BEHAVIORAL SCIENCES – DR.

SANAARIF Lecture 9
8/24/2023 LECTURE 1 1
REVIEW OF LAST LECTURE
Common Ethical issues
Common Ethical Dilemmas in a doctor’s life
Rights and Responsibilities of Patients and Doctors
LECTURE OUTLINE
Doctor-Patient relationship
Reactions in Doctor-Patient relationship
Professionalism in Health care
Professional character development
Assessment of attitude
DOCTOR-PATIENT
RELATIONSHIP
It is the capacity of the doctor to appreciate the
complexity of human behavior, his ability to
empathize, his skills of active listening, effective
verbal and non verbal communication.
A DOCTOR MUST BE
Sensitive to the effects of history ,culture, and
environment on his patients.
Trustworthy
Unconditional positive regards
 FORMS/MODELS OF
DOCTOR-PATIENT RELATIONSHIP

1. Vertical model
2. Teacher-Student model
3. Horizontal model
 1.VERTICAL MODEL
❖Where the doctor completely takes over the
process of care with no role of patient.
e.g.
When patient is unconscious, immobilized or
altered state of conscious.
 2.TEACHER-STUDENT
MODEL
❖Doctor plays the similar role as the authority figure
(teacher or parent), who dominates, controls and
guide the patient.
e.g.
A patient who is recovering from surgical
intervention
3.HORIZONTAL MODEL

❖Also called Mutual Participation, doctor and

patient behave as partner in the process of
healing and care. Patient fully aware and
informed and plays an active role in treatment
process.
e.g.
A patient with diabetes and renal failure on
dialysis are active partners in management
process.
 DANGER IN
DOCTOR-PATIENT
RELATIONSHIP
These models or bonding are good to some extent but not on
the base of friendship, sympathy.
1. Doctors fanaticizing that only they can rescue the patient from all the troubles of the
world.
2. An enthusiastic medical student handing over financial and material help or seeking the
same. Both are unethical.
2. The doctor’s inability to leave behind the distress and
problems of patients when away from clinical setting.
3. A need to control everything in life of patient and try to
prevent death which is not possible in all cases.
4. A doctor visualizing his/her own troubles and complexes in
patients.e.g. dr having disturbed relationship with father.
5. The doctor may start to pass value judgements or become
judgmental in his relationship with patient.
PSYCHOLOGICAL
REACTIONS IN
DOCTOR-PATIENT
RELATIONSHIP
1. Transference
2. Counter-transference
3. Resistance
4. Social bonding
5. Dependence
6. Physician Burnout
 TRANSFERENCE
“ A type of a reaction in which redirection of
client’s feelings from a significant person to a
therapist”
Desires and wishes originally linked with an
important figure in patient’s early life.
e.g. mother, father or someone that patient close
too.
 If an adult patient in the medical ward want to
be examined by one particular doctor, feels that
the same doctor comes to his bed 1st and wants to
spend longer time in the company of
the same doctor . It may be on an account for
paternal transference.
 Counter-transference

❖A type of reaction in which the emotional responses of

the doctor are directed towards the patient in the form
of his or her own needs, desires and feelings.

Patient in such situations remind the doctor of

a well-loved or hated from the past.
 E.g.
A young doctor during his housejob was
found to spend long hours in the care of a 60
years patient with hemiplegia.
Reason the young doctor had failed to look
after his father who died of stroke many years
ago.
 HOW TO DEAL?
1. Never make the statement “you remind of my
mother”. So have the constant awareness of the
2 phenomenon.

2. If this doesn’t work then its better to shift the

care of the patient to an experienced colleague.
RESISTANCE
This reaction involves the patients who
constantly defy the prohibitions by the doctor in
spite of repeated warnings of serious
consequences.
 E.g.
A patient of coronary artery disease who in
spite of regular advice from the doctor, refuses to
give up smoking, eats red meat regularly.

So this is the resistance in doctor-patient

relationship
 PROFESSIONALISM IN HEALTH
CARE
A healthy doctor-patient relationship is
dependent on the professional standards and excellence
of a doctor. This is based on

❑ Knowledge

❑ Skills

❑ Attitudes
 KNOWLEDGE
a. Distinguish normality from abnormality in the
light of not only medical terms but also from a
social and psychological perspective
b. Relate biological factors with psychosocial
factors in health and disease.
c. Use principles of behavior sciences in clinical
interviews, assessments and management plans.
d. Request not only laboratory, radiological
investigations but also make social and
psychological inquiries
e. Use pharmacological as well as non
pharmacological interventions.
f. Apply evidence base to clinical situations.
 SKILLS
❑ Written communication skills
❑ Verbal communication skills
❑ Patient management skills
❑ Skills in research
WRITTEN
COMMUNICATION SKILLS
Write comprehensive history of the patient.
Update medical records in clear, concise and
accurate manner.
Write management plans, discharge summarizes
and referral notes.
Demonstrate competence in medical writing.
 VERBAL COMMUNICATION
SKILLS
1. Establish professional relationship with patients
in order to obtain a history, conduct a physical
examination and provide appropriate
management.
2. Demonstrate usage of appropriate language in
e-communication, seminars, bedside sessions, out
patients and other work situations.
3. Demonstrate the ability to communicate clearly,
considerably, and sensitively with patients.
4. Provide information care and counsel patients.
5. Use principles of effective communication skills.
PATIENT MANAGEMENT
SKILLS
Interpret and integrate the history and examination findings
and arrive at an appropriate differential diagnosis and final
diagnosis.
Demonstrate competence in problem identification, analysis and
management of the problem at hand by the use of appropriate
resources, and interpretation of investigation result.
Prioritize clinical problems for the start of intervention.
Use evidence-based pharmacological and
non-pharmacological intervention.
Independently undertake counselling and
information care sessions.
Skills in research
Undertake literature search and collect evidence
based medicine and standard guidelines for use in
clinical practice.
CONT…

Interpret and use results of only peer reviewed and

standard articles to improve clinical practice.
Organize and actively participate in educational,
training and research activities.
 ATTITUDES
❑ Towards patients
❑ Towards self development
❑ Towards society
ATTITUDE TOWARDS
THE PATIENT
Establish therapeutic and ethical relationship with all
patients.
Demonstrate commitment to BPS model in the assessment
and management of patient.
Demonstrate sensitivity, empathy and understanding while
performing physical and mental state examination.
Demonstrate the ability to work as a team member and
leader.
 Consistently show consideration of the interest of the
patient and community paramount and always above
personal interest.
Adhere to the principles of medical ethics under all
circumstances.
Exhibit highest standards of professionalism through the
practice of integrity, respect for patient, colleagues,
seniors and juniors
ATTITUDE TOWARDS SELF
DEVELOPMENT

Demonstrate consistent respect for every human

being irrespective of the ethnic background,
culture, religion and socioeconomic status.
Deal with the patient in a non discriminatory and
prejudice free manner.
Deal with patients with honesty, equity and compassion.
Demonstrate flexibility and willingness to adjust to
the changing circumstances.
Foster the habit and principles of self education in
order to constantly update and refresh knowledge
as a commitment to the continuing education.
Recognize stress in self and others.
Deal with stress and support medical colleagues
or patients constantly.
 Handle self criticism or criticism by patients and
colleagues.
nd
Obtain and value the 2 opinion on clinical matter.
Demonstrate effectiveness as a member of the team,
as well as a leader.
Attitude towards the society
Exhibit sensitivity to towards social, ethical and legal
aspects of health care provision.
Offer cost effective services.
 PROFESSIONAL CHARACTER
DEVELOPMENT
✔Professional attire ✔Conscientiousness
✔Respect for time and punctuality ✔ Integrity in reporting patient’s findings
✔Grasp the knowledge about patient ✔ Relationships
under care
✔Availability to patients
ASSESSMENT OF ATTITUDES
(PROFESSIONALISM) IN
DOCTORS
1. Professional attire
2. Respect for the time and punctuality
3. Grasp the knowledge of own patient
4. Conscientiousness
5. Integrity in reporting patients findings
6. Availability to patients
7. Relationship with patients, colleagues and hospital
staff and patients.
Score = 1-10,
1 = Poor
2-4 = Not desirable
5-6 = Average: needs improvement
7-8 = Good
9-10 = Exemplary: can be role model