Patients' Influence on Doctors' Behavior: A Case Study of Patient Strategies in Somatization

Objective: Extensive empirical data and theory describe the inequality of power in relations between doctors and their patients. However, the focus has been on the ways in which doctors control the doctor-patient relationship. This has meant that the extent to which patients influence the consultation, and the ways in which they do this, have been neglected. Methods: In this article, we use a single case to identify and illustrate distinct ways in which patients exert power to determine the outcome of consultations. Conclusion: This analysis leads to a more powerful explanation than is presently available to understand the somatization of psychological needs. According to this, the patient organizes strategies, which include the presentation of emotional and social distress, around a biomedical model. Because of their prior decisions as to their role, doctors permit themselves to be trapped in this model.

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The Doctor as Parent, Partner, Provider… or Comrade? Distribution of Power in Past and Present Models of the Doctor–Patient Relationship

Health Care Analysis ◽

10.1007/s10728-021-00432-2 ◽

2021 ◽

Author(s):

Mani Shutzberg

Keyword(s):

Patient Relationship ◽

Sickness Certification ◽

Doctor Patient Relationship ◽

Partnership Model ◽

Distribution Of Power ◽

Consumer Model ◽

Patient Relationships ◽

Point Of Departure

AbstractThe commonly occurring metaphors and models of the doctor–patient relationship can be divided into three clusters, depending on what distribution of power they represent: in the paternalist cluster, power resides with the physician; in the consumer model, power resides with the patient; in the partnership model, power is distributed equally between doctor and patient. Often, this tripartite division is accepted as an exhaustive typology of doctor–patient relationships. The main objective of this paper is to challenge this idea by introducing a fourth possibility and distribution of power, namely, the distribution in which power resides with neither doctor nor patient. This equality in powerlessness—the hallmark of “the age of bureaucratic parsimony”—is the point of departure for a qualitatively new doctor–patient relationship, which is best described in terms of solidarity between comrades. This paper specifies the characteristics of this specific type of solidarity and illustrates it with a case study of how Swedish doctors and patients interrelate in the sickness certification practice.

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Boundaries of reasoning in cases: The visual psychoanalysis of René Spitz

History of the Human Sciences ◽

10.1177/0952695120908491 ◽

2020 ◽

Vol 33 (3-4) ◽

pp. 66-84

Author(s):

Rachel Weitzenkorn

Keyword(s):

Experimental Psychology ◽

Developmental Psychology ◽

Patient Relationship ◽

Visual Displays ◽

Doctor Patient Relationship ◽

Interpersonal Emotions ◽

The Individual ◽

Key Aspects

This article argues that the foundational separation between psychoanalysis and experimental psychology was challenged in important ways by psychoanalytic infant researchers. Through a close examination of American psychoanalyst René Spitz (1887–1974), it extends John Forrester’s conception of reasoning in cases outside classic psychoanalytic practices. Specifically, the article interrogates the foundations of reasoning in cases—the individual, language, and the doctor–patient relationship—to show how these are reimagined in relation to the structures of American developmental psychology. The article argues that the staunch separation of experimental psychology and psychoanalysis, reiterated by philosophers and historians of psychology, is flimsy at best—and, conversely, that the maintenance of these boundaries enabled the production of a cinematic case study. Spitz created films that used little language and took place outside the consulting room with institutionalized infants. Yet key aspects of the psychoanalytic case, as put forth by John Forrester, were depicted visually. These visual displays of transference, failure, and interpersonal emotions highlight the foundations of what Forrester means by reasoning in cases. The article concludes that Spitz failed at creating classic psychoanalytic evidence, but in so doing stretched the epistemology of the case.

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A child-friendly school: How the school implements the model

International Journal of Evaluation and Research in Education (IJERE) ◽

10.11591/ijere.v10i1.20765 ◽

2021 ◽

Vol 10 (1) ◽

pp. 273

Author(s):

Somariah Fitriani ◽

Istaryatiningtias Istaryatiningtias ◽

Lelly Qodariah

Keyword(s):

Empirical Data ◽

Quantitative Data ◽

Single Case ◽

Single Case Study ◽

Case Study Method ◽

Model Following ◽

Essential Components ◽

Child Friendly ◽

Research Analysis

The study was to examine the implementation of child-friendly school (CFS) in a public elementary school. This study employed a single case study method, as Public Elementary School ofRagunan 01 is the unit of research analysis. The school has been declared as a child-friendly school since 2015. The quantitative data generated, however, were only used to see the percentage of the characteristics of CFS model. Thus, the data were gathered through observation, questionnaires and interviews to obtain more comprehensive empirical data. The questionnaire was distributed to all teachers and 15 class coordinators of students’ parents to obtain data about the implementation of CFS. Interviews were conducted with several important multi-stakeholders identified. The results showed that thirteen characteristics of the CFS had been implemented well with a percentage value above 95%. It indicates that this school has been able to realize the CFS model following its principles. Besides, the school has met the requirement of the six essential components of CFS adapted according to Indonesian educational contexts. It indicates that the implementation of CFS is in accordance with the concept of UNICEF but with some differences.

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A survey of Irish psychiatric trainees attitudes to balint groups

BJPsych Open ◽

10.1192/bjo.2021.691 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S259-S259

Author(s):

Sudha Jain ◽

Emma Adams ◽

Alyson Lee

Keyword(s):

Thematic Analysis ◽

Online Survey ◽

Psychological Needs ◽

Free Text ◽

Patient Relationship ◽

Doctor Patient Relationship ◽

Cross Sectional Survey ◽

Online Groups ◽

Face To Face ◽

Balint Groups

Aims1. To compare the experience of psychiatric trainees in Ireland of online Balint Groups (BG) in contrast to face to face groups.2. To assess the general attitudes of trainees to BG using the Psychological Medical Inventory (PMI) (Ireton and Sherman, 1988) scale.MethodAn online survey comprising two sections: 1. A questionnaire exploring participants experience, effectiveness and obstacles to attending the two formats of BG with a free text box response. 2. General attitude of trainees towards BG using PMI scale.An online cross-sectional survey using Survey Monkey. An invitation to participate in the survey was emailed to all trainees by the College of Psychiatrists in Ireland. All data were anonymised, and all data processing was conducted in line with GDPR. Statistical analysis was undertaken using Microsoft Excel. Thematic analysis was applied to the free-text box responses.Result16.49% (64/388) responded to the survey. Responses were uniform across all stages of training. 97% of respondents attended BG; 72% attended both formats, 25% attended only face-to-face and 3% online only. 65% of respondents preferred face to face compared to 18% online, whilst 11% stated no preference.On thematic analysis, trainees asserted a preference for face-to-face, describing better group cohesion, feeling safer to share, increased ease of interpreting non-verbal communication, and that conversation was more fluid. They described greater ease of engagement with the group/facilitator and preferred direct social interaction with peers.Conversely, most trainees acknowledged that online groups were convenient to attend, less time consuming & mitigated COVID risk associated with face-to-face meetings. Common themes against the use of online groups were: less psychotherapeutic in nature, technical issues, silences, unable to see participants faces and as though speaking “into the void”.Regarding trainees' attitudes to attending BG, most of the trainees found BG had been beneficial in developing more interest and confidence in dealing with the psychological aspects of patient care. Trainees agreed that skills improved in developing an excellent doctor-patient relationship, recognising patients under stress/ in distress, systemically obtaining psychological information and making treatment decisions based upon psychological needs and psychotherapeutic engagement. They agreed that they could better understand the influence of doctors' emotions on the doctor-patient relationship.ConclusionThis survey showed that most trainees find BG beneficial in developing better doctor-patient relationships, preferring face-to-face rather than online BG. However, they found online more convenient. A blended learning approach could provide trainees with the benefits of both formats of BG.

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A Crisis of Trust: A Case Study of Doctor–Patient Relationship in Guangzhou

Confronting the Challenges of Urbanization in China ◽

10.4324/9781315558547-21 ◽

2016 ◽

pp. 176-190

Keyword(s):

Patient Relationship ◽

Doctor Patient Relationship

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Fundamentos humanísticos na formação de estudantes de medicina: estudo de caso

International Journal of Health Education ◽

10.17267/2594-7907ijhe.v2i1.1815 ◽

2018 ◽

Vol 2 (1) ◽

pp. 19

Author(s):

Luiz Alberto Queiroz ◽

Nara Lima Alexandre

Keyword(s):

Death And Dying ◽

Patient Relationship ◽

Physician Patient Relationship ◽

Doctor Patient Relationship ◽

Student Community ◽

Documentary Analysis ◽

School Of Medicine ◽

The Subject ◽

Physician Patient

Background: Medicine has been gaining high technological power, essential for many diagnoses and current treatments. On the other hand, one observes the distancing of the physician from what should be his instrument of work: the person. Bahiana School of Medicine has been implementing actions aimed at integrating the student into the subjective elements of medical practice through such subjects as the Psychodynamics of the Medical Clinic. Objectives: To portray the reality of the teaching of the discipline Psychodynamics in the Bahiana School of Medicine and Public Health; to evaluate the performance of the psychodynamic material taught in the 7th semester of the medical course, as well as the need to teach humanistic fundamentals to the student community of this school. Methods: Case study conducted through documentary analysis, interview with professor of the subject and application of questionnaire. After approval by the Ethics Committee, questionnaires containing sex, age, year of the course, questions related to the subjects developed in the subject were applied, such as doctor-patient relationship, death and dying, medical vocation and humanization etc. Results: The goal of psychodynamics is to provide an integral view of the patient. The questionnaires were answered by 124 students distributed between the 4th, 5th and 6th grades. 88.7% agreed that the subject provided grounds for establishing an effective physician-patient relationship. 91.2% agreed that the subject drew attention to the therapeutic aspect that can have the doctor-patient relationship. 99.2% agree that in order to meet humanity, it is first necessary to humanize. 86.3% of the students agree on the need to teach humanistic fundamentals throughout the course. Conclusions:A Psicodinâmica da Clínica médica vem atingindo os objetivos propostos. Há necessidade do ensino de fundamentos humanísticos durante todo curso de medicina.Background:Medicine has been gaining high technological power, essential for many diagnoses and current treatments. On the other hand, one observes the distancing of the physician from what should be his instrument of work: the person. Bahiana School of Medicine has been implementing actions aimed at integrating the student into the subjective elements of medical practice through such subjects as the Psychodynamics of the Medical Clinic. Objectives:To portray the reality of the teaching of the discipline Psychodynamics in the Bahiana School of Medicine and Public Health; to evaluate the performance of the psychodynamic material taught in the 7th semester of the medical course, as well as the need to teach humanistic fundamentals to the student community of this school. Methods: Case study conducted through documentary analysis, interview with professor of the subject and application of questionnaire. After approval by the Ethics Committee, questionnaires containing sex, age, year of the course, questions related to the subjects developed in the subject were applied, such as doctor-patient relationship, death and dying, medical vocation and humanization etc. Results: The goal of psychodynamics is to provide an integral view of the patient. The questionnaires were answered by 124 students distributed between the 4th, 5th and 6th grades. 88.7% agreed that the subject provided grounds for establishing an effective physician-patient relationship. 91.2% agreed that the subject drew attention to the therapeutic aspect that can have the doctor-patient relationship. 99.2% agree that in order to meet humanity, it is first necessary to humanize. 86.3% of the students agree on the need to teach humanistic fundamentals throughout the course. Conclusions: A Psicodinâmica da Clínica médica vem atingindo os objetivos propostos. Há necessidade do ensino de fundamentos humanísticos durante todo curso de medicina.

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