Most doctors know much about drug choice, dose, adverse effect and treatment duration but do not try to investigate patients' prognosis and environment. Some surgeons concern little about anxiety and worry of patients about their operation.
It has been reported many times that patients with psychological problems had trouble with postoperative recovery. It has been also reported in internal medicine that kind of patients had bad prognosis in cases of cerebral stroke and myocardial infarction. 20-50 percents of patients have complaints that are not associated with organic diseases. Doctors focus on physical complaints such as headache, back pain, heart burn and so on but do not recognize their psychological characteristics. Therefore doctors treat unnecessary examination and treatment. Even in the cases that they recognize patients' psychological problem their therapy is only a form of pharmacotherapy such as amitriptylline, imipramine, SSRI and diazepam.
This treatment is not perfect because it excludes psychosocial factors leading to delayed recovery of patients.
That is why doctors should focus on psychological problems of patients.
We explain some types and principles of counseling in order for doctors to help patients with their psychological health and control with a knowledge of interaction between physique and psyche.
Counseling is not only for doctors in psychiatry but also for all doctors in all departments. Counseling is an interaction between dialoguers. It has both aspects of diagnosis and treatment. Counseling is inevitable as it helps to eliminate symptoms by different psychological techniques.
Counseling can be held both with language and without language. What is explained below should be known by non-experts as well as experts.
Nonverbal counseling
- Positive attitude
Positive attitude depends on attention and care held by doctors during counseling. It affects the good doctor-patient relationship.
1. Eye-contact
Proper eye contact provides patients with opportunities in which they can say anything they want. If patients avoid eye contact, do not enforce it.
2. Gestures
Gestures should match talking. Nodding shows doctors' interests in patients' talk and make patients feel free to talk their troubles.
3. Facial expressions
Doctors' facial expressions should be positive to patients. It makes counseling more comfortable.
- Negative attitudes
1. Facial expressions
Doctors should not have facial expression of anxiety, being annoyed or bored. These factors disturb dialogue.
2. Behavior
Yawning, hesitation, thudding against desks, scratching head, looking at a watch, discursive behavior and so on should be avoided.
Verbal counseling
- Positive attitude
1. Showing interest
Doctors should show that they are interested in patients' talk. You would better remember and repeat patients' words. Holding a dialogue calling patient's name means doctor's interest.
2. Agree
Some patients talk about funny things but doctors should show acceptance regardless of characteristics of patients' problems.
3. Be supportive.
Doctors should deliver his supportive idea through words. You can say "I understand what your troubles are. Feel free to talk about your problems so that we can figure out solution"
4. Showing your understanding
After you understand patients' trouble you can say "it must have bothered you", "His attitude must have been annoying you".
5. Words to calm patients down.
When the patients worry a lot or, feel uncertain or unsafe, calming them down is necessary.
6. Changing topics.
Sometimes patients branch their topic. At that time doctors can remind them of their main topic. "you have mentioned about this. Would you like to say about it in more detail?"
7. Promoting conversation
Sometimes patients stop or forget the main topic. At that time you can say "you mentioned about this", "What happened after that?"
- Negative attitudes
1. You should avoid showing your surprised feeling, which has negative effect on treatment.
2. You should avoid showing too much interest. Appropriate interest is needed.
3. You should avoid ethic conclusion. It is none of doctors' business.
4. You must not criticize your patient. It exacerbate their symptoms.
5. You must not make a fake promise. Patients are good at detecting fakes.
6. You must not be full of yourself. Patients visit hospital not to ask about doctors' ability but to be cured.
7. You should avoid scolding your patients. It harms doctor-patient relationship.
8. You should avoid discussing with your patient on your problems. It affects on doctor-patient relationship.
9. You must not prevent or suppress your patients. It harms your rights.
10. You should avoid neglect attitude. Patients with affective disorders are not confident. You should help them build up their confidence.
11. You must not dismiss your patients. It harms their confidence.
12. You should not overvalue yourself. Everybody is independent and respects the self.
13. You should avoid immature analysis. You should give the first priority to understanding patients' troubles. The analysis needs time.
14. You should avoid too much curiosity. It is doctors' purpose to help patients not to satisfy your curiosity.
15. You should avoid asking directly or making patients embarrassed. If patients consider you ill mannered they will answer nothing.
16. You should avoid enforcing patients to answer if they are reluctant. You should take gradual process.
17. You should avoid taking sides. It might satisfy patients in a short time but afterwards will make a bad impact.
18. You should avoid being mad in front of patients. Some patients upset you. Do not respond to it but analyze it.
19. You must not argue with your patients. Different opinions should be gradually worked out through good doctor-patient relationship.
20. You must not say more than patients. Listening is better. Patients visit you to talk.
