PSYCHOLOGICAL

ASPECTS OF
MEDICAL ACTIVITY
Slide title

1 Stages of diagnostic process

2 “Syndrome of burning out”

3 Types of reaction to the disease

4 Aggravation, simulation, dissimulation

5 Psychological types of doctors

 STAGES OF DIAGNOSTIC PROCESS

1st stage - the contact phase of intercourse;

2nd phase - the phase of orientation;

3rd phase - the phase of argumentation;

4th phase - the phase of correction.

 1st - the contact phase of intercourse

• doctor meets with a patient;

• the psychological contact is established;
• pre-conditions are formed for next inter
personality cooperation;
• patient must have the picture that a doctor wants
and can help him;
• unverbal cooperation, as contact by eyes (look);
• convincing by the look of patient in reliability of
psychological contact;
• doctor asks about the reasons of visit.
 2nd - the phase of orientation
• With a question «What complaints do you have?» the
phase of orientation begins.
• Doctor some time hear to the patient in active hearing
- that active perception and awareness with
simultaneous structure of verbal message and selection
in him of separate rich in content units all plenitude of
information.
• The active hearing of complaints of patient in the phase
of orientation is the element of the psychotherapy
influencing, what acquaintance to every doctor.
• Second psychotherapy element of phase of orientation
is acquisition by the patient of collective emotional
experience.
 2nd - the phase of orientation
• patient can idealize doctor, expecting the effective healing of
all enemies, has a hope sometimes not only on deprivation
from somatic illness but also often unconsciously, on the
decision of the psychological problems.
• this expectation of help not only in deprivation from illness
but also in satisfaction of necessities and hopes dissatisfied
before results in forming of transfer (transfer).
• reactions of transfer of patient (positive, negative,
ambivalent) - influence on efficiency of co-operation.
• The phenomenon which in the individuals mutual relations
concerns by a term «psychological incompatibility” has in the
basis more frequent mutual negative transfers and| contra-
transfers .
 3rd - the phase of argumentation

• the receipt of additional information which can be verbal

(additional questions on motion of conversation) and
unverbal (examination of patient);
• duration of it can be different, depending on the state of
patient, from his individually-psychological descriptions
nosology belonging of illness;
• doctor mentally sorting out all possible hypotheses which
the orientations formulated in a phase were;
• Task - not only to write the proper directions but also to
convince a patient to pass all necessary diagnostic
procedures.
 4th - the phase of correction
Meeting with a patient must have completion not only in
a professional plan but also in psychological.
Task: to give an emotional support for the patient.
•Unverbal conduct of doctor in this phase matter very
much
•Maintenance of final phrase is important, for example:
«Now there are three: you, I and yours illness. If you will
be on my side, we will overcome it».
•This is expressed by quiet, sure voice, is accompanied
by the friendly look, gesture, accompanying and
simultaneously such, that invites a patient on the next
meeting.
 3 models of mutual
relations «patient-physician»:

1. guidance;
2. partnerships;
3. contract model.
 MORE FREQUENT USEFULL
MEDICATION IN MEDICAL PRACTICE IS
A PHYSICIAN

М. Balint
The professional burn-out syndrome concerns as
the state of emotional, psychical and physical
exhaustion that develops as a result of
chronic unsolved stress on a workplace.
 Burning-out syndrome
chronic fatigue - exhaustion, tiredness, a sense of being
physically run down;
anger at those making demands;
self-criticism for putting up with the demands;
cynicism, negativity, and irritability;
a sense of being besieged;
exploding easily at seemingly inconsequential things;
frequent headaches and gastrointestinal disturbances;
weight loss or gain;
sleeplessness and depression;
shortness of breath;
suspiciousness;
feelings of helplessness;
increased degree of risk taking.
Signs of physical exhaustion:

•chronic feeling of fatigue, weaknesses, sum, lowering of energy;

•frequent headaches, pains in the back, muscular tension, nausea;
•liability to the diseases.

Signs of emotional exhaustion:

•feeling oppression, insolvency, hopelessness;
•overvoltage and conflict in family;
•increasing of frequency and intensity of negative emotions
(crabbiness, fury);
•lowering frequency and level of the positive emotional states
(sympathy, disturbance, courtesy, etc.).

Signs of psychical exhaustion:

•dissatisfaction and negative attitude toward itself, works and to life on
the whole;
•increasing of frequency of conduct forms, which are related to
avoidance of work (skipping, frequent stay on hospital letters).
 The patients’ attitude to the disease

• Normal, i.e. corresponding to the patient's state or the

information given to him about the disease.
• Scornful, when the patient underestimates the severity
of his disease, is not treated and does not take any care
of himself, as well as demonstrates ungrounded
optimism with respect to the prognosis of the disease.
• Denying, when the patient «does not pay attention to the
disease», does not take medical advice, fights back any
thoughts on his disease and reasonings about it; it also
includes dissimulation.
 The patients’ attitude to the disease
• Nosophobic, when the patient is disproportionately
afraid of the disease, undergoes repeated
examinations, changes his doctors;
• Hypochondriac, when the patient guesses or is sure
that he suffers from a severe disease, or when he
overestimates the severity of some less serious
disease.
• Nosophilic, connected with some calming and
pleasant sensations during the disease, the family is
attentive to the patient and takes more care of him.
 The patients’ attitude to the disease
• Utilitarian, which is the highest manifestation of the
nosophilic response.
It can have a triple motivation:
1.receiving of sympathy, attention and a better
examination;
2.finding a way out of some unpleasant situation, as, for
instance, imprisonment, military service, hated work,
obligation to pay alimony;
3.receiving of material benefits: pension, vacation, free
time which can be also used with some economic
benefit.
 Aggravation
is exaggeration of signs of the disease and
subjective complaints.
This exaggeration can be completely deliberate,
but sometimes is rather caused by emotional
motives of a deeper origin, e.g. fear, distrust,
feeling of solitude, hopelessness, suspect that
the doctor does not believe him.
Transitions from the deliberate aggravation to a
less deliberate one are sometimes rather
unostentatious, and in some cases even hardly
perceptible.
 Simulation
-is a pretendance with the help of which a person tries to
create an impression that there is a disease and its signs.

•As a rule, it is used only by very primitive persons in whom its

revealing can be relatively easy, or, on the contrary, by well-
experienced and irresponsible persons.
•A great risk for the malingerer is incurred by the fact that he
strives for a certain benefit, this aim being revealed sooner or
later. If he does not reach his aimthis circumstance cannot be
concealed from surrounding people and revision of the case will
put an end to the simulation.
•The doctor should not be in a hurry to make a conclusion
about simulation until he absolutely makes sure that his
suspicions are correct.
 Dissimulation
- means concealing of the disease and its signs, It often occurs
in psychiatry in cases of psychoses.

 As far as other patients are concerned, it is mainly observed

in the diseases resulting in some objective or subjective
disadvantages for the patient, e.g.: in tuberculosis it is a
prolonged staying at a sanatorium, syphilis is accompanied
by notification about the disease and revealing of the focus
of the infection, surgery is fraught with a possible operation.

 The greater is the extent of saving the patient from the fear
of the forthcoming examination, treatment and
consequences of the disease, the more successful is
prevention of dissimulation.
 Psychological types of doctors:
1. «Compassionate» - tender-hearted, merciful,
easily responsive to the patient's sufferings.
2. «Pragmatic» -taking into consideration only the
objective side of the disease in the work with his
patients, does not pay any attention to the patients'
sufferings.
3 «Moralist» - inclined to moral admonitions and
indignant if the patient doubts or does not follow his
doctor's recommendations.
4. «Diligent» - honest in his work, serious, assiduous,
industrious and not inclined to joke with the
patients.
 Psychological types of doctors:

5. «Activist» («public worker») - prefers solving of various

organizational problems and serving of social duties in the
medical institution to work with his patients.
6. «Dogmatic» - strictly follows the mastered diagnostic and
therapeutic directions and schemes, hardly apprehends any
new things.
7. «Technocrat» - overestimates the significance of laboratory
and apparatus data, does not attach any importance to the
patients' sufferings and other subjective aspects of the disease.
8. «Psychotherapist» - tries to grasp the patient's sufferings,
help him with a piece of advice or making him change his mind.
 Psychological types of doctors:

9. «Sybarite» - likes consiness and comfort, the patients

irritate him with their complaints, he does not consider
much their opinion and is inclined to the Bohemian mode of
life.
10. «Artist» - inclined to demonstration of his knowledge
and professional skills to the patients and their relatives,
11. «Bored idler» - a high self-estimation with a rather
modest stock of knowledge, stereotyped diagnosis and
administration of treatment, a scornful attitude towards his
inquisitive colleagues.
12. «Misanthrope» - a doctor under compulsion: a lack of
any calling for the doctor's activity is displayed through the
absence of such streaks as mercifulness, kindness, as well as
through rudeness, a disgusted attitude towards the patients
and malicious jokes.
 Psychological aspects during a
therapeutic process :
illness especially difficult is related to the
threat of invalid, becomes independent by a
psychical trauma;
vibrations of feel often result in doubting of
patient, uncertainty of curing, in the
competence of treating doctor;
an alarm is the most frequent emotional
reaction;
hard position doctor, simple, logically clear
explanations, his confidence and optimism
are very important.