The Patient "Doctor

Relationship
o Simple –complicated ) Relationship.

o A matter of Common sense –Skills need to be learned.

 The Patient "Doctor
Relationship
 techniques of talking and listening to people.

 To diagnose, manage, and treat an ill person, doctors and therapists

must learn to listen.

 They need the skills of active listening, which means listening both to
what they and the patient are saying and to the undercurrents of the
unspoken feelings between them
 An effective relationship is characterized by good rapport

 Rapport is the spontaneous, conscious feeling of harmonious

responsiveness that promotes the development of a constructive
therapeutic alliance.

 It implies an understanding and trust between the doctor and the

patient. Frequently, the doctor is the only person to whom the patients
can talk about things that they cannot tell anyone else.

 Most patients trust their doctors to keep secrets, and this confidence
must not be betrayed.
 Establishing Rapport
 putting patients and interviewers at ease;

 finding patients' pain and expressing compassion;

 evaluating patients' insight and becoming an ally;

 showing expertise;

 establishing authority as physicians and therapists;

 balancing the roles of empathic listener, expert, and authority.

 Empathy

To put oneself in another person's place.

 Sympathy:

Feeling sorry.
 Biomedical model:
approach to pt care in which only the biological and medical aspects
of apt illness are considered.

 Biopsychosocial model:
Comprehensive approach.
 Transference:

The pt are transferring feelings toward others in their

life onto the physician.

 Counter-transference:

Emotional reactions to the pt from the doc that often

involve the doctor past experience.
 Physician styles:
 The paternalistic style.

 The shared decision making style.

 The consumer based style

 Professional Boundaries

 Difficult Doctor-Patient :Relationships

 The Seductive Patient
 The “Hateful” Patient
 The Patient With a Thousand Symptoms
 The Patient in the Hospital Setting
 The Mentally Disturbed Patient
 The Dying Patient
 Correct diagnosis and treatment is only half the way
 Factors that impede compliance:

Low level of distress

Denial of illness

Poor communication

Complex regimens

Treatment that is embarrassing

Pts perception

Side effects
Factors that enhance compliance

 Rapport

 Simple regimen

 Increased level of distress

 Waiting room time

 Increased time with doc

 Family support
 Erikson's Theory of
Psychosocial Development ;
 What is Psychosocial Development?

 Erik Erikson’s theory of psychosocial development is one of the best-

known theories of personality in psychology.

 Much like Sigmund Freud, Erikson believed that personality develops in

a series of stages.

 Unlike Freud’s theory of psychosexual stages, Erikson’s theory

describes the impact of social experience across the whole lifespan.
 One of the main elements of Erikson’s psychosocial
stage theory is the development of ego identity.

 Ego identity is the conscious sense of self that we

develop through social interaction.
 According to Erikson, our ego identity is constantly changing due to
new experience and information we acquire in our daily interactions
with others.

 In addition to ego identity, Erikson also believed that a sense of

competence also motivates behaviors and actions.

 Each stage in Erikson’s theory is concerned with becoming competent

in an area of life.
 If the stage is handled well, the person will feel a sense of mastery,
which he sometimes referred to as ego strength or ego quality

 If the stage is managed poorly, the person will emerge with a sense of
inadequacy.
stage Basic Conflict Important Events Outcome

Erikson's Psychosocial Stages Summary Chart

Stage-1 Children
develop a
sense of trust
-infancy Trust vs. Feeding when
birth to 18 mistrust caregivers
months) provide
reliabilty, care,
and affection. A
lack of this will
lead to
mistrust.
Stage-2 Children need
to develop a
sense of
personal
Early Childhood Autonomy vs. Toilet Training control over
(2 to 3 years) Shame and physical skills
Doubt and a sense of
independence.
Success leads
to feelings of
autonomy,
failure results
in feelings of
shame and
doubt.
Stage-3 Children need
to begin
asserting
control and
power over the
Initiative vs. Exploration environment.
Preschool
Guilt Success in this
(3 to 5 years) stage leads to a
sense of
purpose.
Children who
try to exert too
much power
experience
disapproval,
resulting in a
sense of guilt.
Stage-4 Children need
to cope with
new social and
academic
demands.
Industry vs. School
School Age (6 Success leads
Inferiority
to 11 years) to a sense of
competence,
while failure
results in
feelings of
inferiority.
Stage-5
Teens needs to
Adolescenc Identity vs. Social
Role Relationships develop a sense of
e (12 to 18
Confusion self and personal
years)
identity. Success
leads to an ability to
stay true to yourself,
while failure leads
to role confusion
and a weak sense of
self.
Stage-6 Young adults
need to form
intimate, loving
young
Adulthood
intimacy vs. relationshi relationships
(19 to 40 isolation ps with other
years people. Success
leads to strong
relationships,
while failure
results in
loneliness and
isolation.
Stage-7 Adults need to create
or nurture things that
will outlast them,
Middle Generativity Work and often by having
Adulthood
vs. Parenthood children or creating a
(40 to 65
Stagnation positive change that
years)
benefits other
people. Success leads
to feelings of
usefulness and
accomplishment,
while failure results
in shallow
involvement in the
world.
Stage-8 Older adults
need to look
back on life and
feel a sense of
Maturity(65 to Ego Integrity Reflection on fulfillment.
death) vs. Despair Life Success at this
stage leads to
feelings of
wisdom, while
failure results
in regret,
bitterness, and
despair.