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Chapter: Essentials of Psychiatry: Listening to the Patient

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Listening in Special Clinical Situations

Listening to younger children often involves inviting them to play and then engaging them in describing what is happening in the play action.

Listening in Special Clinical Situations

 

Children

 

Listening to younger children often involves inviting them to play and then engaging them in describing what is happening in the play action. The psychiatrist pays careful attention to the child’s feelings. These feelings are usually attributed to a doll, puppet, or other humanized toy. So if a child describes a stuffed animal as being scared, the psychiatrist may say, “I wonder if you, too, are scared when…” or “That sounds like you when…”. The following case is an example.


Geriatric Patients

 

Working with the elderly poses its own special challenges. These challenges include not only the unique developmental issues they face but also the difficulty in verbalizing a lifetime of experience and feelings and, commonly, a disparity in age and life experi-ence between the clinician and the patient.

 



 

It is challenging to elicit the elements of a story especially when they span generations. The elderly are often stoic. In the face of losses that mark the closing years of life, denial often becomes a healthy tool allowing one to accept and cope with de-clining abilities and the loss of loved ones. The psychiatrist must appreciate that grief and depression can often be similar in some respects.

 

Chronically Mentally Ill

 

Listening to the chronically mentally ill can be especially chal-lenging, too. The unique choice of words characteristic of many who have a thought disorder requires that the physician search for the meanings of certain words and phrases that may be peculiar and truly eccentric.

 


 

Chronically psychiatrically disabled patients may have a unique way of presenting their inner world experiences. Some-times the link to the outer world is not so apparent. The psychia-trist is regularly challenged with making sense of the meanings of the content and changes in intensity or frequency of the psy-chotic symptoms.

 

Physically Ill Patients

 

In consultations with a colleague in a medical or surgical special-ity one is evaluating a patient who has a chronic or acute physical illness. The psychiatrist must listen to the story of the patient but also keep in mind the story as reflected in the hospital records and medical and nursing staff. Then the psychiatrist serves as the liaison not only between psychiatry and other medical col-leagues, but also between the patient and his caregivers.

 


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