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Dr Andrew Tresidder MBBS MRCGP

Learn how to maintain professional detachment in consultations by understanding the Drama Triangle dynamics and implementing the Five Agreements for effective communication and change.

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Dr Andrew Tresidder MBBS MRCGP

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  1. The Drama Triangle and the Five Agreements – Helping Maintain Professional Detachment in the Consultation Dr Andrew Tresidder MBBS MRCGP

  2. Relationships – the Solihull Triangle • A model for achieving effective communication and change • Containment • Reciprocity • Behavioural management • 1 Safety, trust and rapport • 2 A dialogue • 3 Support to change

  3. Anatomy of a complaint • Story – Andrew, new patient, prescription request ‘just a quick one, doc, I know you’re running late…’ • Observed by medical student • Why was he unhappy?

  4. Complaints • Usually about facts (or misconceptions) – which may be major, or minor • Always about feelings

  5. The Seat of Power • Every profession is a conspiracy against the layman, said George Bernard Shaw in ‘The Doctor’s Dilemma’

  6. The Consultation Two people approach a consultation, both independent adults. However, the expert knowledge lies with the professional. The layman (the patient), through ignorance or fear/anxiety, may give away his power of autonomy. This power must be handed back at the end, to ensure a tidy ending

  7. ‘Stuff’ in the Consultation • Three dynamics • 1 the patient’s stuff • 2 joint stuff • 3 my stuff • My stuff is my responsibility • Responsibility = ability to choose our response

  8. Transactional Analysis • Parent Parent • Adult Adult • Child Child

  9. The Drama Triangle • 3 roles – 1 Child and two Parents • The Child can give away their power - to a parent, and can play Victim, playing the script “If you help me / save me / protect me, I will give you my power”. • The Parent takes the power and becomes Rescuer “If you give me your power, I will protect and help you”

  10. The Drama Triangle • Victim • Rescuer Persecutor

  11. The Drama TriangleSometimes hidden agreements • Doctor as Parent – Patient as Child – I will take care of you and use my skill to help you • If……. • You agree to approve of me and give me respect (Doctor as Child needing patient as parent –many of us doctors are Little Pleasers)

  12. The Drama Triangle • Win –win? • Win – lose? • Lose – win? • Lose – lose?

  13. Exercise • In pairs, please study the scenarios • One person play physician role, the other the patient role • Five minutes to ‘consult’ • Then we will discuss

  14. Resolving the Drama Triangle • Be authentic – be true to yourself • To Thine Own Self Be True (Shakespeare) • “Try to treat others as you would wish to be treated yourself”- the number one rule at Her Majesty’s Prison Guy’s Marsh, Dorset, UK • Try to keep to the Four Agreements

  15. The Five Agreements • Be Impeccable with Your Word • Take Nothing Personally • Make No Assumptions • Always Do Your Best • Be Sceptical – but Learn to Listen

  16. The Drama Triangle • References • Karpman, S. (1968). Fairy tales and script drama analysis. Transactional Analysis Bulletin, 7(26), 39-43 http://karpmandramatriangle.com/dt_article_only.html, • Edwards, Gill. Conscious Medicine, Piatkus 2010, pp130-133 • The Four Agreements, Don Miguel Ruiz, Amber-Allen Publishing • The Five Agreements, same author • Games People Play, Eric Berne, 1964 Thankyou for your participation!

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