If our Society was asked to redesign the GP curriculum we should be in no doubt about the priority. We would wish to help our young doctors to understand the importance of the emotions in clinical practice; to be aware of their own feelings as well as those of their patients and to be able to manage those emotions without being overwhelmed or disabled. We would provide this education by offering at least a year of Balint group experience to all trainee family doctors. After all this can be done in Germany and increasingly it is happening in the USA. Why couldn't it happen here, in the land where Balint groups began?Why indeed? Back in 1970, Marshall Marinker made the following suggestion with regard to diminishing numbers of GPs attending Balint groups:
...it is not the logistic difficulties, but the massive psychological resistances that stands in the way of the growth of seminar training. The work involves doctors in exercises which have become alien to their habits of thought. (p. 84)Journal of the Royal College of General Practitioners 1970; 19(91): 79-91
Are these resistances still in place? Back to the editorial:
There is still a subterranean prejudice against Balint which lurks in the minds of many GPs. These doctors view the idea of doctors sitting round in a group discussing their feelings with suspicion and distaste. The phrase 'navel-gazing' crops up. The practice encourages too much introspection and fruitless speculation. It can't be healthy. These doctors should get out in the fresh air more often.Perhaps prejudices can be reduced by hearing of other countries' experiences. For example, a small sample of Swedish GPs were found to have benefited from group participation:
In this study, we examined Balint group participants' sense of control and satisfaction in their work situation and their attitudes towards caring for patients with psychosomatic problems. Forty-one GPs filled in a questionnaire with a 10-point visual analogue scale. Of these, 20 had participated in Balint groups for more than one year and 21 were a reference group. The Balint physicians reported better control of their work situation (e.g. taking coffee breaks and participating in decision making), thought less often that the patient should not have come for consultation or that psychosomatic patients were a time-consuming burden, and were less inclined to refer patients or take unneeded tests to terminate the consultation with the patient. These results might indicate higher work-related satisfaction and better doctor-patient relationship.Balint wouldn't have liked the use of 'psychosomatic' to designate a type of patient rather than a style of approaching the medical encounter, and he might have thought it a little strange to gauge a GP's 'control of their work situation' by their ability to take coffee breaks, but I suppose we must be grateful for any positive news.
3 comments:
Not directly related to this entry, but I wanted to direct your attention to an article, which you may have seen, called "Why Trauma Makes People Sick: Inflamation, Heart Disease and Diabetes in Trauma Survivors" by Kathleen Kendall-Tackett, appearing in the Winter 2007 issue of the APA Trauma Division newsletter.
The abstract:
Trauma survivors have higher than average rates of serious illness including heart disease, diabetes and metabolic syndrome, the precursor to type 2 diabetes (Batten et al., 2004; Felitti et al., 2001; Kendall-Tackett & Marshall, 1999). The intriguing question is why this is so. One possible explanation is the connection between disease and inflammation-specifically, elevated levels of proinflammatory cytokines. Cytokines are proteins that regulate immune response and proinflammatory cytokines help the body heal wounds and fight infection. But there can be too much of a good thing; chronic inflammation is a likely cause of a wide range of illnesses including heart disease, diabetes, Alzheimer's disease, and even cancer (Batten et al., 2004; Robles et al., 2005; Suarez, 2006).
Thanks very much for mentioning this article, Theo. It's full of fascinating physiological information.
One thing, however, which tends to happen with this kind of research is that as the physiology gets more sophisticated, there's a 'flattening' at the level of the psychology. We hear of a class of 'trauma survivors', but there's no attempt to draw distinctions within this class.
If you look back at the article on pages 1, 4 & 5, there's an interesting discussion of varying ways of dealing with trauma. E.g., does rapid debriefing by counsellors help or hinder the recovery process, and does the answer to theis question depend on the kind of victim?
Now imagine if these approaches could be combined!
APA, of course, and the Trauma division within it, rarely flatten their psychology. I agree that "trauma survivor" is a general term --- of the psychologists who study trauma, the one whose work I'm most familiar with is Jennifer Freyd, who does a good job of imposing at least a two-dimensional regime on types of trauma, e.g. here.
On a separate note, I do hope you comment on this New York Times article?
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