The current state of health and ill health of man is increasingly determined by psychological factors, which means that the treatment of many diseases, the stabilization of self-destructive behavior is not possible without taking into account the socio-psychological factors of man’s relationship with the surrounding microenvironment, which requires, in turn, the doctor skills to build a relationship of trust with the patient. In this regard, the study of the fundamental aspects of a psychological portrait of the physician to become the most significant, because Each patient should be able to expect at the doctor’s face to meet a person trained as an attentive listener, a careful observer, effective clinician, as well as a person with high susceptibility in the field of communication.
Belonging to the professions subject-subjective type, physician activity takes place in conditions of increased social and psychological requirements and is associated with high intellectual and psycho-emotional stress. Professional medical activity, as a rule, often occurs in conditions of stress, particularly emotional response to various situations of professional activity, factors influencing the professional and personal development of the subject of the treatment process, the individual psychological characteristics inherent to doctors of different specializations – problems, poorly understood, despite a high degree of relevance of their scientific and practical thinking. It can be said that the issues of labor psychology and personal physician are among the most important and little-studied problems of theoretical and applied psychology as a whole and its individual sectors, in particular.
Considering this problem in the medical and psychological literature, the vast majority of references to the identity of the doctor describes only a deontological perspective. This traditional deontological approach is chronologically the first, and has not lost value to date. It can be described as normative and regulatory, as it contains the basic requirements for the individual physician, developed society. Main deontological requirements for medical practice and personal physician formulated in known precepts of Hippocrates, doctors who take a professional oath. The basis of these claims is the traditional view of the role relationship “doctor – patient”, is an element of the structure of social relations. In these respects, the doctor prescribed to assist the patient, who is entitled to expect this aid. To effectively carry out the role of the doctor prescribed a society must possess not only the skills and experience, but certain personality characteristics that contribute to the establishment of contact with the patient and ensure the credibility of the patient. Due to the fact that the object is a human activity, the requirements for moral, civic and intellectual qualities of the specialist were always higher in comparison with other categories of professions.
On this basis, it is necessary to timely review of the main approaches to the study of the problem of personal and professional characteristics of the doctor, their specific relationship, as well as individual psychological characteristics of the individual physician.
The urgency has led to the choice of research topic “The psychological portrait of the doctor.”
- CHAPTER 1.
THEORY OF LEARNING PROBLEMS OF PSYCHOLOGICAL PORTRAIT OF DOCTOR
1.1 The historical approach to the study of the problem of personal and professional characteristics of the doctor.
A.L. Groisman described that during the formation of medicine also paid great attention to the selection of future physicians and their methods of psychological and moral preparation. This must consider the age, state of health, memory and the necessary moral qualities: modesty, piety, chastity. The most important duty of the teacher, along with vocational training was instilling in students a sense of the love of truth, humility and justice. I wish to become a doctor had to get rid of all sorts of passions:.. Hatred, greed, cunning and so on, and it was considered important to the confidentiality: the doctor should not have been, not only to disclose information about the patient, but also to express doubts about his recovery. To win the full confidence of the patient, the doctor had to “hold sacred family secrets”
The greatest doctor of antiquity, Hippocrates was the first to attempt to systematize the rules of medical ethics based on the centuries-old experience of medicine. In his famous “Oath” in the books “The physician” and “On blagoprilichnom behavior”, “On the Art”, in the “Aphorisms”, written about two and a half thousand years ago, he created a code of moral norms, mandatory for those who a lifetime chosen doctoring their profession. At the heart of the ethics of Hippocrates on the idea of respect for the patient, the patient, a mandatory requirement that all treatment does not harm him. Known commandment ethics of Hippocrates it is prohibited to disclose medical confidentiality. Code of Medical Ethics, developed in ancient Greece two and a half thousand years ago in the so-called school of Hippocrates of Kos, can be reduced to four ethical imperatives:
1) to heal;
2) do no harm;
3) The principle of equal treatment to patients regardless of their age, gender, wealth (the “principle of justice”);
4) The principle of absolute priority of life (patient’s perception of life as the highest value)
Most clearly the principles of medical ethics were presented doctor – healer Paracelsus. In contrast to the model of Hippocrates, when the doctor gaining social trust of the patient, in the model of Paracelsus major importance paternalism – emotional and spiritual physician contact with the patient, based on which the entire healing process is built. The whole essence of the doctor-patient relationship is determined by the physician beneficence, benefit, in turn, has a divine origin, for every blessing comes from above, from God.
Such a profound humanistic understanding of the role of medicine in enhancing human health is preserved and so far, so MM Abdullayev stresses the importance of certain abilities and skills of the physician, which should guide everyone in their practice, they are:
– The need for the patient to inspire confidence in his recovery;
– Use an individual approach to a sick view of its characterological capacities, among them to prevent excessive reactions to react to different situations in life.
Proceeding from the fundamental tenets of medicine, medical ethics and psychology activities KK Platonov empirical typology doctor personality was made, which is based on the degree of matching functions corresponding to the status of a doctor, with his real personality, character traits. Depending on the orientation of the person the author has identified three types of medical specialists:
– A doctor that focuses on a variety of values;
– Doctor, whose orientation to the professional, moral and ethical values is an external, formal nature;
– Doctor, disoriented in relation to personal values, due to the low spiritual and moral level.
They also attempted to determine the orientation of the individual physicians based on their individual psychological characteristics:
– A doctor that focuses on a variety of values;
– Doctor, whose orientation to the professional, moral and ethical values is an external, formal nature;
– Doctor, disoriented in relation to personal values, due to the low spiritual and moral level.
1.2 The specificity of the relationship of the patient and the doctor
N.A. Magazanik distinguishes between two types of relations in a dyad “doctor – patient”:
1) authoritarian – directorial positions physician, who is the head of the competent patient occupying an active position (dominance principle), and the patient is driven, relatively inactive person. Such a relationship is sometimes advisable, for some psychotherapeutic physician facilitate action, especially if you need the authority to carry them out, and increased faith in the miraculous effects of psycho (gipnosuggestiya, the placebo effect) and others. At the same time a doctor dominance over the patient, which is generally preferred to immature hysteroid aktsentuaty identity and leads to the patient and prevents passive counter generating an active disease;
2) another option in the system of relations “doctor-patient” preferred for those seeking the highest possible manifestation of activity, based on the so-called “principle of partnership”. In this position the doctor seeks partnerships with the patient, based on respect for the patient’s personality and the revival of its activity, and most importantly to sympathetically – (empathic) to him. Activate with the mechanisms of imitation and identification with the doctor allows medical doctors to learn better installation.
V.A. Tashlykov recommends that in the first stage of normal psychotherapeutic contact mainly accentuated the principle of cooperation, as well as confidence of the patient the doctor can move to a more directive style of leadership behavior of the patient in order to achieve the adjectival alteration of personal relationships. The choice of style is due to the type of patient, distinguish:
– Harmonious. A sober assessment of their condition without tendency to exaggerate its severity and with good reason to see everything in a gloomy light, but without underestimating the severity of the disease. The desire of all to contribute actively to the success of treatment. The reluctance to burden other hardships care. In case of poor prognosis in terms of disability – shifting interests in those areas of life that are available to the patient. When poor prognosis – focus, interest on the fate of loved ones in their field.
– Alarm. Continuing anxiety and mistrust in relation to the unfavorable course of the disease, possible complications, ineffective and even dangerous treatment. The search for new methods of treatment, the thirst for more information about the disease, possible complications, treatment methods, continuous search for the authorities.
– Hypochondriac. Focusing on the subjective disease and other unpleasant sensations. The desire to constantly talk about them to others. On this basis, an exaggeration of the real and seeking out non-existent disease and suffering. Exaggeration of the adverse drug action. The combination of the desire to be treated and disbelief in the success demands a thorough examination and fear of harm and pain treatments. A patient with hypochondriacal type of response is prone to self-centered.
– Melancholic. Dejected disease, lack of confidence in the recovery, in the possible improvement in the effect of treatment. Active depressive statements up to suicidal thoughts. The pessimistic outlook on everything. Disbelief in the success of the treatment, even under favorable objective data.
– Apathetic. Complete indifference to his fate, to the outcome of the disease, the results of treatment. Passive submission procedures and treatment insistent prompting from the side. Loss of interest in everything that previously cared.
– Neurotic. Behavior in an “irritable weakness”. Tantrum, especially for pain, with discomfort, with treatment failure, under unfavorable survey data. Irritation often translates to the first comer, and often ends with repentance and tears. Intolerance of pain. Impatience. Failure to wait for relief. Subsequently, – remorse for anxiety and lack of restraint.
– Obsessive – phobic. The alarming suspiciousness, especially regard to such fear, is real and unlikely complications of the disease, treatment failures, as well as possible (but ill-founded) failures in life, work, family situation due to illness. Imaginary danger due to the illness of concern more than real. Protection from anxiety becomes signs and rituals.
– Sensitivity. Excessive concern about the unfavorable impression which may make on others information about their illness. Fear that others will be avoided, considered inferior, disparage, to dismiss the gossip or adverse information about the cause and nature of the disease. The fear of becoming a burden to their loved ones and unwholesome attitude on their part in this regard.
– Egocentric. “Care in the disease,” flaunting of family and others of their suffering and experiences with a view to fully capture their attention. The requirement of exceptional care – all should forget and leave everything and just take care of the sick. “The” Discussions surrounding quickly transferred. In other people, also need attention and care, see only the “competitors” and treat them with hostility.
– Euphoric. Unreasonably high spirits, often manipulative. Neglect, flippant attitude to the disease and treatment. The hope that “everything will cost.” The desire to get out of life despite the disease. The ease of an abnormality, although these disorders can adversely affect the course of the disease.
– Anosognostic. Active Denial thoughts about the disease, its possible consequences. Non-recognition of sick. The denial of the obvious manifestations of the disease in, attributing them to chance circumstances or other frivolous diseases. Waiver of examination and treatment. The desire to “do their own means.”
– Ergopathic. “Care of the disease in the work.” Even with the severity of disease and suffering are trying, in that whatever was to continue the work. Labor furiously, with even greater zeal than before the illness, try to be treated and subjected to the survey so that it leaves open the possibility of continuing the work.
– Paranoid. The belief that the disease is the result of someone’s malicious intent. Extreme suspicion of drugs and procedures. The desire to ascribe to treat possible complications or side effects of drugs negligence or malice of doctors and staff.
1.3 The psychological portrait of the doctor.
S.L. Solovyov among the most important psychological qualities highlights:
– Communicative competence – as professionally significant quality of a doctor. The medical profession requires a greater or lesser degree expressed an intense and long-lasting communication:. with the patients, their relatives, medical personnel, etc. From the ability to communicate, to establish and develop relationships with people physician professional success depends largely. A good psychological contact with the patient helps to more accurately collect anamnesis, a better understanding and insight into the patient. The ability to communicate, or communicative competence, ensure mutual understanding, trust in relationships, effective in solving the problems. If the patient trusts his doctor, do not hesitate to correct diagnosis and adequate treatment, then it will perform the appointment will take place all the necessary diagnostic and therapeutic procedures.
– Communicative tolerance – is reflected in the activities of a doctor, tolerance, forbearance, which shows the extent to which the doctor carries subjectively undesirable, unacceptable for him the individual characteristics of the patients, negative qualities, condemned the actions, habits, styles of alien behavior and thinking patterns. Communicative competence in professional work of the doctor means the ability to not only psychologically correctly build relationships with patients, but also the ability to process these relationships remain within the professional role.
– Professional adaptation – is the development of skills to identify the extent of emotional “involvement” of the patient, which is necessary in each specific case of professional communication. This plantation component associated with empathy, with the “dosing” empathic engagement in the process of interpersonal interaction with the patient.
– The professional image – this is one of the most important elements of confident behavior physician based on non-verbal behavior as an open posture in a position to communicate, communicative and expressive gestures, calculated by the product of a particular experience, facial reactions, expressing friendliness, quiet confidence, interpersonal instance, reflecting the degree of emotional intimacy in every moment of communication depending on the tactical tasks. What is important and the appearance of the doctor, especially his speech – confidence, overbearing, or calm, confident tone, smooth, well-constructed speech that enhances the credibility of the information received and the confidence in the professional competence of a doctor.
V.A. Tashlykov indicates psychological quality to ensure adequate communication in the system of relations “doctor – patient” is empathy – the ability to empathize, empathy, compassion, a kind of psychological “involvement” in the world of the patient experience. The modern concept of empathy as the comprehension of the emotional state, penetration, empathy into the inner world of another person presupposes the existence of three types of empathy:
1) emotional empathy, based on the identification and authentication mechanisms;
2) cognitive empathy (cognitive) empathy, based on intelligent processes (comparison and analogy);
3) predicative empathy – which manifests itself in the ability to predictive perception of another person, based on intuition
In addition to their direct professional duties, the physician should be able to provide the necessary psychological support, both patients and colleagues as indicated by AM Rudenko. The key to providing this type of assistance should be to improve the ability to solve their own problems, including through enhanced internal psychological reserves. The important role of psychotherapeutic physician the potential is undeniable. Has the value of formation of receptions and mental self-doctor practices, to help in the preservation of their own emotional stability, psychological safety professional “image”, sustained in the face of such destructive factors such as periodic doubts about the correctness of the chosen solutions, rejection by peers, and many others who a certain extent due to limited possibilities of modern medicine and the inability to take into account and provide an impact on the patient of all the factors – external and internal, organic and psychological nature.
. Conclusion.
Each person must choose the profession that corresponds to his natural abilities and inclinations, then it will work, as they say, not out of fear but out of conscience. Favorite business people gives all the power, all the energy, all the knowledge, and then this thing will run better returns will be greater.
Of course, we need all professions, they should be evenly distributed and it is expedient in the society. But every doctor, every teacher, turner, carpenter must possess cultural outlook. There should not be blind to the beautiful, deaf to the word, and this music, stale for good, forgetful of the past.
The doctor – one of the most noble professions. The medical profession, as the AP Chekhov – a feat. “It requires purity of the soul and of the mind. It should be clear mentally, morally clean and tidy physically.”
A doctor should always be kind and merciful, because the thing that he was doing, facilitates the suffering of the patient and saves him from death. To doctors people are always special, they are valued and respected. In the hands of a doctor is a human life. It is easier to become a doctor, than they were. Doctor – it is not just a professional, is the creator.
A true doctor – is not someone who has known and deeply studied medicine, but the one who is aware of his duty to the people. The great and we are all indebted to the doctors, bow our knees in front of their courage, kindness and infinite tenderness, because thanks to them and kept moving world.
