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When Patients Won’t Do What Their Doctors Tell Them To

Learn about the Balint Group method, a case-based approach to improve interaction and management of patient relationships, focusing on emotions and communication. Explore useful questions and real-life examples.

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When Patients Won’t Do What Their Doctors Tell Them To

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  1. When Patients Won’t Do What Their Doctors Tell Them To Johanna Shapiro, Ph.D. Family Medicine Residency April, 2009

  2. Definition of a Balint Group 1) Case-based presentation 2) in a peer-group setting, 3) focusing on the doctor-patient relationship and 4) the patient as a person in order to 5) improve interaction with, 6) management of, and 7) physician feelings about the patient

  3. Useful Balint Questions • What’s going on here? • What’s the doctor feeling? • What’s the patient feeling? • How would you be feeling? • What’s causing these feelings? • What’s happening between doctor and patient? • What’s another way of looking at this situation? • What might be done differently?

  4. Walking the Dog – John Wright, M.D. She weighed Walking the dog Three hundred pounds. twice a day Fat and high sugars I thought were killing her might persuade, I thought. might motivate. So, She was pleased I thought. with my prescription So, she laughed, she rocked I gave her a puppy from side to side. with dark curly hair, nothing else had worked

  5. Reflection • What is this doctor feeling? • How do you feel about “noncompliant” patients? • What does this doctor do in response to his feelings? • What are some examples of your own “out-of-the-box” interventions with patients?

  6. She lived for twelve years hugging that little black dog While her lean husband walked it faithfully, twice a day.

  7. Reflection II • Do you think the intervention is a success or a failure? • What aspects were unsuccessful? • What aspects were successful? • What can you do when the patient does not follow your advice? • “Noncompliance” a starting, not an ending, point • What lies behind the pt’s resistance? • Use self – express frustration, concern • Let the patient do the problem-solving • Negotiate, compromise • Retreat, but never abandon

  8. Relationship-Centered Care • Personhood • Awareness of emotions • Acknowledgment of emotions • Relationship/communication is not always predictable, controllable • Openness to introducing/responding to novelty • Engagement/connection with patient

  9. Examples of Relationship-Centered Care • Personhood • Physician • Patient • Awareness of emotions • Physician – frustration; appreciation; humility • Patient – humor, appreciation • Power • Physician – authoritative expertise • Patient – exercise of power through • Resistance to compliance • Relationship to puppy

  10. Examples ofRelationship-Centered Care • Relationship/communication is not always predictable, controllable • “Telling,” “patient education” do not produce the desired outcome • Openness to introducing and responding to novelty (puppy; patient interaction with puppy) • Engagement/connection with patient • Physician resists emotional strategies of distance, detachment • Physician does not abandon patient • Physician appreciates the relationship in all its complexity

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