Presentation in Doctor Patient Relationship in Psychiatry

1. Rapport and Doctor Patient
Relationship in Psychiatry
Dr Rakesh Kumar Mehta
Department of Psychiatry
Nepalgunj Medical College

2. Patient-Doctor Relationship
• Doctor Patient relationship is the core of the practice of medicine.
The patient comes for the interview seeking help, sometimes on the
insistence of others.(Spouse, family, court).
• Patient’s willingness to share information is increased or decreased
depending on the verbal and often not verbal intervention of the
physician and staff.
• As the psychiatrist begin to show respect and consideration to the
patient, Rapport begin to develop

3. Rapport
• An effective relationship is characterized by good rapport.
• Rapport is the spontaneous, conscious feeling of
harmonious responsiveness that promotes the development
of a constructive therapeutic alliance.
• It implies an understanding and trust between the doctor
and patient

4. • Rapport increases patient comfortability & trust about the
confidentiality to the treating psychiatrist.
• The patient start sharing more information.
• Thus Doctor - Patient relationship itself becomes part of the
therapeutic process

5. Components
1. The sharing is reinforced by the nonjudgmental attitude and
behavior of the Physician.
2. Physician should understand what the patient is stating and
emoting and this understanding should be conveyed to the patient.
This makes patient aware that the physician not only understand
but cares for too. This increases the trust and therapeutic alliance
becomes stronger.

6. 3. The Doctor Patient relationship is reinforced by the genuineness of the
physician.
Eg: Laugh at the humor
Apology for missing an appointment
Admit a mistake
Patient brings an item to show , show some interest and thank
for sharing
4. Patient asking about the personal questions should be answered
depending upon the type of psychotherapy and type of question .
Question regarding qualification and position should always be answered.

7. 5. Conscious/Unconscious
Transference: The process of patient unconsciously attributing to
their doctors aspect of important past relationship, especially those
with their patents.
They may be hostile , angry, demanding because of their formal
relationship.
Countertransference :
When doctor unconsciously attributes to patient that come from
the doctor past relationship

8. 6. Person centered- disorder centered interview.
Interview should be patient centered not doctor centered.
Patient goal(safe housing) should be emphasized rather than doctor
goal( hallucination)
7. Safety and Comfort
Both Patient and doctor safety should be considered.
Patient especially psychotic needs to be reassured as they may feel
threatened.
Doctor should have clear , exit path.

9. • Thank YOU