hardwick GPR 2008
Why is he important? • The Doctor, his Patient and the Illness • Understanding the physical, psychological, social aspects of the consultation • Balint groups • A doctor’s apostolic function • An entry ticket • A hidden agenda • The collusion of anonymity • The “drug doctor” • The mutual investment fund
Work in pairs and discuss what you understand by these terms
A doctor’s apostolic function • An entry ticket • A hidden agenda • The collusion of anonymity • The “drug doctor” • Balint groups • The mutual investment fund
Mechanism of action You can help by being: • Supportive • Informative • Catalytic • Cathartic
Prescribing yourself as a drug Working in pairs consider the: • Indications • Dose • Side effects
Prescribing the Doctor – When? Potential indications – to help tackle/alleviate: • Multiple problems (often insoluble) • Multiple attendances • Multiple referrals to no avail • Multiple treatments (tried & failed) • Heart sinks • Persisting patient uncertainty or concern
Prescribing the Doctor – How? You have to utilise/explore: • Your advanced consultation skills • Active listening • Picking up and using cues • Building rapport • Empathy • Triangular thinking • Ideas Concerns and Expectations
Prescribing the doctor – common problems • If the doctor doesn’t realise they are the drug and therefore does not understand why the patient keeps re-attending • Time constraints (long and sometimes multiple consultations) • Differing agendas between patient & doctor
Prescribing the doctor – side effects • Encouraging doctor dependency • Transference – negative emotions engendered in the patient being transferred to the GP • Counter transference – negative emotions (expressed by the patient) are engendered in the GP and are reflected back by the GP to the patient
Summary • The doctor as a drug is a powerful tool • Be aware of when it can be effective • Utilise consultation skills to make the most of this therapy • Remember that there may be pitfalls for both patient and doctor
Balint Groups – The Bradford Way • A small group(6-12) • The material of the group is based on the presentation of current cases giving the clinician cause for thought • Not necessarily limited to problem cases but can include ones which have intrigued, interested, maybe disturbed • The purpose of the group is to increase understanding of the patient's problems, not to find solutions • The discussion focuses on the relationship between the presenting doctor and his patient
Balint Groups • Standard rules for small group working apply • The facilitator takes ultimate responsibility for trying to ensure that the group functions!
