The Patient "Doctor

Relationship
o

Simple complicated ) Relationship.

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:

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 Eriksons 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 Freuds theory of psychosexual stages, Eriksons

theory describes the impact of social experience across the
whole lifespan.

One of the main elements of Eriksons

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 Eriksons 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
-infancy
birth to 18
months)

Trust vs.
mistrust

Feeding

Children
develop a
sense of
trust when
caregivers
provide
reliabilty,
care, and
affection. A
lack of this
will lead to
mistrust.

Stage-2

Early
Childhood
(2 to 3
years)

Autonomy
vs. Shame
and Doubt

Toilet
Training

Children
need to
develop a
sense of
personal
control
over
physical
skills and a
sense of
independen
ce. Success
leads to
feelings of
autonomy,
failure
results in
feelings of

Stage-3

Preschool
(3 to 5
years)

Initiative
vs. Guilt

Children
need to
begin
asserting
control and
Exploration power over
the
environme
nt. Success
in this
stage leads
to a sense
of purpose.
Children
who try to
exert too
much
power

Stage-4

Industry
School Age vs.
(6 to 11
Inferiority
years)

School

Children
need to
cope with
new social
and
academic
demands.
Success
leads to a
sense of
competenc
e, while
failure
results in
feelings of
.inferiority

Stage5
Identity
vs.
Adolesce Role
nce (12
Confusi
to 18
on
years)

Social
Relationships

Teens needs to
develop a
sense of self
and personal
identity.
Success leads
to an ability to
stay true to
yourself, while
failure leads to
role confusion
and a weak
sense of self.

Stage6
young
Adulthoo
d
(19 to 40
years

intimacy
vs.
isolation

Young adults
need to form
intimate,
relations loving
relationships
hips
with other
people.
Success
leads to
strong
relationships
, while
failure
results in
loneliness
and

Stage
-7

Adults need to
create or
nurture things
that will outlast
Generativ Work
them, often by
Middle ity vs.
and
Adultho Stagnatio Parentho having children
od (40 to n
od
or creating a
65
positive change
years)
that benefits
other people.
Success leads
to feelings of
usefulness and
accomplishmen
t, while failure
results in

Stage-8
Reflection
Maturity(6 Ego
on Life
5 to death) Integrity
vs. Despair

Older
adults
need to
look back
on life and
feel a
sense of
fulfillment.
Success at
this stage
leads to
feelings of
wisdom,
while
failure
results in
regret,
bitterness,