Psikiyatri Pratiğinde Zor Hasta: Bir Vaka-Kontrol Çalışması

Year 2018, , 1064 - 1073, 15.12.2018

Murat Eren Ozen , Mehmet Hamdi Orum , Aysun Kalenderoglu

https://doi.org/10.30569/adiyamansaglik.458680

Cited By: 6

Abstract

Amaç: Bazı hasta-hekim karşılaşmaları
ilgili hekimler tarafından "zor" olarak kabul edilir. Somatik
belirtiler, madde kötüye kullanımı, saldırganlık, düşmanlık ve işbirliği
eksikliği, zor hastalarla ilgili en sık görülen özelliklerdir. Yani, psikiyatri
pratiğinde zor hastalarla karşılaşma riski yüksektir. Zor ilişki hastaya olduğu
kadar hekime de bağlı olabilir. Biz bu çalışmada hasta ile ilgili zor hasta
özelliklerini araştırmayı amaçladık.

Gereç ve Yöntem: Zor ilişki “psikiyatrist-hasta
ilişkisinin sorunlu olarak algılandığı durumlar” olarak tanımlanmaktadır. Olgular,
çalışmakta olan psikiyatristlerin en az iki tanesi tarafından zor ilişki olarak
tanımlandı. Kontroller bu hekimlere göre zor ilişkileri olmayan hastalardan
oluşuyordu. Çalışmaya 45 olgu ve 90 kontrol dahil edildi.

Bulgular: İki grup arasında yaş, cinsiyet,
medeni durum, eğitim durumu ve çalışma durumu açısından anlamlı bir fark yoktu.
Olgu grubunda hastaneye yatış sayısı, kullanılan ilaçlar, psikoterapi ve sosyal
müdahale, kontrol grubuna göre daha yüksekti. Olgu grubunda kişilik
bozuklukları anlamlı olarak yüksek bulundu.

Sonuçlar: Daha fazla ilaç kullanımı, daha
fazla sosyal müdahale, daha fazla hastane yatışı zor olarak nitelendirilen bu
hastaların memnuniyetsizliğinden kaynaklanabilmektedir. İlerletilmiş iyi bir
terapötik ilişki, bu zor hastalarda daha az semptom ve daha az girişimi-yatışı
sağlar. Hem etiyolojisini hem de çözümünü daha iyi anlayabilmek için
hasta-hekim ilişkisine ilişkin daha fazla sistematik araştırma yapılmalıdır.

Keywords

Vaka-Kontrol Çalışması, Zor Hasta, Hekim-Hasta İlişkisi, İlişki

Difficult Patient in Psychiatry Practice: A Case-Control Study

Abstract

Aim: Some of the patient-physician
encounters are considered "difficult" by the relevant physicians. Somatic
symptoms, substance abuse, aggression, hostility, and lack of co-operation are
the most common features related to difficult patients. That is, the risk of
encountering difficult patients in psychiatric practice is high. The difficult
relationship may be related to the patient as well as to the physician. We
aimed to investigate the difficult patient characteristics associated with the
patient in this study.

Material and Methods: Difficult relationship is defined
as "situations in which the psychiatrist-patient relationship is perceived
as problematic”. The cases were defined as difficult relationship with at least
two of the psychiatrists who were studying. Controls consisted of patients
without difficult relationships. 45 cases and 90 controls were included in the
study.

Results: There was no
significant difference in terms of age, sex, marital status, education status,
and working status between the two groups. The number of hospitalization, drugs
used, psychotherapy, and social intervention was higher in the case group than
in the control group. Personality disorders was significantly higher in the
case group.

Conclusion: The
use of more medicines, more social interventions, more hospital admissions have
been attributed to the dissatisfaction of these patients.
The improved good
therapeutic relationship can lead to less symptoms and fewer applications in
these difficult patients. Further systematic research should be conducted with
respect to patient-physician relationship to provide a greater understanding of
both its etiology and solution.

Keywords

Case-Control Study, Difficult Patient, Physician-Patient Relation, Relationship

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