The document discusses the qualities of a good doctor from multiple perspectives. It lists several attributes that people want in doctors, including respecting patients, promoting health, giving unbiased advice, and having a work-life balance. The responses provide additional views on what makes a good doctor, such as having compassion, being a lifelong learner, and possessing both scientific knowledge and a sense of "magic" in caring for patients.
The document discusses various consultation models in family medicine, including traditional disease-focused models and more comprehensive models that emphasize the patient-physician relationship and address psychosocial factors. It then presents Fayza Rayes' comprehensive consultation model, which aims to integrate effective communication skills into the traditional clinical method in a practical way that can be incorporated into daily practice and medical records. The model emphasizes a patient-centered and holistic approach that addresses patient needs beyond just disease management.
The document outlines key topics in medicine including smart physicians, training, communication between doctors and patients, health education, psychiatry, alternative medicine, medical research, ethics and legal issues, and quality assurance. It discusses the importance of quality assurance and monitoring in medicine through audits and ensuring proper protocols are followed for patient care and documentation.
Last semester's lecture on truth telling and breaking bad news to patients. It was presented by Dr Ghaiath Hussein for Farabi Medical College medical students.
Suicide assessment and management guidelinesNursing Path
The document provides guidelines for assessing and managing suicide risk. It outlines that a thorough assessment should evaluate for the presence of a mental disorder, suicidal ideation, intent, means, and risk factors. Treatment involves addressing the underlying disorder, mitigating risk factors, strengthening support systems, and maintaining long-term treatment. Ongoing monitoring of at-risk patients is important. Hospitalization may be necessary for patients deemed a high suicide risk, while others can be treated as outpatients with close follow-up. Proper documentation of assessments and safety plans is also discussed.
Communication Skills in Between Doctor and Patient and Breaking the bad news Orindom Shing Pulock
This document discusses communication skills, with a focus on patient counseling and breaking bad news. It covers several key topics:
- The importance of communication in the doctor-patient relationship for comprehensive treatment, patient satisfaction, and improved health outcomes.
- Effective communication involves listening to understand the patient, making sure they understand as well, and receiving feedback from their responses.
- Basic elements of counseling patients include explaining their disease and treatment plan, providing information materials, discussing lifestyle changes, and answering questions about medications and recovery.
- Examples show counseling patients pre- and post-operatively, including discussing diagnosis, treatment plans, diet and pain management, follow-up care and potential complications.
1. Communication skills are important for medical interviews and diagnoses are often made based on the patient history obtained during interviews. Effective communication between the doctor and patient is key.
2. Patients want doctors who listen to them, do not rush the appointment, provide information, and allow participation in decisions. Qualities like competence, care, and involvement are highly valued by patients.
3. There are challenges to communication including the complexity of interviews, variability in patient and doctor personalities, and difficulties assessing and conveying risk. Doctors must be prepared to improvise while maintaining structure.
This document is a report submitted by Rachna Mishra, an MA student in Psychology at Delhi University, to the Siddhartha Vashishta Charitable Trust (SVCT). It details her dissertation research on the relationship between spirituality and mental health in five groups of people. She needed help finding participants and contacted SVCT. Mr. Ashok Passy of SVCT agreed to introduce her to cancer patients. The report describes the assessment tools used, three sample cases assessing depression and spiritual wellness, and expresses gratitude to SVCT for their assistance with her research.
Building a Doctor-Patient Relationship (Additional PLUS Reading Materials)Positive_Force
This document provides guidance on building a cooperative relationship between patients and doctors for HIV care. It suggests that patients should (1) share their point of view, learn as much information as possible, and prepare for appointments, while doctors should (2) support their patients' interests, be flexible in their responses, and describe issues from multiple sides. It also addresses how to handle disagreements, noting that changing doctors should only be a last resort when other options cannot establish an acceptable relationship.
The document discusses various consultation models in family medicine, including traditional disease-focused models and more comprehensive models that emphasize the patient-physician relationship and address psychosocial factors. It then presents Fayza Rayes' comprehensive consultation model, which aims to integrate effective communication skills into the traditional clinical method in a practical way that can be incorporated into daily practice and medical records. The model emphasizes a patient-centered and holistic approach that addresses patient needs beyond just disease management.
The document outlines key topics in medicine including smart physicians, training, communication between doctors and patients, health education, psychiatry, alternative medicine, medical research, ethics and legal issues, and quality assurance. It discusses the importance of quality assurance and monitoring in medicine through audits and ensuring proper protocols are followed for patient care and documentation.
Last semester's lecture on truth telling and breaking bad news to patients. It was presented by Dr Ghaiath Hussein for Farabi Medical College medical students.
Suicide assessment and management guidelinesNursing Path
The document provides guidelines for assessing and managing suicide risk. It outlines that a thorough assessment should evaluate for the presence of a mental disorder, suicidal ideation, intent, means, and risk factors. Treatment involves addressing the underlying disorder, mitigating risk factors, strengthening support systems, and maintaining long-term treatment. Ongoing monitoring of at-risk patients is important. Hospitalization may be necessary for patients deemed a high suicide risk, while others can be treated as outpatients with close follow-up. Proper documentation of assessments and safety plans is also discussed.
Communication Skills in Between Doctor and Patient and Breaking the bad news Orindom Shing Pulock
This document discusses communication skills, with a focus on patient counseling and breaking bad news. It covers several key topics:
- The importance of communication in the doctor-patient relationship for comprehensive treatment, patient satisfaction, and improved health outcomes.
- Effective communication involves listening to understand the patient, making sure they understand as well, and receiving feedback from their responses.
- Basic elements of counseling patients include explaining their disease and treatment plan, providing information materials, discussing lifestyle changes, and answering questions about medications and recovery.
- Examples show counseling patients pre- and post-operatively, including discussing diagnosis, treatment plans, diet and pain management, follow-up care and potential complications.
1. Communication skills are important for medical interviews and diagnoses are often made based on the patient history obtained during interviews. Effective communication between the doctor and patient is key.
2. Patients want doctors who listen to them, do not rush the appointment, provide information, and allow participation in decisions. Qualities like competence, care, and involvement are highly valued by patients.
3. There are challenges to communication including the complexity of interviews, variability in patient and doctor personalities, and difficulties assessing and conveying risk. Doctors must be prepared to improvise while maintaining structure.
This document is a report submitted by Rachna Mishra, an MA student in Psychology at Delhi University, to the Siddhartha Vashishta Charitable Trust (SVCT). It details her dissertation research on the relationship between spirituality and mental health in five groups of people. She needed help finding participants and contacted SVCT. Mr. Ashok Passy of SVCT agreed to introduce her to cancer patients. The report describes the assessment tools used, three sample cases assessing depression and spiritual wellness, and expresses gratitude to SVCT for their assistance with her research.
Building a Doctor-Patient Relationship (Additional PLUS Reading Materials)Positive_Force
This document provides guidance on building a cooperative relationship between patients and doctors for HIV care. It suggests that patients should (1) share their point of view, learn as much information as possible, and prepare for appointments, while doctors should (2) support their patients' interests, be flexible in their responses, and describe issues from multiple sides. It also addresses how to handle disagreements, noting that changing doctors should only be a last resort when other options cannot establish an acceptable relationship.
This document discusses nursing health assessment and critical thinking in nursing. It provides an overview of the nursing process, which includes assessment, diagnosis, planning, implementation, and evaluation. The nursing process is described as a systematic, dynamic, and outcome-focused framework that promotes humanistic care. Critical thinking in nursing involves purposeful, results-oriented thinking driven by patient needs based on nursing process and scientific principles. It requires identifying problems, analyzing them, developing responses, and following through while considering strengths and limitations. Characteristics of critical thinkers such as open-mindedness, flexibility, and willingness to learn from mistakes are also outlined.
Breaking Bad News https://www.youtube.com/watch?v=AK1r-1gJkSkImad Hassan
This document provides information and guidance on effectively breaking bad news to patients. It discusses why mastering this skill is important, as effective communication can improve patient outcomes. It defines bad news as any information that drastically changes a patient's view of their future. The document recommends using empathy and active listening skills when delivering bad news. It presents the SPIKES protocol as a framework, including setting, perception, invitation, knowledge, emotions, and strategy/summary. Examples of conditions requiring bad news and techniques like the "sandwich method" are provided. The overall message is the importance of compassion and ensuring patients understand their diagnosis and future options.
Zackary Berger gave a seminar on encouraging patient autonomy in practice. He discussed how patient autonomy is viewed in theory as patients evaluating treatment options based on their own values, but in reality patients often do not feel able to make autonomous decisions. The study examined how physicians elicit patient concerns in HIV clinic visits. It found that generic opening questions did not effectively elicit concerns, and physicians did not typically probe further after patients responded that they were "fine". When setting visit agendas, physicians often directed the agenda rather than exploring patient priorities.
This free book helps doctors and patients to cut through medical jargon, so they can learn to talk to each other. This book will help to improve doctor-patient communication, so that patients can learn to trust their doctors. This will reduce medical errors , and make medical practise more fulfilling for doctors
Person-centred therapy, also known as person-centred or client-centred counselling, is a humanistic approach that deals with the ways in which individuals perceive themselves consciously, rather than how a counsellor can interpret their unconscious thoughts or ideas.
The core purpose of person-centred therapy is to facilitate our ability to self-actualise - the belief that all of us will grow and fulfil our potential. This approach facilitates the personal growth and relationships of a client by allowing them to explore and utilise their own strengths and personal identity. The counsellor aids this process, providing vital support to the client and they make their way through this journey.
This document provides information and guidance for starting a ketamine assisted psychotherapy practice. It discusses treatment indications for ketamine therapy including treatment resistant depression, anxiety, PTSD, and addictions. It also lists contraindications. Treatment approaches for ketamine are described, including low and moderate to high dosing. A sample treatment protocol is outlined involving medical and psychological assessment, in-office sessions, at-home sessions, and maintenance phases. Training resources for ketamine therapy are listed. Considerations for a ketamine practice such as vision, education, set and setting, staff training, protocols, partnerships, and adverse events are reviewed.
This document provides an overview of ketamine-assisted psychotherapy (KAP). It discusses ketamine's rapid onset and safety profile, and its ability to access different states of consciousness for therapeutic purposes. Key aspects of the KAP process are outlined, including medical intake and screening, psychological preparation, low to high dosing strategies, and potential experiences during sessions like empathogenic states. Risks and challenges of KAP are addressed. Major goals of the integration process after sessions are described, such as emotional processing and resolving pathogenic beliefs. The document promotes a multidisciplinary treatment approach and lists training opportunities provided by Polaris Insight Center.
PELATIHAN PERAWATAN PALIATIF PADA STROKE - 16 maret 2020papahku123
This document discusses palliative care and end-of-life care for stroke patients. It outlines the seven principles of palliative care programs which focus on informed patient and family involvement, support for caregivers, a palliative approach to care, access to specialist palliative care, coordinated and integrated treatment, quality care from skilled staff, and community support. It also discusses assessing patient needs, managing symptoms, communication with patients and families, and the goals of palliative care for stroke which are to manage symptoms, provide counseling and support, and improve quality of life.
This document discusses the concept of mindfulness and its importance for physicians. It defines mindfulness as attending in a nonjudgmental way to one's own physical and mental processes during everyday tasks. This enables critical self-reflection which is important for listening to patients, recognizing errors, making evidence-based decisions, and clarifying values. The document outlines different types of knowledge physicians rely on, including explicit knowledge that can be taught versus tacit knowledge gained from experience. It argues mindfulness is key for integrating these different types of knowledge and exercising good clinical judgment. The document provides an example of how mindfulness helped in a complex patient case that required considering medical, relationship and personal factors.
Improving the Family Experience at the End of Life in Organ DonationAndi Chatburn, DO, MA
Communication skills strategies for improving family experience at the end of life for patients who die in the ICU after determination of brain death or after removing mechanical life support. Audience: Organ Procurement Organization staff and hospital administration
Ketamine-assisted psychotherapy is an emerging treatment that combines ketamine administration with psychotherapy. It is distinguished from ketamine infusion clinics by its emphasis on set and setting, the therapeutic relationship, and preparation and integration into the treatment plan. Ketamine has rapid onset and metabolism, and produces dissociative states from psycholytic to psychedelic. Its mechanisms of action involve glutamate and neuroplasticity. Risks include nausea, increased blood pressure, and potential for abuse with chronic use. Polaris Insight Center provides ketamine-assisted psychotherapy following screening, dosing, integration processes to maximize benefits and safety.
The document outlines 12 principles of psychiatric nursing presented by Ms. Kiran Nayyar. The principles include accepting patients as they are without judgment, using self-understanding as a therapeutic tool, maintaining consistent behavior to build patient trust and security, giving subtle reassurance to patients, focusing on feelings over intellect to change behaviors, avoiding unnecessary increases in patient anxiety, maintaining a realistic nurse-patient relationship focused on patient needs not nurse needs, avoiding physical or verbal force which can cause trauma, providing individualized care by considering each patient's unique needs and strengths, giving explanations at the patient's level of understanding to reduce anxiety, and maintaining basic nursing principles of safety, comfort and individualized care.
The document outlines 13 basic principles of psychiatric nursing:
1) Accepting patients unconditionally by showing non-judgment and understanding their feelings and behaviors.
2) Maintaining contact with reality by not encouraging unrealistic ideas and ensuring the patient is grounded in reality.
3) Seeking validation from the patient to understand their perspective and check the nurse's interpretations.
4) Using self-understanding as a tool to effectively respond to patient behaviors and attitudes.
5) Establishing consistency, security, and appropriate expectations to reduce patient anxiety.
Carl Rogers developed client-centered therapy in the 1940s as an alternative to traditional psychoanalytic approaches. In client-centered therapy, the therapist takes a non-directive approach, actively listening without judgment to help clients gain self-understanding and acceptance. The therapist provides empathy, genuineness, and unconditional positive regard to create an environment where clients can explore their feelings and find their own answers. Research shows client-centered therapy can be as effective as cognitive behavioral therapy and has influenced other approaches like motivational interviewing. While criticism includes the lack of diagnoses, some find it less effective for certain disorders, client-centered therapy changed psychotherapy by making it more client-focused and flexible.
In 21st Century, when medical information is freely available to everyone, soft skill-set combined with technical competence is the key to professional success as a clinical care provider. The various components of soft-skills viz, Professionalism Humanism, Communication skills are discussed. Research findings on how to enhance patient satisfaction 8-fold by improving communication skills is highlighted.
- ACT (Acceptance and Commitment Therapy) provides a therapeutic framework for psychedelic-assisted therapy by promoting acceptance of difficult experiences and committed action according to one's values.
- The six core ACT processes - contact with the present moment, acceptance, defusion, self-as-context, values, and committed action - are consistent with experiences commonly reported during psychedelic sessions like increased mindfulness, letting go of control, and insights into one's values and life goals.
- Preparation and integration sessions before and after psychedelic experiences can help apply ACT concepts like exploring one's values, committed to behavioral changes, and embracing difficult thoughts and emotions that arise.
This document provides an overview of Gestalt therapy. It discusses the origins and founders of Gestalt therapy, Fritz and Laura Perls. Some key concepts of Gestalt therapy are described, including the holistic view of individuals, the figure-ground process, contact and resistance to contact. Gestalt therapy focuses on awareness in the present moment and experiencing feelings fully rather than interpreting them. The document also discusses techniques used in Gestalt therapy such as exaggeration to increase awareness of tension or blocked energy.
Our Conversations lecture 'Hope, Humanity and Empowerment: Strengths-focused Cognitive Behavioural Therapy for Psychosis (& Schizophrenia)' was presented by staff members of the Integrated Forensic, Recovery and Schizophrenia programs at The Royal.
Psychosis can be associated with a variety of mental health problems, including schizophrenia, severe depression, bipolar disorder, anxiety, and post-traumatic stress disorders. While traditional treatments for psychosis have emphasized medication-based strategies, research now suggests that individuals affected by psychosis can greatly benefit from talk therapies such as cognitive behavioural therapy for psychosis (CBTP).
Learn more: www.theroyal.ca
Competence is a legal term determined by a court, while physicians can determine a patient's capacity to understand their medical condition; minors generally require parental consent except in emergencies where consent is implied or for issues like contraception where a mature minor may consent; determining capacity involves assessing memory, comprehension, reasoning and judgment through a neurological exam.
This document discusses what makes a good doctor. It defines many qualities of good doctors such as being attentive, caring, ethical, and knowledgeable. It emphasizes that good doctors are good people above all else. While it is difficult to define a good doctor, the document suggests the most important things are having compassion for patients and genuinely wanting to help them. It also stresses the importance of training doctors with experience as patients themselves in order to cultivate empathy.
This document discusses what makes a good doctor. It suggests that while it is difficult to define, good doctors have qualities like being attentive, caring, ethical, friendly, honest, knowledgeable, mature, and respectful. Good doctors are simultaneously learned, kind, humble, enthusiastic, and efficient. To nurture good doctors, medical students should experience being patients and schools should teach the realities and uncertainties of medicine while selecting students committed to helping people. Making a good doctor requires cultivating their humanity as much as their skills.
This document discusses nursing health assessment and critical thinking in nursing. It provides an overview of the nursing process, which includes assessment, diagnosis, planning, implementation, and evaluation. The nursing process is described as a systematic, dynamic, and outcome-focused framework that promotes humanistic care. Critical thinking in nursing involves purposeful, results-oriented thinking driven by patient needs based on nursing process and scientific principles. It requires identifying problems, analyzing them, developing responses, and following through while considering strengths and limitations. Characteristics of critical thinkers such as open-mindedness, flexibility, and willingness to learn from mistakes are also outlined.
Breaking Bad News https://www.youtube.com/watch?v=AK1r-1gJkSkImad Hassan
This document provides information and guidance on effectively breaking bad news to patients. It discusses why mastering this skill is important, as effective communication can improve patient outcomes. It defines bad news as any information that drastically changes a patient's view of their future. The document recommends using empathy and active listening skills when delivering bad news. It presents the SPIKES protocol as a framework, including setting, perception, invitation, knowledge, emotions, and strategy/summary. Examples of conditions requiring bad news and techniques like the "sandwich method" are provided. The overall message is the importance of compassion and ensuring patients understand their diagnosis and future options.
Zackary Berger gave a seminar on encouraging patient autonomy in practice. He discussed how patient autonomy is viewed in theory as patients evaluating treatment options based on their own values, but in reality patients often do not feel able to make autonomous decisions. The study examined how physicians elicit patient concerns in HIV clinic visits. It found that generic opening questions did not effectively elicit concerns, and physicians did not typically probe further after patients responded that they were "fine". When setting visit agendas, physicians often directed the agenda rather than exploring patient priorities.
This free book helps doctors and patients to cut through medical jargon, so they can learn to talk to each other. This book will help to improve doctor-patient communication, so that patients can learn to trust their doctors. This will reduce medical errors , and make medical practise more fulfilling for doctors
Person-centred therapy, also known as person-centred or client-centred counselling, is a humanistic approach that deals with the ways in which individuals perceive themselves consciously, rather than how a counsellor can interpret their unconscious thoughts or ideas.
The core purpose of person-centred therapy is to facilitate our ability to self-actualise - the belief that all of us will grow and fulfil our potential. This approach facilitates the personal growth and relationships of a client by allowing them to explore and utilise their own strengths and personal identity. The counsellor aids this process, providing vital support to the client and they make their way through this journey.
This document provides information and guidance for starting a ketamine assisted psychotherapy practice. It discusses treatment indications for ketamine therapy including treatment resistant depression, anxiety, PTSD, and addictions. It also lists contraindications. Treatment approaches for ketamine are described, including low and moderate to high dosing. A sample treatment protocol is outlined involving medical and psychological assessment, in-office sessions, at-home sessions, and maintenance phases. Training resources for ketamine therapy are listed. Considerations for a ketamine practice such as vision, education, set and setting, staff training, protocols, partnerships, and adverse events are reviewed.
This document provides an overview of ketamine-assisted psychotherapy (KAP). It discusses ketamine's rapid onset and safety profile, and its ability to access different states of consciousness for therapeutic purposes. Key aspects of the KAP process are outlined, including medical intake and screening, psychological preparation, low to high dosing strategies, and potential experiences during sessions like empathogenic states. Risks and challenges of KAP are addressed. Major goals of the integration process after sessions are described, such as emotional processing and resolving pathogenic beliefs. The document promotes a multidisciplinary treatment approach and lists training opportunities provided by Polaris Insight Center.
PELATIHAN PERAWATAN PALIATIF PADA STROKE - 16 maret 2020papahku123
This document discusses palliative care and end-of-life care for stroke patients. It outlines the seven principles of palliative care programs which focus on informed patient and family involvement, support for caregivers, a palliative approach to care, access to specialist palliative care, coordinated and integrated treatment, quality care from skilled staff, and community support. It also discusses assessing patient needs, managing symptoms, communication with patients and families, and the goals of palliative care for stroke which are to manage symptoms, provide counseling and support, and improve quality of life.
This document discusses the concept of mindfulness and its importance for physicians. It defines mindfulness as attending in a nonjudgmental way to one's own physical and mental processes during everyday tasks. This enables critical self-reflection which is important for listening to patients, recognizing errors, making evidence-based decisions, and clarifying values. The document outlines different types of knowledge physicians rely on, including explicit knowledge that can be taught versus tacit knowledge gained from experience. It argues mindfulness is key for integrating these different types of knowledge and exercising good clinical judgment. The document provides an example of how mindfulness helped in a complex patient case that required considering medical, relationship and personal factors.
Improving the Family Experience at the End of Life in Organ DonationAndi Chatburn, DO, MA
Communication skills strategies for improving family experience at the end of life for patients who die in the ICU after determination of brain death or after removing mechanical life support. Audience: Organ Procurement Organization staff and hospital administration
Ketamine-assisted psychotherapy is an emerging treatment that combines ketamine administration with psychotherapy. It is distinguished from ketamine infusion clinics by its emphasis on set and setting, the therapeutic relationship, and preparation and integration into the treatment plan. Ketamine has rapid onset and metabolism, and produces dissociative states from psycholytic to psychedelic. Its mechanisms of action involve glutamate and neuroplasticity. Risks include nausea, increased blood pressure, and potential for abuse with chronic use. Polaris Insight Center provides ketamine-assisted psychotherapy following screening, dosing, integration processes to maximize benefits and safety.
The document outlines 12 principles of psychiatric nursing presented by Ms. Kiran Nayyar. The principles include accepting patients as they are without judgment, using self-understanding as a therapeutic tool, maintaining consistent behavior to build patient trust and security, giving subtle reassurance to patients, focusing on feelings over intellect to change behaviors, avoiding unnecessary increases in patient anxiety, maintaining a realistic nurse-patient relationship focused on patient needs not nurse needs, avoiding physical or verbal force which can cause trauma, providing individualized care by considering each patient's unique needs and strengths, giving explanations at the patient's level of understanding to reduce anxiety, and maintaining basic nursing principles of safety, comfort and individualized care.
The document outlines 13 basic principles of psychiatric nursing:
1) Accepting patients unconditionally by showing non-judgment and understanding their feelings and behaviors.
2) Maintaining contact with reality by not encouraging unrealistic ideas and ensuring the patient is grounded in reality.
3) Seeking validation from the patient to understand their perspective and check the nurse's interpretations.
4) Using self-understanding as a tool to effectively respond to patient behaviors and attitudes.
5) Establishing consistency, security, and appropriate expectations to reduce patient anxiety.
Carl Rogers developed client-centered therapy in the 1940s as an alternative to traditional psychoanalytic approaches. In client-centered therapy, the therapist takes a non-directive approach, actively listening without judgment to help clients gain self-understanding and acceptance. The therapist provides empathy, genuineness, and unconditional positive regard to create an environment where clients can explore their feelings and find their own answers. Research shows client-centered therapy can be as effective as cognitive behavioral therapy and has influenced other approaches like motivational interviewing. While criticism includes the lack of diagnoses, some find it less effective for certain disorders, client-centered therapy changed psychotherapy by making it more client-focused and flexible.
In 21st Century, when medical information is freely available to everyone, soft skill-set combined with technical competence is the key to professional success as a clinical care provider. The various components of soft-skills viz, Professionalism Humanism, Communication skills are discussed. Research findings on how to enhance patient satisfaction 8-fold by improving communication skills is highlighted.
- ACT (Acceptance and Commitment Therapy) provides a therapeutic framework for psychedelic-assisted therapy by promoting acceptance of difficult experiences and committed action according to one's values.
- The six core ACT processes - contact with the present moment, acceptance, defusion, self-as-context, values, and committed action - are consistent with experiences commonly reported during psychedelic sessions like increased mindfulness, letting go of control, and insights into one's values and life goals.
- Preparation and integration sessions before and after psychedelic experiences can help apply ACT concepts like exploring one's values, committed to behavioral changes, and embracing difficult thoughts and emotions that arise.
This document provides an overview of Gestalt therapy. It discusses the origins and founders of Gestalt therapy, Fritz and Laura Perls. Some key concepts of Gestalt therapy are described, including the holistic view of individuals, the figure-ground process, contact and resistance to contact. Gestalt therapy focuses on awareness in the present moment and experiencing feelings fully rather than interpreting them. The document also discusses techniques used in Gestalt therapy such as exaggeration to increase awareness of tension or blocked energy.
Our Conversations lecture 'Hope, Humanity and Empowerment: Strengths-focused Cognitive Behavioural Therapy for Psychosis (& Schizophrenia)' was presented by staff members of the Integrated Forensic, Recovery and Schizophrenia programs at The Royal.
Psychosis can be associated with a variety of mental health problems, including schizophrenia, severe depression, bipolar disorder, anxiety, and post-traumatic stress disorders. While traditional treatments for psychosis have emphasized medication-based strategies, research now suggests that individuals affected by psychosis can greatly benefit from talk therapies such as cognitive behavioural therapy for psychosis (CBTP).
Learn more: www.theroyal.ca
Competence is a legal term determined by a court, while physicians can determine a patient's capacity to understand their medical condition; minors generally require parental consent except in emergencies where consent is implied or for issues like contraception where a mature minor may consent; determining capacity involves assessing memory, comprehension, reasoning and judgment through a neurological exam.
This document discusses what makes a good doctor. It defines many qualities of good doctors such as being attentive, caring, ethical, and knowledgeable. It emphasizes that good doctors are good people above all else. While it is difficult to define a good doctor, the document suggests the most important things are having compassion for patients and genuinely wanting to help them. It also stresses the importance of training doctors with experience as patients themselves in order to cultivate empathy.
This document discusses what makes a good doctor. It suggests that while it is difficult to define, good doctors have qualities like being attentive, caring, ethical, friendly, honest, knowledgeable, mature, and respectful. Good doctors are simultaneously learned, kind, humble, enthusiastic, and efficient. To nurture good doctors, medical students should experience being patients and schools should teach the realities and uncertainties of medicine while selecting students committed to helping people. Making a good doctor requires cultivating their humanity as much as their skills.
How to be a good doctor - Oslers clinical pearlsEric Mugambi
The document discusses the traits of a good doctor from multiple perspectives. It provides quotes from physicians and experts throughout history on what makes a good doctor. Key points include that a good doctor observes patients closely, understands them beyond just their medical issues, respects patients, promotes health, accepts death as natural, and works with a healthcare team. A good doctor gives unbiased advice while respecting patient preferences and uses evidence alongside clinical experience.
I managed the UK campaign for this fun and informative survival guide for first year medical students. I also contributed to the editorial of this publication.
Attitude, ethics & communication (aetcom)3 Module 1.3: Doctor-Patient Rel...DRRAJNEE
This document discusses the importance of the doctor-patient relationship and maintaining proper attitudes and communication. It is presented by Dr. Rajnee and addresses competencies for Indian Medical Graduates. The learning objectives are to describe professional qualities of doctors, demonstrate empathy, and discuss fundamentals of the doctor-patient relationship and medical ethics. The document outlines factors that impact the relationship like attitude, benevolence, communication skills, evidence-based practice, and maintaining competency. It emphasizes treating patients with dignity and respecting diversity. Case studies are also provided to facilitate discussion of relationship issues.
This document discusses the history and modern understanding of medical professionalism. It provides definitions of medical professionalism from various organizations over time, from the Hippocratic Oath to more recent charters. The document also examines perspectives on professionalism from medical students, residents, faculty and patients which commonly include clinical competence, patient relationships, and character virtues. It notes that trust between the medical profession and society breaks down when expectations are not met. The document concludes by discussing the application of medical ethics codes to clinical scenarios and relationships with patients.
attitudeethicscommunicationaetcom3-201226185123 (1).pdfNevil Shah
This document discusses the importance of the doctor-patient relationship and ethics in medicine. It is presented as a learning module with the following key points:
1. Professional qualities of doctors include empathy, communication skills, and maintaining patient dignity. Maintaining a good relationship with patients can help reduce litigation against doctors.
2. Factors that are important for a strong doctor-patient relationship include having a benevolent attitude, competency, evidence-based practice, obtaining informed consent, and effective communication.
3. Case studies are provided as examples of how poor communication and lack of shared decision-making can damage the relationship between doctors and patients. Maintaining trust and discussing treatment options are emphasized as important ethical components of medical
doctor patient relationship العلاقة العلاجية arabic & englishismail sadek
doctor patient relationship is a critical relation that need specific measure and qualities to proceed in treatment plan
العلاقة العلاجية من أهم العلاقات البشرية التي تعتبر من اخطرها حيث أن لها هدف هام وهو استمرار وتنفيذ الخطة العلاجية والتى تحتاجلقواعد وضوابط لتحكم هذه العلاقة فى اتجاهها السليم
This document summarizes a career enhancement workshop that examines how personal values and beliefs influence communication. It discusses developing self-understanding, effective listening and communication skills, and analyzing experiences with different cultures. The workshop also focuses on establishing rapport with patients, counseling, and making informed decisions. Barriers to communication like assumptions and emotional responses are addressed, as well as how to be a better listener through techniques like acknowledging, questioning, and encouraging further discussion.
The document discusses effective communication when delivering bad news to patients. It provides guidance on how to approach patients and their families sensitively when breaking news of a terminal illness or poor prognosis. The document outlines several models for delivering bad news, including building rapport, assessing the patient's emotional state, communicating clearly, and dealing with reactions in an empathetic manner. It also addresses how to handle situations where family members request not informing the patient about their diagnosis.
Patients facing chronic illness re-frame their definition of wellness and manage to cope in spite of adversity. This patient led research project delves into the myriad ways that those suffering from chronic illness chart a new path for themselves.
This document is a philosophy of nursing paper written by Steven Appelhof. It discusses nursing as involving problem solving, ethics, personal connections and caring for patients seeking help. Nursing requires a mix of didactic theory, experience, and personal problem-solving skills. Nurses have direct patient care and personal connections. The paper discusses the importance of viewing patients holistically and maintaining their quality of life through safe and effective care. It also discusses the level of interaction nurses have with patients and how they are considered one of the most trusted providers. The author discusses how their personal experiences and family history led them to pursue nursing and how they aim to provide the best quality of life for their patients.
This document provides tips for maintaining good health and preventing illness. It emphasizes that adopting a healthy lifestyle can help avoid needing medical care. While doctors are good at treating illness, they know less about wellness. Traditional wisdom and practices like yoga and Ayurveda can help tap into the body's innate ability to heal itself. Making lifestyle changes can be difficult, but is important for health. Learning from others' experiences with illness can motivate positive changes without needing to experience health problems firsthand. The most important thing is adopting preventive health behaviors.
Medicine is at heart a narrative activity–the telling and receiving of story. The patient interview is based on the notion that the patient, as story-teller, will share his or her experience, and that the doctor, as active listener, will be able to take that story and make sense of it in the world of science and medicine.
Health care is supposed to build on the story with each contact, but if we don’t know the story, each contact becomes a closed episode of its own, disconnected from every other episode. Fragmentation results as the outcome of a nonstoried approach to health care.
In this workshop, we will explore how the ancient art of storytelling can foster an empathetic healthcare model and generate a framework for a more holistic approach to treating the patient, while at the same time providing a rich source of diagnostic clues.
Narrative medicine represents a storied understanding of health. It’s a return to listening to the patient’s story. Doctors who are trained to listen to the story of the disease need to learn to listen also to the story of the illness. We’ll explore how to incorporate narrative medicine and storytelling into medical education
Transform Healthcare, Tap Into A Great Low Cost Resourcedandelt
Transform healthcare by tapping into a great low-cost resource ‒
Focus the patient experience on healing by empowering each person to be an agent of healing.
This document provides an introduction to mindfulness and its role in caring for dying patients. It defines mindfulness as regulating attention to bring non-judgemental awareness to current experiences. Mindfulness can help cultivate empathy, self-awareness, and the ability to hold contradictory truths. Practicing mindfulness can help clinicians address burnout, errors, and lack of presence by learning to stay present with discomfort. Formal mindfulness practices like meditation as well as informal practices like mindful moments can promote mindfulness. Mindfulness may improve physician well-being, quality of care, and quality of caring.
The document discusses the doctor-patient relationship (DPR) and how to build a good DPR. It defines the DPR as an emotional association between a doctor and patient where the doctor helps alleviate the patient's suffering. A good DPR involves effective communication, understanding the patient as an individual rather than just their disease, showing empathy, answering questions honestly, and involving the patient in decision making. Principles of medical ethics like beneficence and autonomy are important to DPR, as are models like the paternalistic, informative, and deliberative models described by Parsons. A good DPR improves treatment compliance, avoids unnecessary intervention, and prevents issues.
Metabolic syndrome is not a disease, but rather a clustering of conditions like obesity, high blood pressure, impaired glucose tolerance, and dyslipidemia that increase the risk of diabetes and cardiovascular disease. A study of NHANES data from 2011-2016 found the prevalence of metabolic syndrome varies by age, sex, and race/ethnicity in the United States. Lifestyle changes like following a Mediterranean or DASH diet, engaging in regular exercise, quitting smoking, and reducing risk factors can help prevent and manage metabolic syndrome.
Dengue is a febrile illness caused by a flavivirus transmitted by Aedes aegypti or Aedes albopictus mosquitoes while taking a blood meal. There are four dengue virus (DENV) types (DENV-1, DENV-2, DENV-3, and DENV-4), all of which are capable of inducing severe disease (dengue hemorrhagic fever [DHF]/dengue shock syndrome [DSS]). Dengue is endemic in more than 125 countries in tropical and subtropical regions and causes an estimated 390 million infections annually worldwide, of which 96 million are clinically apparent
In dengue-endemic regions, suspected, probable, and confirmed cases of dengue infection should be reported to the relevant authorities as soon as possible, so that appropriate measures can be instituted to prevent dengue transmission
dengue fever is a disease endemic to southeast asia, americas, africa. an early diagnosis and appropiate classification of the syndrome, helps the physician to provide the most adequate treatment.
Este documento describe la experiencia de una estudiante de medicina cuando su primer paciente, una mujer llamada Carmen, muere de un derrame cerebral. La autora se sintió triste y culpable por no haber podido comunicarse mejor con Carmen o evitar su muerte. Los profesores no brindaron apoyo a la estudiante para enfrentar este momento difícil. El documento argumenta que es importante enseñar a los estudiantes a lidiar con la muerte de pacientes y compartir estas experiencias para mejorar el aprendizaje.
This document provides guidelines for emergency physicians on diagnosing and treating acute complications of diabetes, specifically diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS). It outlines the diagnostic criteria, clinical features, precipitating factors, management guidelines including fluid replacement, insulin treatment, potassium replacement, and resolution criteria for DKA and HHS. Tables are provided detailing diagnostic criteria, precipitating factors, and treatment goals.
This document discusses the approach to hypertensive urgencies in primary care. It defines hypertensive crisis, urgency, and emergency, and how to recognize them based on blood pressure readings and presence of target organ damage. For hypertensive urgencies where there is high blood pressure but no organ damage, the goal is to lower blood pressure gradually over 24 hours to under 160/100. For emergencies where there is high blood pressure and acute organ damage, treatment needs to lower blood pressure more rapidly in the first few hours through intravenous medications. The document provides guidance on evaluation, potential secondary causes, red flags to watch for, how fast and how low to lower blood pressure, and examples of oral and intravenous medications to treat
Most of the prescriptions for antibiotics occurs in Primary care. Careful utilization of current antibiotics can decrease the growing problem about antibiotic resistance
Pulmonary embolism (PE) is a form of venous thromboembolism that can be fatal, accounting for 100,000 annual deaths in the US. PE is a cause of death or major contributing factor in up to 16% of hospital deaths, though the diagnosis is only suspected in one third of cases before death. PE is classified based on timing (acute, subacute, chronic), hemodynamic stability, and whether symptoms are present. Hemodynamically unstable patients may experience hypotension from large or small PEs in those with underlying cardiopulmonary disease. Risk factors include increasing age, malignancy, pregnancy, hospitalization, and inherited or acquired thrombotic conditions. Over 90% of e
Este documento presenta el caso de un hombre de 60 años de edad que consulta por disartria progresiva de un mes de evolución. El paciente tiene una historia de 4 años de debilidad muscular progresiva en extremidades inferiores que luego se extendió a las superiores, acompañado de pérdida de peso, disfagia y fasciculaciones. El examen físico muestra atrofia muscular, espasticidad, hiperreflexia y debilidad. Los estudios complementarios sugieren esclerosis lateral amiotrófica. El diagnóstico final es esclerosis lateral
Hypovolemic shock is a life-threatening condition caused by a reduction in circulating blood volume, resulting in decreased oxygen delivery. Early recognition is important to avoid tissue injury. Hypovolemic shock can be hemorrhagic, caused by blood loss from trauma or gastrointestinal bleeding, or non-hemorrhagic due to causes like burns, diarrhea, or excessive diuresis. Treatment involves rapid fluid resuscitation with crystalloids to restore circulating volume, with goals of maintaining an adequate blood pressure depending on the cause of shock. Lactate levels should be monitored to assess tissue perfusion.
The role of primary care in the management of crf patientsIvan De Paz Mejia
This document discusses the role of primary care in managing patients with chronic renal failure (CRF). It notes that CRF is a growing public health problem due to its association with other vascular diseases. Primary care plays an important role in educating the public, early identification of CRF, and integrated management of the condition. In the UK, general practitioners receive specialized training to care for CRF patients. The Quality and Outcomes Framework provides incentives for GPs to implement best practices for conditions like CKD. Primary care is well-positioned to monitor at-risk populations and detect CRF through universal lab reporting of estimated glomerular filtration rates.
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Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...The Lifesciences Magazine
The cyclothymia test is a pivotal tool in the diagnostic process. It helps clinicians assess the presence and severity of symptoms associated with cyclothymia.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
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2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...Media Logic
When it comes to creating marketing strategies that target older adults, it is crucial to have insight into their media habits and preferences. Understanding how older adults consume and use media is key to creating acquisition and retention strategies. We recently conducted our seventh annual survey to gain insight into the media preferences of older adults in 2024. Here are the survey responses and marketing implications that stood out to us.
The Ultimate Guide in Setting Up Market Research System in Health-TechGokul Rangarajan
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
Many 0 to 1 startup founders often overlook market research, but this critical step can make or break a venture, especially in health tech.
But Why do they skip it?
Limited resources—time, money, and manpower—are common culprits.
"In fact, a survey by CB Insights found that 42% of startups fail due to no market need, which is like building a spaceship to Mars only to realise you forgot the fuel."
Sudharsan Srinivasan
Operational Partner Pitchworks VC Studio
Overconfidence in their product’s success leads founders to assume it will naturally find its market, especially in health tech where patient needs, entire system issues and regulatory requirements are as complex as trying to perform brain surgery with a butter knife. Additionally, the pressure to launch quickly and the belief in their own intuition further contribute to this oversight. Yet, thorough market research in health tech could be the key to transforming a startup's vision into a life-saving reality, instead of a medical mishap waiting to happen.
Example of Market Research working
Innovaccer, founded by Abhinav Shashank in 2014, focuses on improving healthcare delivery through data-driven insights and interoperability solutions. Before launching their platform, Innovaccer conducted extensive market research to understand the challenges faced by healthcare organizations and the potential for innovation in healthcare IT.
Identifying Pain Points: Innovaccer surveyed healthcare providers to understand their difficulties with data integration, care coordination, and patient engagement. They found widespread frustration with siloed systems and inefficient workflows.
Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
Solution manual for managerial accounting 18th edition by ray garrison eric n...rightmanforbloodline
Solution manual for managerial accounting 18th edition by ray garrison eric noreen and peter brewer_compressed
Solution manual for managerial accounting 18th edition by ray garrison eric noreen and peter brewer_compressed
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CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
Psychedelic Retreat Portugal - Escape to Lighthouse Retreats for an unforgett...
Good doctor
1. What’s a good doctor and how
do you make one?
Doctors should be good companions for
people
Editor—Imagine waking tomorrow to find a
magic lamp by your bed, and the genie tells
you that there is only one wish left. You
decide to devote it to making good doctors.
What kind of people would these good
doctors be?
We ask this question often among
ourselves—a doctor embarking on his
career, an active researcher approaching his
peak, and a retired clinician needing
geriatric care. We sometimes ask other
people too. Despite the disparate vantage
points, the wish lists are amazingly similar.
We all want doctors who will:
x Respect people, healthy or ill, regardless
of who they are
x Support patients and their loved ones
when and where they are needed
x Promote health as well as treat disease
x Embrace the power of information and
communication technologies to support
people with the best available information,
while respecting their individual values and
preferences
x Always ask courteous questions, let
people talk, and listen to them carefully
x Give unbiased advice, let people partici-
pate actively in all decisions related to their
health and health care, assess each situation
carefully, and help whatever the situation
x Use evidence as a tool, not as a
determinant of practice; humbly accept
death as an important part of life; and help
people make the best possible arrangements
when death is close
x Work cooperatively with other members
of the healthcare team
x Be proactive advocates for their patients,
mentors for other health professionals, and
ready to learn from others, regardless of
their age, role, or status
Finally, we want doctors to have a
balanced life and to care for themselves and
their families as well as for others. In sum, we
want doctors to be happy and healthy,
caring and competent, and good travel com-
panions for people through the journey we
call life.
Unfortunately, we do not have a magic
lamp, and there is no genie. We must use our
own skills and endeavours to make the good
doctors we want and need. It is an awesome
responsibility.
Carlos A Rizo research fellow
crizo@uhnres.utoronto.ca
Alejandro R Jadad director
Murray Enkin consultant
Centre for Global eHealth Innovation, University
Health Network, Toronto, Canada M5G 2C4
ABC of being a good doctor
Editor—I offer some quotations on being a
good doctor.
“To be a doctor, then, means much more
than to dispense pills or to patch up or
repair torn flesh and shattered minds. To be
a doctor is to be an intermediary between
man and GOD” (Felix Marti-Ibanez in To Be
a Doctor).
“One of the essential qualities of the cli-
nician is interest in humanity, for the secret
of the care of the patient is in caring for the
patient” (Frances W Peabody in The Care of
the Patient).
“Being a good doctor means being
incredibly compulsive. It has nothing to do
with flights of intuition or brilliant diagnoses
or even saving lives. It’s dealing with a lot of
people with chronic diseases that you really
can’t change or improve. You can help
patients. You can make a difference in their
lives, but you do that mostly by drudgery—
day after day, paying attention to details, see-
ing patient after patient and complaint after
complaint, and being responsive on the
phone when you don’t feel like being
responsive” (John Pekkanen in MD—Doctors
Talk About Themselves).
“You can’t know it all. And even if you
knew everything that anyone else knows
(which you can’t, so stop worrying about it),
you still wouldn’t know what you need to
know to help many patients” (Perri Klass in
A Not Entirely Benign Procedure).
Some of the qualities that a good doctor
should possess are measurable, others are
not. A good doctor should be:
A: attentive (to patient’s needs), analyti-
cal (of self), authoritative, accommodating,
adviser, approachable, assuring
B: balanced, believer, bold (yet soft), brave
C: caring, concerned, competent, com-
passionate, confident, creative, communica-
tive, calm, comforter, conscientious, compli-
ant, cooperative, cultivated
D: detective (a good doctor is like a
good detective), a good discussion partner,
decisive, delicate (don’t play “God”)
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Letters
Website: bmj.com
711BMJ VOLUME 325 28 SEPTEMBER 2002 bmj.com
2. E: ethical, empathy, effective, efficient,
enduring, energetic, enthusiastic
F: friendly, faithful to his or her patients,
flexible
G: a “good person,” gracious
H: a “human being,” honest, humorous,
humanistic, humble, hopeful
I: intellectual, investigative, impartial,
informative
J: wise in judgment, jovial, just
K: knowledgeable, kind
L: learner, good listener, loyal
M: mature, modest
N: noble, nurturing
O: open minded, open hearted, optimis-
tic, objective, observant
P: professional, passionate, patient, posi-
tive, persuasive, philosopher
Q: qualified, questions self (thoughts,
beliefs, decisions, and actions)
R: realistic, respectful (of autonomy),
responsible, reliever (of pain and anxiety),
reassuring
S: sensitive, selfless, scholarly, skilful,
speaker, sympathetic
T: trustworthy, a great thinker (especially
lateral thinking), teacher, thorough, thought-
ful
U: understanding, unequivocal, up to
date (with literature)
V: vigilant, veracious
W: warm, wise, watchful, willingness to
listen, learn, and experiment
Y: yearning, yielding
Z: zestful.
Malvinder S Parmar director of dialysis
Timmins and District Hospital, Timmins, Ontario,
Canada P4N 8R1
atbeat@ntl.sympatico.ca
Good doctors abound
Editor—It is fairly easy to define in a few
words what makes a good lawyer, a good
architect, or a good writer, by saying that it is
one who wins difficult trials, who builds the
best constructions, or who writes moving
novels—no more qualities would be abso-
lutely necessary. In contrast, to define what
makes a good doctor is a rather difficult task.
A good doctor is not one who cures the
most because in many specialties recovery is
not a frequent outcome. It is not one who
makes the best diagnosis because in many
cases of self limited or incurable disorders
the precise and timely diagnosis does not
make a great difference for the patient. It is
not one who knows more scientific facts
because in medical science ignorance is still
rampant in several diseases. It is not one
who is gentle, compassionate, and honest
with the patient because these qualities are
often insufficient for an effective medical
course of action. It is not one who discovers
a new fact or treatment because nowadays
new information is only a small fraction of
knowledge to be inserted in the enormous
puzzle of biomedical research.
Other professionals can be judged by
their end results, but a doctor can be defined
as good only when he or she has as many as
possible of the above attributes. A good
doctor is simultaneously learned, honest,
kind, humble, enthusiastic, optimistic, and
efficient. He or she inspires total confidence
in patients and daily renews the magical rela-
tionship that by itself constitutes good
treatment for any kind of ailment and the best
starting point for confronting all causes of
pain and suffering. Although so many virtues
are difficult to find in a single human being,
the medical profession is fertile ground for
finding such combinations. Fortunately, in
our profession good doctors abound.
Julio Sotelo general director
National Institute of Neurology and Neurosurgery,
Insurgentes Sur 3877, Mexico City, Mexico
jsotelo@servidor.unam.mx
Some magic is required
Editor—As I think about the past when
doctors were soothsayers, astrologers, histo-
rians, philosophers, artists, and so on, my
feeling is that to be a doctor requires a lot of
science but also a little bit of “magic.”
Where does this magic come from? Well,
it is a result of being a complete, integrated
person trying to help other people by being
understanding and caring but also knowl-
edgeable, prepared, and ready to give your
best—not to save lives but to make them as
good as possible.
But why do I consider it a gift, or
compare it with magic? There is not a single
piece of evidence or the means to measure
whether a doctor is good or bad. Patients
need knowledge, but that is not all. They
need someone who cares about people, not
about illnesses.
As a recently qualified doctor, I consider
myself ignorant in many ways, but I know my
limitations, and I hope to become better for
the good of my future patients. A good doc-
tor should always admit that he or she is
human and has limits, but these boundaries
must not stunt us. Secure in the knowledge
that our boundaries make us strong, we may
excel, trying always to be better as human
beings and doctors.
Gabriel S Gorin Rosenbaum physician
Centro Dermatológico, Federico Lleras Acosta Av,
Bogota, Colombia
gabrielgorin@yahoo.com
We are trying to make doctors too good
Editor—We are trying to make doctors too
good today, and that is the problem. Medical
training demands that doctors master at least
the basics of a host of scientific disciplines—
anatomy, pharmacology, molecular biology,
computer science, epidemiology, nutrition
and diet, psychology, and so on. At the same
time, they are asked to be insurance
specialists, anthropologists, ethicists, marriage
counsellors, small business owners, social
workers, economists—the range of disciplines
we ask our medical students to consider is
staggering.
The guilt is poured on as articles appear
almost every day in the literature, lamenting
how little doctors know about some
important issue or another—doctors miss
depression, don’t ask about sexual behav-
iours, misunderstand familial abuse, don’t
know enough about subcultural beliefs,
haven’t been brought up to date on the
functioning of the (fill in the blank) system,
have not read up on drug interactions,
ignore patients’ spiritual needs, and on and
on. Doctors reel under the breadth of exper-
tise they are supposed to master.
As society becomes increasingly medi-
calised, and more and more social problems
that used to be the jurisdiction of law or reli-
gion (such as drinking too much alcohol or
coping with stress, street violence, or general
world weariness) fall under the rubric of
medical care, doctors are expected to under-
stand more and more as they heal our social
and our physical failings. Doctors simply
cannot assimilate so much information, or at
least they cannot assimilate it well. The truly
good doctor must, of course, be technically
proficient and know the craft of medicine. In
addition, however, the good doctor must be
able to understand patients in enough
breadth to call on a community of skilled
healers—nurses, social workers, insurance
specialists, yoga teachers, psychotherapists,
technicians, chaplains, whatever is
necessary—to help restore the person to
health (or perhaps, to support the person in
their journey towards death).
To do that, the doctor must be able to be
touched by the patient’s life as well as his or
her illness. The doctor need not be an
anthropologist but must know how to ask
about a person’s culture; he or she need not
be a marriage counsellor but must be able to
spot the signs of spousal abuse or the
depression that may be the result of a failing
union. Good doctors are humble doctors,
willing to listen to their patients and gather
together the full array of resources—
medical, human, social, and spiritual—that
will contribute to their patients’ healing.
Paul Root Wolpe senior fellow
Center for Bioethics, University of PA, 3401 Market
Street, Suite 320, Philadelphia, PA 19103, USA
wolpep@mail.med.upenn.edu
Letters
712 BMJ VOLUME 325 28 SEPTEMBER 2002 bmj.com
3. Tools of the trade must be put to good use
Editor—Good doctors must be able to put
their tools to good use. With their ears, they
must hear all that the patient tells. With their
eyes, they must see all that the patient shows.
With their hands, they must feel all that is
hidden from their eyes. With their mind,
they must detect all that is unspoken. When
all this information has been assimilated,
they must use their mouths to tell patients
their thoughts and their body language to
reassure. All the time, remembering their
duty to the patients.
It must be remembered that as a profes-
sion, we have the highest ideals and
standards to uphold. We can do this only
when we ourselves are well trained, have the
appropriate time with the patient, and have
patients who remember their duty to us too.
Dipan N Mistry senior house officer (ear, nose, and
throat medicine)
Leeds General Infirmary, Leeds LS2 9NS
dipanmistry@hotmail.com
Medical profession needs input from
belief in humanity and ethics
Editor—In the developing world with its
deficient facilities and patients who need to
eat before they need medical care, the medi-
cal profession needs input from a belief in
humanity and the ethics of the job more
than scientific professionalism.
A good doctor needs to develop an
abundance of patience; to explain and edu-
cate before prescribing drugs; and to think
about the proper decision—this does not
always have to be what is written in the text-
books. Costly investigations that confirm
only what history and examination have
discovered have no place, and neither
have investigations that would not alter
management.
The choice of treatment of a patient
who cannot pay immense costs also needs
special consideration, as does that of a
patient who has to travel long distances to
reach appropriate care. Taking time to
explain and understand, choosing the
language to fit each and every patient, is not
taught in medical school. Deciding to wait
rather than to interfere, when interfering in
a deficient and too short lived manner
would only prolong suffering, sharing the
sufferings from disease not only in a
biological but in a social sense these are
skills that a good doctor definitely needs but
is not always successful in developing.
Recognising your limits and acting only
within them and giving yourself the chance
to gain relief and regain energy are
sometimes more important than just hang-
ing around helplessly in a busy ward.
Honesty and humility—the slogan of my
medical school in Khartoum—are easy to
write and say but very difficult to practise in
an overpressed emergency department
where tiredness and nervousness gain the
upper hand.
Magdeldin A Elgizouli house officer
Khartoum Hospital, Sudan
m_elgizouli@hotmail.com
Being a patient helps
Editor—Aside from the obvious benefits of
a fine medical school, great teachers, and
lots of hands on clinical experience, I think
the very best way to produce a good (sympa-
thetic and humane) doctor is to force
student doctors or residents to become
patients.
I believe every doctor in pupa should
have many tubes of blood drawn over a few
days by poor phlebotomists, have a nasogas-
tric tube inserted once or twice, undergo a
thorough sigmoidoscopy, barium enema, and
bowel preparation, and perhaps even be
made to spend a night or two confined to a
hospital bed, plugged into an intravenous
drip, and then be subjected to harried and
uncaring staff doctors and nurses while
bedridden.
I’ll bet a case of wine that this trenchant
exercise will produce far more empathetic,
sympathetic, and good doctors then multi-
ple lectures on sensitivity and humanism by
some medical academic, ethics professor, or
member of the cloth. I daresay that I truly
believe that my experiences of being a
patient as a student sure as hell helped
mould me into the caring and sensitive
practitioner I am today!
Robert I Rudolph clinical professor of dermatology
University of Pennsylvania School of Medicine,
1134 Penn Avenue, Wyomissing, Philadelphia,
PA 19610, USA
rudolph@epix.net
A nurse speaks
Editor—From a nurse’s point of view, being
a good doctor is not that hard. Good doctors
have graduated from medical school so
should have a reasonable depth of knowl-
edge to inform their decisions.
The key to becoming a good doctor is to
gain the confidence not to need support
when capable of carrying out a task or mak-
ing a decision and to ask for help and
support when not capable. Remember, the
clinical picture is more important in most
circumstances than the laboratory results.
Look at the patient, not the numbers.
A good doctor also needs to be a team
player. Nurses and those in professions allied
to medicine can make your life easier or
harder. Most house officers and senior house
officers have limited practical knowledge of
the specialties, whereas nurses often have
many years of experience—use this to your
advantage. You will not lose your authority by
asking for their help but will gain nurses’
respect for realising your limits. Nurses often
know consultants quite well and can tell you
what information they like available on their
ward rounds and when they would favour
being asked for help and advice.
Remember, most nurses don’t envy your
responsibilities but do wish to have their con-
cerns heard and answered. We don’t mind
our advice being overturned. We just want to
know you have registered our concerns, have
thought about them, and weighed the pros
and cons of action or inaction.
Finally, and often hardest to achieve, is
good communication with patients. Listen
to them, and try to be empathetic. The
ultimate responsibility for health decisions is
theirs. Remember this. Policies and proce-
dures can be bent to suit the patient, just
remember to document that it was the
patient’s request.
It looks so simple written down like this,
but most doctors still find these attributes
difficult to acquire.
Mark J Wilson registered nurse
Oncology and Haematology Unit, Torbay Hospital,
Torbay TQ2 7AA
justineandmark@hotmail.com
A patient speaks
Editor—For several years I was registered
with a wonderful general practitioner in my
home town. I never appreciated him until I
moved away to study at university.
I went from being an empowered
individual to a patient number. There was
no recognition that I had existed before I
joined my new practice—the staff never
referred to any of my previous doctor’s
notes. It was upsetting to sit across the desk
from the general practitioner, give an
account of what had happened, and then
find out that the salient points had not been
recorded in my notes. My suggestions for
what might be happening were treated with,
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713BMJ VOLUME 325 28 SEPTEMBER 2002 bmj.com
4. I felt, derision. After all, what would I know—
I’m a mere patient.
It got to the point where I would see my
general practitioner only if I had a fair idea
of what was going on. If I were concerned or
worried I’d return home and see my “real”
general practitioner as a temporary resident.
So why was one general practitioner
wonderful and the other not?
My real general practitioner became my
expert best friend. He took an interest in me
as a person and not as a set of symptoms. He
knew when to speak and, more importantly,
when to shut up. My history was my history,
not his questions with his answers. I felt
empowered and never bullied into taking a
course of action that I didn’t want to follow.
He seemed to realise that I might be better
placed to make suggestions about what was
going on. My experiences lead me to make
the following as a summary of a good
consultation.
The doctor asks questions; patients give
answers. The doctor uses his or her
knowledge and skills to help patients make
sense of their answers; patients ultimately
decide what they want to do with their doc-
tor’s support. My unhappiness arose when
the doctor filled in her own answers.
Louise Ward patient
LouiseWard36@hotmail.com
Eulogy for a good doctor
Editor—In June this year I went to the
memorial service for an exceptionally good
doctor, Phyllis Mortimer. I had been both a
colleague and a patient of hers some years
ago. An inimitable woman (one of three
women in her year of 150 medical students),
she had graduated despite having polio as
an undergraduate and myriad health prob-
lems that continued all her life.
Perhaps this explained something of the
compassion she had for her patients and her
sheer humanity. Jungians speak of the
concept of the wounded healer: that
clinicians must be aware of their own
woundedness so patients can find the health
in themselves. The relationship between the
two of them becomes in itself a creative
medium unique to that encounter. The pro-
tocol is a necessary, but enormously limited,
tool, which provides only the beginnings of
good care. Real evidence based practice is
fluid, ever changing and continually revis-
able specific knowledge. Some of the neces-
sary knowledge is that which is created in
the consulting room itself.
My husband and I had treatment for
subfertility for about five years with several
clinicians. Phyllis cared for me through
many months of it. With her, unlike others,
the unpleasant procedure was no more
invasive than if she were looking in my ear.
This was due to her gentle physical handling
of me (despite her own handicap with hand
and arm) but especially because of her inter-
personal skills, which were nothing short of
extraordinary. She was also the only
clinician we encountered who was able to
work (and work well) with the continual dis-
appointment of treatment failure. As her
colleague (at the time I was the regional lead
for quality improvement), I knew of Phyllis’s
reputation for searching to extend the tech-
nical quality of care and also of her gifts as
writer, dramatist, and director. Phyllis also
had her flaws. But it was her capacity for
equality and sensitivity of relationship—and
at the same time holding her professional
boundaries and standards—that made her
such an exceptionally good doctor.
She relished the chance to find creative
ways of communicating just as well with the
patient from a severely deprived back-
ground as with the educated patient. Phyllis’s
consultations were of a dramatically higher
standard than most I have witnessed over
the years and uniquely tailored to the
patient in front of her.
There is no such thing as the perfect doc-
tor. The good doctor is not one type or one
thing. He or she is “good enough” in the
Winnicottian sense—someone who is truly
mindful of her or his own limitations and the
profession’s limitations. The good doctor has
a high tolerance for “not knowing”—an ability
to suspend judgment and work with situa-
tions of high intractability. He or she is always
searching for, moving towards, and finding
creative solutions in the moment at hand,
able to hold both hope and failure simultane-
ously, being different things to different
patients and thereby meeting myriad needs.
Can you imagine a world where more
clinicians, like Phyllis, were able to transform
their inherent handicaps into increased
effectiveness? That would mean powerful
medicine indeed.
Valerie James fellow in leadership development
King’s Fund, London W1G 0AN
V.James@kingsfund.org.uk
Now I am retired . . .
Editor—What is a good doctor? How do we
make one? Now I am retired I know how to
be a good doctor. I know how to listen to a
patient. I know how to put myself at the
patient’s disposal. Put down your pen. Turn
away from your desk. Face the patient. Sit
back. Give him or her your full attention.
Only thus will you fully understand the
problem.
Before I took up medicine I knew what
made a good doctor. I was a mature student.
Furthermore, I had had extensive experi-
ence of being a patient. I had often had
blood taken through an old fashioned, reus-
able needle, had had barium meals, sig-
moidoscopies, nasogastric feeding, intra-
venous drips, and more than one operation
under general anaesthesia. I knew what a
good doctor and a good nurse were like.
Once I was qualified things were rather
different. Although I was still full of youthful
idealism, I became less inclined to sit and lis-
ten. I seldom had the chance to sit at all. Still,
I loved the work, and, on the whole, I loved
the patients. I still felt compassion and fellow
feeling for them. But as time went by, things
changed. For one thing I was perpetually
aware of time’s winged chariot hurrying
near and most of the time it seemed to be
accompanied by the hound of heaven.
Although I had studied art, literature,
and philosophy, although I had the gift of
tongues and of clear thinking, if not of clair-
voyance, I found that the benison of charity,
of the milk of human kindness, was leaking
out of my soul, squeezed out by the
pressures of work, of financial anxiety, of a
wife and five children to care for and keep
happy, of nights broken by the cries of my
own children or the urgent clinical needs of
others, of committee work and administra-
tive responsibilities. I became less patient
with my patients, less tolerant of the foibles
of the human race, less willing to listen, less
able to care.
Once I retired, however, things changed
again. Suddenly my financial worries were
over. I had savings instead of debts. Most of
my children had left the nest. I had time
once more. Doing locum consultant work
here and there when I felt inclined had all
the pleasures and little of the pain of full
time consultant work. No committee meet-
ings, virtually no administrative duties. Just
ward rounds, outpatient clinics, teaching,
and on-call duties every three or four nights.
The outpatient clinics were generally less
heavily booked than I had been used to. I
could sit back and listen to patients and their
parents, could put myself entirely at their
disposal. It made a tremendous difference.
If I had my time again, would I do it any
differently? I’m not sure. I hope I would
worry less. I hope I would be more patient,
with the patients and with myself. But nowa-
days it would be all different. Whereas in my
first preregistration job I was on call for 108
hours a week, nowadays I might at worst be
on for 80 hours. In all my 30 years from
qualification to retirement, except when I
was in the United States, I was always on a
one in two rota. Nowadays as a consultant, I
would be on a one in four rota at worst.
Would that make it easier to love one’s
patients? I sincerely hope so.
Peter McMullin retired consultant paediatrician
Winchelsea TN36 4EN
Peter.McMullin@care4free.net
Teach medical students reality to make
good doctors
Editor—To make a good doctor we need
medical schools to be honest with students
and teach them about how things really are.
We need to provide medical students with
that most powerful and dangerous of life
forces—reality.
Some patients can be difficult and
dangerous. Most clinical decisions have no
evidence base. Pursuing ethical aspects of
each case is an activity that needs prohibi-
tively intense resources. Uncertainty looms
over all of medicine, and you must be able to
cope with the pain and guilt that it brings.
We teach students about a cosy, idealised
medical environment that really exists in the
minds of the academics. When students
experience the real world they do not see the
majority of doctors spending a vast amount
of time discussing ethics with patients. They
find the evidence base to be sorely deficient.
They soon realise that many serious illnesses
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714 BMJ VOLUME 325 28 SEPTEMBER 2002 bmj.com
5. can present with minimal signs and symp-
toms, and they must somehow devise a
personal way of coping with the pain and
guilt that this uncertainty produces.
I believe that we harm our medical
students by not being honest about the real
medical environment in which they will
eventually practise. We need to give them
the skills to help them make their patients
healthy but we also need to give them the
skills to help them remain healthy them-
selves. Placing students in a real medical
environment with deficient skills simply
confuses and alienates them and ends up
damaging everyone. If we want to make
good doctors then we must teach them in
the real world.
Colin Guthrie general practitioner
1448 Dumbarton Road, Glasgow G14 9DW
(grey_triker@hotmail.com)
How not to do it
Editor—First of all, take “raw” medical
graduates and place them in a busy medical
unit. Write a job description that details their
rest periods but not their role, their tasks but
not their contribution. Make them work with
an ever changing variety of senior
colleagues—not for them an old fashioned
apprenticeship. Ensure that they never see
the same patient twice because compliance
with hours is more important than the
insights they gain from providing continuity
of care.
As they move into specialist training,
require them to collect and collate precise
details of everything except the quality of
doctoring they are learning to provide.
Teach them that they too can profit from the
drug industry through its necessary supple-
mentation of study leave budgets. Make sure
that resources in your institution go where
they are really needed—the only computer
doctors need is between their ears.
When the time comes for research, use
this opportunity to reinforce the importance
of numerous competing regulatory frame-
works in providing the bureaucratic frame-
work essential to employment in NHS
management and its support industries, and
to deforestation.
As with all healthcare providers, ensure
that their salary, once trained, is sufficiently
modest to attract only those who are (or
should be) committed.
When issues of professional practice
arise, it is better to get someone who isn’t
involved in providing health care to take it on
—they aren’t constrained by their understand-
ing of the system they have been asked to
change, and the system will cope with all the
rogue recommendations—we always have.
The fundamental principle underlying
this approach is attention to detail. If we col-
lect all information available, write detailed
job plans, and provide coherent written jus-
tifications for everything, then all will be well.
Good doctoring is nothing more than the
sum of these individual parts, and those who
argue that there is some higher value system,
some “professionalism” which should be
involved, belong in the past. Count every-
thing and value nothing.
Not.
Malcolm R Macleod specialist registrar in neurology
Western General Hospital, Edinburgh UK
EH4 2XU
malcolm@apoptosis.freeserve.co.uk
Summary of responses
Editor—Altogether 102 people wrote in
response to our questions “what makes a
good doctor?” and “how can we make one?”1
They were clearer on the first question than
the second, listing more than 70 qualities a
good doctor should have. Among the
usual—compassion, understanding, empa-
thy, honesty, competence, commitment,
humanity—were the less predictable: cour-
age, creativity, a sense of justice, respect,
optimism, grace.
Responses came in from 24 countries all
over the world, and almost all of the
respondents had something different to say,
indicating, as one respondent put it, that “a
good doctor will be different things to differ-
ent people at different times.” For some, the
notion was very simple: a doctor who
satisfies his or her patients; a doctor you
would trust yourself; a doctor who likes
people and likes the job; even “a doctor who
feels for himself the sorrow of human kind.”
For others, it was more difficult. Like
describing a good car, a good play, or good
weather it all depends on your perspective.
A member of the library faculty at a New
York university described a good doctor as
one who “reads and reads and reads.” A pro-
fessor of bioethics (with an interest in medi-
cal history) argued that good doctors are
also good historians, adding that medical
history should take up at least a quarter of
the undergraduate curriculum. Educators
gave a high priority to being a good teacher,
coach, and mentor. And a quality improve-
ment specialist thought a good doctor was
one who critically examined what he or she
did and tried to improve on it.
Patients, however, wanted little more
than a doctor who listened to them.
From this great diversity a few common
themes emerged.
Firstly, there are plenty of good doctors
around and we should nurture them better.
Secondly, to be a good doctor, you first
have to be a good human being: “a good
spouse, a good colleague, a good customer at
the supermarket, a good driver on the road.”
Thirdly, it’s easier to be a good doctor if
you like people and genuinely want to help
them. A general practitioner from Wolver-
hampton wrote: “To like other people, from
this all else follows. Liking your patients will
get you through the grind and tedium of
your working day, and patient contact will be
a source of strength and renewal. You may
even do some good.”
Finally, good doctors, unlike good
engineers, good accountants, or good
firemen, are not just better than average at
their job. They are special in some other way
too. Extra dedicated, extra humane, or extra
selfless. More traditional contributors
wanted doctors to sacrifice themselves for
the good of their patients. Others said
doctors must look after themselves first—or
they wouldn’t be able to help anyone.
Doctors are patients too.
Few respondents had anything to say
about what makes a good doctor in special-
ties with little patient contact. Pathology, for
example, or epidemiology. There wasn’t
much either on what makes a good surgeon.
One of only eight contributing surgeons (a
urologist from Saudi Arabia) wrote that
good surgeons are “good doctors with
extras.” Another surgeon said that it was
important for doctors to find medicine fun,
fascinating, and stimulating.
Making a good doctor seemed a greater
challenge than defining one. There was gen-
eral agreement, though, that we aren’t very
good at it. To paraphrase 13 responses: all
we can hope to do is select students with the
right gifts (not the right exam results) and
somehow stop them from going rotten
through overload cynicism and neglect dur-
ing their training and early career.
One first year intern from Israel echoed
several others when she suggested bad soci-
eties were unlikely to produce good doctors:
“Whilst doctors are overworked, underpaid,
and abused, the debate on defining a good
doctor will remain academic,” she wrote.
“Our society undervalues doctors yet
expects and will accept nothing short of per-
fection . . . Even with perfect risk manage-
ment mistakes will be ‘made’ . . . people will
die young or decline with age, and not all
pregnancies will have a good outcome.
Unfortunately doctors are more easily sued
than God, and moreover . . . pay cash.”
Alison Tonks freelance medical journalist
Bristol
1 Theme issue: What is a good doctor and how can we make
one? bmj.com 2002. bmj.com/cgi/content/full/324/
7353/DC1 (accessed 31 July 2002).
Correspondence submitted electronically
is available on our website
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