DOCTOR-PATIENT RELATIONSHIP

dr.Manoe Bernd P, SpKJ. MKes

Refference
Kaplan, HI. Sadock, BJ: The doctor-patient relationship and interviewing
techniques. In Synopsis of Psychiatry behavioral sciences/clinical
psychiatry, ed 8, Williams&Wilkins, Baltimore. p:1-3, 5-6

 Medical Situation
 Situation related to the effort and process of treating a disease
 Rapport, the relationship of the doctor and the patient
 Core of medical practice
 Influence the effort and process of treatment
 doctor→ a sick person ( not just “a sick person”)
 Good rapport :
 Spontaneous team work
 Conscious
 Compatible
 Constructive → mutual understanding & trust
 George Engel
Integrated biopsychosocial approach to human behavior and
disease
 Biological
 Anatomical, structural, molecular substrate of disease & it s iffects ofn the
patient biological functioning
 Psychological
 Effects of psychodynamic factors, motivations & personality on the experience
of illness & the reaction to it
 Social
 Emphasize cultural, environmentall & familial influences on the expression &
the experience of illness
↓
comprehensive understanding of disease and treatment

Illness Behavior & Sick Role

Affected by previous experience with illness, psychological
factors & cultural background
Illness Behavior
 Patient’s reaction to the experience of being sick
 5 stages (Edward Suchman)
1. Symptom experience
2. Assumption of the sick role
3. Medical care contact
4. Dependent-Patient role
5. Recovery, rehabilitation

Sick role
The role that society ascribes to the sick person
(excused from certain responsibilities, expected to
obtain help to get well)
 Models of the Doctor-Patient
Relationship
Influence by personalities, expectations & needs of the
doctor & the patient
↓
Unspoken Difference
↓
Miscommunication & Disappointment
↓
Flexible → Needs of patient & treatment
requirements

Doctor-Patient Relationship (Continued…)

1. Active-Passive
 The patient fully passive & the doctor taking over totally the patient care
& treatment
2. Teacher-Student
 Doctor: dominant → paternalistic, controlling
 Patient: dependence, acceptance (recovery from surgery)
3. Mutual Participation
 Both doctor & Patient require and depend on each other’s input
 Active participation of the patient is needed (chronic illness)
 Doctor-Patient Relationship (Continued…)
4. Friendship / Socially intimate
 Dysfunctional, unethical
Underlying psychological problem in the
physician → relation with the patient is a
substite for another broken relationship

 Some characteristics of good doctor-patient relationship

 Acceptance
 Honesty
 Empathy
 Trust
 Some obstacles
 Sympathy
 Transference
 Counter Transference
 PSYCHIATRIC EXAMINATION
HETEROANAMNESTIC :
 CHIEF COMPLAINT
 HISTORY OF PRESENT ILLNESS
 HISTORY OF PAST ILLNESSES
 FAMILY HISTORY
 PATIENT HISTORY ( PREGNANCY - OLD AGE )
 OCCUPATIONAL HISTORY
 MARITAL HISTORY
 OTHERS ( MILITARY EXPERIENCE, LAW VIOLATION, ETC )
 PERSONALITY ( INITIATIVE, INTELECTUAL ACTIVITY,
FANTASY LIFE, PSYCHOSEXUAL LIFE, EMOTIONAL LIFE,
CONCEPT OF LIFE, SOCIAL RELATIONSHIPS, HABITS )

AUTOANAMNESTIC :

 FIRST IMPRESSION ( EXPRESSION, ATTITUDE, DECORUM )

 CHIEF COMPLAINT ( ACCORDING TO THE PATIENT )
 DISTURBANCE OF ORIENTATION, PERCEPTION, MEMORY,
THOUGHT, EMOTION, SPEECH &BEHAVIOR)

RESUME OF PSYCHIATRIC EXAMINATION

OTHERS :
- LAB. RESULTS
- PSYCHODYNAMICS
- DIAGNOSIS & DD/
- TREATMENT
- PROGNOSIS (AD VITAM & AD FUNCTIONAM )
End of Slides