Professional Documents
Culture Documents
Characteristic features[edit]
A fantasy prone person is reported to spend a large portion of their time fantasizing, have vividly
intense fantasies[5] People with FPP are reported to spend over half of their time awake fantasizing
or daydreaming and will often confuse or mix their fantasies with their real memories. They also
report out-of-body experiences.[5]
A paracosm is an extremely detailed and structured fantasy world often created by extreme or
compulsive fantasizers.[6]
Wilson and Barber listed numerous characteristics in their pioneer study, which have been clarified
and amplified in later studies.[7][8] These characteristics include some or many of the following
experiences:
What is maladaptive
daydreaming?
Maladaptive daydreaming is a psychiatric condition. It was identified by
Professor Eliezer Somer of the University of Haifa in Israel.
This condition causes intense daydreaming that distracts a person from their
real life. Many times, real-life events trigger day dreams. These events can
include:
topics of conversation
sensory stimuli such as noises or smells
physical experiences
This disorder is not part of the new edition of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-V). It doesn’t have any official treatment.
But some experts say it is a real disorder that can have real effects on a
person’s daily life.
The MDS is a 14-part scale. It rates the five key characteristics of maladaptive
daydreaming:
It’s not yet understood how these disorders are related to maladaptive
daydreaming.
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Compassion
Understanding
What does this mean for you and your patients? You want your patients to understand
your recommendations, understand how and when to take a medicine, as well as its
benefits and side effects, or understand what's involved in a certain procedure and its
potential outcomes. In other words, you want your patients to not only have the
knowledge, but to be able to act and make decisions based on that knowledge.
Now switch places with your patient. They want you to appreciate their knowledge, and
to be able to act on it accordingly. When you think about it that way, how well do you
truly understand what your patient is trying to tell you?
Empathy
Empathic nonverbal cues vs unempathic ones. (Photo: Kraft-Todd GT, et al; CC BY 4.0)
In simple terms, empathy comes across as warmth. In more scholarly terms, empathy is
"a social-emotional ability having two distinct components: one affective: the ability to
share the emotions of others, and one cognitive: the ability to understand the emotions
of others," according to authors of a recent paper on the subject.
There's some thought that patients may believe that doctors who show warmth are less
knowledgeable or less competent, and thus these doctors face a trade-off between
being perceived as competent or as empathetic. But the authors found just the opposite
in their study. Doctors who displayed empathic nonverbal behavior—such as eye
contact, smiling, and uncrossed arms—were perceived as both warmer and more
competent.
"Our findings might reflect a changing concept of the role of doctors in our society. No
longer are they judged solely on their technical competence—that is, their ability to
perform medical procedures. Rather they may increasingly be judged on
their interpersonal competence—that is, their ability to navigate the difficult social
interactions inherent in managing patients' illness and wellness," wrote study author
Gordon T. Kraft-Todd in a Scientific American blog.
Honesty
Being honest with patients should be straightforward—just part of the routine. It's right
there in the American Medical Association's Code of Medical Ethics.
Unfortunately, modern medicine can lead physicians into gray areas, in which the most
helpful thing to say might not be the most truthful thing. In fact, one-fifth of physicians
said that fudging the truth is not necessarily out of bounds, according to a 2012
nationwide survey of nearly 1,900 practicing physicians. More than 1 in 10 admitted
they had told patients something untrue within the previous year.
"Some physicians might not tell patients the full truth, to avoid upsetting them or causing
them to lose hope," the survey authors wrote. However, "studies of communication with
gravely ill patients show that patients prefer honest and accurate information, delivered
with empathy and understanding by clinicians, even when prognoses are dire."
In short, honesty is still usually the best policy when communicating with patients,
especially if you convey it with genuine care and concern.
Competence
"In measuring doctor quality, we might focus on 'soft' skills like empathy, which we can
measure through patient experience surveys," Dr. Jha wrote. "But we also have to focus
on intellectual skills, such as [the] ability to make difficult diagnoses and emotional
intelligence, such as the ability to collaborate and effectively lead teams—and we don't
really measure these things at all, erroneously assuming that all clinicians have them."
Caring is essential to be a good doctor, Dr. Jha indicated, but providing good care
means keeping abreast of the best care to provide.
Commitment
You're probably a physician who's committed to your profession, to your patients, and to
continued self-improvement. That's good news because doctors who are committed—
who feel that the profession of medicine is not just a job but a calling—may be less
likely to experience burnout.
In short, if you're feeling distancing coming on, get some help and you may be able to
restore your sense of calling.
Humanity
Sir William Osler said, "The good physician treats the disease; the great physician treats
the patient who has the disease." Surely, some mentor in medical school told you much
the same thing: "Treat the patient, not the disease."
One of the conclusions in The BMJ survey cited at the beginning of this article: "To be a
good doctor, you first have to be a good human being: 'a good spouse, a good
colleague, a good customer at the supermarket, a good driver on the road.'"
Also, the authors noted, it's easier to be a good doctor if you like people and genuinely
want to help them. One respondent wrote: "To like other people, from this all else
follows. Liking your patients will get you through the grind and tedium of your working
day, and patient contact will be a source of strength and renewal. You may even do
some good."
Courage
Nelson Mandela said, "I learned that courage was not the absence of fear, but the
triumph over it."
The term frequently used in medicine is moral courage. "Moral courage can be defined
as the voluntary willingness to stand up for and act on one's ethical beliefs despite
barriers that may inhibit the ability to proceed toward right action. Such courage is
critical to physicians' commitment to act in the best interest of patients," wrote authors in
an article about measuring moral courage.
"Physicians commonly face situations that call for moral courage, including delivering
care to an infectious patient, meeting an angry patient or family member, addressing an
incompetent or impaired colleague, disclosing a medical error, and raising concerns
about unethical or unsafe practices," the authors wrote.
Don't be discouraged if you can't always meet these high expectations. Remember that
courage isn't always the act of trying to do what is right, but sometimes just the act of
trying again.
Respect
Do you give your patients the respect they deserve? "Patients are generally aware of
how much their physician respects them. Physicians who have respect for particular
patients provide more information and have a more positive affect in visits with those
patients," according to a study
Physicians reported higher levels of respect for older patients and for patients they
knew well, researchers found. However, "the level of respect that physicians reported
for individual patients was not significantly associated with that patient's gender, race,
education, or health status," they observed.
The researchers recommended that physicians remain aware of how their feelings
might impact their behavior as perceived by patients. "It might be tempting for
physicians to think that their behaviors are not influenced by how they view or feel about
patients. Our results suggest that ignoring this association may negatively impact
patients," the study authors wrote.
"MDs no longer get the same respect as we used to," said an internist in an MDLinx
survey earlier this year. Still, 76% of respondents reported being very or somewhat
satisfied with the social status of physicians in the United States.
Do you inspire your patients with optimism? Generally speaking, patients who are more
optimistic tend to have better health outcomes. Optimism has been linked with a range
of physical health benefits, from reduced risk for cardiovascular disease and stroke to
healthier levels of antioxidants and lipids. Optimism is also associated with healthier
behaviors—optimists are more likely to exercise, eat more healthily, manage stress
better, and abstain from smoking.
Fortunately, optimism can be learned and shaped by social influences, to some extent.
Patients who have an optimistic spouse, for example, tend to have better health than
patients who don't.
If nothing else, most patients would prefer a bad diagnosis to be delivered with at least
a hint of hope. One meta-analysis concluded that the majority of patients with terminal
illnesses and their caregivers want physicians to be honest when discussing prognosis
and end-of-life issues. "However, there are different views of what constitutes an honest
approach, with some desiring a straightforward or direct approach, others desiring
accurate information but without bluntness or too much hard, factual, or detailed
information, and still others desiring a combination of honesty and optimism," the
authors wrote. Many patients and caregivers identified this combination of honesty with
sensitivity and empathy as "hope giving."
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