The Doctor as a Drug Emma Hardwick GPR 2008

Michael Balint  He developed the concept of ‘the drug ‘doctor’ (ie the doctor herself/himself is a powerful medication)  Balint, M. ( 1957) The doctor, his patient and the illness. London.

Prescribing yourself as a drug You need to consider the:  Indications  Dose  Side effects

Mechanism of action You can help by being:  Supportive  Informative  Catalytic  Cathartic

Prescribing the Doctor – When? Potential indications – to help tackle/alleviate:  Multiple problems (often insoluble)  Multiple attendances  Multiple referrals to no avail  Multiple treatments (tried & failed)  Heart sinks  Persisting patient uncertainty or concern

Prescribing the Doctor – How? You have to utilise/explore:  Your advanced consultation skills  Active listening  Picking up and using cues  Building rapport  Empathy  Triangular thinking  Ideas Concerns and Expectations

Prescribing the doctor – common problems  If the doctor doesn’t realise they are the drug and therefore does not understand why the patient keeps re-attending.  Time constraints (long and sometimes multiple consultations).  Differing agendas between patient & doctor.

Prescribing the doctor – side effects  Encouraging doctor dependency  Transference – negative emotions expressed by the patient being engendered in the GP.  Counter transference – negative emotions expressed by the GP being transferred to the patient.

Summary  The doctor as a drug is a powerful tool.  Be aware of when it can be effective  Utilise consultation skills to make the most of this therapy  Remember that there may be pitfalls for both patient and doctor.