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Those hateful patients

Those hateful patients. Swansea Tuesday 22 nd May 2007. The contribution of Michael Balint. The doctor his patient and the illness … 1957. The most effective drug a doctor prescribes is himself. The doctor as a drug. Specific The appropriate dose.. Loading/maintenance/overdose

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Those hateful patients

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  1. Those hateful patients Swansea Tuesday 22nd May 2007

  2. The contribution of Michael Balint The doctor his patient and the illness … 1957

  3. The most effective drug a doctor prescribes is himself

  4. The doctor as a drug • Specific • The appropriate dose.. Loading/maintenance/overdose • Combination therapy but possible interaction..potentiate or negate • Frequency & Timing • Suitable form ..package • Tolerance & Resistance • Allergy • Anaphylaxis Placebo • Storage • Side effects • Dependency

  5. The apostolic function of doctors You get the patients you deserve!

  6. Diagnosis precedes treatment • The feelings the patient engenders in his doctor is an important physical sign.

  7. Taking care of the hateful patient J.E.Groves N.E.J.M. 1978 • The dependant clinger • The entitled demander • The manipulative help rejecter • The health denier

  8. A farewell to heart sink?Gwenda DelanyBJGP April 2007 Vulnerable.. Abused … Manipulative

  9. Don’t forget to care for the doctor as well as the patient. ..or as Michael Balint might say … ..Drugs that are not stored properly lose their effectiveness and may become poisonous.

  10. The end

  11. Describe a patient who • Made you feel *bad* • Made you feel *good*

  12. The Health Belief Model • Motivation – people’s interest in their health and degree to which they are motivated to change varies widely. • Perceived vulnerability – perception of likelihood to be affected by disease or belief in diagnosis and consequences varies widely • Perceived seriousness • Perceived costs and benefits • Cues to action

  13. The doctor as a witness

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