Book contents
- Frontmatter
- Contents
- Foreword by Professor Paul Freeling, O.B.E.
- Preface
- Acknowledgments
- 1 Doctor–patient interaction
- 2 The clinical transaction
- 3 Interpersonal influences
- 4 The influence of past relationships
- 5 Contextual influences
- 6 Managing complicated clinical transactions
- 7 Interventions in complicated clinical transactions
- 8 Implications for the clinical setting
- 9 Implications for training
- Appendix I Clinical phenomena related to ‘problem patients’
- Appendix II Personality disorder
- References
- Index
4 - The influence of past relationships
Published online by Cambridge University Press: 19 March 2010
- Frontmatter
- Contents
- Foreword by Professor Paul Freeling, O.B.E.
- Preface
- Acknowledgments
- 1 Doctor–patient interaction
- 2 The clinical transaction
- 3 Interpersonal influences
- 4 The influence of past relationships
- 5 Contextual influences
- 6 Managing complicated clinical transactions
- 7 Interventions in complicated clinical transactions
- 8 Implications for the clinical setting
- 9 Implications for training
- Appendix I Clinical phenomena related to ‘problem patients’
- Appendix II Personality disorder
- References
- Index
Summary
Introduction
Henry, an adolescent male, became a frequent presenter at surgery, requesting sick certification for depressed mood and self-mutilation. A full syndrome of depressive disorder, which might have justified a course of antidepressant medication, was never present. In any case, the patient had volunteered that he would ‘never touch any drugs’. The self-mutilation was not serious enough to warrant medical treatment in its own right. The patient refused the doctor's invitation to discuss his psychosocial circumstances yet repeatedly returned to the surgery.
The three doctors in the primary care practice were equally irritated and frustrated by the patient's behaviour and resolved to confront him with their views of the unsatisfactory nature of the consultations. When this took place, an ugly scene ensued, in which Henry, who had taken alcohol, became physically threatening and eventually the police were called to remove him from the premises. The woman doctor who had confronted Henry had herself felt extremely aggressive and near to physically shaking him. This same partner was then called by the youth, a few days later, to attend to his mother (with whom he lived) in the middle of the night, on account of what sounded over the telephone to be an acute abdominal emergency. Having misgivings about what situation she might find, and being somewhat fearful of the reception that might await her, she gritted her teeth and made the visit. The mother was indeed in acute pain and there were physical signs of acute appendicitis. This in fact was the diagnosis, as revealed at operation, and after surgery she recovered uneventfully.
- Type
- Chapter
- Information
- Problems with PatientsManaging Complicated Transactions, pp. 54 - 66Publisher: Cambridge University PressPrint publication year: 1994