By

Prof. Yasser Elserogy

Prof. of Psychiatry
 DOCTOR-PATIENT RELATIONSHIP

The doctor-patient relationship has been defiend as the coming

together of an expert and a help seeker in order to clarify,
comprehend, and solve the help seeker’s problems.

Models of the Doctor-Patient Relationship:

1. The active- passive model

2. The teacher-student model

3. The mutual participation model

4. The friendship model

 Factors affecting the Doctor-Patient Relationship:

A. Sociocultural factors

. Culture defines what is normal and provides explanations of

how and why people become ill.

B. Psychological factors

Defence Mechanisms

Transference and Countertransference

Clues to countertransference reactions include:

- Feeling more intense than one would expect to

experience (especially anger, fear, guilt, disgust,
sympathy, or sexual attraction).
- Difficulty paying attention to the patient
- Dreading the patient’s visit or avoiding the patient
- Feeling attacked by the patient and becoming
defensive
- Trying to impress the patient
- Becoming preoccupied with the patient
Importance of effective doctor-patient communication:

1. Accurate diagnosis.
2. Patient's compliance.
3. Doctor's clinical competence and self-assurance.
4. Patient's satisfaction.
5. Cost and resource effectiveness.
6. Institutional gains.
Communication skills training:

Medical students need to acquire:

A. Core communication skills:
· Doctor-patient interpersonal skills.
· Information gathering skills.
· Information giving skills.
B. Advanced communication skills:
- Skills for motivating patient's adherence to
treatment plans.
- Skills for specific situations.
A. Core communication skills:

1- Doctor-patient interpersonal skills:

· Creating an appropriate physical environment
· Greeting others
· Empathy
· Showing respect and interest
· Showing warmth and support
· Using appropriate language
· Developing a collaborative relationship
· Closing the interview
2- Information gathering skills:
· Using an appropriate balance of open and closed questions
· Silence
· Clarifying patient's expectation about the consultation
· Clarifying the information given to the patient
· Sequencing of events
· Directing the flow of information
· Summarizing
3- Information giving skills:
· Providing clear and simple information
· Using specific advice with concrete examples
· Pushing important things first
· Using repetition & restatement
· Summarizing
· Categorizing information
· Using tools such as diagrams
· Checking patient's understanding of what has been said
· Asking patients to repeat back what they had heard and
understood
B. Advanced communication skills:
1- Skills for motivating patient's adherence to treatment plans:-
•Tailoring the treatment to suit the patient's life style
•Providing a rationale for behavior change
•Countering barriers to change
•Providing examples of role model
•Allowing opportunities for verbal rehearsal of the details of the
treatment regime
•Feedback (positive reinforcement of constructive behavior
changes achieved since earlier consultations)
 2- Other applications of communication skills in special
situations:-
a) Special groups of population:
b) Special groups of disorders:
C) Special personality problems:
D) Special clinical situations: