1. Unlocking Balint & the ‘Drug Doctor’ Courtesy of Emma Hardwick GPR 2008

2. Michael Balint

3. Why is he important?  The Doctor, his Patient and the Illness  Understanding the physical, psychological, social aspects of the consultation  Balint groups  A doctor’s apostolic function  An entry ticket  A hidden agenda  The collusion of anonymity  The “drug doctor”  The mutual investment fund

4. Work in pairs and discuss what you understand by these terms

5.  A doctor’s apostolic function  An entry ticket  A hidden agenda  The collusion of anonymity  The “drug doctor”  Balint groups  The mutual investment fund

6. The Doctor as a Drug

7. Mechanism of action You can help by being:  Supportive  Informative  Catalytic  Cathartic

8. Prescribing yourself as a drug Working in pairs consider the:  Indications  Dose  Side effects

9. Prescribing the Doctor – When? Potential indications – to help tackle/alleviate:  Multiple problems (often insoluble)  Multiple attendances  Multiple referrals to no avail  Multiple treatments (tried & failed)  Heart sinks  Persisting patient uncertainty or concern

10. Prescribing the Doctor – How? You have to utilise/explore:  Your advanced consultation skills  Active listening  Picking up and using cues  Building rapport  Empathy  Triangular thinking  Ideas Concerns and Expectations

11. Prescribing the doctor – common problems  If the doctor doesn’t realise they are the drug and therefore does not understand why the patient keeps re-attending  Time constraints (long and sometimes multiple consultations)  Differing agendas between patient & doctor

12. Prescribing the doctor – side effects  Encouraging doctor dependency  Transference – negative emotions engendered in the patient being transferred to the GP  Counter transference – negative emotions (expressed by the patient) are engendered in the GP and are reflected back by the GP to the patient

13. Summary  The doctor as a drug is a powerful tool  Be aware of when it can be effective  Utilise consultation skills to make the most of this therapy  Remember that there may be pitfalls for both patient and doctor

14. Time for Coffee!

15. Balint Groups – The Bradford Way  A small group (6-12)  The material of the group is based on the presentation of current cases giving the clinician cause for thought  Not necessarily limited to problem cases but can include ones which have intrigued, interested, maybe disturbed  The purpose of the group is to increase understanding of the patient's problems, not to find solutions  The discussion focuses on the relationship between the presenting doctor and his patient

16. Balint Groups  Standard rules for small group working apply  The facilitator takes ultimate responsibility for trying to ensure that the group functions!

17. Break into Groups