Get The Patient: Biological, Psychological, and Social PDF

By Hoyle Leigh M.D., F.A.P.A., Morton F. Reiser M.D., F.A.P.A. (auth.)

The out of date surgeon, whose departure from the modem scientific scene is so significantly lamented, used to be amply conscious of each one patient's character, kin, paintings, and lifestyle. this present day, we regularly blame a doctor's absence of that wisdom on ethical or moral deficiency both in clinical schooling or within the personality of people that turn into physicians. an alternate rationalization, even though, is that medical professionals are only as ethical, moral, and anxious as ever earlier than, yet huge quantity of extra new details has gained the contest for consciousness. the knowledge on hand to the old school health care provider have been a patient's background, actual exam, and "per­ sonal profile," including a constrained variety of usually ineffectual therapeu­ tic brokers. a physician this day bargains with a big array of extra new info, which comes from X rays, biopsies, cytology, electrographic tracings, and the phantasmagoria of up to date laboratory exams; and the health care professional also needs to pay attention to an inventory of healing chances which are either way more potent and much extra vast than ever before.

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Extra resources for The Patient: Biological, Psychological, and Social Dimensions of Medical Practice

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A biologically oriented psychiatrist using mainly a medical model of psychiatric illness may legitimize the full assumption of the sick role for the mentally ill patient. On the other hand, psychiatrists with a more sociopsychological orientation may be reluctant to grant their patients exemptions from social role responsibilities and to expect them to work at getting well through their own efforts assisted by the psychotherapist. Then, there are some who still believe that mental illness is a condition for which the patients are totally responsible, that they could "pull themselves together" if they really wanted to.

A patient brings to the consultation with the physician both overt and covert expectations of the doctor. Conversely, the physician holds expectations of the patient consonant with societal expectations about the sick role and automatically expects the patient to behave according to them (see Chapter 2). Especially important is the expectation that the patient will cooperate with the doctor in order to get well. Often there is an associated implicit idea that patients should and will be candid with physicians and that they will volunteer pertinent information.

In essence, both patient and doctor have the same and/or mutually syntonic central expectations, but the physician's intentions are often implicit and need to be made explicit. Treating the underlying illness first will lead to relief of symptoms; there is no inherent conflict, and, in fact, one follows the other. The patient, however, does not understand how an immediately distressful and seemingly irrelevant procedure like a breast biopsy (vignette 1) might eventually help relieve the felt distress of low back pain unless the physician explains explicitly that (1) the lump in the breast may be unrelated to the back pain but needs to be evaluated before it becomes a problem; (2) although unlikely, the back pain may be related to the lump in the breast (metastatic cancer); in which case, both need to be treated; and (3) in any case, the doctor will treat the back pain with medications.

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