Those hateful patients Swansea Tuesday 22nd May 2007

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

The most effective drug a doctor prescribes is himself

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

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

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

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

A farewell to heart sink? Gwenda Delany BJGP April 2007 Vulnerable.. Abused … Manipulative

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

The end

Describe a patient who Made you feel *bad* Made you feel *good*

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

The doctor as a witness