Doctor Patient Relationship
Doctor Patient Relationship
Doctor Patient Relationship
Relationship
Dr.
Dr. Lynna
Lynna Lidyana
Lidyana SpKJ
SpKJ
Medical Situation
Situation Related to the effort and process of
treating a disease
Rapport, the Relationship of the Doctor and
the Patient:
Core of Medical Practice
Influence the effort and process of treatment
Doctor A Sick person
Not just “ a diagnostic number “
• Good rapport :
Spontaneous team work
Conscious
Compatible
Constructive
1. Symptom Experience
something is wrong
5. Recovery , Rehabilitation
give up the patient role
Models of Doctor - Patient
relationship .
Influence by Personalities, Expectations & needs of
the Doctor & the Patient
Unspoken difference
Miscommunication & disappointment.
Flexible Needs of patient
& treatment Requirements
Sick role ( peran sakit )
3. Mutual Participation
Both Doctor & Patient require and depend on each other’s
input . Active participation of the Patient is needed
( chronic illness.)
4. Friendship / Socially intimate
Dysfunctional , Unethical.
Underlying psychological problem in the physician
Relation with the Patient is a substite for another
broken Relationship.
Some characteristics of good Doctor - Patient
relationship. - Acceptance - honesty
- empathy - trust
Some Obstacles - sympathy
- transference
- Counter transference
Interview ( anamnesis )
To obtain psychological background and symptoms
classification
proper diagnosis & treatment .
Psychiatric Examination - interview / anamnesis
Steps :
1. Establishing Rapport
Doctor - Patient at ease : Empathy to patient complaints, Express
compassion, Evaluating the Patient’s insight and becoming an ally,
showing expertise, establishing authority as physician and therapist;
Balancing the roles of Emphatic listener, expert and authority.
2. Specify the chief complaint
3. Based on the chief complaint develop A provisional DD/
4. Probe DD/ by using focused and detailed Qs.
5. Clarify vague / obscure replies to get the right answer.
6. Let the patient talk freely enough to observe the coherency of his /
her thoughts.
7. Use a mixture of open & closed ended Qs
8. Don’t be afraid / hesitate to ask difficult / embarrassing topics.
9. Ask about suicidal thoughts
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” )
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.
Demanding and Dependent
Often become angry or frightened if the doctor seems not
taking their concern seriously.
Set necessary limits within the context of an expressed
willingness to listen and to care for the patient.
Interviewing relatives
Important , ESP. If auto anamnesis is not possible
(psychotic, severely depressed , suicidal ideation )
keep patient’s privacy ( secrets)