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Doctor-Patient Relationship and Initial Patient Interview Michael Blumenfield, M.D. Professor of Psychiatry - NYMC Director of Medical Student Education.

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Presentation on theme: "Doctor-Patient Relationship and Initial Patient Interview Michael Blumenfield, M.D. Professor of Psychiatry - NYMC Director of Medical Student Education."— Presentation transcript:

1 Doctor-Patient Relationship and Initial Patient Interview Michael Blumenfield, M.D. Professor of Psychiatry - NYMC Director of Medical Student Education in Psychiatry Director of C/L Psychiatry - Westchester Medical Center

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3 “...Some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.” Hippocrates Precepts, Chapter I

4 Placebo Effect l Placebo Effect is a combination of a psychological expectation blended with a neurochemical response that transforms an anticipated effect into a real effect

5 Placebo Effect l The Placebo Effect can positively or negatively effect pain, swelling, GI, CV, GU responses, mental state and side effects of treatment

6 Placebo Response l At least % of patients have been shown to respond to treatment with placebo l Placebo pain response can be blocked by naloxone which suggests it is mediated by the endogenous opioid system

7 Transference l Expectation, beliefs and emotional responses that the patient brings to the doctor- patient relationship based on important relationships in the patient’s past

8 Positive Transference l Patient views doctor as good and has confidence in his or her ability l Can lead to over idealization and tremendous disappointment when doctor can’t solve all problems or is not always available

9 Positive Transference l Idealization of the the doctor can lead to having sexual feelings toward the doctor

10 Negative Transference l Patient views doctor as harsh punitive parent or authoritative figure who doesn’t care about well being and patient may be non-compliant

11 Negative Transference l Patient with experience with untrustworthy parent may seek many consultations and may be provocative to doctors

12 Countertransference l Refers to doctor’s reaction towards patient based on their own earlier experience

13 Countertransference l Doctors can feel guilty when they are unable to help patient l Doctor may have feelings towards patient who remind them of close relative or friend l Doctor may minimize the severity of another physician’s illness

14 Models of Doctor Patient Relationship

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16 Doctor-Patient Relationship Alternative Models

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19 Empathy l The ability to momentarily experience the the feelings of another person ( put yourself in another person’s place)

20 Empathy -Components l Transiently experience feelings of the patient and use those feelings to gain understanding of the the patient’s subjective experience l Communication of that understanding to the patient

21 Empathy-Techniques of Learning l Intuitive - Reflect on emotions when with patient l Cognitive - Ask self how would I feel in patient’s situation l Cognitive- Relate to similar situation in own life ( ie. threat to you or a parent)

22 Empathy- Examples of empathic responses l You seem understandably upset with how things are going l It must have been very painful after the injury until you received pain medication l I am sorry (when learning of death of family member or friend of patient)

23 Clinical Interview The Interview Process The Interview Process INE HRAA-VF- WAY5 To MAV WE mvF- WAY5TOMA14F- ~ WE RA.VF-

24 Clinical Interview l Be Polite l Introduce yourself to patient l Make the patient comfortable l Initial Question-Invite the patient to tell you how he or she came to be in the hospital (chief complaint )

25 Clinical Interview l Listen to patient- Don’t interrupt patient especially at the beginning of the interview l Begin each topic with open ended question and close with detailed specific question

26 Clinical Interview l Pay attention to patient’s associations so you can return later to get more information l Be empathic- Respond to patient’s emotional reactions

27 Usual Order of Interview l Chief Complaint l History of Present Illness- nElaborate all aspects of symptoms äAggravating factors äAlleviating factors äAssociated manifestations l Past Illness l Review of Systems

28 Usual Order of Interview l Mental Status Exam ( especially in psychiatric patients )

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30 Let’s Go To The Video Tape !!!

31 Doctor-Patient Relationship and Initial Patient Interview Michael Blumenfield, M.D. Professor of Psychiatry - NYMC Director of Medical Student Education in Psychiatry Director of C/L Psychiatry - Westchester Medical Center


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