Psychological

Attitudes

Anxiety/depression Dementia

Fears and phobias, e.g. AIDS Health understanding Hysteria

Hypochondriasis Personality disorders

Sensitive issues, e.g. sexuality, bereavement, malignancy

Adolescent, elderly Opposite

Deaf, blind, speech impairment Speech disorders, visual impairment Acutely ill/injured

Aggressive, hostile Demanding

Aggrieved, e.g. fees, mistakes Perception of doctor's authority

Social

Social class Ethnic group Education Dress

Political group Familarity

However, doctors have a professional responsibility to transcend interpersonal conflict and facilitate productive communication by establishing a caring and responsible relationship even with 'difficult' patients. Not surprisingly, such patients can also be found to be warm and pleasantly human beneath their 'shoulder-chip' facade and so be helped immeasurably by an empathetic doctor. It is important to bear in mind that medical communication often occurs in an emotional environment, because 'disease' has important emotional connotations for patients and their relatives and friends. Inappropriate communication and management can generate hostility.

The doctor-become-patient in the hands of his colleagues learns fast, but possibly too late. Illness plus defective communication can bring confusion, anxiety and pain; suspicion and confinement add new dimensions to suffering.

Sooner or later we come to see ourselves as persons, both as doctor and as patient ('wearing his moccasins'). The patient in us longs for the ideal doctor who is truly professional with sound knowledge and sane judgment, who is available, unhurried, caring and responsible.

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