Communication with Patients Difficult to Communicate with Communication and Self-experience Skřivanová Kateřina, General Medicine, Autumn 2009 General Recommendations nFind out the case history, ask about quality of contact with the previous doctor and learn a lesson from it nThe doctor controls the development of the situation nThe doctor accepts the patient and expresses them support and understanding nThe doctor puts emphasis on the therapeutic contract Mentally Retarded Patient nThe patient reacts sensitively to the emotional condition of the doctor. Avoid impatient, reserved, unconfident, agressive and anxious behaviour nCommunicate primarily with the patient, the accompanying person only specifies the information nThe basis of cooperation is a positive emotional response to the patient, appreciation of his/her effort, thorough and patient explanation of the examination procedure, medical report and further treatment Blind Patient nCommunicate primarily with the patient nDescribe what you are going to do and how nAlways inform in advance about a medical intervention and why it is necessary nRearrange your consulting room, remove obstructions and barriers nCreate acoustically reasonable environment nAvoid expressing pity Hard of Hearing Patient nArticulate clearly, speak slowly nAsk nCheck carefully your as well as the patient‘s non-verbal communication nBe patient nAppreciate the patient, even non-verbally nIn case of problematic communication ask an interpreter for help n Agressive Patient nExplore motives of the patient‘s agressive behaviour (e.g. As an expression of the phase of acceptance of the illness) and act carefully according to their judgement, do not let yourself get impulsively into a conflict nDeal with the patient in compliance with the assertiveness rules, possibility of using the retreat/confrontation model nCombination of an agressive and anxious patient – anxious pedant with ambivalent behaviour n Anxious Patient nThey demand feeling of safety and certainty, reassurance and support. It is the doctor‘s duty to reduce the patient‘s anxiety nAnxiety is accompanied by adrenergic (sympathicotonic) activity nDuring an illness the patient suffers from lose of control. They feel ashamed and vulnerable when they are weakened nThe doctor gains trust by using a scientific approach with a thorough collection of anamnestic data, patient listening Depressive Patient nA depressive patient shows irreparable sad mood, powerlessness and hopelessness, lack of energy and life perspective nIn case of suicidal tendencies it is neccessary to open up the topic, anti-suicidal contract nAppeal to patient‘s strong will makes things worse n Narcissistic patient nDesires to be looked after. Their illness represents secondary gaining of attention. They represent their problems as unique and special. If they do not receive an “adequate“ care, they get angry = complications in care = interruption. It is possible to use their self-admiration for treatment purposes. nThe doctor should set clearly his proposal and possibilities. He should motivate the patient by continuous appreciating their cooperation. Paranoid patient nUpon contact with the doctor during the illness the following appears: distrust, hypersensitiveness to humiliation, fear of dependence, intensified feelings of embarrassment and vulnerability nBe prepared for: exaggerated reaction to undesirable effects of medication, painfulness of intervention, unkind approach of the doctor, accusing of malpractice, lack of qualification of the doctor nContact can be helped by: objective, friendly contact without jovial or intimate approach, timely information (about side effects), patient and kind facing the hostility of the patient suffering from distrust and fear Sources nVymětal, J. Lékařská psychologie, Psychoanalytické nakladatelství, 1999 nHonzák R., Komunikační pasti v medicíně. Galén, 1977. nTate P. Příručka komunikace pro lékaře. Praha, Grada, 2005 nHájek K. Práce s emocemi pro pomáhající profese. Praha, Portál, 2007.