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By

Dr. Mahmoud A. Abdel-mohdy

Psychiatric Specialist

SGH

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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

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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 patients visit or avoiding the patient

- Feeling attacked by the patient and becoming

defensive

- Trying to impress the patient

- Becoming preoccupied with the patient

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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.

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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 totreatment plans.

Skills for specific situations.

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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

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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

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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

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B. Advanced communication skills:

1- Skills for motivatingpatient's adherence to treatmentplans:-

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 regimeFeedback (positive reinforcement of constructive behavior

changes achieved since earlier consultations)

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2- Other applications of communication skills in specialsituations:-

a) Special groups ofpopulation:

b) Special groups of disorders:

C) Specialpersonality problems:

D) Special clinical situations:

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