How doctors feel: affective issues in patients' safety

Department of Emergency Medicine and Department of Medical Education, Dalhousie University, Halifax, NS, Canada B3H 2Y9.
The Lancet (Impact Factor: 39.21). 11/2008; 372(9645):1205-6. DOI: 10.1016/S0140-6736(08)61500-7
Source: PubMed
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    ABSTRACT: Aims and method To explore experiences of psychiatrists considering medication for patients with personality disorder by analysis of transcribed, semi-structured interviews with consultants. Results Themes show important relational processes in which not prescribing is expected to be experienced as uncaring rejection, and psychiatrists felt helpless and inadequate as doctors when unable to relieve symptoms by prescribing. Discontinuity in doctor-patient relationships compounds these problems. Clinical implications Problems arise from: (a) the psychopathology creating powerful relational effects in consultation; (b) the lack of effective treatments, both actual and secondary to under-resourcing and neglect of non-pharmaceutical interventions; and (c) the professionally constructed role of psychiatrists prioritising healing and cure through provision of technological interventions for specific diagnoses. There is a need for more treatments and services for patients with personality disorder; more support and training for psychiatrists in the relational complexities of prescribing; and a rethink of the trend for psychiatrists to be seen primarily as prescribers.
    06/2014; 38(3):116-21. DOI:10.1192/pb.bp.113.044081
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    Annals of Emergency Medicine 05/2014; DOI:10.1016/j.annemergmed.2014.05.003 · 4.33 Impact Factor
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    ABSTRACT: Abstract Making an accurate clinical diagnosis is an essential skill for all medical students and doctors, with important implications for patient safety. Current approaches for teaching how to make a clinical diagnosis tend to lack the complexity that faces clinicians in real-life contexts. In this Guide, we propose a new trans-theoretical model for teaching how to make an appropriate clinical diagnosis that can be used by teachers as an additional technique to their current approach. This educational model integrates situativity theory, dual-information processing theory and socio-cognitive theory. Mapping and microanalysis help the teacher to identify the main processes involved in making an accurate clinical diagnosis, so that feedback can be provided that is focused on improving key aspects of the skill. An essential aspect of using the new educational model is the role of the experienced clinical teacher in making judgments about the appropriateness of the learner's attempts to make a clinical diagnosis.
    Medical Teacher 11/2014; 37(3):1-17. DOI:10.3109/0142159X.2014.975195 · 2.05 Impact Factor


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Jun 10, 2014