Patient dependency on the doctor

 

…or is it doctor dependency?

How and why do patients become dependent?

Consider

  • The patient’s role
    • Why are patients reliant on their doctor? Consider positive and negative aspects to this.
    • Emotional attachment to the doctor
  • The doctor’s role
    • Why do doctors “need” patients? Where does this need come from?#
    • Emotional attachment to the patient
  • The role of family and friends
  • Societal influences

Other issues to consider

  • “Doctor shopping”
  • Dependency on medication eg analgesics
  • The “analgesic headache”
  • The “quiet prescription”
  • The role of complementary therapy
  • Making the wrong diagnosis (or even a very clever diagnosis)
  • Trust

Responding to dependency

  • Recognising that it is happening
    • Regular appointments for  minor illness or minor trauma
    • Regular appointments with little content or repeated content. So why is the patient here?
    • The patient won’t see another doctor, or presents with problems more logically dealt with by the nurse
    • Refusal to terminate treatment
    • Gifts
    • Inappropriate positive feedback
    • Collusion (see Balint)
    • No faith in external advice eg specialist advice
    • Genuine symptoms without any identifiable pathology or aetiology despite extensive examination and investigations.
  • Addressing the issue
    • Self awareness for the doctor
    • Flagging up the problem
      • Defining the observed behaviour in a factual, non-judgmental way – “I have noticed that…”
      • Exploring the reasons behind the behaviour
      • Negotiating – “I wonder if…” “perhaps…”
    • Moving forward
  • Preventing dependency
    • Planning and agreeing to specific goals and if possible a timeframe
    • Identifying what is possible and what is unrealistic
    • Keeping adult-adult, avoiding parent-child and the child hook

The Bottom line?

Ideas, concerns and expectations right at the beginning, and taking a process route to the problem with the patient rather than a task-based one, including giving something of your own feelings (and wondering aloud why they are there).

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