Unlocking Balint the Drug Doctor Courtesy of Emma

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

Michael Balint

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

Work in pairs and discuss what you understand by these terms

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

The Doctor as a Drug

Mechanism of action You can help by being: ¨ Supportive ¨ Informative ¨ Catalytic ¨ Cathartic

Prescribing yourself as a drug Working in pairs consider the: ¨ Indications ¨ Dose ¨ Side effects

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

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

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

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

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

Time for Coffee!

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

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

Break into Groups