Emotional Interactions of Patient and Staff: A Focus of Psychiatric Consultation

Abstract

Factors in the relationship with the medical staff often precipitate a psychological crisis in a patient eventuating in a request for psychiatric consultation. Such reactions and the part the medical staff plays in them usually go unrecognized. The view presented is that the psychiatrist is maximally helpful when he applies both understanding of underlying personality variables with the additional focus directed toward the nature of the psychological relationship at the interface of the staff and patient. Consultation becomes the vehicle for understanding and sensitizing the staff to the complexity of patients as well as their own psychological reactions.

Clinical cases are reported which illustrate the mutual and reciprocal effects of patient-doctor interaction. The context of illness and the hospital setting leads to a labile psychological equilibrium. Medical staff who are able to agree on some generalizations about treating the “whole patient” often have “scotomata” in actually dealing with specific difficulties in their interaction. This difficulty is seen stemming in part from medical education and in part from a model of medical care which emphasizes the physician's separateness from the patient in terms of an active-passive polarity.