Session 4 - psychological management of medical patients 1: counselling Flashcards
(34 cards)
What stems out of a good patient-doctor relationship?
Greater access to potentially relevant diagnostic information.
Increased likelihood that patients will follow medical advice.
What does the quality of a doctor-patient relationship depend on?
The patient’s expectations and the practitioner’s style
What are the expectations of the patient?
A competent practitioner who exhibits, friendliness, interest, empathy and concern. The practitioner also has to provide clear explanations about illnesses and treatment and should encourage the patient to ask questions.
What are the consequences of a patient-doctor relationship mismatch?
more stress during unpleasant procedures
reduced likelihood of following advice
switching doctors
What characterises a doctor-centered practitioner style?
closed-ended questions
focus on the first problem mentioned
use of medical jargon
patients are not involved in decision-making
What characterises a patient-centred practitioner style?
open-ended questions
patients are given the opportunity to discuss other problems
avoid use of medical jargon
participation of patients in decision-making
What are the rules effective helping?
- all insights, understandings, decisions and solutions should occur within the person experiencing the problem, not the doctor.
- differentiate between an internal frame of reference (how the patient feels about their situation) and an external frame of reference (how the doctor sees the patient’s situation)
What are the aspects of counselling?
building rapport
helpful responding
helping relationship
goals
process
support systems
multi-cultural considerations
Which nonverbal skills help build rapport?
relaxed posture
open posture
lean in
eye contact
squarely face your patient
Which aspects determine how helpful you are with regards to helpful responding?
your intentions and attitude
the phrasing of your response
List the different response styles.
Advising
Interpreting
Reassuring
Probing
Understanding
Explain the Advising response style
These responses communicate an evaluative, corrective or moralizing attitude or intent. The doctor implies what the patient ought to do or might do to resolve the problem.
Explain the Interpreting response style.
The doctor’s intentions are to teach, to tell the patient what their problem means or to impart some psychological knowledge to the patient.
The doctor implies what the patient might or ought to think.
It attempts to give the patient some additional insight through an explanation.
Explain the Reassuring response style.
It indicates that the doctor wants to reassure, be sympathetic, or reduce the intensity of the patient’s feelings.
Explain the Probing response style.
It indicates that the doctor wants to get further information, guide the discussion along certain lines, or bring the patient to a certain realization or conclusion the doctor has in mind.
The doctor implies that the patient ought to or might profitably develop or discuss a point further.
Explain the Understanding response style
It indicates that the doctor’s intention is to understand the patient’s thoughts and feelings. It asks the patient whether the doctor has understood what they are saying and how they are feeling.
What are the 3 situations in which you would use the Understanding response style?
- When you are not sure you have understood the patient’s thoughts and feelings.
- When you wish to ensure that the patient hears what they have just said.
- When you want to reassure the patient that you are trying to understand their thoughts and feelings.
Explain the Respect component of the Helping Relationship.
The patient is accepted in totality as a unique being and as someone with the right to self-determination. This also forms the basis for the ‘first do no harm’ rule and prompts the doctor to assume the patient’s goodwill and not rush to judgement.
Explain the Empathy component of the Helping Relationship.
The patient’s true feelings are understood and reflected accurately. The patient is understood from their point of view and through the context of their life. The doctor understands the dissonance between the patient’s point of view and reality.
What are the goals of counselling?
- manage specific problems and develop opportunities
- improve the patient’s ability to manage problems in everyday life
- help the patient develop an action-orientated prevention mentality
Name the stages of counselling.
Stage 1 - the current picture
Stage 2 - the preferred picture
Stage 3 - the way forward
What are the tasks under Stage 1 of counselling?
Task 1 - help the patient to tell their story and identify their problems
Task 2 - help the patient develop new perspectives that help them reframe their stories more constructively.
Task 3 - help the patient to meaningfully select issues to work on.
What are the tasks under Stage 2 of counselling?
Task 1 - help the patient to imagine the possibilities for a better future
Task 2 - help the patient to choose realistic and challenging goals
Task 3 - help the patient find incentives for change and to commit to goals
What are the tasks under Stage 3 of counselling?
Task 1 - help the patient develop possible strategies to achieve their goals
Task 2 - help the patient to choose the strategies that best fit their resources
Task 3 - help the patient to formulate these strategies into a plan of action
