Unconscious Interactions

Patients and physicians may unconsciously react to each other. These are not defense mechanisms, although they may seem to function similarly. These reactions can be classified as transference and countertransference.

Transference: patient may unconsciously transfer thoughts onto physician:

• Unconscious
• Thoughts or attitudes are typically of a parent or significant other
• Patient identifies within the physician similar traits that lead the association and transference
• Transference may be positive (cause you to unaccountably like someone) or negative (cause you to unaccountably dislike someone)
• Likelihood of transference is not related to the duration of treatment.

Countertransference: physician may unconsciously transfer thoughts onto patient:

• Affects attitude of the physician toward patient
• May be positive (physician wants to help an elderly patient because she reminds him of his parent)
• May be negative (physician unaccountably dislikes a patient)

Review Questions

For the scenarios below, identify whether you would treat or not treat.

• A patient refuses lifesaving treatment on religious grounds
• A wife refuses to consent to emergency lifesaving treatment for her unconscious husband, citing religious grounds
• A wife produces a card stating her unconscious husband’s wish to not be treated on religious grounds
• A mother refuses to consent to emergency lifesaving treatment for her daughter on religious grounds
• A child’s life is at risk, but the risk is not immediate

Answers

• Do not treat.
• Treat the woman’s husband; this is no time to assess substituted judgment.
• Do not treat the woman’s husband.
• Treat the woman’s daughter.
• Court will take guardianship.

Recall Question

1. When considering the physician-patient relationship, which of the following is correct?

   1. Accepting gifts from patients is acceptable, as long as it is not monetary
   2. Addressing patient safety is the first step in dealing with an impaired physician
      
   3. If a patient is acting inappropriately, it is your job to immediately involve the authorities
      
   4. It is acceptable to date parents of pediatric parents or children of geriatric patients
      
   5. Providing treatment for personal friends is acceptable as long as no invasive procedures are involved
      

Answer: B