COMMENTARY

The Doctor-Patient Relationship III: A Way of Listening -- The Balint Group Revisited, 2008

Ursula Snyder, PhD

Disclosures

January 02, 2009

 

 


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Patients feel at odds with their doctors.[1] The onus to improve this situation lies not first with the patient, nor with the doctor and patient, but with the doctor herself. The onus should be on the one in power. Serious efforts to improve the doctor-patient relationship have been made, notably by psychoanalysts Michael and Enid Balint and their colleagues -- general practitioners -- who began in the 1950s to use group conversation and analysis "to share experiences and enable people to observe and rethink aspects of their relationships with patients and their work as doctors.[2,3,4]" Balint group work remains a vital tool.

In a Balint group, a doctor recounts -- from memory -- a patient's presentation of symptoms and the doctor-patient interaction. There are things the doctor won't remember, things that she remembers in detail or that affected her emotionally in some way -- that made her annoyed or angry or defensive or sad perhaps -- things that may have confused or surprised her. The group listens and asks the doctor questions. In the process of truly thoughtful conversation, the group and the doctor may discover aspects about the doctor-patient relationship the doctor hadn't seen or heard or thought of. In some cases, the result is in follow-up meetings between the doctor and patient; the doctor may more easily "tune in" and listen to the patient, and the therapeutic potential of the doctor is enhanced.

Balint group work is more common in Europe than in North America, and is even part of medical training in Germany.[5,6,7] As to why it's not more popular here, one Canadian doctor answers: "I think it is a vulnerability thing.... [Doctors] struggle with the idea they are presenting difficulties...[and] are often concerned their conduct or skill will be criticized.[7]" With all due respect and sensitivity, vulnerability is what is called for. Doctors have the courage to be vulnerable.

That's my opinion. I'm Dr. Ursula Snyder, former editor, Medscape Women's Health.

 


 

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