Individual psychological characteristics of a doctor’s personality. The personality of the doctor, her psychological characteristics
Medical practice is a difficult profession. A person who devotes himself to medicine must undoubtedly have a vocation for it. The desire to help another person has always been considered a useful personality trait and should have been cultivated from childhood. Only when these personality traits become a need can we consider that a person has the main prerequisites for successfully mastering the medical profession. It is no coincidence that the famous writer and doctor V.V. Veresaev wrote that it is impossible to learn the art of medicine, just like the art of stagecraft or poetry. You can be a good medical theorist, but in practical terms with patients you can be incompetent.
Doctor's humanism . The patient, first of all, has the right to expect from the doctor a sincere desire to help him and is convinced that the doctor cannot be otherwise. He endows the doctor with the best qualities inherent in people in general. One might think that the first person who provided medical assistance to his neighbor did it out of a feeling of compassion, a desire to help in misfortune, to ease his pain, in other words, out of a sense of humanity. There is hardly any need to prove that humanity has always been a feature of medicine and the doctor, its main representative.
Humanism, consciousness of duty, endurance and self-control in relations with patients, conscientiousness have always been considered the main characteristics of a doctor. For the first time, these moral, ethical and moral standards of the medical profession were formulated by the physician and ancient thinker Hippocrates in his famous “Oath.” Of course, historical and social conditions, class and state interests of changing eras have repeatedly transformed the Hippocratic Oath. However, even today it is read and perceived as a completely modern document, full of moral strength and humanism. Its main provisions are as follows:
respect for life(“I will not give anyone the lethal means they ask from me and I will not show the way for such a plan, just as I will not give any woman an abortifacient pessary”);
prohibition of harming the patient(“I will direct the treatment of the sick to their benefit according to my strength and my understanding, refraining from causing any harm or injustice”);
respect for the patient's personality(“Whatever house I enter, I will enter there only for the benefit of the sick, being far from everything intentional, unrighteous and harmful, especially from love affairs with women and men, free and slaves”);
medical secrecy("Whatever during treatment - and also without treatment - I see or hear about human life that should never be disclosed, I will keep silent about it, considering such things a secret");
respect for the profession(“I swear... to consider the one who taught me the art of medicine on an equal footing with my parents... I will conduct my life and my art purely and immaculately”).
Medical confidentiality (confidentiality). In the relationship between a doctor and a patient, an important role belongs to the doctor’s ability to maintain medical confidentiality. It usually includes three types of information: about illnesses, about the intimate and family life of the patient. The doctor is not an accidental owner of this information, the innermost experiences and thoughts of patients. They trust him as the person from whom they expect to receive help. Therefore, it is possible to dispose of the information about the patient available to the doctor at his own discretion only in rare cases. The requirement for non-disclosure of medical confidentiality is lifted only in cases where the interests of society require it (for example, when there is a threat of the spread of dangerous infections), as well as at the request of judicial investigative authorities.
General and professional culture . We can note a number of general and more common personality traits that need to be cultivated by a doctor. This includes a high general culture and culture of medical practice, organization in work, love of order, accuracy and cleanliness, i.e. features that Hippocrates pointed out. Requirements for the personality of a doctor, his appearance and behavior gradually took shape in a special teaching - medical deontology, which is considered as the science of the proper moral, aesthetic and intellectual appearance of a medical worker, what should be the relationship between doctors, patients and their relatives, and also between colleagues in the medical environment.
Professional deformation. In professions related to human-human interaction, orientation toward the Other as an equal participant in the interaction is of great importance.
Medical activities are very diverse and are not limited to just treatment, as is commonly believed in the non-medical environment. The variety of types of medical activity creates different ways of its implementation, a wide field of activity for a professional, but poses the problem of the specific influence of different types of medical activity on the professional position of the doctor, his value orientations.
To describe the influence of a profession on the mental life of a professional, a special concept has been introduced - “professional deformation”. It first began to be described in the 60s as a problem of human functional capabilities. In our country, the problem of professional deformation began to be studied for the first time in the field of pedagogy. Research has shown that in “person-to-person” professions, professional deformation exists, as well as different levels of training and qualifications of a professional, and that professional selection must be carried out, since there is an idea of professional suitability.
Professional deformation develops gradually from professional adaptation. A certain degree of adaptation is natural for a healthcare worker. A strong emotional perception of the suffering of another person at the beginning of professional activity, as a rule, is somewhat dulled in the future. Of course, a certain degree of emotional resistance is simply necessary for a doctor, but he must maintain those qualities that make him not just a good professional, but also a person capable of empathy, respect for another person, capable of observing the norms of medical ethics. A striking example of professional deformation is the approach to the patient as an object, a carrier of a symptom and syndrome, when the patient is perceived by the doctor as an “interesting case.”
G.S. Abramova and Yu. A. Yudchits (1998) consider professional deformation in the form generalized model, which includes both its socially determined causes and causes caused by the phenomena of individual consciousness. They include among social reasons the influences associated with the need for a doctor, as a civil servant, to comply with numerous instructions that regulate his activities. The concept of “instruction” here generalizes all forms of ready-made knowledge (textbooks, classifications of diseases, standards, etc.) that are given to us from the outside; they are not “passed” through our own experience and understanding. As soon as a professional accepts an instruction as the absolute truth, all professional relationships are deformed in a certain way: the doctor may perceive the patient not as an integral person, but as a certain set of symptoms or an object of manipulation.
On the other hand, a doctor can believe in his power and authority over a person, accepting on faith numerous myths circulating in the non-medical environment about the capabilities of a doctor and modern medicine. The external side of treatment, which seems magical to an inexperienced person, accessible only to a doctor, gives rise to the “caste” nature of medical knowledge. This is how another phantom of a doctor’s professional activity is formed - a feeling of power over a person for whom medical care is the last chance to protect himself from illness.
Thus, the doctor deals with two realities: inanimate (phantoms and instructions) and living reality - the life of himself and other people. There is a temptation to identify them and create the illusion of simplicity. A professional begins to experience extremely simple feelings, expressed in the attractive formula “I can”, “I am a professional and I know better how... what...”. As a result of accepting phantoms as truth, the consciousness of a professional also becomes phantomized - it becomes static, motionless, it always knows “how it should be,” “what should be” and “what to do with it.” These phantoms can sometimes be recognized by the doctor at the level of experience - in the form of a feeling of dissatisfaction with oneself and the profession. However, as long as there is an experience, we can talk about the possibility of realizing the fact of professional deformation and the prospects of working with it. Professional deformation is not realized when the doctor refuses experiences because they require effort and involve manifestations of an attitude towards someone or something.
Chronic fatigue syndrome in medical workers. In professions involving human-human interaction, professional fatigue is, first of all, fatigue from another person. This is a very specific type of fatigue, caused by constant emotional contact with a large number of people. This especially applies to the medical profession, since it places great demands on the professional’s personality and involves taking responsibility for the life and health of another person. To a large extent, the appearance of fatigue can be facilitated by the peculiarities of work in healthcare (on duty, shift work), and excessively large reception. “Asthenia of overfatigue” usually always develops gradually (within 6 or more months from the start of hard work), it is preceded by a more or less long period of volitional effort, mental stress and continued work in conditions of fatigue. Fatigue reduces a person’s performance and the effectiveness of his work, which creates a constant psychologically traumatic situation in the form of a feeling of personal inadequacy and can even lead to a neurotic breakdown. The most common symptom of asthenia is irritability. It manifests itself in increased excitability, impatience, touchiness and lack of restraint. Manifestations of irritability are often in the nature of short-term outbursts, which are often replaced by remorse, apologies to others, and feelings of lethargy and fatigue. In addition to these main symptoms, those suffering from asthenia complain of absent-mindedness, poor sleep, anxiety, mood instability, and headaches.
In the ordinary consciousness of society, there is an opinion that the health status of doctors is better than that of other people. However, this is far from the case, especially with regard to their psycho-emotional and mental state. Doctors have predominantly two types of attitude towards their condition in this regard: 1) denying - does not pay attention to their own psychological state, considers it a consequence of simple overwork, and does not seek help from specialists; 2) dismissive - underestimates one’s fatigue; does not change his lifestyle, which, as a rule, is incompatible with psychological health. Very often, a doctor with chronic fatigue syndrome is inclined not only to imperfect “self-diagnosis”, but also to imperfect “self-therapy” - excessive use of tranquilizers or drinking alcohol to relieve “stress”.
Physician fatigue negatively affects his professional performance and thus his patients. The consequences of fatigue can be very diverse. They can manifest themselves in impatience and irritability - the doctor reduces the time of seeing each patient, strives to finish tiresome work as quickly as possible, while the patient gets the impression that the doctor wants to get rid of him, does not take the seriousness of his complaints and generally treats him disrespectful. A doctor’s labor productivity decreases and slows down due to difficulties concentrating attention, difficulties in making a diagnosis and choosing a treatment method, the predominance of so-called diagnostic short connections like: “high acidity + blood in the stomach = peptic ulcer” (Konechny R., Bouhal M., 1985). Such a doctor gives the patient the impression of being absent-minded, preoccupied with his own problems, and often simply incompetent. Inattention and haste can lead to careless statements with mental trauma to the patient (iatrogenism) and even to direct medical errors - an unfounded diagnosis or unsuccessfully chosen treatment.
The experience of one’s own professional failure as medical errors increase, difficulties in concentration, difficulties in perceiving new material cause traumatization for the doctor himself and lead to a feeling of dissatisfaction with the results of his work. His condition can be aggravated by the emergence of conflicts both with the administration (due to complaints about unsatisfactory work), and with colleagues (due to irritation caused by fatigue) and with patients (due to medical errors, lack of a psychological approach, unqualified statements).
Syndrome of "emotional burnout" among health workers. The term “emotional burnout” was introduced by the American psychologist H. J. Freudenberger in 1974 to characterize the psychological state of healthy people who are in intensive and close communication with clients (patients) in an emotionally overloaded atmosphere when providing professional assistance.
The medical profession requires from a professional not only professional skill, but also great emotional dedication. The doctor constantly deals with the death and suffering of other people, and in many other cases the doctor has the problem of “not including” his feelings in the situation, which he does not always succeed in doing. Naturally, only an emotionally mature, holistic person is able to solve these problems and cope with such difficulties. There is probably an individual limit, a ceiling on the ability of our emotional “I” to resist exhaustion, to counteract “burnout”, self-preserving. The “emotional burnout” syndrome is typical specifically for professionals who initially have great creative potential, are focused on another person, and are fanatically devoted to their work.
With the syndrome of “emotional burnout,” a professional experiences a kind of disappearance or deformation of emotional experiences that are an integral part of our entire life. Its symptoms are in many ways similar to those of chronic fatigue and form the main framework for the possibility of subsequent professional deformation.
First of all, a person begins to noticeably feel fatigue and exhaustion after active professional activity; psychosomatic problems such as fluctuations in blood pressure, headaches, symptoms of the digestive and cardiovascular systems, and insomnia appear.
Another characteristic sign is the emergence of a negative attitude towards patients and a negative attitude towards the activities performed. The doctor’s desire to improve in his profession disappears, tendencies appear towards “accepting ready-made forms of knowledge”, acting according to a template with a narrowing repertoire of work actions, and rigidity of mental operations. Dissatisfaction with oneself with feelings of guilt and anxiety, pessimistic mood and depression often manifest themselves outwardly in the form of aggressive tendencies such as anger and irritability towards colleagues and patients.
Doctor's authority- a professional with SEV inevitably loses his authority among both patients and colleagues. Authority is associated primarily with professionalism and personal charm. When a doctor, due to indifference and a negative attitude towards his work, is unable to thoughtfully and carefully listen to the patient’s complaints, makes medical errors or shows aggressiveness and irritability, he loses confidence in himself as a professional and the respect of his patients and colleagues.
Doctor's optimism- the patient should feel the doctor’s healthy optimism, and not based on the desire to finish the examination as soon as possible (“that you are worrying in vain, everything is fine with you, you can go”). Conversely, under the influence of burnout, the doctor demonstrates a cynical, often cruel attitude, exaggerating the consequences, for example, of late attendance at the hospital (often due to the desire to “punish” the patient for his own emotional failure).
Honesty and truthfulness- with anxiety, worry and uncertainty caused by SEV, the doctor loses the ability to truthfully and honestly present information about the state of a person’s health. Either he unnecessarily spares the psyche of a sick person, forcing him to remain in uncertainty, or, conversely, he loses the necessary measure in the presentation of diagnostic or therapeutic information.
Doctor's word- the word has a huge suggestive influence on any person, and even more so the word of a doctor for his patient. A professional with SEV who experiences feelings of meaninglessness, hopelessness and guilt will inevitably convey these feelings to his patients in words, intonation, and emotional reaction.
Doctor's humanism- is determined by a value-based and holistic approach to another person. A doctor who has lost the content of his mental reality stops addressing this content in other people, thus devaluing both himself and them.
Test knowledge control:
1. A. Maslow’s “Pyramid of Needs” consists of “floors” arranged in ascending order in the following order:
Physiological needs
Need for security
Need to belong
Needs for love, recognition
Need for self-actualization
2. The motivation to achieve success is most clearly manifested in the following case:
athlete training, wanting to win an Olympic medal
student prepares for the session, not wanting to be expelled
a student skating shows caution for fear of getting injured
a soldier runs away from the battlefield, wanting to survive
3. Fast, emotional, impetuous, rather hot-tempered and easily excitable person according to the type of temperament:
phlegmatic person
sanguine
melancholic
4. Human character is a set of individual psychological characteristics, manifested in:
inclinations and abilities
sensory organization of personality
typical responses
strategies for solving mental problems
5. The predominant orientation of the individual is described by a couple of concepts:
introversion-extroversion
temperament-character
psychoanalysis-psychosynthesis
accentuation-psychopathy
analytical-synthetic
6. Conscious, purposeful human activity is called:
activity
individuality
interaction
designation
7. Property of the psyche that characterizes the dynamics of nervous processes
ability
temperament
character
creativity
8. Active, sociable, emotionally balanced person by temperament type:
phlegmatic person
sanguine
melancholic
9. A calm, unhurried person who loves regularity and thoroughness according to the type of temperament:
phlegmatic person
sanguine
melancholic
10. A strong, unbalanced type of higher nervous activity is characteristic of:
choleric
phlegmatic
sanguine
melancholic
11. Disharmony of character, excessive expression of individual traits is called:
accentuation
polarization
interaction
attraction
sensitization
12. Increased impressionability, a violent reaction to what is happening is a sign of such character accentuations:
dysthymic
pedantic
cyclothymic
exalted
13. The concept of “personality” is used when they want to emphasize
biologically determined human properties
socially determined human qualities
manifestations of intelligence of higher animals
psychophysiological differences between people
interspecific communication of higher animals
14. The system of stable ideas of a person about himself is called:
rationalization
self-concept
projection
attribution
metacognition
15. Activities related to achieving private goals of activity are called:
action
motivation
operation
adaptation
16. The properties of an individual are the following, except:
temperament
value orientations
inclinations
17. Personal properties are the following, except:
responsibility
position and status
focus
constitution
18. The properties of temperament are the following, except:
activity
emotionality
pace of activity
neatness
19. The structure of individuality includes all of the following components except:
individual properties of the organism;
individual psychophysiological properties;
individual genetic qualities;
individual mental properties;
individual socio-psychological properties.
20. There are several basic instincts that are common to all people. They
have an innate character, they are not treason and constitute the essence of human nature. Who is the author of this theory?
S. Anokhin.
2. R. Simonov.
Z. Freud.
G. Sullivan
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Lesson topic No. 5. Elements of developmental psychology and
LECTURE 6. COMMUNICATION AND BEHAVIOR OF A DOCTOR
Psychological aspects of communication between doctor and patient.
Socio-psychological portrait of a doctor’s personality.
Patient's personality characteristics.
To become a doctor, you must be an impeccable person. One must not only be able to adhere to such ethical categories as duty, conscience, justice, love for a person, but also understand people and have knowledge in the field of psychology. Without this, there can be no talk of the effectiveness of demonological influence on the patient.
The question often arises whether it is necessary to study the psychology of communication with a patient at all, because among doctors there are real masters of their craft, although they have never studied psychology. Indeed, among doctors there are innate psychologists who became them mainly intuitively, thanks to their personal moral and ethical qualities. However, it does not at all follow from this that in order to communicate with a patient it is not enough to have only intuition or experience. In addition, the doctor also needs special training. It is known that the medical profession has certain psychological characteristics. A doctor cannot dogmatically adhere to certain postulates and instructions, not only from the point of view of the nature of the disease, but also from the point of view of psychological and other factors and causes of its occurrence. Each time a doctor faces many atypical tasks, the solution of which requires independent thinking and the ability to foresee the consequences of one’s actions.
The psychologization of doctors’ work is also associated with the individual characteristics of both patients and the doctor himself, with his personal qualities, experience, and authority. The same methods of deontological influence that are effective for one doctor may be completely unacceptable or hardly acceptable for another. This is one of the most important psychological aspects of a doctor’s activity. In fact, not everyone is capable of this work, therefore, when choosing a profession as a doctor, professional orientation is important.
It is impossible to become a good doctor without love for your work and for a sick person. A doctor who is indifferent to the patient, to people, and generally “deaf” to social problems is a great social and professional evil, for which society pays dearly. After all, the doctor treats not only by using various medications, but also by influencing the patient with his own personality. Unfortunately, the moral and psychological principles of medical practice and their deontological embodiment have not yet been sufficiently studied.
The work of a doctor as a specific social phenomenon has its own characteristics. First of all, this work involves a process of interaction between people. In the work of a doctor, the subject of labor is a person, the instrument of labor is a person, the product of labor is also a person. Here, therapeutic and diagnostic methods are inextricably intertwined with personal relationships. Therefore, it is so important to study the moral and psychological aspects of a doctor’s activity. A doctor’s communicative competence is based on knowledge and sensory experience, the ability to navigate situations of professional communication, understanding of motives, intentions, behavioral strategies, frustration of both one’s own and communication partners, the level of mastery of technology and psychotechnics of communication.
Competence in the implementation of perceptual, communicative and interactive functions of communication;
Competence in implementing, first of all, subject-subject interaction with communication partners (it is clear that communication by type of instructions, orders, instructions, requirements, etc.) (subject-object model of interaction) must also be mastered;
Competence in solving both productive and reproductive communication problems;
Competence in the implementation of both behavioral, operational-instrumental, and personal, deep level of communication.
The defining aspect of a doctor’s communicative competence in modern conditions is competence in subject-subjective communication, in solving production problems, in mastering a deep, personal level of communication with other people.
In the structure of a doctor’s communicative competence, we highlight:
Gnostic component (a system of knowledge about the essence, structure, functions and characteristics of communication in general and professional in particular; knowledge about the style of communication, in particular, about the characteristics of one’s own communicative style; background knowledge, that is, general cultural competence, which, without being directly related to professional communication, allows you to catch and understand hidden hints, associations, etc., that is, to make the understanding more emotional, deep personal; creative thinking, as a result of which communication acts as a type of social creativity);
Conative component (general and specific communication skills that allow you to successfully establish contact with an interlocutor, adequately understand his internal states, manage the situation of interaction with him, apply constructive behavior strategies in conflict situations; speech culture; expressive skills that provide adequate expression of facial expressions and pantomime accompaniment; perceptual-reflexive skills that provide the opportunity to penetrate into the inner world of a partner in communication and understanding oneself; the dominant use of organizing influences in interaction with people (compared to those who evaluate and, especially, those who discipline);
Emotional component (humanistic attitude towards communication, interest in another person, willingness to enter into personal, dialogical relationships with her, interest in one’s own inner world; developed empathy and reflection; high level of identification with professional and social roles; positive self-concept; adequate requirements of professional activity (psycho-emotional states).
Here are the basic communication skills required in the practice of a doctor:
1. ability to conduct a conversation with a patient;
2. the ability to manage one’s mental states and overcome psychological barriers;
3. sufficient understanding of the individual psychological characteristics of patients and the ability to take them into account;
4. the ability to penetrate into the patient’s inner world;
5. the ability to show sympathy (empathy) for the patient in his illness;
6. ability to listen and give advice to the patient;
7. the ability to analyze all components of one’s activities and oneself as a person and individuality.
The peculiarities of studying the psychological foundations of medical communication are to be able to overcome these difficulties, namely: the ability to know the patient and oneself, to draw up a psychological portrait of the patient, the ability to communicate psychologically competently, etc. The doctor must have a positive attitude towards the patient’s personality, recognition of his value without prejudices, excessive criticality. Based on the above, let us pose a problematic question: what should a doctor of the 21st century be like, what does his professionalism consist of?
2. Socio-psychological portrait of a doctor’s personality
Professional qualities of a doctor:
The professional training of the doctor, his availability of all professional skills and abilities.
Psychological training of a doctor. The specificity and complexity of this training lies in the fact that the doctor must have deep knowledge of psychology and related scientific disciplines.
The doctor’s professionalism is also influenced by the characteristics of his personal life: how prosperous his own life is - whether there is love in it, mutual understanding with loved ones, material security, household arrangements, etc. A lot is required of the doctor, he is responsible for a lot of things, but he himself is largely defenseless : society, represented by the state, does not provide decent and necessary living conditions at the proper level. This applies to both material, legal and social security of a professional. But, despite the different living and working conditions, despite the individual personal characteristics of specialists, the medical profession has significant professional values that must be present in its activities and determine the level of professionalism. The profession of a doctor presupposes, first of all, love for one’s work, love for a person, for a sick person. Without this, it is impossible to become a good doctor, in the full sense of the word.
The medical profession is a unique profession that must contain a complex of such characteristics: a constant desire for self-improvement, vast practical experience, knowledge of the specifics of this activity, ability to work as a doctor, knowledge of the prospects for the development of the medical industry.
Let us highlight a set of personal qualities that a doctor should have.
1. Moral and ethical qualities of a doctor: honesty, decency, commitment, responsibility, intelligence, humanity, kindness, reliability, integrity, selflessness, ability to keep one’s word.
2. Communication qualities of a doctor: personal attractiveness, politeness, respect for others, willingness to help, authority, tact, attentiveness, observation, being a good conversationalist, sociability, availability of contacts, trust in others.
3. Strong-willed qualities of a doctor: self-confidence, endurance, risk-taking, courage, independence, restraint, poise, decisiveness, initiative, independence, self-organization, perseverance, determination.
4. Organizational qualities of a doctor: demanding of himself and others, a tendency to take responsibility, the ability to make decisions, the ability to correctly assess himself and the patient, the ability to plan his work.
The activity of a doctor is a complex, multifaceted, dynamic phenomenon. Its specificity is determined, first of all, by the expansion of communication between the doctor and the patient. For a doctor, this is not a luxury, but a professional necessity. With its help, the mutual influence of two equal subjects is carried out - the doctor and the patient. An indicator of the effectiveness of such mutual influence is the predominance of positive aesthetic feelings, humanity, and creativity. A doctor must have certain qualities that contribute to the effectiveness of a doctor’s work. First of all, this is the ability to control oneself and manage one’s behavior. It is quite clear that the doctor needs to be prepared for this.
We will offer several rules for optimizing communication between a doctor and patient, which will optimize the treatment process:
1. Greet the patient cheerful, confident, and energetic.
2. The general feeling in the initial period of communication with the patient is cheerful, productive, and confident.
3. There is a communicative mood: the readiness to communicate is clearly expressed.
4. When communicating with the patient, an appropriate positive emotional mood is created.
5. Manage your own well-being (even emotional mood, the ability to manage your well-being despite unfavorable circumstances, etc.).
6. Achieve communication productivity.
7. Speech should not be oversaturated with medical terms.
8. Expressive facial expressions are emotionally appropriate, that is, they must correspond to the emotional mood of the patient.
Great importance should be given to the well-being of the doctor. For the doctor, it is not his personal matter, because his mood is reflected both on the patient and on his work colleagues, which creates a certain atmosphere in the treatment process. It is extremely difficult to achieve such an optimal internal state, since to some extent the work of a doctor has aspects of routine.
A doctor must be able to maintain efficiency and manage situations to ensure success in his work and maintain his health. To do this, you need to work on yourself, be self-confident, be able to control your emotions, relieve yourself of emotional stress, be purposeful, and decisive.
A doctor’s activities should be based on a positive emotional attitude towards himself, his patients, and his work in general. It is positive emotions that activate and inspire the doctor, give him confidence, cause a feeling of joy, and have a positive effect on relationships with patients and work colleagues. Negative emotions, on the contrary, inhibit activity, disorganize behavior and activity, and cause anxiety, fear, and suspicion in the patient.
A doctor needs to be able to act like an actor, and not only on the outside.
The doctor’s facial expression should be friendly not only in order to get into a good mood, but also to change behavior patterns. Therefore, a doctor should not walk in front of patients with a gloomy, bored face, even when he is in a bad mood. If, nevertheless, the bad mood does not leave you, you should force yourself to smile, hold back the smile for a few minutes and think about something pleasant.
In addition to the fact that the doctor must control his internal state, he must be able to control his body, which clearly reflects the internal state, thoughts, and feelings. The elements of a doctor’s external technique are verbal (speech) and non-verbal means. It is through them that the doctor reveals his intentions; it is through them that patients “read” and understand.
The doctor's appearance should be aesthetically expressive. You can't be careless about your appearance. The main requirement for clothing is modesty and elegance. Aesthetic expressiveness is manifested in the friendliness and goodwill of the doctor’s face, in composure, restraint of movements, in a stingy, justified gesture, in posture, and gait. Fussiness, artificiality of gestures, and their flabbyness are unacceptable. Even in how to receive a patient, look at him, say hello, how to move a chair, there is a power of influence. In movements, gestures, and gaze, the patient should feel restrained strength, complete self-confidence and a friendly attitude.
Body plasticity, or pantomime, allows you to highlight the main thing in a doctor’s appearance and paints his perfect image. The effectiveness of communication is helped by the doctor’s open postures and gestures: do not cross your arms, look into the patient’s face, reduce the distance, which creates the effect of trust.
The doctor's facial expression has the greatest impact on patients, sometimes even more than his word. It is gestures and facial expressions that increase the emotional significance of information. Patients “read” the doctor’s face, remembering his attitude and mood, so the face should not only express, but also hide some feelings: you should not transfer the burden of household chores and troubles onto the patient. It should be shown on the face and in gestures that it concerns the matter and contributes to the treatment.
The doctor's facial expression should always correspond to the nature of his speech when talking with the patient. The doctor’s face should express confidence, approval, dissatisfaction, condemnation, joy, interest, passion, that is, express a wide range of emotions, which indicates the moral strength of the doctor’s personality.
A doctor in his professional activity must reach the pinnacle of communication skills, namely, mastery of his own body and the ability to influence the patient using the power of his body. Here biomechanics, the science of developing motor coordination of behavior and the ability to control one’s body, which was developed by the Czech theater director Meyerhold, can come to the doctor’s aid. Its final task is to subordinate one’s motor behavior to the expression of a certain impact on the patient, to make it automatic, to turn it into a perfect communication technique, an internal need.
An important basis for a number of professionally important qualities of a doctor’s personality is emotional stability, anxiety, and propensity to take risks, these are features of neurodynamics.
For professional psychology, it is very important that the characteristics of neurodynamics influence the formation of professionally important personality traits. It is known that the weakness of nervous processes gives rise to increased anxiety, emotional instability, decreased activity, etc. For individuals with very high levels of nervous system strength, there is an increased likelihood of establishing inflexible, inadequately high self-esteem.
Emotional stability as the ability to maintain optimal performance when exposed to emotional factors also largely depends on the characteristics of self-esteem. It is closely related to anxiety - a property that is essentially biologically determined. Both of these qualities, sometimes considered as properties of temperament, and more often as personal characteristics, are professionally significant in many types of activities, which are noted in many types of regular professional activities. A similar dependence is most often observed between the success of activities and emotional stability. In many types of activities, emotionality turns out to be important - the integral ability to experience emotional experiences. Particularly serious demands on this area are made by professions that require high emotionality and at the same time emotional stability, for example, the work of a doctor.
The property of extra-introversion is considered to be professionally important, primarily for group activities or professions related to communication and working with people. But this quality can also be important for individual work. There is evidence that introversion is associated with higher levels of resting cortical activation, which is why introverts prefer activities that avoid excessive external stimulation. Extroverts strive for external stimulation and prefer activities that provide additional movement and emotional and motivational support. It is known that introverts are more resistant to monotonous work and cope better with work that requires increased vigilance and accuracy. At the same time, in stressful work situations they show a greater tendency to anxious reactions, which negatively affect the success of their activities. Extroverts are less accurate, but are better at navigating stressful work situations. When working in groups, it is necessary to take into account the greater suggestibility and conformity of extroverts.
Among the actual personal qualities, responsibility is most often mentioned as a universal, professionally important quality. Responsibility is considered as one of the properties that characterize the orientation of a doctor’s personality and influence the process and results of professional activity, primarily through the attitude towards one’s work responsibilities and one’s professional qualities.
Most other personal qualities are more specific and are important only for certain types of professional activities. Summarizing the above, we can assume that personality traits can act as professionally important qualities in almost any type of professional activity, in particular in the activity of a doctor.
A doctor’s abilities are usually considered as individual personality traits that contribute to the successful performance of his activities.
Two large groups of special abilities of a doctor can be distinguished:
1. perceptual-reflexive (perception - perception) abilities that determine the doctor’s ability to penetrate into the individual uniqueness of the patient’s personality and understand him (these abilities are leading);
2. projective abilities associated with the ability to act on another person, on a patient.
Among them, the main ones can be identified as follows:
1. The ability to correctly assess the patient’s internal state, sympathize, empathize with him (the ability to empathize).
2. The ability to be an example to those being treated in thoughts, feelings and actions.
3. The ability to adapt to the individual characteristics of the patient.
4. The ability to instill confidence in the patient and calm him down.
5. The ability to find the right style of communication with everyone, to achieve their favor and mutual understanding.
6. The ability to command respect from the patient, to enjoy (informal) recognition, to have authority among those whom you are treating.
3. Patient's personality characteristics
The patient’s personal characteristics include the following qualities: temperament, character, abilities, intelligence, etc. The doctor must take into account all these groups of properties when establishing psychological contact with the patient.
Different patients come to see a doctor. The doctor sometimes has no idea about his identity and, as a result, may not be prepared to meet him. Subconsciously, the doctor is always tuned to the image of the “ideal patient.” This term is sometimes used to describe patients who consciously came to be cured of an illness; they have no doubts about their abilities and skills as a doctor, a willingness to carry out all the doctor’s prescriptions, the ability to briefly state their problems and complaints, and little awareness of medical terms.
But, as practice shows, the percentage of such patients is small and the doctor directly encounters different patients, with manifestations of their different characters, which, of course, creates certain barriers to treatment. Therefore, the doctor needs to take into account all the characteristics of the patient’s personality in order to effectively form contact with him.
Patients vary in their personal characteristics. Let's look at them.
External patients are more focused on the outside world that surrounds them, they are sociable, they have a wide circle of friends, acquaintances, high excitability and impulsive behavior. They are able to blame external circumstances, their fate, chance for their illnesses and illnesses. Such patients usually show aggression and anger, both towards the doctor and towards other patients. The main tactic that a doctor should use is first of all to establish emotional contact with such patients, and only then move on to the informational aspects of the conversation.
Internal patients. For them, their inner world, their experiences are of greater interest, and the external environment is unimportant. Such patients are “closed in themselves”, uncommunicative, they are never bored with themselves, have difficulty adapting to changes in the external environment, are prone to introspection, and a distrustful-skeptical type of communication predominates. For internals, there are no trifles in their health. They place the blame for their lost health only on themselves and place responsibility for the events in their lives only on themselves. Such patients are extremely responsible, diligent, demanding both of themselves and of the doctor. Therefore, when working with such patients, the doctor must discuss all issues in as much detail as possible, otherwise the patient may experience a feeling of anxiety. There is no need to save time when conducting a consultation, because the pace of thinking of internals can be slow. The doctor must come to terms with this and be patient and calm. In this case, the tactics with the patient should be the opposite of those previously given, namely: contact with such a patient should begin with neutral, informational contact, and only then form a positive emotional attitude towards the doctor.
There are some prerequisites for creating a certain relationship between doctor and patient that operate even before they come into direct contact. It should be taken into account that the patient who comes to the doctor, as a rule, knows more about him than the patient's doctor. The reputation of healthcare in general and the medical institution where the patient comes is also important. Tension, dissatisfaction and anger of the patient, who was forced to get to the doctor by inconvenient transport and wait a long time in the waiting room until it was his turn, is often a mechanism for the generalization of affect, which was inadequately manifested when meeting with a nurse or with a doctor who has no idea about the reasons this affect. For most patients, the image of a doctor summarizes personal experience of interaction with persons who are authoritarian for him at different periods of life. The theoretical foundations in the field of relationships between doctor and patient were developed by 3. Freud in his concept of “transference” (“transference”). According to this concept, the doctor subconsciously reminds the patient of some emotionally significant person from his childhood, for example, his father. Depending on what impressions and attitudes once prevailed during the patient’s contact with his father, the current attitude toward the doctor tends to be either negative (hostile) or positive (feelings of love, trust). “Antitransfer” (“countertransference”) operates in the opposite direction.
Currently, this initial understanding of 3. Freud is considered too narrow and artificial, but sometimes rational, which points to the possibility that to the patient some elements of the doctor's behavior, appearance or reputation may resemble something positive or negative from his past life and, above all, - experience with those persons who had great emotional significance for him. In addition to parents, these could be grandparents, uncles and aunts, brothers and sisters, teachers, close friends. And not only in relationships with a doctor, but also with every new contact that arises between people, it makes sense to think about why someone whom we are quite likely seeing for the first time in our lives evokes in us quite expressive feelings of sympathy or antipathy, who from our past, how they resemble. Keeping this “burden of the past” in mind can help us more realistically understand and cope with situations related to relationships with other people.
In this context, it is also worth mentioning the possibility of action "transfer aesthetic stereotype." Namely, that beautiful people are more likely to evoke sympathy and trust, while ordinary people are more likely to evoke antipathy and uncertainty. This element traditionally appears in fairy tales in the figures of an ugly witch and a handsome prince. Ideas about beauty are associated with good qualities, ugliness - with evil. Despite the fact that this prediction is unfounded, it subconsciously has a rather strong effect: an outwardly attractive patient evokes more sympathy from the doctor, even if in reality he requires less help than the patient, which arouses antipathy with his appearance. Conversely, a doctor who acts aesthetically positively inspires more confidence in the patient.
Consequently, the doctor’s knowledge and consideration of the patient’s image of the “ideal” doctor contributes to the establishment of better psychological contact between the two.
The doctor will gain the patient's trust if he is a harmonious person, calm and confident, but not arrogant, and if his behavior is fast, persistent and decisive, which is accompanied by human sympathy and delicacy. When making a serious decision, the doctor must imagine the results for the health and life of the patient, and thereby strengthen his sense of responsibility. The need to be patient and control oneself places special demands on him. He should always consider the various possibilities for the development of the disease and should not consider it ingratitude, reluctance or even personal insult on the part of the patient if his condition does not improve.
It is difficult to combine the necessary caution and prudence with the necessary determination, composure, optimism, critical attitude and modesty in the work of a doctor. There are situations when it is inappropriate to show a sense of humor without a hint of irony and cynicism, according to the principle: “Laugh with the patient, but never at the patient.” However, some patients cannot tolerate humor even with good intentions and understand it as disrespect and humiliation of their dignity.
The balanced personality of a doctor is for the patient a complex of harmonious external stimuli, the influence of which takes part in his recovery. The doctor must educate and shape his personality, firstly, by observing the reaction to his behavior directly (by conversation, assessing the patient’s facial expressions, gestures), and, secondly, indirectly, when he learns about the view of his behavior from his colleagues. The colleague himself can also help his colleagues guide their behavior.
There are facts where people with unbalanced, insecure and absent-minded manners gradually harmonized their behavior towards others, both through their own efforts and with the help of others. Of course, this requires certain efforts, a certain critical attitude towards oneself and the necessary degree of intelligence, which for a doctor should be self-evident.
A young doctor, whom patients know has less life experience and less qualifications, is at a disadvantage compared to his older colleagues, but he will be helped by the knowledge that this disadvantage can be compensated for by conscientiousness, readiness to help at any moment and modesty.
Before a young doctor becomes a professional in his field, he must gain authority and trust among patients and colleagues. A fundamental component of the patient-doctor relationship is trust. But the acquisition of trust does not follow only from the psychological side of the relationship between doctor and patient, but also has a broader, social side. The doctor can gain the patient's trust and establish a generally positive relationship with him by satisfying his unreasonable demands for treatment. He can contribute to this, so that patients will turn to him and “trust” in him will increase. The development of such relationships, of course, follows from the mutual satisfaction of the interests of the doctor on the one hand, and the patients on the other hand, who can do some service for the doctor, for example, using their profession (repairmen, artisans, retail chain workers, etc.). If such cases become too numerous, then the actual and actually necessary examination and treatment of all patients suffers, which should be carried out depending on their disease, and not on their social status or capabilities.
In practice, a psychological problem arises in cases where the doctor notices that the relationship between him and the patient is developing unfavorably. Then the doctor has no choice but to behave with restraint, patiently, not to succumb to provocations, not to provoke himself, and to try to gradually win the patient’s trust with calmness and understanding. Thus, we create a correct experience, that is, the patient’s negative manifestations should be corrected with the help of our own positive manifestations, for example, patience, tact and tolerance. And, conversely, the stereotypical, unfortunately still often spontaneous, “natural” reaction - anger for anger, irony for irony, helplessness for helplessness, depression for depression - strengthens the patient’s “sinful” and problematic attitude and the possibility of conflicts and misunderstandings grow. This behavior can be characterized by the expression: “adding fuel to the fire.” Moreover, it is precisely this “natural” reaction that is a waste of time, while the opposite approach, that is, accepting a person as he is, saves time for the doctor and the patient.
An equally important aspect in the professional activity of a doctor is knowledge and consideration of the common clinical classification of types of patients and types of doctors. This classification was derived from long-term observations of the behavior of patients and doctors. Let's get acquainted with the clinical classification of types of patients.
Anxious patient. The behavior of such patients is marked by increased anxiety, which is not justified. Very often such patients have an anxious personality type. They are cowardly, submissive, unsure of themselves, and during diagnostic and therapeutic procedures they can lose consciousness, and various vegetative-vascular reactions occur. When dealing with this type of patient, the doctor should seek the help of a medical psychologist who will relieve emotional stress and anxiety, which will contribute to an effective treatment process.
Distrustful patient. The behavior of such a patient is characterized by increased distrust of the doctor’s activities and his personality. Such patients are skeptical and cautious about the treatment process. Before agreeing with a doctor, they will think a hundred times, and then begin to follow his recommendations. If the doctor distinguishes suspicion from possible psychopathy in time, then he should, first of all, begin treatment, overcoming the barriers of mistrust and alienation of the patient.
Patient suggestions. This type of patient is trying to get attention from both doctors and other patients. Constantly needs recognition that he is really sick, that he is experiencing unbearable torment. The patient shows the doctor that he requires special attention to his personality and exaggerates the descriptions of his complaints. While working with such a patient, the doctor must provide the patient with a certain amount of recognition of his “heroism” and the stability of his character.
Depressed patient. Such a patient is depressed, isolated from others, refuses to talk with other patients and staff, and does not reveal his inner world well. He is extremely pessimistic because he has lost faith in the success of treatment and recovery. Effective advice for a doctor is his optimism, faith in the patient’s recovery, which are of great importance to him; It is worth involving him in caring for other patients and performing simple tasks.
Neurotic patient. This type of patient is overly attentive to his health, is interested in all laboratory tests, unreasonably assumes the presence of a wide variety of diseases, and reads specialized literature. When communicating with such a patient, the main thing is to maintain a distance, that is, “not to follow the patient’s lead,” using methods of persuasion and suggestion to explain the importance of the treatment process prescribed by the doctor and its effectiveness.
To develop the ability to communicate with a patient, in particular a psychotherapeutic approach to him, any doctor must have information about his professional type of behavior.
To understand the peculiarities of your communication capabilities, to help the doctor see himself “through the eyes of the patient,” personality classification gives doctors per I. Hardy (1973).
Robot doctor. The most characteristic feature of his activities is the mechanical performance of his duties. These doctors are thorough, well technically qualified, and carefully carry out all assignments. However, while working strictly according to instructions, they do not put psychological content into their work. Such a doctor works like an automaton; he perceives the patient as a necessary addition to the instructions for his care; their relationships with patients are devoid of emotional sympathy and empathy. They do everything, leaving one thing out of sight - the patient. It is such a doctor who is able to wake up a patient who is sleeping in order to give him sleeping pills at the appointed time.
Doctor-soldier. This type of doctor is well portrayed in popular comedies. Patients already recognize him from afar by their gait or loud voice, and quickly try to organize their bedside tables and beds. This doctor is decisive, uncompromising, persistent, and reacts instantly to the slightest violation of “discipline.” With insufficient culture, education, and a low level of intellectual development, such a tough “strong-willed” doctor can be rude and even aggressive with patients. In favorable cases, if he is smart, educated, with such a decisive character, he can become a good educator for young colleagues.
Maternal type doctor (“mother” and “doctor”). He transfers his warm family relationships to work with patients or compensates for their absence in his work. Working with patients and caring for them is an essential condition of life for him. He is good at empathy and the ability to empathize.
Expert doctor. Ego doctor - narrow specialist. Due to the high need for professional recognition, he shows special curiosity in a certain area of professional activity and is proud of his importance in his industry, where he sometimes even “eclipses” the doctor. Young doctors do not hesitate to turn to them for professional advice. Sometimes people of this type become fans of their narrow activities, excluding all other interests from their field of vision, and are not interested in anything except work.
"Nervous Doctor" This type of unprofessional behavior by a doctor should not exist in a medical institution and indicates poor quality professional selection of personnel and errors in the work of the administration. Emotionally unstable, quick-tempered, irritable, he constantly gives neurotic reactions, is prone to discussing personal problems and can become a serious obstacle to the work of a medical institution. A “nervous doctor” is either a pathological personality or a person suffering from neurosis. Such people often themselves need serious psychotherapeutic help and are professionally unsuitable for working with patients.
A doctor who belongs to the above types has not yet formed or has already formed as a person; such behavior is marked by unnaturalness. Unnaturalness in communication prevents him from establishing contacts with people, so such a doctor must clearly define his professional goals and develop an adequate style of communication with the patient.
Thus, if the main principle in a doctor’s work is “the patient comes first,” then planning and conducting medical practice is impossible without the ability to conduct a survey, formulate problems, plan activities and train the patient in self-care skills, and for this, doctors must continuously learn and improve not only in professional training, but also in the psychological foundations for therapeutic activities.
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Lecture course
Psychological foundations of the professional activity of a doctor
Tserkovsky Alexander Leonidovich
Editor Yu.N. Derkach
Technical editor I.A. Borisov
Computer layout E.Yu. Prudnikova
Proofreader A.L. Tserkovsky
PREFACE
Curing disease is a science.
Treating a patient is an art.
The 21st century is the century of medical art.
The 21st century is marked by a very close interaction between psychology and medicine. In this regard, psychological training is becoming one of the most rapidly developing and attracting attention aspects of medical education. (WHO, 1993).
The clinical competence of a doctor should be based on socio-psychological culture - the ability to communicate with the patient, his relatives, colleagues, and administration.
Research has shown that there are significant relationships between many aspects of clinicians' interpersonal skills and patient satisfaction and motivation (Thomson et. al., 1990). Poor communication on the part of the physician is a major factor leading to patient and family dissatisfaction with treatment, leading to accidents and subsequent litigation (Vincent, 1992).
Medical students' learning of the fundamentals of general, developmental and social psychology, and medical psychology can subsequently influence the cost of treatment and the efficiency of resource use in healthcare, opening up the possibility of more accurate diagnosis and greater patient compliance with treatment plans.
The psychologization of medical knowledge can help the physician more effectively cope with the need to develop an adequate treatment plan and communicate it to the patient in the time available for this, and prevent unnecessary prescriptions of drugs that are either erroneously prescribed or misused by patients (Kaplan, 1989; Sandler, 1980). Physician psychological incompetence has negative consequences for the medical, psychosocial and economic aspects of health care.
Currently, the formation of communicative competence The skills of a medical specialist are not yet fully considered as one of the most important components in the professional training of a doctor. This creates social and psychological problems within the health care system itself.
1. Currently, a new model of relationships is being actively introduced in medicine, based on the ethical doctrine of “informed consent” and oriented (K. Rogers) to a “client-centered approach” (subject - subject interaction). This model clashes with the opposite tradition - the “nosocentric” (from the Latin nosos - disease), rooted in the structure of medical student education and the health care system. It is based on subject-object interaction. The doctor's focus is on the disease.
Within the framework of a client-centered approach, a person who seeks professional medical help becomes an active participant (accomplice, subject) of the therapeutic process. The doctor must be “at the level” of the client, must be ready to cooperate, in particular, to communicate “as equals”. The therapeutic alliance in the doctor-patient dyad, based on trust, is the most important factor determining the success of therapy, regardless of its orientation.
Currently, the relationship between a doctor and a patient is paternalistic in nature - the nature of a “subject-object” relationship. This nature of the relationship may be due to several reasons:
a) the doctor often does not attach a special role to communication with the patient in the therapeutic process and does not bother himself with careful preparation and organization of communicative space and communication;
b) the doctor does not always know how to interact with himself in such a way as to rely on his potential;
c) in his actions towards the patient, the doctor is guided by ideas about the patient as a passive executor of the doctor’s orders, as an object that is not competent, not autonomous, and has no potential for medical self-education.
2. According to a number of experts, nine out of ten Americans “do not live out their life,” and in absolute first place in the world are diseases that can be classified as “lifestyle” diseases.
The traditional division between “organic” and “functional” diseases is now increasingly being questioned. Medical specialists began to understand that diseases often arise from multiple etiological factors.
Such views on the causes of disease give rise to particular interest in the role that psychological and social factors may play in this regard.
Practical medicine begins to expand its field of vision: the patient is no longer just a carrier of some diseased organ, he must be considered and treated as a person as a whole, since “illness is a consequence of the incorrect development of relations between the individual and the social structures in which he is included” ( B. Luban-Plozza, 1994).
Modern medicine tends to absolutize the somatic sphere to the detriment of the psychosocial one (N.G. Ustinova, 1997), and the medical model of disease, which is highly adequate to the clinical paradigm of health, often distorts the patterns of social etiology of the bulk of the pathology existing in society. The socio-psychological approach to health in its theoretical content is most adequate to the sanocentric paradigm of modern medicine, which replaces the pathocentric paradigm (I.N. Gurvich, 1997). “Quality” of medical services, adequate treatment without a deep study of the socio-psychological category is hardly possible (both emphases are important: “lifestyle” and “lifestyle”).
3. Family, like other immediate surroundings, usually gives a person the amount of warmth, attention and love that he needs. Here he is loved infinitely, unconditionally and accepted for who he is.
That is why a number of experts believe that it is more appropriate to count the planet’s population “in families”, and to count single people “as an incomplete family”. The contribution of the family to a person’s health and life is difficult to overestimate, and in this regard, as world statistics prove, 26% of errors in medical diagnostics are attributed to ignorance of the patient’s family environment (R.S. Duff, A.B. Hollingshead, 1968). Therapy for gastric ulcers, ulcerative colitis, diabetes, asthma, coronary heart disease, anorexia, and migraines requires a family approach (M.V. Avsentyeva, 1994).
At the same time, a medical graduate navigates the field of family psychology at the level of common sense and the life experience he has at the time he begins independent work. Patterns of family functioning can represent a powerful factor of healing or, conversely, an elusive, invisible, but constantly operating factor of pathogenesis (for example, in a psychiatric clinic a “schizophrenic family” is known).
4. The world-wide practice of creating groups of patients (“Alcoholics Anonymous”; the society of “exceptional cancer patients” by B. Siegel; groups of patients with severe pain; groups of patients who survived a suicide attempt, etc.) can be initiated by a doctor oriented in modern psychology and in the field of social psychology, first of all. Patients discover the opportunity to master (with the subsequent transfer of experience to each other) the principles of such work, but the awareness of the importance of this direction of work and the main effects (opportunities and prospects) of group work remains with the attending physician.
5. According to K.K. Platonov (1990), the word “rehabilitation” was first used in the trial of Joan of Arc, and this, legal in nature, concept is interpreted (in the strict sense) as “the return of individual rights.” It is no coincidence that in the history of medicine, psychiatrists were the first to turn to it, and only then did it penetrate into other areas of medical work.
The crisis nature of a person’s collision with social stereotypes, labels (even stigmatization) is well known, and the upcoming prospect of life in the status of “OTHER” frightens many people suffering from serious illnesses.
6. In the strict sense of the term, “management” means the “development” of the system, while maintaining the “quality” of the system and the task of “stabilizing” the work are combined under the term “administration”. The professional training of managers of treatment and preventive institutions does not fully meet the socio-psychological realities of “attacking behavior of an organization in the service market”, which has been successfully mastered in other areas of public practice (V.P. Dubrova).
The doctor comes face-to-face with these problems at least twice. In one case, it is an element of the management system (being built into it or not), in another case, the doctor himself will have to create a treatment management system, where the microenvironment and the patient himself, specialized specialists and nurses, and the patient’s neighbors in the ward must be united and colleagues who come to him (creation of a so-called “therapeutic community” in a health care facility). The doctor must create (recreate) this system and transfer its control “into the hands” of the patient himself. All elements of the system should contribute to recovery and not interfere with it.
This problem can also be viewed through the prism of forming an “internal picture of treatment”, as learning self-government skills. It should be noted that the “internal picture of the disease” is widely discussed among doctors, the “internal picture of health” is beginning to gain recognition, but the concept of “internal picture of treatment” is practically ignored and not developed.
7) The modern approach to the diagnostic and treatment process involves the use of a sociopsychosomatic approach to the patient and the disease. This approach is systematic. It involves a comprehensive vision of the mutual influence of the disease process, the patient’s personality and her social environment. The use of a sociopsychosomatic approach in one’s professional activities can improve the quality of the diagnostic and treatment process.
The listed socio-psychological problems, if not addressed, can reduce the quality of treatment, the income of the medical institution and, ultimately, the earnings of the doctor himself.
The expanded introduction of general, developmental and social psychology courses into the practice of training doctors at all levels contributes to the formation of the socio-psychological competence of a doctor. This allows:
1) better recognize and respond more correctly to patients’ verbal and nonverbal signs and extract more relevant information from them;
2) carry out diagnostics more effectively, since effective diagnosis depends not only on identifying the physical symptoms of the disease, but also on the doctor’s ability to identify those somatic symptoms, the causes of which may be of a socio-psychological nature, which, in turn, requires other treatment plans;
3) obtain patient agreement with the treatment plan, since studies have shown that training communication skills has a positive effect on patient compliance with the prescribed medication;
4) provide patients with adequate medical information and motivate them to adopt a healthier lifestyle, thus enhancing the role of the physician in promoting health and preventing disease;
5) influence various forms of reflection of the disease (um national, intellectual, motivational) and activate compensatory mechanisms, increasing the psychosomatic potential of the patient’s personality, help him restore contact with the world, overcome the so-called “learned or trained helplessness,” destroy stereotypes created by the disease and create patterns of healthy response;
6) doctors to act more effectively in particularly “sensitive” aspects of the doctor-patient relationship that are often encountered in practice, for example, the need to inform a patient that he is terminally ill, telling the patient’s relatives that he is about to die, or other examples of delivering bad news.
This course of lectures is primarily focused on the theoretical socio-psychological training of medical students. It is based on a systemic concept of the psyche, which allows us to consider the human psyche as a system with feedback (A. Gorbatenko, 1999). This approach, in our opinion, contributes to the formation of a holistic understanding of human mental activity in a medical student, which will allow him to purposefully carry out the diagnostic and treatment process in his future professional activities (A.L. Tserkovsky).
The use of examples from medical practice in lectures equips students with specific knowledge in the field of practical interaction skills. This is especially important now, when the need to increase the number of family doctors increases.
conflict medical temperament ability
CHAPTER I. PSYCHOLOGY IN MEDICINE
LECTURE 1. THE IMPORTANCE OF PSYCHOLOGY IN DOCTOR TRAINING
1. Relevance of psychological training of the future doctor
The active interaction of psychology with medicine is currently due to the fact that the relationship between the doctor and the patient is still mainly paternalistic (traditional) in nature, and today it is necessary to ensure cooperation between them, on the other hand, a change in the nosocentric approach to the patient (subject-object relationship between doctor and patient) to anthropocentric (subject-subject interaction in the “doctor-patient” dyad) and the need in this regard for psychological training of doctors (V.P. Dubrova).
Consequently, the implementation of a program for developing the psychological competence of a doctor is one of the most pressing psychological and social problems of our time.
In recent years, the state of the general problem of psychological analysis of medical activity has changed for the better. Research has been conducted (V.A. Averin, A.G. Vasyuk, M.I. Zhukova, L.A. Tsvetkova, N.V. Yakovleva, etc.), a number of monographs and articles have been published on various aspects of the psychological analysis of a doctor’s activity (V.P. Andronov, N.A. Magazanik, V.A. Tashlykov, F.D. Burg).
However, progress in theoretical developments is not yet sufficiently connected with the solution of practical problems, which fully applies to the formation of the psychological competence of a doctor in the process of professional training at a university (N.V. Yakovleva, 1994).
The need for such training is obvious and due, according to V.P. Dubrovoy, for several reasons:
1) recognition of the role of the psychological factor in the occurrence and course of the disease;
2) a professional attitude towards the “average patient”, leading to ignoring the individuality of the patient’s personality and serious medical errors;
3) the specificity of medical activity, which lies in the fact that this is an activity in the sphere of communication, in the sphere of “person - person” and an important aspect of the success of a doctor’s activity is not only the high level of his special medical training, universal human culture, but also the socio-psychological aspects of his personal potential;
4) communication problems in dyads “doctor - patient”, “colleague - colleague”, “doctor - nurse”, “administrator - doctor”, “doctor - relatives of the patient”, etc.;
5) the intensity of medical work and the need, in this regard, to maintain a high level of performance for a long time and quickly make decisions in extreme situations.
Partially, the tasks of psychological training of a doctor are solved by the clinical and general humanities departments of a medical university, where, depending on the interests and level of erudition of the teacher, this or that amount of psychological information is included in special courses (L.A. Bykova, V.S. Guskov, N.V. Yakovleva, etc.).
However, it should be noted that the main way to develop a doctor’s psychological competence at a university is to study psychological disciplines (general and social psychology, “Medical Ethics”, “Pharmaceutical Ethics”, elective courses “Psychology of Communication”, “Practical Conflictology”, “Psychology of Management” " and etc.). Only in this case can we talk about the formation of a doctor’s psychological anthropocentric worldview and a sufficient level of his socio-psychological culture (V.P. Dubrova).
The socio-psychological culture of a doctor presupposes that he has certain professional views and beliefs, an attitude towards an emotionally positive attitude towards the patient, regardless of his personal qualities, and a whole range of communication skills and abilities necessary for a doctor to communicate medically.
More adequate mutual understanding between the patient and the doctor allows optimizing the professional activity of the latter.
The purpose of psychological training is to expand the humanitarian training of the medical student in the field of fundamental human sciences V.P. Dubrova).
Based on the goal, the following tactical tasks are solved, aimed at developing a psychological anthropocentric worldview and a sufficient level of socio-psychological culture of medical students:
Development of ideas among medical students that any human activity and the activity of a doctor, first of all, is regulated by certain values, which are one of the central components of the worldview;
Formation of the “I-concept” of a medical specialist;
Development of a high level of empathy (feeling into the psychology of another person) and self-esteem;
Formation of communicative competence and skills of optimal medical communication (socio-psychological culture);
Development of “clinical thinking” and a professional position that ensures person-centered medical interaction (person-centered attitude towards the object of one’s activity, awareness of one’s self-worth and that of another person, and attitude towards the patient as an active participant in medical interaction).
This view of the tasks and nature of teaching students at a medical university in the process of studying psychology is currently due to global educational trends, which in the psychological and pedagogical literature are called “megatrends” (M.V. Clarin, A.I. Piskunov, A.I. Prigozhy, R. Seltser, N.R. Yusufbekova). These include:
1) the mass nature of education and its continuity as a new quality;
2) significance, both for the individual and for social expectations and norms;
3) orientation towards a person’s active development of methods of cognitive activity;
4) adaptation of the educational process to the requests and needs of the individual;
5) orientation of education to the student’s personality, providing opportunities for his self-disclosure.
Thus, the most important feature of modern training is its focus on preparing specialists not only to adapt, but also to actively master situations of social change.
Currently, science has formulated ideas about the main types of learning, understanding learning in the broad sense of the word - as a process of increasing experience, both individual and sociocultural. These types include “supportive learning” and “innovative learning” (J.W. Botkin, V. Elmandra, M. Malitza).
“Supportive learning” is the process and result of such educational (and as a result, educational) activity that is aimed at maintaining and reproducing the existing culture, social experience, and social system. This type of training (and education) ensures the continuity of sociocultural experience, and it is this type that is traditionally inherent in both school and university education.
“Innovative learning” is the process and result of such training and educational activities that stimulate making innovative changes to the existing culture and social environment. This type of training (and education), in addition to maintaining existing traditions, stimulates an active response to problematic situations that arise both for the individual and for society.
Designing training sessions with students based on the ideas of “innovative teaching” changes the didactic structure of the educational process at a medical university in a specific specialized discipline and affects socially significant results, forming the “I-concept” of the future doctor.
2. Psychology and medicine
2.1 Current understanding of the disease
Currently, the positive definition of health given by WHO has received wide international recognition: “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO Constitution, 1946).
Currently, health is interpreted as: 1) the ability to adapt and adapt; 2) the ability to resist, adapt and accommodate; 3) the ability for self-preservation, self-development, for an increasingly meaningful life in an increasingly diverse habitat (V.A. Lishchuk, 1994).
From the WHO definition it follows that health consists of three components: physical, mental (or mental) and social.
In medicine, thanks to the positive definition of health, along with the pathocentric approach (fighting diseases), a sanocentric approach (focus on health and its provision) is also being established.
The emergence of a sanocentric approach changes the paradigm of medical thinking, which until recently dominated modern culture, and was based on the principle of “pathology”, on what is wrong in a person.
There was a stereotype in the public consciousness according to which it was considered success if a person became “better” with the help of medicine. In this case, “better” was understood as the absence of illness. A focus on the full realization of all the body's capabilities or an optimal lifestyle was rare.
Until recently, cultural beliefs assumed a view of life in which a person learns to cope with the negative rather than move towards a positive goal. This approach was reminiscent of a gardener who spends time searching for and removing weeds and neglects planting, caring for and cultivating fruit plants (D. Gershon, G. Straub, 1992).
2.2 Sociopsychosomatic approach to man
Modern medicine proceeds from the recognition of the unity of the somatic and mental in all the complexity of their relationships. Being qualitatively different phenomena, they represent only different aspects of a single, living person.
The departure from the dualism of body and psyche, the approval of the systemic organization of man led to the adoption of a systematic approach in various fields of activity: in politics, business, sports, education. Including in medicine. Systematicity prescribes keeping in mind the integrity of man.
The systemic approach to health declared at the international level involves the inclusion of the “Body - Mind” system in the supersystem “Man and Others,” “Man and Family,” “Man and Society,” and the study of man in a social context.
1. The influence of somatic diseases on the psyche. The influence (somatogenic and psychogenic) of somatic diseases on the psyche has been known for a long time. Somatogenic influence is carried out through intoxicating effects on the central nervous system, and psychogenic influence involves an acute reaction of the individual to the disease and its consequences.
The range of possible mental changes in patients includes:
Negative emotional reactions associated with changes in the physical condition of patients (anxiety, depression, fear, irritability, aggression, etc.);
Neurotic and asthenic conditions developing against the background of somatic illness;
Experiences caused by the consequences of the disease, changes in the ability to work, marital status, and the entire social status of the sick person;
Restructuring of the patient’s entire personality, expressed in the formation in conditions of illness of new attitudes, protective and compensatory personal formations, changes in the patient’s life orientation and self-awareness (Nikolaeva V.V., 1987).
However, the influence of the somatic sphere on the human psyche can be not only pathogenic, but also sanogenic.
2. The influence of psychological factors on the somatic sphere. There is no less data today about the influence (pathogenic and sanogenic) of psychological factors on the somatic sphere of a person. The origins of this approach are the Hippocratic school, which interpreted illness as a disorder in the relationship between the subject and reality. The term “psychosomatics” arose in 1818 (R. Heinroth).
Emotional overload can lead to both mental and physical illnesses. A convincing example of this is a stomach ulcer, caused by the constant secretion of gastric juice during severe anxiety.
According to the results of the study by G.Yu. Eysenck, a person with an extremely low external manifestation of emotionality and with a severe reaction to a stressful situation, giving rise to feelings of depression, depression, hopelessness, helplessness, is prone to cancer. A person prone to IHD in a stressful situation demonstrates a feeling of hostility, aggressiveness, and openly expresses his feelings.
Psychosomatic pathology is a kind of somatic resonance of mental processes. “The brain cries, and the tears go to the stomach, to the heart, to the liver...” - this is how the famous domestic doctor R.A. wrote figuratively. Luria. According to domestic and foreign authors, from 30 to 50% of patients in somatic clinics only need correction of their psychological state.
True psychosomatosis includes: bronchial asthma, hypertension, coronary heart disease, duodenal ulcer, ulcerative colitis, neurodermatitis, nonspecific chronic polyarthritis.
In contrast to these diseases, the occurrence of which is determined by mental factors, other diseases are influenced by mental and behavioral factors that weaken the body’s nonspecific resistance, involving the autonomic and endocrine systems.
Psychosomatic medicine solves the following theoretical problems:
a) the question of the trigger mechanism of the pathological process and the initial stage of its development;
b) the question of the different influence of the same super-strong stimulus on emotional reactions and vegetative-visceral shifts in different people;
c) the question of why mental trauma can cause different localizations of the disease (in some the cardiovascular system, in others the digestive system, in others the respiratory system, etc.);
e) the sanogenic influence of the mental factor on the general psychosomatic state of a person also constitutes a special aspect of research. We are talking in particular about the positive impact on the course of somatic illness. This includes: psychotherapy, setting a person to fight his illness, to cultivate his health, the positive influence of the social environment on the course of the disease, etc.
Thus, some experiments have shown that the immune system is more stable when a person in a stressful situation has good relationships with others (O. Dostalova, 1994). WHO has paid serious attention to the “social support system against stress.”
3. Family. Like other immediate surroundings, the family gives a person the amount of warmth, attention and love that he needs. But if the same family relationships make a person constantly feel irritated or unhappy, then this situation will soon affect his mental state, and then the state of his body.
Up to 26% of errors in medical diagnosis are attributed to ignorance of the patient’s psychosocial environment (R.S. Duff, A.B. Hollingshead, 1968). Therapy for gastric ulcers, ulcerative colitis, diabetes, asthma, coronary heart disease, anorexia, and migraines requires a family approach (M.V. Avsentyeva, 1994).
2.3 Systems to be analyzed when studying a disease
When studying health and illness, a certain dynamics is revealed in the change of systems to be analyzed:
a) from the study of individual organs to the study of body systems and the entire organism as a whole,
b) from the study of the body to the study of psychosomatic and somatopsychological relationships,
b) from studying the relationship between the body and the psyche to the study of the influence of a person’s psychosomatic characteristics on his behavior and social life (as well as the reverse influence of social life on the psyche and body).
Indeed, the most important factors influencing health are (Noack, 1987):
a) biological system and physical-biological environment (physical resources, microenvironment, macroenvironment),
b) psyche (cognitive and emotional systems) and behavior (habits, work, etc.),
c) sociocultural system (social integration and social connection, culture and health practice, health services, etc.).
2.4 Palliative care
One example of a sociopsychosomatic approach to a person in medicine is palliative treatment with the goal of creating the highest quality of life for both the patient and his family.
Palliative care supports the patient's desire to live while treating death as a natural process. Palliative treatment makes it possible to control pain and other symptoms that bother the patient, as well as provide a combination of psychological, physical and social support, which allows the patient to lead an active lifestyle for a longer period of time until death.
Palliative treatment also involves a support system for the patient's family both during the patient's illness and after his death (WHO).
3. Psychological aspect of the disease
The study of a person’s personal reactions to his psychosomatic condition implies consideration of both the psychological component of the disease and his health.
In the event of psychosomatic diseases, not only the activity of systems and organs of the human body is disrupted, but also a person’s self-awareness changes.
Self-awareness, being inextricably linked with the intensity of stimulation of both interoreceptors and exteroreceptors, forms an idea of the physical state, which is accompanied by a peculiar emotional background (A.V. Kvasenko, Yu.G. Zubarev, 1980).
3.1 Sensological stage
When considering the psychological aspect of the disease and the formation of personal reactions to the disease, it is necessary, first of all, to highlight the sensorological stage (from the Latin sensus - feeling).
At this stage, vague unpleasant sensations of varying severity with uncertain localization arise. Being early symptoms of a disease threat, they cause a condition referred to as discomfort.
In addition to vague diffuse subjective sensations of discomfort, local discomfort is possible, for example, in the heart, stomach, liver, etc. Discomfort is an early psychological sign of morphofunctional changes. It can develop into painful sensations.
Pain can have positive and negative meanings. In a positive sense, pain is seen as an important and effective signal of danger for the body (surgeons with an “acute abdomen” do not relieve pain until the end of the examination).
The negative aspect of pain is as follows: 1) the lack of a signaling function in some cases makes diagnosis difficult (progressive pulmonary tuberculosis); 2) discrepancy between the severity of pain and the nature of the disease (toothache); 3) possible conditioned reflex decrease in pain sensitivity:
US soldiers endured severe wounds less painfully during World War II because they knew they were being evacuated from the front;
Of the two participants in a fight, the winner endures pain better;
A masochist perceives pain positively, since it is a form of sexual pleasure;
Thanks to training, a boxer can more easily perceive pain.
Thus, pain, being information about disruption of the functioning of organs and systems, being processed in consciousness, can form the basis for the patient’s assessment of his psychosomatic suffering.
Pain can be assessed not only as a symptom of a disease, but also as a threat to life (changes in situation in the family, in professional activities, etc.).
There are 3 levels of pain:
1) level of physiological feelings (pupil dilation, facial pallor, cold sweat, tachycardia, increased blood pressure);
2) emotional and motivational level (fear, desires, aspirations);
3) cognitive level (rational, rational attitude towards pain and assessment of its role in one’s life).
In addition to discomfort and pain, at the first stage it is also possible that deficit disorders in biosocial adaptation may occur (decreased creative activity, weakened motivation for activity, etc.). There is a feeling of constrained freedom, limitations of one’s previous capabilities, and a feeling of one’s own inferiority.
Thus, the sensory stage includes the following components: 1) discomfort component (feeling of discomfort); 2) algic component (experience of pain); 3) deficit component (experiences of feelings of one’s own inferiority, limitation of one’s capabilities).
3.2 Evaluation phase
This stage is the result of internal (intrapsychological) processing of sensory data.
It is at this stage that the “internal picture of the disease” develops. This concept is important in medical psychology, since the objective picture of the disease and the internal picture of it, as it is perceived by the patient, are different.
Fear and anxiety about a disease that does not pose a danger on the one hand and the optimism and confidence of the patient at the most dangerous stage of myocardial infarction or the euphoria preceding death speak about this. Therefore, the doctor needs to be able to balance and coordinate the internal picture of the disease with the objective condition of the patient.
The internal picture of the disease is the patient’s inner world, everything that the patient experiences and experiences, his ideas and sensations about the disease and its causes (R.A. Luria, 1944).
The assessment stage has the following structure: 1) vital component (biological level); 2) social and professional component; 3) ethical component; 4) aesthetic component; 5) component related to intimate life.
The main elements of the internal picture of the disease are:
The patient’s feelings, perception and experience of symptoms, that is, the protective actions of one’s own body;
- emotions associated with the disease: fear, pain, anxiety, depression, eif Oriya, organic sensations;
Understanding the origin and causes of disease, that is, the concept of disease;
Forecast of her further development and hope for recovery;
Body diagram and its violation.
The internal picture of the disease, refracted differently in each case and acquiring an individual coloring, depends on the following factors:
1) premorbid personality characteristics (what she was like before the disease): age; degree of general sensitivity to pain, environmental factors (noise, smells); the nature of emotional reactivity (emotional patients are more susceptible to fear, pity and fluctuate more between hopelessness and optimism); character and scale of values (attitude to health, comfort, success, as well as the level of responsibility to oneself, family, team, society); medical awareness (real assessment of the disease and one’s own situation)
2) the nature of the disease (acute, chronic, life-threatening or non-life-threatening, requiring outpatient or inpatient treatment, etc.);
3) the circumstances in which the disease occurs: the problems and uncertainty that the disease brings (the cost of the drug, the degree of disability, possible changes in family relationships and at work, etc.) the environment in which the disease develops (at home, abroad , visiting, with friends and relatives); causes of the disease (whether the patient considers himself to be the culprit of the disease or others: if he is to blame, then he will recover faster).
3.3 Stage of attitude towards the disease
At this stage, the patient’s attitude towards the disease manifests itself in the form of experiences, statements, actions, as well as a general pattern of behavior associated with the disease. The main criterion of the stage is recognition or denial of the disease.
Types of attitudes towards illness. Somatonosognosia is an attitude towards illness that is formed at the stages of a person’s personal response to his painful condition.
Normosomatonosognosia is a patient’s adequate assessment of his condition and prospects for recovery. The patient's assessment of his disease coincides with the doctor's assessment. The attitude towards treatment and medical procedures is positive.
Options for disease control activity: 1) adequate assessment of the disease and high activity in the fight against the disease; 2) adequate assessment combined with passivity and inability to overcome negative experiences.
Hypersomatonosognosia is an overestimation of the significance of both individual symptoms and the disease as a whole.
Options: 1) anxiety, panic, anxiety, increased attention to the disease, greater activity in terms of examination and treatment, too many doctors and medications; 2) hypertrophied interest in medical literature, low mood (apathy, monotony), a pessimistic forecast for the future, scrupulous compliance with all the doctor’s requirements.
Hyposomatonosognosia is a patient’s underestimation of the severity and seriousness of the disease as a whole and its individual symptoms.
Options: 1) decreased activity, apparent lack of interest in examination and treatment; unreasonably favorable forecast for the future, downplaying the danger; a deeper analysis reveals a correct assessment of one’s health; compliance with the regime, following the doctor’s recommendations; in the chronic course of the disease, they get used to the disease and are treated irregularly; 2) reluctance to see a doctor, negative attitude towards the treatment process, denial of the disease.
Dyssomatonosognosia- denial of the presence of the disease and symptoms. Complete non-recognition of the disease.
Options: 1) non-recognition of the disease with mild symptoms (oncological diseases, tuberculosis, etc.), deliberate concealment of the disease (for example, syphilis); 2) repression of thoughts about the disease from consciousness, especially with a predicted unfavorable outcome.
Factors influencing the formation of types of attitudes towards illness.
1. Individual psychological characteristics of the personality (premorbid personality). Normosomatonosognosia develops in strong, balanced people.
People with hypersomatonosognosia are characterized by premorbid personality traits such as rigidity, being stuck on emotions, anxiety, and suspiciousness.
People with the first variant of hyposomatonosognosia are characterized by superficial judgments and frivolity. In the second option, among the premorbid characteristics, purposefulness and “hypersociality” stand out.
2. Age factor.
In all forms of somatonosognosia, the age factor should be taken into account.
At a young age, there is an underestimation of the severity of the disease, and in cases affecting the aesthetic and intimate aspects of personal reactions, an overestimation of the severity.
In adulthood, dissomotonosognosia is most often characteristic.
In old age, due to underestimation of the body's strengths and capabilities, there is a tendency to hypersomatonosognosia. Hyposomatonosognosia at this age is associated with a decrease in general reactivity.
Pathological types of attitude towards illness. The pathological reaction to the disease is based on the following reasons:
The response does not correspond to the strength, duration and significance of the stimulus;
The impossibility of correcting the patient’s ideas, judgments, and behavior.
Duration of pathological reactions: from several hours to several weeks. In the chronic course of the disease, the pathological reaction may develop into pathocharacterological development of the personality.
Depressive reaction. It includes:
1) anxiety-depressive syndrome, which usually occurs at the initial stage of the disease. It is characterized by: concentration of attention on experiences associated with illnesses, suicidal tendencies.
2) Astheno-depressive syndrome, which occurs at the stage of the height or outcome of the disease. This syndrome is characterized by: low mood, depression, confusion, slow motor skills.
Phobic reaction. A phobic reaction is characterized by the presence of obsessive fears. During an attack of fear, the experienced danger is perceived as quite real. Outside of acute attacks of phobias, criticality is restored. The phobic reaction has a certain dynamics: 1) the appearance of obsessive fears under the influence of a real traumatic stimulus (hypsophobia - fear of heights that occurs on the balcony); 2) fears arise not only in a traumatic situation, but also when anticipating the impact of a traumatic stimulus (fear of heights that occurs in a room leading to the balcony); 3) the appearance of phobias in an objectively safe situation (on the street, in the entrance).
Hysterical reaction. A hysterical reaction is characterized by: a sharp change in mood; demonstrativeness; theatricality; tendency to acts of self-harm in a state of passion; exaggeration of complaints.
Hysterical reactions include pseudosomatic disorders such as psychogenic pain (pseudoreumatic, phantom, abdominal), psychogenic suffocation.
Hypochondriacal reaction. With this reaction, the patient stubbornly holds on to the thought that he is sick with another, more serious disease, even despite the objective situation of recovery.
At the slightest discomfort, patients begin to think about the danger to health and life. The hypochondriacal reaction may include psychogenic suffocation, psychogenic nausea and vomiting.
Anosognosia. Anosognosia is a denial of the disease, associated not with the personal characteristics of the patient, but with the nature of the disease. It occurs in case of life-threatening diseases (cancer, tuberculosis, etc.). The patient does not realize the fact of the disease and therefore denies it. Sometimes importance is attached to the slightest somatic disorders and the symptoms of another very dangerous disease are not noticed.
4. The importance of psychology in the training of medical students
To implement an integrated approach to a person and develop strategies and ways to achieve health, a doctor needs, along with a deep knowledge of biomedical disciplines, an equally deep knowledge of psychology.
A doctor needs knowledge of psychology not only to influence his client’s worldview (in particular, the internal picture of the disease), to manage his cognitive and emotional processes, behavior, psychosomatic relationships, but also to help the patient become an accomplice in the treatment process, intensify its focus on health.
4.1 Traditional medical model
The traditional medical model assumes that the doctor is responsible for the patient, in the sense that the power in the relationship rests with the doctor. This model states that the disease follows certain laws, the laws of microbial life, cholesterol accumulation, increased blood pressure, etc., and the patient's attitude towards the disease has some, but not the main, significance.
The disease can be endogenous or exogenous and occurs because a person has become a “victim” of foreign bodies (viruses, bacteria, microbes). Some hint of liability in this approach falls on the individual if he does not follow his doctor's orders. When a person gets better, it is because he has a good doctor and medicine, or, thanks to a genetic “accident,” he has a strong constitution, which helped him recover (V. Shute, 1993).
4.2 Selection model
However, there is another model - the choice model. According to the latter, a person chooses his own illness and heals himself (V. Shute, 1993; A.S. Zalmanov, 1991, etc.).
Viruses are part of the balance of nature and correspond to the nature around them. Some bacteria that exist in a healthy body are beneficial. However, if they are in a toxic environment, they become toxic and enhance toxic processes. Pasteur's dying words in 1895 reflected his understanding of this: “Bernard was right. Microbes are nothing, soil is everything.”
In stressful situations, the content of ACTH (adrenocorticotropic hormone of the pituitary gland), glucocorticoids (hormones of the adrenal cortex) and beta-endorphins (hormones synthesized in the body and acting like opium drugs) increases. An increase in the content of glucocorticoids negatively affects the function of lymphocytes, which manifests itself in suppression of the immune response. It was also found that the immune reaction depends on how a person psychologically perceives difficult situations (O. Dostalova, 1994).
If a person unknowingly decides to get sick, then he weakens his body, does not remove waste well, creating a toxic environment for viruses. He suspends the action of the immune system, allows external substances to invade and becomes ill (R. Glasser, 1976). His decisions regarding diseases are made throughout life, as the organism develops. The role of the doctor, according to the choice model, is to create the conditions under which the patient chooses to become aware of the causes of the disease; The doctor helps you accept a conflict-free desire to be healthy, introduces you to techniques and ways to acquire health. This is more than suppressing a symptom; This is the creation of a health mindset. The choice model does not exclude standard medical treatments. It only suggests additional areas for improving health.
One can argue about the positive and negative aspects of both the traditional medical model and the choice model. However, it should be recognized that the doctor’s tactics can be aimed both at manipulating the patient’s sociopsychosomatic relationships and at attracting the patient’s personality to cooperation, so that the doctor and the patient are together against the disease and cooperate in the name of health, so that the patient realizes his responsibility for how he lives, what he feels, whether he is sick or remains healthy.
CHAPTER II. PSYCHE AS A SYSTEM OF SELF-GOVERNMENT
LECTURE 2. PSYCHOLOGY AS A HUMAN SCIENCE
1. The formation of psychology as a science
1.1 The concept of “psychology”
Psychology owes its name to Greek mythology. Eros, the son of Aphrodite, fell in love with a very beautiful young woman, Psyche. Aphrodite, dissatisfied that her son, a celestial, wanted to unite his fate with a mere mortal, forced Psyche to go through a series of tests. But Psyche’s love was so strong that it touched the goddesses and gods who decided to help her. Eros, in turn, managed to convince Zeus - the supreme deity of the Greeks - to turn Psyche into a goddess. Thus, the lovers were united forever.
For the Greeks, this myth was a classic example of true love, the highest realization of the human soul. Therefore, Psyche - a mortal who has gained immortality - became a symbol of the soul searching for its ideal.
The word “psychology” itself, from the Greek words “psyche” (soul) and “logos” (study, science), first appeared only in the 18th century (Christian Wolf).
1.2 Psychology as an independent science
Psychology has a short history, formed at the end of the last century. However, the first attempts to describe human mental life and explain the reasons for human actions are rooted in the distant past. So, even in ancient times, doctors understood that in order to recognize diseases it was necessary to be able to describe a person’s consciousness and find the reason for his actions.
1. Psychology as the science of the soul. Until the beginning of the 18th century, the presence of a soul was recognized by everyone. Moreover, throughout history there have been both idealistic (for example, the soul, as a manifestation of the divine mind) and materialistic (for example, the soul as the finest matter, pneuma) theories of the soul. The soul was seen as an explanatory, but itself inexplicable force, which was the root cause of all processes in the body, including its own “mental movements.”
Psychology as a science of the soul arose more than two thousand years ago and developed within philosophical science, as its integral part.
2. Psychology as the science of consciousness. At the end of the 17th century, in connection with the development of natural sciences and the strengthening of a strictly causal worldview, the concept of the soul, which is hidden behind observable phenomena, was excluded from science. Since the 18th century, psychology begins to be considered as a science of consciousness. Moreover, consciousness was the ability to feel, think, desire. The place of the soul was taken by phenomena that a person finds “in himself”, turning to his “inner mental activity.” Unlike the soul, the phenomena of consciousness are not something assumed, but actually given.
Since the end of the 18th century, psychology first emerged as a relatively independent field of knowledge, covering all aspects of mental life, which were previously considered in different departments of philosophy (the general doctrine of the soul, the theory of knowledge, ethics), oratory (the doctrine of affects) and medicine (the doctrine of temperaments).
The extension of the natural scientific, albeit mechanistic, worldview to the “region of the spirit” led to the idea of the formation of all mental abilities in individual experience.
The study of consciousness has acutely raised the question: how does the human body react to information received from the senses? It was assumed that all our knowledge stems from sensations. The basic elements that make up sensations are combined according to the law of association of ideas. Through sensations are created by association of perceptual ideas that underlie an even more complex idea.
In 1879, at the University of Leipzig, Wilhelm Wundt began to study the content and structure of consciousness on a scientific basis, i.e. combining theoretical constructs with reality testing. He went down in the history of psychology as the founder of scientific psychology, because he legitimized the right of experiment to participate in the study of consciousness.
In contrast to the associationist approach, he laid the foundation for the structuralist approach to consciousness, setting the goal of studying the “elements” of consciousness, identifying and describing its simplest structures. It was assumed that the mental elements of consciousness are sensations, images, and feelings. The role of psychology was to provide as detailed a description of these elements as possible. Structuralists used the method of experimental introspection (subjects who had undergone preliminary training described how they felt when they found themselves in a particular situation).
At the same time, a new approach to the study of consciousness emerged. Since 1881 in the USA, William James, inspired by the teachings of Charles Darwin, argued that “conscious life” is a continuous flow, and does not consist of a number of discrete elements. The problem is to understand the function of consciousness and its role in the survival of the individual. He hypothesized that the role of consciousness is to enable adaptation to different situations, either by repeating already developed forms of behavior, or changing them, or mastering new actions. He placed the main emphasis on the external aspects of the psyche, and not on internal phenomena. The main method of study remains introspection, which allows us to find out how an individual develops awareness of the activity in which he indulges.
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Introduction
Chapter I. Psychological characteristics of the personality and professional activity of a doctor 16
I.I Theoretical and methodological background of the study. Content and structure of a doctor’s professional activity 17
1.2. Self-attitudes of doctors 51
1.3. Professionally significant personality traits of a doctor 71
1.4. Typological personality traits of doctors 93
Conclusions on Chapter I 104
Chapter II. Psychological conditions for the professional development of a doctor’s personality .107
2.1. Theoretical and empirical approaches in psychological studies of professional development 107
2.2. Ways to increase the psychological readiness of a doctor for professional activity 122
2.3. Development of professional self-knowledge of the doctor’s personality and the formation of experience in his creative activity 144
Conclusions on Chapter II 175
Conclusion 182
Bibliography 190
Appendix 213
Introduction to the work
Relevance of the problem. The increasing role of applied* psychological research during the period of transition of the socio-economic structure of society and attitudes towards people, the need to improve the system of professional training of specialists and the retraining of a large number of people attach particular importance to work on the study of the professional development of specialists. This is all the more important since it is known that the failure of professional training is often associated not so much with the training itself, but with the difficulties of professional development. Only a deep understanding of its processes and mechanisms will ensure their effective management.
A study of the problems of professional development and training of Erach shows that improving the quality of their professional growth is characterized by a constant change of extensive and intensive approaches, their mutual transitions. An increase in the volume of content necessary for medical practitioners and future doctors of informational-creative knowledge, professionally significant practical skills and abilities, accompanied by an increase in the required time to master knowledge, as well as a decrease in the amount of time for rehabilitation activities, leads to a decrease in the effectiveness of training The educational process in a medical university and the professional activities of doctors do not provide significant positive changes in improving the quality of training of specialists. Researchers note the formalism of the knowledge of students and practitioners, the ability to apply it in specific situations, and poor command of basic functions.
Thus, the main contradiction has arisen between the requirements that society at the present stage of its development places on the level of activity (the degree of mastery of professional and practical actions) of doctors, and the actually existing practice of its functional training. To resolve this contradiction, it is necessary to resolve the problem of intensifying the process of professional development of doctors.
As an analysis of complaints received by health authorities about the quality of work of medical institutions shows, they are most often associated with personal qualities - the professional skills of doctors and other medical workers, which most often appear in. as one of the main reasons for dissatisfaction with medical care.
The core of the personality of a professional working in healthcare is their personal qualities that are most necessary for successful professional activity, which should be the object of targeted study. Consequently, the expediency and necessity of highlighting the personal qualities of doctors as an object of study is due to the fact that the topic we have chosen represents, first of all, a real, very acute socio-economic and psychological problem. Obviously, in this regard, the question of appropriate improvement in the professional development of a doctor’s personality is of particular importance.
So, the severity of real contradictions, “as well as the theoretical and practical lack of development of these issues allow us to formulate the research problem: what are the psychological features of the professional development of a doctor’s personality?
Purpose of the study- explore personal characteristics, the level of development of professionally significant, typological personality traits and the doctor’s psychological readiness for professional activity, conditions and factors ensuring its productivity.
Object of study- basic psychological characteristics
tics of the doctor’s personality and professional activity, their development
ties and relationships at different stages of professional development
nia. ,
Subject of study- psychological features of the process of professional development of a doctor’s personality.
Research hypothesis. The success of a doctor’s professional development is determined not only by the degree of complexity of the profession itself, but also by the development of psychological readiness to perform professional activities. This readiness is expressed by the adequacy of motives to the real conditions of professional activity, the presence of the required professional knowledge, abilities, skills and necessary personal qualities that determine the productivity of a doctor’s professional maturity. Research objectives:
I) organize a critical review of the ideas available in psychology about the activity-based means of personal development and professional development of a specialist;
conduct an analysis of personality psychology, substantiating the psychological structure and content of a doctor’s professional activity;
identify the conditions and factors for the productive professional development of a doctor: the formation of professional orientation, professional aspirations, professional consciousness, authority, professional creativity and experience of his creative activity;
Methodological basis of the study made up: general scientific principles of cognition, provisions on the structure and dynamics of the individual, on the dynamic nature of its interaction with society, on the leading role of the active activity of the individual in the process of its formation, on the social determinism of mental processes, on the dialectical essence and social conditionality of cognition; methodological principle of consistency, concept of lifelong education, modern socio-psychological theories, methodology of active learning methods. When studying the problem, methodological and philosophical literature, relevant government documents, general and special scientific literature - domestic and foreign authors, and the current press - were used.
Theoretical basis of the study there were works that revealed the basic principles of applying the systems approach (P.K. Anokhin, N.V. Kuzmina, V.I. Sadovsky, A.I. Uemov, etc.); personal approach (K.L. Abulkhanova-Slavskaya, L.I. Bozhovich, A.I. Kovalev, A.N. Leontyev, A.V. Petrovsky, A.U. Kharash, etc.); conditions for the manifestation and development of an individual’s creative potential, issues of optimizing the activities of personnel (Yu.K. Babansky, A.A. Derkach, I.A.Z:! U-nlya, Ya.A. Ponomarev, etc.); concepts of social perception (A.A. Bodalev, V.A. Labunskal); theories of relationships (A.A. Bodalev, V.N.Yya-sishchev, E.B. Storovoygenko); value orientations (E.N. Bogdanov, O.I. Zotova, I.S. Kon, A.I. Krupnov, V.V. Shtikl, A.3. Petrovsky); social return of the individual (..A. Abulkhanova-Slavskaya, A.A. Kokorev, V.G. Krysko, R.G. Gurova). Considering the special gf-gku of the object of study, the works that reveal psychologists’ personality and work of a doctor turned out to be very significant (A.P. Gromov, I.N. Gurvich, Y.I. Dukova, A.M. Izutkin, B.D. Karvasarsyaii, V.P. Petlenko, G.N. Tsorego-
Rodtsev, etc.), as well as foreign studies: R.N. Burns, E. Fromm, R.B. Kegel, J. Kelly, A. Maslow, K. Redaers, H. Reed, B. Simon, etc.
In accordance with dialectical logic, which prescribes the study of all life processes in the unity of the general, the particular and the individual, “I am a concept” was adopted as a methodological construct in the study of the psychology of a doctor’s personality and his professional development. This made it possible to implement a holistic approach in the analysis of the psychological structure of the individual, as well as to focus on the subjective activity of doctors, i.e. represent the dialectical relationship between general and specific human properties at the experimental level and theoretical interpretation.
Research methods. The work used a set of methods for preparing and organizing the research (theoretical analysis of literature on the problem; generalization of domestic and foreign work experience; system-structural analysis; modeling); for the purpose of collecting information (questionnaire; press survey; interview; conversation; observation; content analysis; expert assessment and self-assessment; scaling; psychodiagnostic techniques; rating); for processing and interpretation of data (mathematical processing on a computer - SM * - 1420 according to a program that includes the calculation of average values of characteristics; correlation, factor and cluster analysis of variance).
The sample population of the study was 2180 people, incl. 680 doctors and 1300 patients in Donbass.
Reliability And and credibility scientific results and conclusions are ensured by the clarity of the initial methodological portions, a set of methods adequate to the goals, objectives and subject of the study, confirmed by experimental methods.
Scientific novelty and theoretical significance of the research.
It has been established that the psychological characteristics of the personality of doctors that determine their phenomenology include: self-; criticality; not expressed positivity of the integral “I”, self-esteem, autosympathy; orientation towards a positive attitude towards oneself from others; high level of self-involvement; average level of sociability; emotional stability and self-control; adequate self-esteem and realism; average level of gullibility, etc. -
The self-concept of doctors is generally positive and tends to increase in positivity with increasing experience. The level of positivity in the views of rural and urban doctors is based on different concentrations. For the former, it is provided by more effective components of their “I” (attitudes and expectations of a positive attitude towards themselves from others, self-acceptance, self-interest, self-esteem, etc.). City doctors - positive self-attitudes are supported by self-consistency, self-respect, self-interest, self-blame, etc., i.e. cognitive and behavioral components of the self-image.
A system-structural approach to the study of the personality and professional activity of a doctor has been implemented. Factor analysis of personal properties and the level of implementation of components of professional activity by doctors made it possible to identify the state of psychological readiness of the personality of doctors and indicators of the effectiveness of their professional activity. In all the factors that ensure the success of a doctor’s work, indicators of excitability, tension, anxiety and neuroticism play a negative role and negatively affect the doctor’s psychological involvement in his professional activities.
The professional readiness of the doctor was substantiated as an integral quality, reflecting an emotionally positive attitude towards the activity and the state of the doctor’s adaptation to professional activity, which, in turn, made it possible to identify a system of indicators (professional interest, professional self-awareness, professional calling, professional orientation, authority) and develop diagnostic techniques that make it possible to record external and internal (psychological) dominant manifestations of readiness.
The process of developing readiness is considered as a goal of optimizing the professional development of a doctor. It was discovered that such personality traits of an authoritative doctor, such as attentiveness, kindness, interest in the matter, fairness, and a general high cultural level, have a positive impact on patients. It has been established that the personal and professional qualities of a doctor and his professional skills are the basis of his authority. During the study, data were obtained on patients’ high assessment of the skills of an authoritative doctor
take into account the psychological characteristics of patients. It was found that the self-esteem of authoritative doctors is adequate, but somewhat underestimated, while the self-esteem of non-authoritative doctors tends to be overestimated.
The feasibility and effectiveness of implementing certain psychological and pedagogical conditions for the formation of individual experience of creative activity among doctors has been proven. Their use in the system of advanced training of doctors and the educational process of medical universities will ensure an increase in the creative potential of future specialists, strengthen the individual’s desire for self-development and self-improvement, and create a prerequisite for the formation and development of the holistic personality of a new type of doctor. In addition, the acquired experience in creative activity will significantly improve the preparation of doctors for their upcoming professional activities. The results obtained create a scientific and psychological basis for determining prospects in the development of the psychology of the doctor’s personality, and are also a contribution to the new psychological direction of acmeology - the development of productive models of doctors of various specialties, optimization of their professional training.
Practical significance of the work. The results of the study can become theoretical guidelines for carrying out a number of practical tasks: compiling a qualification profile for a doctor; assessment and certification of a doctor; consulting a doctor in case of difficulties; building a program of self-education and self-education for individual doctors and a team of doctors; determining the forms, methods and content of advanced training for doctors and the implementation of their continuing education.
The research materials can be used in the professional orientation of schoolchildren to become doctors.
Approbation and implementation of research results into practice. The main provisions and results of the study were discussed at meetings of the departments of pedagogy and psychology of the Kaluga Pedagogical Institute. The dissertation material was presented at the Scientific and Practical Regional Conference on the problems of restructuring professional activity (Lugansk, T99I), psychological readings of the Russian Academy of Management (1992). Dissertation materials
Provisions for protection.
The state of a doctor’s psychological readiness for professional activity is determined by the basic (in particular, characterological) and programming (motivational and intellectual) properties of the individual, with the leading role of the individual’s active-positive attitude towards himself as a specialist, reflecting the formation of self-awareness.
The structure of professional self-knowledge of doctors with a positive attitude towards the medical profession (high, medium, low levels) is characterized by diversity and complete connectedness.
The interaction of procedural and substantive in the professional self-knowledge of doctors is manifested: I) in the progressive development of all substructures (high level); 2) in the progressive development of cognitive and emotional, 8 partial - vocal substructures (average level); 3) in the partial development of cognitive and emotional substructures (low level); 4) in partial cognitive development (very low level).
The formation of professional aspects of the “self-image” in the course of professional activity and self-education is ensured by developing the doctor’s ability for self-analysis, reflection, introspection and self-control in the process of modeling professional situations, including methods of direct and indirect knowledge of one’s own activities.
An indicator of the development of a doctor’s professional self-knowledge is his ability to adequately and differentiatedly understand his own actions in accordance with the normative model of his professional activity.
The defining property of the professional orientation of a doctor’s personality is dynamism, i.e. its ability to be restructured based on internal conditions. The main condition is the professional activity of a doctor. The level of professional activity of a doctor is determined by a number of factors: the connection between professional orientation and gnostic, communistic
rolled by both reflexive skills and emotional qualities of the individual; a positive local background of the process of professional activity, in which overall satisfaction with work is determined by satisfaction with the content of work, the results, and the process of activity itself; the presence of developed motivation for activity at all stages of professional self-determination and the formation of authority
The assimilation by doctors of anany about the specifics of their activities and the characteristics of their personality from the position of professional orientation allows them to form an adequate idea of the professional activity of a doctor, the requirements for his personality and professional skills. Professional skill is a concentrated indicator of the personal and active essence of a doctor, determined by the measure of the implementation of his professional and civic maturity, responsibility and professional duty. It consists of a combination of general cultural, special and psychological knowledge, and the ability to solve professional problems at a high level of productivity.
The developed methodology for a comprehensive study of the individual personality characteristics of doctors allows for differential diagnosis of their psychological readiness for professional activity and creative growth.
Readiness for professional creativity is an integrative quality of a doctor’s personality. The structural components of readiness for professional creativity are professional orientation (goal-setting, motivation, ideals), professional self-awareness, professional thinking (synthesis of heuristic and logical thinking), diagnostic culture, ability to forecast, improvise, technological innovation.
The gradual nature of the formation of the experience of creative activity, resulting from the essence and dynamics of its formation, allows for timely control and correction in the development and formation of the creative individuality of a young doctor. At the same time, the individual psychological characteristics of the doctor’s personality influence the intensity and quality of the process of forming the experience of his creative activity.
At every stage of a doctor’s professional development, conditions are created for his creative professional self-expression. External conditions include professional orientation towards the development of readiness for professional creativity, the orientation of this process towards the individuality of the doctor, taking into account professional aspirations, the need for self-knowledge, personal development, self-affirmation and self-creativity in all types of his work.
Internal conditions (i.e., depending on the doctor himself) include: a) individual characteristics of memory, imagination, thinking; b) empathy that arose on the basis of emotional identification with the patient’s personality and the medical team; c) komu-kikatiokost and culture of communication; d) the ability for self-control and control of one’s activities, prognostic ability as a way of anticipating the results of one’s activities.
Dissertation structure. It is determined by the objectives and logic of the study and consists of an introduction, 2 chapters, a book, a list of references and an appendix.
Theoretical and methodological background of the study. Content and structure of a doctor’s professional activity
Psychology, as B.F. Lomov notes, is primarily interested in the structure (structure) of purposeful activity and the mechanisms of its regulation (1972, p. 141).
The structure, interpreted as a “stable picture of the mutual relations of the elements of an integral object” (N.F. Ovchinnikov, 1969, p. 112), in relation to the analysis of activity should be considered in unity with its typology, which is due to both the genetic relationship of the elements of activity in the process socialization of the individual (B.G. Ananyev, 1977), and the complex hierarchical nature of human activity.
Pedagogical psychology traditionally distinguishes between such types of activities as play, study and work, with work being the leading, main human activity. A.N. Leontyev considers the “formative” of individual human activities - actions, as a form of activity (1974, p. 12; 1977, p. 104). The structure of actions is formed by operations - fixed methods by which action is carried out (1974, p. 12). Individual types of activities are distinguished by the author according to their subject matter (1965, p40).
L.P. Dueva identifies two general forms of activity - practical and spiritual, and the author attributes “... the reproduction and development of man as a natural and social being” to the results of practical activity (1978, p. 82).
M. S. Kagan (1974) proposed a typology of activities that has received wide recognition. The author identifies transformative, cognitive, value-orientation and communicative activities. Transformative activity, among other grounds, is divided by him depending on the nature of the object into the transformation of nature (labor), the transformation of society, the transformation of “man, taken both in his physical and in his spiritual being” (p. 55), and when the subject activity becomes its object, and also by the difference in the subject - into activity that has an individual character, carried out by a group or society as a whole.
It should be noted that M.S. Kagan’s identification of communicative activity as an independent type of activity is consistent with the position we share of a number of leading Soviet psychologists (see, for example, B.G. Ananyev, 1977, p. 167; A.A. Bodalev, 1979, p.26, etc.).
Although a critical analysis of the above typologies of activity is not part of the task of our work, it is necessary to point out the possibility of very significant theoretical differences in their philosophical interpretation. At the same time, these typologies. “activities set, in our opinion, that necessary system of logical-olmantic relations” within the framework of which medical activity can be characterized from a general psychological point of view.
Within the framework of the concept of the structure of activity proposed by A#N»1ontyev, Z.Shyanushkevicius describes the medical activity of the doctor, highlighting the stages of taking anamnesis, research, diagnosis and treatment (1974); J#Hardy structures the activity of a doctor similarly, however, he combines examination and diagnosis into one stage (1972)# The subject of activity here is a sick person. In accordance with the typology of L.P. Daeva, activity in the field of health care is practical (1978 ) According to M.S. Kagan, this is a transformative activity (1974), and it is of an individual nature, i.e. not requiring direct interpersonal interaction in the process of activity with other workers (with the possible exception of surgical interventions performed by a team of doctors).
From the perspective of M.S. Kagan’s concept, medical practice is not work (although a person, in a certain respect, can act as a part of the natural world). We cannot agree with this, if only because such an interpretation of medical activity contradicts the view of work as the leading form of activity. adult. In this regard, let us consider the grouping of professional occupations proposed by E.A. Klimov (1975, pp. 16-23), and productively used in a significant number of works devoted to the problems of labor psychology. In the aspect that interests us - on the subject of labor ( “first tier” of the classification), - the author distinguishes the following types of subject of labor and the corresponding types of professions: biological - bionomic professions; technical - technonomic professions; social - socionomic professions; sign systems are signonomic professions, systems of artistic images are artonomic professions. The profession of a doctor is classified by E.A. Klimov as socionomic, i.e. professions of the “person-to-person” type, which determines its specific place in the whole diversity of human labor activity,
The inclusion of a component of direct social connection with other people in the very content of a doctor’s professional work makes it important, from the point of view of the objectives of this work, to consider medical activity from the “angle of view” of socio-psychological theory.
Productive use of the category of activity in the theoretical and methodological apparatus of socio-psychological io-. research today faces a number of serious difficulties. An adequate way to overcome them seems to us to be the orientation of research in accordance with the position put forward by S.L.Zubinshtein: “Vitally significant knowledge of the psychology of people in their... complex, holistic manifestations, in their vitally significant experiences and actions is comprehended only from the context of their life and activity" (1973, oD5G).
On this path, as A.U. Kharash believes, turning to the category of objective activity will also contribute to overcoming the mechanistic combination of sociology and social psychology, when “... the activity of the production team is present in the reasoning of the social researcher exclusively as a matter of course, an objective condition, a task, i.e. not as a person’s activity, but as his production function” (1977, p. 27). This conclusion is absolutely fair, but the author does not offer any specific methodological tools for using the category of activity in empirical socio-psychological research.
A step forward towards the integration of the operating principle with. the system of socio-psychological knowledge was the “theory of activity mediation”, developed by A.V. Letrovsky and his colleagues (A.V. Petrovsky, V.V. Shpalinsky, 1978 j A.V. Petrovsky, 1979). The “theory of activity mediation” postulates the mediation of collective activity by its content (A.V. Petrovsky, 1979, p. 203), however, the theoretical and empirical validation of the stratometric concept of intragroup activity carried out by A.S. Morozov (1979) does not actually include the content of group activity as a subject of psychological analysis. This indicates that at this stage of development of the “theory of activity mediation” the difference between activity as an explanatory principle and activity as a subject of study has not been overcome. When this difference, as noted by Z.G. Shchin, “... eludes the attention of researchers, ... it turns out that the effectiveness of the explanatory principle is taken as an indicator of the effectiveness of the subject of study...” (1978, p. 309).
J. Nurvich (1981) formulated his position on the question of the methodological role of the principle of activity in socio-psychological research as follows. Objective activity is included in the context of empirical socio-psychological research not by the very fact of its existence (then it acts as an abstract external formative of group activity), and not by its internal structure (then it focuses on itself nothing more than the activity of the individual, which is already the second object of influence of the group ), but its side, which includes communication in the unity of all its characteristics relevant for the effectiveness of activity (1981, p. 19).
Typological personality traits of doctors
To study the typological properties of the personality of doctors, the “Eysenck Personality Questionnaire” or EP was used.
In the interpretation of the results obtained, the data of the 16th RG test (by R.B. Kettela), presented in the previous paragraph, were also involved. At the same time, the theories of G.Yu. Eysenck (understanding extra-introversion by the level of reactive inhibition) and R.B. Cattell (explaining introversion as a result of social inhibition, and not general inhibition as in G.Yu. Eysenck’s model) were taken into account as much as possible.
Factors "exvia-invia", "anxiety" (16 RG) and "extra-introversion", "neuroticism" (ER) are the most integral features of individual characteristics of mental regulation of activity. These features are not statistically (functionally) independent, but are combined into integral formations, which turn out to be temperament factors.
Table 6 presents the results of a study of doctors using the G.Yu. Eysenck test.
Thus, the indicator of extra-traversion of doctors (11.24) indicates that they have both an orientation towards the world of external objects and towards the phenomena of their own, subjective world.
The indicators of extra-introversion of rural and urban doctors do not differ significantly, and further interpretation of the results presented in table b allows us to state the fact that the locus of internal control of doctors is strengthening precisely during the period when a deeper understanding of their professional activities occurs and the process of the most effective personal and professional growth, namely for doctors with work experience from 5 to 10 and from 15 to 25 years.
It is noteworthy that doctors with work experience of up to 5 years and over 25 years show greater externality. Their activities are characterized by impulsiveness and expressiveness. However, among young doctors, extroversion is characterized by their greater focus on the environment and people, and a belittlement (to some extent) of personal significance due to insufficient professional competence. The extroversion of doctors with extensive work experience is most likely explained by reasons of a different nature: greater social adaptation, the predominance of external control, and a tendency to attribute the causes of what is happening to external factors. The sociocultural environment of the region also contributes to this.
As a rule, the older a person is and the higher his knowledge, the less he becomes an object of criticism, which, along with authority, creates the basis for self-confidence and expression; This, however, is not a source of conflict in the relationship between young doctors and doctors with extensive experience, although the former may sometimes have quite justified (from the outside) complaints about both the results and the competence of experienced doctors.
Table 6 presents the results of the study on doctors' neuroticism. Even allowing for the imbalance of the relative vector of “social desirability” and the possibility of positional response tactics, the neuroticism scores of doctors are quite high (16.1).
Psychologically, the intensity of a doctor’s professional activity is reflected in such expressions as mental energy, mental tension, internal effort, mental stress, etc.
Based on the results of a study of doctors on the neuroticism indicator, they are prone to emotional instability (according to G.Yu. Eysenck). But such a conclusion in relation to doctors is not justified in most cases,
In fact, emotional tone (neuroticism) is caused by the need to carry out professional activities, but at the same time, cortical tone (self-control) does not weaken, without which it is impossible to achieve results at work. In the presence of internal mental stress, the locus of internal control still dominates among doctors.
Taking into account the results of a study of these same doctors on the R.B. Cattell test (factor C, “strength-I”), we can conclude that they are generally able to control their condition and mood. However, a high level of neuroticism is a symptom, an indicator of the doctor’s inner “I”, depletion of emotional potential
Physical, mental overload, overstrain require increasing emotional and intellectual return, mobilization of the doctor’s internal strengths and resources,
Thus, the socio-psychological complication of a doctor’s activity, the intensification of his existence, on the one hand, should bring success in his work, on the other hand, it increases neuropsychic and intellectual stress, which violates psychological comfort and mental balance,
Rural doctors have higher neuroticism scores than their urban colleagues (17.24 and 14.92, respectively, at p 0.025, Table 6), which violates the traditional idea of more emotionally stable rural doctors. Apparently, there cannot but be a more positive “for” the integral “I” of city doctors, shown in the interpreted mil (Table 1), caused by a number of reasons at the personal, professional and socio-psychological levels. The more pronounced neuroticism of rural doctors is an indicator of the inflated energy cost of their work in conditions of limited information and their emphasis on self-education. The gap between the desired and actual efficiency of work among rural doctors causes great contradictions in the inner world and psychological discomfort, which is reflected in their level of neuroticism. However, a certain unloading and calming effect of the countryside (nature, work in the air, etc.) allows you to maintain and restore energy reserves, and, consequently, the productivity of the doctor.
The highest level of neuroticism is found among doctors with work experience of up to 5 years and over 25 years (Table 6). It should be noted that there is some relative “relaxation” among doctors with work experience of 5 to 10 years. Their indicators are significantly different from the indicators of doctors with work experience of up to 5 years (p / 0.05) and from 10 to 15 years (p 0.10). Although the level of neuroticism (1.5,9.7) of doctors with work experience from 5 to 10 years is also high, it can be assumed that its slight decrease (relative to other doctors) is caused by stabilization of emotional tone after the stage of “entering the profession” "(up to 3"5 years of experience), in which the highest intensity of mental tension was observed.
After 10 years of work, doctors' neuroticism increases. In our opinion, as emphasized above, this is explained both by an increase in the intensity of being and by the accumulation of fatigue and fatigue in the nervous and mental sphere of doctors, which ultimately increases the “energy cost” of their work.
In Table 6, we call the third scale the lie or self-esteem scale. The latter is justified by the results of a number of studies that prove the connection between the lie scale and a person’s self-esteem, and neuroticism with self-esteem - the higher the neuroticism indicators, the lower the self-esteem.
The connection between neuroticism and self-esteem (lying) is clearly shown in Table 6. The results of the lie scale indicate the reliability of the data obtained and do not exceed the threshold, which is equal to 5 points.
Theoretical and empirical approaches in psychological studies of professional development
In the process of professional development of the individual, it is a multidimensional, multifaceted and extremely complex process, if we consider it from the point of view of its objective and subjective content (B.F. Lomov, 198 0. Despite the large number of theoretical and empirical studies carried out in the field of professional development of the individual .
The task of studying the processes of professional development, the situation of personal choice of profession is still relevant due to the great personal and social significance of the very act of choosing a profession both for a specific person and for society, as well as in connection with the constant development, change, socio-economic conditions such a choice.
Considering these circumstances, one can understand that it is not at all by chance that various aspects of this problem are studied by specialists of various profiles: economists, lawyers, sociologists, teachers and psychologists (B.G. Ananyev, 1969, E.A. Klimov, 1988; N.V. .Kuzmina, 1967, etc.).
Naturally, different experts give different interpretations both to the subject area indicated above and to the basic concepts associated with the scientific study of problems arising in this area. In the above-mentioned and other publications, we find very different definitions of the very concept of professional development, and those close to it in meaning, such as professional and personal development, vocational guidance, professional and personal choice, professional self-determination and choice of life path, etc.
It seems to us advisable to highlight two aspects of consideration of these problems; studying issues of a person’s professional development, firstly, from a socio-economic point of view, and secondly, from a psychological and pedagogical point of view.
This division is due to the specific contradictions of the process of professional development itself, which at the social level acts as a contradiction between the needs of society for professional personnel and the real professional (life) plans of people, and at the individual psychological level - as a contradiction between the need to be useful to society and the need for self-realization .
It must be emphasized that resolving the above contradiction at the social level is impossible without influencing the individual process of professional development and vice versa. This means, in particular, that the objective conditions of human life and human relations in Society cannot be brought into line with the interests of each person, and at the same time, objective conditions cannot uniquely determine individual choice,
Admittedly, the founder of the scientific-psychological approach to the problems of professional development of a person is F. Parson (1942)." According to the approach he proposed, each profession corresponds to a certain set of psychological and physical qualities of the individual, and the success of professional activity and satisfaction with the profession are interdependent on the degree correspondence between individual qualities and the requirements of the profession. Thus, for the first time, the psychological concept of PVC appeared - professionally important qualities of a person, which later began to play a leading role in studies of professional development of personality,
The disadvantages of this direction include ignoring the facts that both personal structures and professional requirements for real life are very changeable and not stable, as is accepted in most theoretical constructions: S.N. Chistyakova, N.N. Zakharov (1987 ). Nevertheless,. this direction remains popular to this day, and to a large extent this popularity is due to the fact that F. Parsons’ approach allows the use of almost any existing methods and techniques of diagnostic examination in the analysis of professional development processes.
In line with another approach, the works of Z. Sprangler (1986), S. Bühler (1962), E. Gintsberg (1951), D. Super (1971) and others were carried out, which consider the process of professional development in connection with the peculiarities of choosing a profession in its age dynamics. They note that the search for a profession is one of the main characteristics of adolescence, that it is determined by childhood dreams of a profession, role-playing games, the achievement of a certain level of development, and the formation of abilities and inclinations (ibid.). In addition, it is noted that professional choice is a long process, consisting of a number of stages, that this process is irreversible, since earlier decisions limit further choices, and in general the selection process ends in a compromise between external (prestige, etc.) and internal factors (individual characteristics, needs, etc.) Thus, as the main problems of adolescents that arise in connection with the need for professional choice, E. Ginzberg identified the following: using their abilities, thinking about the time perspective, searching for an adequate form of satisfying personal needs and interests.
One of the very popular theories of professional development in the context of professional development abroad is the theory of D. Super, who developed a stepwise model of professional development based on the development and implementation of the self-concept.
The following approach (H. Thome, 1977; O Hara, 1966, etc.) is characterized by emphasizing the fact that in professional development, professional choice acts as a system of orientation in various professional alternatives and decision-making. Various authors put forward expected success as such guidelines , the possibility of defeat and willingness to take risks, as well as the goals facing the individual.
Another direction considers the problem of professional development from the point of view of the possibilities of constructing various typologies (types of profession and types of personalities). This direction includes, first of all, the works of O. Lippman and J. Holland (1968). The most interesting is the approach to classifications of types of professions, developed in the studies of O. Lippman.
He proposed dividing the variety of professions into three types; “high””, “medium” and “low”. For professions of the “highest” type, the criterion of adaptation (compliance) is the correspondence of the characteristics of the profession to the characteristics of the professional orientation; for the “average” - the characteristics of professional thinking, for the “low” - the correspondence of individual indicators of the development of mental functions and psychomotor skills (0; Lippman, 1923). The theory of J. Hollyad’s types is characterized by the statement that a person chooses a profession that best matches his type personality. He identified six basic types: research, realistic, social, entrepreneurial, conventional, artistic. In his opinion, most professions can be described in the space of these types, and thus any professional environment receives a profile similar to the personal one. According to his assumption, a person enters the professional environment that corresponds to his personality type, similarly, the environment “selects” people in accordance with its own profile, J. Holland in his theory (1968) emphasized the importance of professional behavior as part of personal development and in some way combined personality theory with theory of professional behavior.
Development of professional self-knowledge of the doctor’s personality and the formation of experience in his creative activity
In psychological research, among the conditions that make up the specifics of the process of awareness of oneself as a subject of activity, the following are highlighted: conditioned by the mechanism of discreteness, the turning of consciousness towards oneself as a bearer of consciousness and a subject of activity; setting subject-oriented tasks in the process of activity with an indispensable focus on the performer of the activity and the information supporting it; reasonable external regulation of selectivity of self-awareness; experiencing and verbalizing conflicting meanings, during which a person begins to understand the essence of his difficulties (A.N. Leontiev, 1975); development of the ability to create stimuli for “reversible reflexes” (L.S. Vygotsky, 1925) i.e. ability to reflect; engaging professional terminology and concepts for work on self-knowledge that succinctly, accurately and logically describe the essence of phenomena and properties; effective internalization of the reference block of knowledge; the mandatory use of collective forms of activity, in which, thanks to group apperception, the individual way of activity is corrected, the assimilation of the necessary professional standards and samples is monitored; the optimally broad aspect of the practical involvement of the future specialist in various types of professionally regulated relationships (V.A. Alekseev, 1985); providing opportunities for the most complete comparison and assessment of professionally important qualities, abilities and skills; organization of comprehensive and timely educational “feedback” (L.A. Petrovskaya, 1982); formation of a correct evaluative attitude towards oneself (M.I. Borishevsky, 1980), etc.
Grouping the psychological conditions for the formation of a person’s professional self-awareness allowed Vaskovskaya SV. (1987) identified five principles that she based the developmental experiment on: I) the principle of intensive professional training; 2) the principle of active apperception; 3) the principle of taking into account different points of view on one’s activities and oneself in it 4) the principle of mirror reflection; 5) the principle of adequate assessment and self-assessment. Subsequently, all the principles were concretized in the means and techniques of formation,
The enormous importance of the ability to cognize, analyze and generalize one’s own practical experience is noted in the works of K.D. Ushinsky, J.K. Krupskaya, A.S. Makarenko, V.A. Sukhomliysky, this was experimentally confirmed in the studies of Yu.K. Babansky, N.V. Kuzmina, A.K. Markova and others. The research carried out in this direction can be divided into the following groups: a) the study of the gnostic skills of a professional, his perceptual-reflexive abilities; B) studying the representation of substantive aspects of professional activity in a professional’s self-awareness; awareness of the difficulties and shortcomings of one’s own work; c) research into the assessment and self-assessment of professionally important qualities in the process of professional self-determination. Basically, the presented research groups are aimed at diagnosing the current level of development of a person’s professional self-awareness, studying its structural elements, the degree of influence on professional development, while the dynamics of its development and formation remain out of sight of researchers.
The formation of a doctor’s professional self-knowledge in an experimental study assumed that awareness of the peculiarities of one’s own professional and practical activity occurs through awareness of the contradiction between the actual and desired way of activity, and the identification of difficulties in mastering any professional skill. To record changes, the following criteria were used: a) the volume and differentiation of the doctor’s knowledge about the advantages and disadvantages of his own activities, the development of professional and practical skills in himself and his colleagues; b) the level of development of a specialist’s professional reflection and self-reflection; c) the level of adequacy of evaluating oneself and others as subjects of professional and practical activity
In the ascertaining experiment, the features of professional self-knowledge of doctors with practical experience were studied, and patterns of influence of awareness of one’s own skills and abilities on the development of a professional were identified. Due to the fact that the survey and analysis of the reporting documentation of doctors (164 people in total) did not provide the necessary information, a questionnaire was developed to assess difficulties in mastering professional and practical tools according to the “functional components of professional activity” (N.V. Kuzmina, 1980) and adapted to our study. Using this method, 198 questionnaires of doctors with different work experience were analyzed.
As a result of the statement, the content of the professional aspects of the doctor’s “self-image” was determined; the features of his professional self-knowledge were recorded depending on the stage of practical training; specific differences between the professional self-knowledge of doctors with different work experience are shown.
Thus, it was revealed that the knowledge of young doctors (up to 5 years of work experience) about the development of their own practical skills and their professional appearance differs significantly from the information received from competent judges who observed the work of doctors. The percentage of young doctors who do not objectively differentiate their own difficulties in practice and who downplay the significance of visible failures due to “professional blindness” is almost twice as high as the percentage of young doctors who received “judicial praise,” i.e. those who subjectively overestimate their own difficulties. They deny difficulties in the activities of 45$ of young doctors, exaggerate the noted difficulties - 16$ of young doctors, either exaggerate or underestimate the level of difficulties - 24$ of young doctors and only 19$ more or less adequately reflect their own successes and failures.
The effectiveness of professional self-knowledge increases significantly if the doctor not only records the difficulties encountered in the activity, but also realizes what, first of all, it is necessary to pay attention to, how to eliminate the existing gaps, As evidenced by the data obtained, the hierarchy of difficulties is approaching the objectively observed picture, approximately 44% of doctors realize, 46% cope with this task unsatisfactorily, 9% of doctors have a tendency to noticeably distort the real picture. The measure of conjugacy between expert and self-assessment hierarchies, determined by the Pearson correlation coefficient, varies from f = -0.73, p X 0.05 (opposite dependence) to Ґ = 0.8, p - 0.05 (high level of correspondence). The data obtained indicate that the task of self-education of a young specialist, aimed at understanding the level of development of his practical skills, is very relevant and has real prerequisites for solution at the early stages of professionalization (early diagnosis, counseling, correction, etc.).
In the development of a doctor’s professional self-knowledge, a certain trend is recorded, which has typical characteristics for each group of subjects. Thus, by the 10th year of work, self-assessment of professional skills and abilities loses the uncertainty and superficiality characteristic of the first years of work, becomes more precise and acquires more objective features. An increased sense of difficulties indicates that the acquisition of experience gives rise to a critical attitude towards the level of one’s own achievements and aims at active and purposeful work on oneself. In our opinion, differentiation of difficulties in one’s own practical activities is a criterion for the maturity of a person’s professional self-awareness.
L.A. Leshchinsky (1987) identifies the following professionally important qualities for general practitioners: passion for their specialty, active humanism regardless of the presence of antipathy, desire to do good, sense of duty, ability to compassion, kindness and love for people; the ability to inspire trust in patients, willingness to alleviate suffering, endurance, tolerance towards patients, communication. Willingness to self-sacrifice, business pedantry, responsibility for the results of treatment, the desire to improve oneself in the profession, self-criticism, the ability to place patients at the center of one’s consciousness, developed perception (“clinical nose”, “clinical eye”), stable emotional sphere. The ability not to panic, neatness, high psychological culture, delicacy and tact towards patients, optimism, the ability to suppress the feeling of disgust at the patient’s bedside.
According to A.M. Vasilkova and S.S. Ivanova (1997), stable motivation for the profession of a military doctor is observed among cadets who have social introversion, a tendency towards personal socially approved achievements and rigidity of attitudes, as well as a lack of predisposition to a demonstrative type of behavior and insincerity.
V. Dubrova and I.V. Malkina (2003) showed that medical students include the following characteristics in their idea of the “ideal” doctor: balance, ability to control emotions, cheerfulness and optimism, calmness, discipline, willpower. Self-confidence, autonomy, internal locus of control, ability to reflect, flexible and sharp mind, psychological competence, desire to cooperate with the patient and, of course, erudition and theoretical knowledge. According to some of them, the ideal doctor should be a man, neat, with an attractive appearance and pleasant manners.
It was found that surgeons and resuscitators have high sensitivity, tension, rigidity, emotional stability and high self-control.
According to E.B. Oderysheva (2000), the psychological portrait of a general practitioner and surgeon includes the following qualities: sociability, emotional stability, high social normative behavior, high internal self-control. In the generalized psychological portrait of a surgeon, the same characteristics are highlighted, but to a much greater extent. In addition, social courage was characteristic of surgeons.
Features of the emotional sphere of medical workers. Medicine is a field of human activity where negative emotional states predominate. Patients expect compassion and care from medical personnel, which requires empathy. Therefore, it is believed that people with a high level of empathy should go into medicine, as well as into other socionomic professions. It is believed that the doctor’s high empathy helps to better feel the patient’s condition. Along with this, as noted by M.A. Yurovskaya (1925), a doctor is characterized by the ability to easily overcome unpleasant impressions.
It is also impossible not to take into account the fact that medical workers, constantly faced with people’s suffering, are forced to erect a kind of barrier of psychological protection from the patient, becoming less empathetic, otherwise they are at risk of emotional burnout and even neurotic breakdowns. By the way, it has been shown that two-thirds of doctors and nurses in the intensive care unit experience emotional exhaustion as one of the symptoms of emotional burnout. Another study found that emotional burnout is more pronounced among cardiologists than among oncologists and dentists. This is explained by the fact that cardiologists are more often in extreme situations.
Hence, the demands placed on the emotional sphere of medical workers are quite contradictory. Along with empathy, doctors must also be emotionally stable. Both excessive emotionality and emotional inhibition can be an obstacle to clear and quick action.
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