Lecture 1 1. To be able to describe what empathy is and is not and the role it plays in the Dr/Pt relationship.

Empathy is - An active component of effective listening - To put oneself in another persons place (emotionally) - the ability to experience transiently the feelings of another and then share that with the patient - To thereby gain an understanding of the others subjective experience - A kind of resonance Empathy is NOT - Feeling sorry (sympathy) - Politeness - Being kind - Reassurance/support - Pseudo-empathy: saying I know what you feel (when you really dont) 2. To give examples of what are meant by Boundaries. Physical o With permission can be crossed to physically exam patients body for diagnosis/check-up Emotional o Can be crossed to be empathic Sexual o NEVER crossed Financial o Going into business with a patient is not a good idea o Gaining from a patient is not a good idea 3. To be able to define the terms transference and countertransference. Either can be positive or negative. Transference feelings patient has toward physician (patients feelings) - The phenomenon of projecting (transferring) thoughts, feelings or wishes from the patient on to the MD as though the MD were someone from the patients past Countertransference feelings patient causes in physician (physicians feelings) - The patient engenders feelings in the MD as a result of the MDs past experiences 4. To be able to explain how the Dr/Pt relationship can effect compliance. Rapport (state of mutual confidence and respect between two people) improves disclosure about noncompliance and increases likelihood of compliance. The therapeutic alliance: powerful tool to benefit patients, in some psychiatric illnesses it may be more powerful than biologic treatment. 5. To gain an appreciation of how significant a role the Dr/Pt relationship plays in medicine. Three types of physicians styles: - Paternalistic

o Early 1900s o May be warm or detached o MD makes decisions, dominant and in control o Patient accepts information and decisions but not responsibility o Good when patient is unconscious Shared decision making o Interactive, mutual participation o MD brings factual knowledge/experience, patient brings priorities and specific concerns o Good for long-term or chronic illness scenarios consumer based o Not a good model o Common in elective procedure o Patient may dominate interview Friendship based o Dysfunctional (meets needs of doctor rather than patient) o Often unethical and exploitative o Ex. Dr received stock tip from patient that the Dr profits from o Blurred boundaries