Doctor-Patient Relation in Severe Illness

Abstract

In an attempt to deal with the anxiety aroused in young physicians who must care for terminal patients, and with the often inappropriate defenses employed in response to this anxiety, we organized a practical teaching seminar that used the principles of preventive and social psychiatry. Six to 10 oncology fellows met weekly with a psychiatrist and a senior attending physician for approximately five months. The major initial defenses of the fellows were identified as anger and denial. The most severe problems discussed were the formation of dependency relations between doctors and patients, the patient's denial of illness, the phenomenon of social death, and the physician's identification with his patient. The last problem often appears to be a productive one, since it encourages the physician to confront the basic issues of his own life. When this confrontation had been examined, most oncology fellows became increasingly effective with their patients. (N Engl J Med 288:1210–1214, 1973)