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Department of nervous diseases, psychiatry and medical psychology




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Ministry of Health of Ukraine

Bukovynian State Medical University

Department of nervous diseases, psychiatry and medical psychology



Approved on the methodology meeting

of the Department of nervous diseases, psychiatry

and medical psychology

on “____” ___________ 2009 (Report No __).

Chief of the Department

_______________________

Professor V.M.Pashkovskyy


MethodOLOGical INSTRUCTION

for the lesson

Theme 5: Psychological peculiarities of the stages of diagnostic process. Medical deontology. Informing patient about diagnosis. Co-operating and communication doctor with patients and their relatives. Paternalism, his role in a diagnostic process. Value of the psychological setting of patient. Conflicts in a medical environment, their varieties. Methods of decision and warning of conflicts.


For 4-th year students of medical faculty No 2


Module 1. Medical psychology

Topical module 2. Practical aspects of medical psychology


Сhernivtsi, 2009


^

1. Actuality Aim

Psychological side of relationships “patient-doctor” is important on all stages of diagnostic and therapeutic processes, but especially great value it acquires at the first meeting, establishment of psychological contact that proceeds diagnostics and therapy. The optimum psychological contact on 40% provides success, efficiency of interpersonality co-operation.

2. Hours: 2



3. Teaching goal

The students must know:

  • the stages of diagnostic process;

  • medical deontology;

  • co-operating and communication doctor with patients and their relatives;

  • communication in a medical environment;

  • types of communication in medical environment;

  • value of the psychological setting of patient;

  • conflicts in a medical environment;

  • paternalism, his role in a diagnostic process.


and be able to:

  • objectively and scientifically determine the stages of diagnostic process;

  • interpret conditions to create healthy psychological climate in the medical environment;

  • analyze psychological peculiarities of patients with various pathologies;

  • to determine the way of communication between doctors, doctor – nurse;

  • know methods of research of personality;

  • evaluate the results of experimental-psychological research of patient’s personality and attitude toward a disease.

Assimilate practical skills

  • analyze psychological peculiarities of personality of medical workers;

  • communication with patients;

  • methods of research of «syndrome of burning out»;

  • experimental-psychological research of personality.


^ 4. List of disciplines necessary

for learning theme 1


Title of the discipline

Content of the discipline necessary for learning medical psychology

Anatomy

Brain construction

General psychology

Psychic functions of a normal person. Consciousness and self-consciousness. Psychology of personality.

Neuropsychology

Functions of different brain structures.

Normal physiology

Brain functions. Physiology of high nervous activity.


^ 5. Content of the theme


The 1th stage of professional intercourse of doctor and patient is the contact phase of intercourse. During|for| it|it| a doctor|physician| meets with a patient, between them the psychological contact is established, the first impression is given about each other, pre-conditions are formed for next interpersonality co-operation. The first impression of patient about a doctor|physician| in majority determines how patient will build the relationships with a treatting|treot| doctor|physician|, to execute|implements| his|its| setting|purpose|, adhere to the diet, medical regime etc. Most essential task, which stands before a doctor|physician| in the contact phase of co-operation with a patient – to correct|makes,repairs,produces| on a patient necessary impression. A patient must have the picture that a doctor|physician| wants|wishes| and can help him. The first is built on the empathic capabilities of doctor|physician|, second – on his|its| sure manner of conduct. Unverbal conduct of doctor|physician| on the stage of establishment of contact more important, than verbal. The unverbal report|communication,message| contains|maintains| the most meaningful|meaning| information on which|what| a patient reacts at the first meeting with a doctor|physician|. After the supervisions of psychologists, the picture of man arises up during|for| a 18” acquaintance. Feeling|sense,sentiment| of psychological contact gives the such important element of unverbal co-operation, as contact by eyes (look). That is why|that is why| in the first seconds of professional intercourse a doctor|physician| must look in eyes of the patient, he gives an understanding that he is ready to hear attentively out him. Convincing by the look of patient in reliability|dependability| of psychological contact, a doctor|physician| asks about the reasons|causes| of visit. From this moment the second phase of intercourse begins is phase of orientation.

On previous|preliminary| text we talked with you about estimation|appraisal| of unverbal conduct of patient is pose, interpersonality|individual| distance, behavior, mimicry and look, linguistic components of intercourse. Features of pose of doctor|physician| at intercourse with patients. During|for| a contact phase a doctor|physician| also estimates|evaluates| a pose, mimicry, pantomimic of patient, that allows to make|folds| the picture of features of the state|figure,camp,mill| of patient. With a question «What complaints do you have?» the phase of orientation begins. In reply to a question a patient begins to express|offers| the complaints. Doctor|physician| some time hear to the patient in active hearing – that active perception and awareness with simultaneous structure of verbal message and selection in him of separate rich in content units all plenitude of information.

In the phase of orientation a doctor|physician| gives|provides| to the patient possibility to be freely expressed|offered| and this can in a certain|definite| measure to provide|secures| realization of such therapeutic mechanism as catharsis is partial from reacting in conversation with the doctor|physician| of the negative emotional experiencing, which|what| are related|tied| to pain|anguish|, suffering, physical discomfort, diminishes the level of tension and alarm at a patient. The active hearing of complaints of patient in the phase of orientation is the element of the psychotherapy influencing, what acquaintance to every doctor|physician|.

Second psychotherapy element of phase of orientation is acquisition by the patient of collective emotional experience. Meeting benevolent|friendly|, accepting|taking| position of doctor|physician|, which|what| does not reprobate|condemns|, does not estimate|evaluates|, and does not at the same time support, does not strengthen|aggravates| the emotional reactions of patient, patient new emotional experience, which|what| allows him to change|changes| the emotionally-negative state|figure,camp,mill|, reduce the level of tension, feel|feels| psychologically more комфортно.корективний experience is related|tied| to that a patient, not meeting conviction|censure| or estimation|appraisal| from the side of doctor|physician|, stops to be afraid of the own emotions related|tied| to those or other sickly|morbid| feelings|senses,feeling,sentiments| and begins more freely to express them, acquires|buys|. A patient begins more precisely to describe the symptoms, that helps a doctor|physician| to get|receives| more complete imagination about the flow|stream,current| of his|its| illness.

In the mutual relations «patient - doctor» a patient is predispositioned to add to the doctor|physician| those lines which|what| must help to overcome illness. Examining|considering| personality|individual| of doctor|physician| as meaningful|meaning| figure which|what| has certain|definite| magic capabilities, a patient can idealize him, expecting|waiting| the rapid|quick,fast| and effective healing of all enemies, has a hope sometimes not only on deprivation|privation| from somatic illness but also often unconsciously|irresponsibly|, on the decision of the psychological problems. This expectation of help not only in deprivation|privation| from illness but also in satisfaction of necessities and hopes dissatisfied before|earlier| (necessities in tenderness, sympathy, acceptance), results in|to| forming of transfer (transfer). A patient carries|transfers| on a doctor|physician| past experience of relationships with meaningful|meaning| people, expectations and hopes which|what| existed in these relations. If a patient carries|transfers| on a doctor|physician| the positive|staid| senses|feeling,sentiments| related|tied| to positive|staid| experience of mutual relations in the pas, we talk about the positive|staid| transfer. If a patient carries|transfers| the negative senses|feeling,sentiments| on a doctor|physician|, related|tied| to past|passing,last| negative experience of construction of relations is sense|feeling,sentiment| of crabbiness|irritability|, mistrust, hostility, talk about the negative transfer. In the mutual relations with a doctor|physician| a patient can project on him ambivalent| emotional experience, with experiencing in relation to|toward| him of sense|feeling,sentiment| of watchfulness and tenderness, trust|confidence| and hostility.

Reactions of transfer of patient (positive|staid|, negative, ambivalent)| – complicate communication with him, influence on efficiency of co-operation.

The phenomenon which|what| in the interpersonalities|individuals| mutual relations concernes by a term «psychological incompatibility|inconsistency|» has in the basis|foundation| more frequent mutual negative transfers and| contra-transfers .

Understanding and removal of portable reactions allows to build the relationships with the real man, not with own (traumatic) experience of the pas. The third phase is the phase of argumentation. Basic|main| maintenance of phase is the receipt of additional information which|what| can be verbal (additional questions on motion of conversation) and unverbal (review|examination,survey| of patient). The phase of argumentation is the most active phase of intercourse. Duration of it|it| can be different|diverse|, depending on the state|figure,camp,mill| of patient, from his|its| individually-psychological descriptions nosology belonging of illness. Gradually a doctor|physician| abbreviates|shortens| interpersonality|individual| distance, thus|on this grow| preparing a patient to|by| the physical contact. It is necessary to remember, that in most cases patients emotionally react on the first physical contact with a doctor|physician|. (example with blood pressure|)

The receipt of information about a patient foresees ability of doctor|physician| to formulate a question|o. In the process of questioning and review|examination,survey| of patient, doctor|physician| mentally sorting out all possible hypotheses which|what| the orientations formulated in a phase were. Casts aside vicious, deciding on 2-3 most reliable|trustworthy| in the world of new obtained information . Thus|on this grow| there is a previous|preliminary| diagnosis. In order that the previous|preliminary| diagnosis got|received| at the question and review|examination,survey| of patient in the phase of argumentation became final, it is necessary leadthrough of additional laboratory researches. Task of doctor|physician| – not only to write|orders| the proper directions but also to explain a patient to|by| passing of all necessary diagnostic procedures.

The last phase of intercourse is the |physician phase of correction|. Meeting with a patient must have completion not only in a professional plan but also in psychological. Task of this phase – to give an emotional support for the patient. Unverbal conduct of doctor|physician| in this phase matter very much. Maintenance of final phrase is|appears| important, |accomplish| for example, “now there are three: you, I and Your|yours| illness, If you will be on my| side|flank|, we will overcome it|it|». This|it| is expressed|offered| by quiet, sure voice, is accompanied by the friendly look, gesture, accompanying and simultaneously such, that invites a patient on the next meeting.

During a therapeutic process it is necessary to remember the following psychological aspects:

- illness especially|in particular case| heavy|difficult| is related|tied| to the threat of invalid, becomes|stands| independent by a psychical trauma.

- vibrations of feel, especially|in particular case| at the beginning of|in the beginning of| therapy, often result in|to| doubting of patient, uncertainty of curing, in the competence of treatting|treot| doctor|physician|. Patient became in situation with the deficit of information and vagueness. An alarm is|appears| the most frequent emotional reaction. In such periods especially|in particular case| important hard position doctor|physician|, simple, logically clear explanations, his|its| confidence and optimism.

- influencing of hospitalization, when patient goes in a new social situation for him with the sharp changing of way of life.

- attitude of patient toward|to| medications.

- psychological influencing of extract.

On forming of mutual relations «patient - doctor» influence a sex, age, level of education, social status. There are three models of their mutual relations: guidance, partnership and contract model.

A partner model is more democratic.

A contract model was folded in the conditions of requiring payment medicine. It allows to structure and control a medical process both of its participants. Legal responsibility for|after| the results of treatment is carried by a doctor|physician|, but psychological responsibility in a certain|definite| measure lies on a patient. Executing|implementing| payment of medical services, a patient takes title to choose a doctor|physician|.


^ 5.2. Theoretical questions:

  1. The stages of diagnostic process.

  2. Medical deontology.

  3. Co-operating and communication doctor with patients and their relatives.

  4. Communication in a medical environment.

  5. Types of communication in medical environment.

  6. Value of the psychological setting of patient.

  7. Conflicts in a medical environment.

  8. Paternalism, his role in a diagnostic process.

  9. Peculiarities of communication between doctors, doctor – nurse.


^ 5.3. Practical training during the tutorial

1. Clinical observation of the behavior of the medical personal.

2. Research of «Syndrome of burning out».


5.4. Materials for self-control

A. Questions for self-control:

  1. The stages of diagnostic process.

  2. Medical deontology.

  3. Co-operating and communication doctor with patients and their relatives.

  4. Communication in a medical environment.

  5. Types of communication in medical environment.

  6. Value of the psychological setting of patient.

  7. Conflicts in a medical environment.

  8. Paternalism, his role in a diagnostic process.

  9. Peculiarities of communication between doctors, doctor – nurse.



B. Tasks for self-control

1. Typical, ordinary – II level.

2. Untypical, no ordinary – III level.

C. Tests for self-control.


Literature

  1. R.J.Gatchel An introduction to health psychology. – New York: Random house. – 386 p.

  2. Lectures.

  3. Internet resource.

  4. Вітенко І.С., Вітенко Т.І. Основи психології: Підручник для студентів вищих медичних навчальних закладів ІІІ – ІV рівнів акредитації. – Вінниця, 2001.

  5. Вітенко І.С., Чабан О.С., Бусло О.О. Сімейна медицина: психологічні аспекти діагностики, профілактики і лікування хворих. – Тернопіль, ”Укрмедкнига”, 2002.

  6. Гавенко В.Л., Вітенко І.С., Самардакова Г.О. Практикум з медичної психології. – Харків: Регіон-інформ, 2002.

  7. Квасенко А.В., Зубарев Ю.Т. Психология больного. М., 1980.

  8. Лакосина Н.Д., Ушаков Г.К. Медицинская психология. М., 1984.

  9. Менделевич В.Д. Клиническая и медицинская психология. – М.: Мед.прес., 1998.

  10. Мягков И.Ф., Боков С.Н. Медицинская психология: основы патопсихологии и психопатологии: Учебник для вузов.- М.: Издательская корпорация „Логос”, 1999.



Prepared by. assistant N.V.Bagriy


Positive review

Prof. assistant N.S. Karvatska


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