Murat Eren OZEN, Mehmet Hamdi ORUM, Aysun KALENDEROGLU

Psikiyatri Pratiğinde Zor Hasta: Bir Vaka-Kontrol Çalışması

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.

Anahtar Kelimeler:

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

Difficult Patient in Psychiatry Practice: A Case-Control Study

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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