Ophthalmologist’s patient: psychological peculiarities of work in case of “catastrophic” diagnoses

Authors

  • O.S. Chaban Bogomolets National Medical University of the Ministry of Health of Ukraine, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2309-8147.8.3.2020.220452

Keywords:

glaucoma, psychological problems, SPIKES, “bad news”

Abstract

A typical mistake in glaucoma therapy comes down to the fact that the doctor treats a biological problem without thin­king about its psychological effect on the patient’s quality of life, about the patient’s ability to assess this problem, about the level of social readaptation and the patient’s social support. All these aspects must be taken into account, remembering that the biological problem will remain with the patient for life. Often, already from the first stage of glaucoma, psychological defense mechanisms lead to distortion of information about the disease, which entails an inadequate assessment of the disease. As a result, cooperation with the patient begins to become more difficult — low or no compliance is formed. Patients do not adhere to the therapy regimen and make attempts to find any alternative methods of treatment. They do not believe that citicoline, for example, has to be taken all their lives to be effective, and instead, without immediate results, they stop taking the drug. And our task is to explain to patients the importance of the right attitude to treatment. Thus, the success of psychological adaptation and therapy of glaucoma will fully depend on what information the patient receives from the doctor, and whether he can correctly evaluate this information. Western countries have long developed a protocol for deli­vering “bad news”, which is being studied at medical universities in North America and Europe in the “Physician Communication Skills” course. In Ukraine, we have just started teaching this six-step protocol (the English abbreviation SPIKES): 1. Setting up the interview. 2. Assessing the patient’s perception. 3. Obtaining the patient ‘s invitation. 4. Giving knowledge and information to the patient. 5. Addressing the patient’s emotions with empathic responses. 6. Strategy and summary. Considering all of the above, the article will focus on the psychological problems of glaucoma; how and by what means they can be measured; the protocol for delivering “bad news” will be reviewed; aspects of the doctor’s behavior depending on the characteristics of their patients will be discussed.

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Published

2021-09-27

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Original article