- patient utterances
- doctor utterances
Proposing an illness:
Physical examinations: patients "trained" by us to expect
this - "apostolic function"
Lightening (diluting) the burden of responsibility: Collusion of anonymity - a number of doctors involved but no-one responsible for decisions
The referral syndrome:
perpetuation of the teacher-pupil relationship
- Preference at diagnosing physical illness and giving physical Rx
- Dilution of responsibility by consultant
- Patient can play off one doctor against another
- Teacher-pupil relationship between consultant and GP
- Unhelpful reports
Doctor as drug:
"...no pharmacology of this important drug exists yet. To put this discovery in terms familiar to doctors, no guidance whatever is contained in any textbook as to the dosage in which the doctor should prescribe himself, in what form, how frequently, what his curative and maintenance doses should be, and so on. Still more disquieting is the lack of any literature on the possible hazards of this kind of medication, on the various allergic conditions met in individual patients which ought to be watched carefully, or on the undesirable side-effects of the drug." (Page 1)
Advice and reassurance: what are the dynamics and consequences of this? When the real problem becomes apparent, patient can often solve this without either! (Page 116)
How to start
- Doctor traditionally active and patient inactive
- Listening/open questions/feelings etc
- The "offer"
The patient's attitude towards his illness vs the doctors attitude towards the patient's illness.
Flash points in teaching
Reference: Michael Balint The doctor, his patient and the illness.