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The Patient "Doctor Relationship o Simple –complicated ) Relationship. o 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: Low level of distress Denial of illness Poor communication Complex regimens Treatment that is embarrassing Pts perception Side effects 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 Erikson’s 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 Freud’s theory of psychosexual stages, Erikson’s theory describes the impact of social experience across the whole lifespan. One of the main elements of Erikson’s 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 Erikson’s 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 Children develop a sense of trust -infancy Trust vs. Feeding when birth to 18 mistrust caregivers months) provide reliabilty, care, and affection. A lack of this will lead to mistrust. Stage-2 Children need to develop a sense of personal Early Childhood Autonomy vs. Toilet Training control over (2 to 3 years) Shame and physical skills Doubt and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt. Stage-3 Children need to begin asserting control and power over the Initiative vs. Exploration environment. Preschool Guilt Success in this (3 to 5 years) stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. Stage-4 Children need to cope with new social and academic demands. Industry vs. School School Age (6 Success leads Inferiority to 11 years) to a sense of competence, while failure results in feelings of inferiority. Stage-5 Teens needs to Adolescenc Identity vs. Social Role Relationships develop a sense of e (12 to 18 Confusion self and personal years) identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self. Stage-6 Young adults need to form intimate, loving young Adulthood intimacy vs. relationshi relationships (19 to 40 isolation ps with other years people. Success leads to strong relationships, while failure results in loneliness and isolation. Stage-7 Adults need to create or nurture things that will outlast them, Middle Generativity Work and often by having Adulthood vs. Parenthood children or creating a (40 to 65 Stagnation positive change that years) benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world. Stage-8 Older adults need to look back on life and feel a sense of Maturity(65 to Ego Integrity Reflection on fulfillment. death) vs. Despair Life Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.
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