plenary 4 egener forging a relationship with the patient
DESCRIPTION
The Foundation for Medical Excellence 27th Annual Pain & Suffering Symposium http://tfme.orgTRANSCRIPT
Forging Relationships with
Chronic Pain Patients
Barry Egener, MD
Transference
Countertransference
Transference: the set of expectations, beliefs, and emotional responses that a patient brings to the doctor-patient
relationship
based, at least in part, on the persistent experiences a patient has had with other important authority figures throughout his life
Transferential Responses to Illness Perception:
• Lowered self image anxiety• Threat to homeostasis denial• Failure of self-care depression,
blaming• Sense of loss of control regression,
isolation, dependency, anger
To understand the transference perceptions ask:1. How has your illness affected the way
you feel about yourself?2. Do you ever blame yourself for your
condition?3. Do you ever feel like you are losing
control?4. Are you ever afraid that you will fall
completely apart?
Counter transference: the set of expectations, beliefs, and emotional responses that a doctor brings to the doctor-patient relationship…………..Physicians often have unconscious or unspoken beliefs about the patientA “Good” Patient:• Severity of symptoms correlates with an overtly
diagnosable biological disorder• Compliant and does not challenge treatment• Emotionally controlled• Grateful
How Might These 3 Patients Present?
• 86 yo man with COPD, end-stage cardiomyopathy, ischemic foot ulcer• 51 yo woman chronic low back pain,
domestic violence victim, fibromyalgia• 33 yo addict with “complex regional
pain syndrome” after an injury to the brachial plexus after a fall from a ladder
NW Center – Egener
Physiologic
Social Psychologic
PAIN
BoundariesBeware the Monkey! Whose pain is it? I didn’t cause the pain; I’m not responsible for
the pain; I can’t “fix” the pain The patient’s anger (distress) is about him/her There is no reason to get angry at the patient.Beware Working Harder then the Patient You may be meeting your needs, not the
patient’s!
So What If Not Opioids?
• Use Yourself!– Empathy– Unconditional Positive Regard– Genuineness
• Guide a self-exploration: – How do you assess where you are right now? – What is important and meaningful in your life? – What small step are you willing to commit to to get there? – What help do you need?
• Assist with coping