Negotiating the power gradient

doi:10.1136/bmj.b4063

Published 5 October 2009, doi:10.1136/bmj.b4063
Cite this as: BMJ 2009;339:b4063

Letters

How patients make us feel

Negotiating the power gradient

The first 150 words of the full text of this article appear below.

Although we have something to learn from the death of MichaelJackson,¹ such extreme examples seem far from everyday practice.

Medical education includes occasional vignettes or objectivestructured clinical examinations (OSCEs) featuring difficultpatients, but as doctors we are left to negotiate the powergradient and appropriate boundaries on our own. Feelings elicitedby powerful and difficult patients are waived aside to maintainprofessionalism. Doctors fear attention to feelings may negativelyaffect practice. But is it helpful to deny that patients makeus feel certain ways?

For psychiatrists, feelings elicited from patient interactionsyield invaluable material, offering crucial insight into thepatient’s presentation. This facilitates understandingof why the doctor feels a certain way and of the transferenceand countertransference—basic processes in communication.

Part of the doctor-patient relationship can be reframed as areflection of the patient’s past relationships. If patientsseem dominating or difficult they may have treated others . . . [Full text of this article]

Anna Sobel, ST3 psychiatry¹, Farhana Mann, ST3 psychiatry²

¹ St Ann’s Hospital, London N15 3TH, ² Margarete Centre, London NW1 2LS

a_sobel@hotmail.com