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Doctor-Patient Relationship and Initial Patient Interview. Michael Blumenfield, M.D. Professor of Psychiatry - NYMC Director of Medical Student Education in Psychiatry Director of C/L Psychiatry - Westchester Medical Center.
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Doctor-Patient Relationship and Initial Patient Interview Michael Blumenfield, M.D. Professor of Psychiatry - NYMC Director of Medical Student Education in Psychiatry Director of C/L Psychiatry - Westchester Medical Center
“...Some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.” Hippocrates Precepts, Chapter I
Placebo Effect • Placebo Effect is a combination of a psychological expectation blended with a neurochemical response that transforms an anticipated effect into a real effect
Placebo Effect • The Placebo Effect can positively or negatively effect pain, swelling, GI, CV, GU responses, mental state and side effects of treatment
Placebo Response • At least 20-30 % of patients have been shown to respond to treatment with placebo • Placebo 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 ability • Can lead to over idealization and tremendous disappointment when doctor can’t solve all problems or is not always available
Positive Transference • Idealization of the the doctor can lead to having sexual feelings toward the doctor
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
Negative Transference • 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 experience
Countertransference • Doctors can feel guilty when they are unable to help patient • Doctor may have feelings towards patient who remind them of close relative or friend • Doctor may minimize the severity of another physician’s illness
Empathy • The ability to momentarily experience the the feelings of another person ( put yourself in another person’s place)
Empathy -Components • Transiently experience feelings of the patient and use those feelings to gain understanding of the the patient’s subjective experience • Communication of that understanding to the patient
Empathy-Techniques of Learning • Intuitive - Reflect on emotions when with patient • Cognitive - Ask self how would I feel in patient’s situation • Cognitive- Relate to similar situation in own life ( ie. threat to you or a parent)
Empathy- Examples of empathic responses • You seem understandably upset with how things are going • It must have been very painful after the injury until you received pain medication • I am sorry (when learning of death of family member or friend of patient)
The Interview Process The Interview Process INE HRAA-VF- WAY5 To MAV WE mvF- WAY5TOMA14F- ~ WE RA.VF- Clinical Interview
Clinical Interview • Be Polite • Introduce yourself to patient • Make the patient comfortable • Initial Question-Invite the patient to tell you how he or she came to be in the hospital (chief complaint )
Clinical Interview • Listen to patient- Don’t interrupt patient especially at the beginning of the interview • Begin each topic with open ended question and close with detailed specific question
Clinical Interview • Pay attention to patient’s associations so you can return later to get more information • Be empathic- Respond to patient’s emotional reactions
Usual Order of Interview • Chief Complaint • History of Present Illness- • Elaborate all aspects of symptoms • Aggravating factors • Alleviating factors • Associated manifestations • Past Illness • Review of Systems
Usual Order of Interview • Mental Status Exam ( especially in psychiatric patients )
Doctor-Patient Relationship and Initial Patient Interview Michael Blumenfield, M.D. Professor of Psychiatry - NYMC Director of Medical Student Education in Psychiatry Director of C/L Psychiatry - Westchester Medical Center