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Relationship
Dr. Iwan Arijanto, SpKJ, MKes
.
Medical Situation
Situation Related to the effort and process of
treating a disease
A Sick person
Not just
a diagnostic number
Good rapport :
Spontaneous team work
Conscious
Compatible
Constructive
George Engel
Biological :
Anatomical, Structural, Molecular substrate of disease & its effects
on the Patient Biological Functioning
Psychological
Social :
Emphasize cultural, Environmental & Familial influences on the
Expression & The Expression & The Experience of illness
3.
4.
5. Recovery , Rehabilitation
give up the patient role
Unspoken difference
1, Active - Passive
The patient fully passive ( unconscious, immobilized, delirious )
& 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 others
input . Active participation of the Patient is needed
( chronic illness.)
Some Obstacles
- Acceptance
- honesty
- empathy
- trust
- sympathy
- transference
- Counter transference
Interview ( anamnesis )
To obtain psychological background and symptoms
classification
2.
3.
4.
5.
6.
Let the patient talk freely enough to observe the coherency of his /
her thoughts.
7.
8.
9.
10. Give the patient a chance to ask Qs at the end of the interview
11. Conclude the initial interview by confidence, and if possible, of
hope.
Content vs process
Content, what is verbally expressed between the
doctor and the patient
Process, what is occurring non verbally between
the doctor and the patient
( feelings, reactions body language )
Technique :
Reflection
Confrontation;
Interpretation;
Self - Revelation
Reassurance;
Facilitation;
Silence;
Clarification
Summation;
Explanation;
Transition;
Positive Reinforcement ;
Advice.
Special Cases
Some types of patient requre particular skill (patiency) of
the physician to understand the covert emotions, fears,
conflicts that the patients overt behavior represents.
Histrionic
Seductive behavior emerge from an unconscious need for
reassurance that she is still attractive even ill and from
fear that she will not be taken seriously , unless she
appear (sexually) attractive (actually she never want to seduce the doctor)
The Physician needs to be calm, reassuring , firm and
non flirtations.
Narcissistic
Thought that He / She is superior to other, have a
tremendous need to appear perfect arrogant, rude,
abrupt, demeaning mask for a feeling of inadequacy ,
helplessness and emptiness .
Do not influence by the attitude of the patients even when
he / she disdain the doctor is only an ordinary human being
.
Obsessive
Paranoid
Isolated , Solitary
detached, reclusive, do
not need / want much contact with others.
Treat with as much respect for privacy as possible.
unable to
Violent .
With / without restraints patient should not be
interviewed alone .
Asked specific Qs pertaining to the previous
acts of violence and to violence experienced
as a child.
Under what conditions the patients resorts to
violence , to detect possible precipitating
factors, .
If reality testing is so impaired medication
could be given before started the interview.
Delusional
delusion is patients
defensive & self - protective , Albeit maladaptive ,
strategy against overwhelming anxiety , lowered
self esteem, and confusion.
Do not challenge directly , do not agree , just
understand it.
Interviewing relatives
Important , ESP. If auto anamnesis is not possible
(psychotic, severely depressed , suicidal ideation )
keep patients privacy ( secrets)