Individual psychological characteristics of the doctor's personality. Psychological foundations of the professional activity of a doctor
L.A. Leshchinsky (1987) identifies the following professionally important qualities for therapists: passion for their specialty, active humanism, regardless of the presence of antipathy, the desire to do good, a sense of duty, the ability to compassion, kindness and love for people; the ability to inspire confidence in patients, the willingness to alleviate suffering, endurance, tolerance towards patients, communication skills. Readiness for 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 in the center of one’s consciousness, developed perception (“clinical scent”, “clinical eye”), stable emotional sphere. The ability not to panic, neatness, high psychological culture, delicacy and tact in relation to patients, optimism, the ability to suppress the feeling of disgust at the patient's bedside.
According to A.M. Vasilkov and S.S. Ivanova (1997), stable motivation for the profession of a military doctor is observed among cadets who have social introversion, a tendency to personal socially approved achievements and rigid 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 an “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, willingness 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 therapist and a 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, surgeons were characterized by social courage.
Features of the emotional sphere of medical workers. Medicine is that sphere of human activity where negative emotional states predominate. Patients expect sympathy and care from the medical staff, which requires empathy. Therefore, it is believed that people with a high level of empathy should go to medicine, as well as to other socionomic professions. It is believed that a 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 impossible not to take into account the fact that medical workers, constantly faced with the suffering of people, are forced to erect a kind of barrier of psychological protection from the patient, become less empathic, otherwise they are threatened with 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. In another study, it was found that emotional burnout is more pronounced in cardiologists than in oncologists and dentists. This is due to the fact that cardiologists are more often in extreme situations.
Hence the requirements for emotional sphere healthcare professionals are quite controversial. Along with empathy, physicians must also be emotionally stable. Both excessive emotionality and emotional inhibition can be an obstacle to the implementation of clear and quick actions.
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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. Church
FOREWORD
Treating a disease is a science.
Treating the sick 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).
At the core clinical competence The doctor should have a socio-psychological culture - the ability to communicate with the patient, his relatives, colleagues, administration.
Studies have shown that there are significant relationships between many aspects of interpersonal skills of clinicians, on the one hand, and the degree of satisfaction and motivation of patients, on the other (Thomson et. al., 1990). Poor communication on the part of the physician is a major factor leading to patient and family dissatisfaction with the treatment provided, leading to accidents and subsequent litigation (Vincent, 1992).
The study by medical students of the basics of general, age and social psychology, medical psychology can further influence the cost of treatment and the efficiency of resource use in health care, opening up the possibility for more accurate diagnosis and better patient compliance with treatment plans.
The psychologization of medical knowledge can help the clinician more effectively deal with the need to develop an adequate treatment plan and communicate it to the patient within the time available for this, to prevent unnecessary prescriptions of drugs that are either erroneously prescribed or misused by patients (Kaplan, 1989; Sandler, 1980). The psychological incompetence of a doctor entails negative consequences for the medical, psychosocial and economic aspects of health care.
At present, the formation of communicative competence The role of the medical specialist has not yet been fully considered as one of the most important constituent parts in medical training. This gives rise to social and psychological problems in the health care system itself.
1. Currently, a new model of relations is being actively introduced in medicine, based on the ethical doctrine of "informed consent" and focused (K. Rogers) on the "client-centered approach" (subject - subject interaction). This model clashes with the opposite tradition - "nosocentric" (from Latin nosos - disease), rooted in the structure of medical student education and the healthcare system. It is based on the subject-object interaction. The focus of the doctor is the disease.
Within the framework of a client-centered approach, a person who applied for 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 for cooperation, in particular, for communication “on an equal footing”. 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 the doctor and the patient is paternalistic in nature - the nature of "subject - object" relations. This 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 to carefully prepare and organize the 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 in relation to the patient, the doctor is guided by the notion of the patient as a passive executor of the doctor's orders, as an object that is not competent, not autonomous, and does not have the potential of medical self-education.
2. According to a number of experts, nine out of ten Americans "do not live out their lives", in the absolute first place in the world there are diseases that can be qualified as "lifestyle" diseases.
The usual division between "organic" and "functional" diseases is now increasingly questioned. Medical professionals began to realize that diseases often arise from multiple etiological factors.
Such views on the causes of disease are of particular interest in the role that psychological and social factors can 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 the result of an abnormal development of the relationship between the individual and social structures in which it is included” (B. Luban-Plozza, 1994).
Modern medicine tends to absolutize the somatic sphere to the detriment of the psychosocial (N.G. Ustinova, 1997), and the medical model of the disease, highly adequate to the clinical paradigm of health, often distorts the patterns of social etiology of the main volume of 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 is replacing the pathocentric paradigm (IN Gurvich, 1997). The “quality” of medical services, adequate treatment without a deep study of the socio-psychological category is hardly possible (both accents are important: “lifestyle” and “lifestyle”).
3. The family, like other immediate environment, usually gives a person the amount of warmth, attention and love that he needs. Here he is loved without limit, unconditionally, and accepted for who he is.
That is why a number of experts believe that it is more adequate to count the population of the planet “by families”, and count the lonely “as an incomplete family”. The contribution of the family to the health and life of a person 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 of gastric ulcer, ulcerative colitis, diabetes, asthma, coronary heart disease, anorexia, migraine requires a family approach (MV Avsent'eva, 1994).
At the same time, a medical graduate is guided in the field of family psychology at the level of common sense and the independent work life experience. The patterns of family functioning can be a powerful factor in recovery or, conversely, an elusive, invisible, but constantly acting factor in pathogenesis (for example, a “schizophrenic family” is known in a psychiatric clinic).
4. The practice of creating groups of patients, which is widespread in the world (“Alcoholics Anonymous”, B. Siegel’s society of “exceptional cancer patients”, groups of patients with severe pain, groups of patients who have survived a suicide attempt, etc.) can be initiated by a doctor oriented towards modern psychology and in the field of social psychology, in the first place. Patients discover the possibility of mastering (with the subsequent transfer of experience to each other) the principles of such work, but the awareness of the importance of this area 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 concept is interpreted (in the strict sense) as "the return of the rights of the individual." It is no coincidence that in the history of medicine, psychiatrists were the first to turn to it, and only then it was introduced into other areas of medical work.
The crisis nature of a person's encounter with social stereotypes, labels (up to stigmatization) is well known, and the prospect of life in the status of "OTHERS" frightens many people suffering from serious illnesses.
6. In the strict sense of this term, "management" means "development" of the system, while maintaining the "quality" of the system and the task of "stabilizing" the work, are combined by the term "administration". The professional training of heads of medical institutions does not fully meet the socio-psychological realities of the “attacking behavior of an organization in the service market”, successfully mastered by other areas of social practice (V.P. Dubrova).
The doctor, at least twice, comes face to face with these problems. In one case, it is an element of the management system (integrating into it or not), in the other case, the doctor himself will have to create a treatment management system, where the microenvironment and the patient himself, narrow specialists and nurses, and the patient's neighbors in the ward should be combined and colleagues who come to him (the creation of a so-called “therapeutic community” in the health 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 the formation of an “internal picture of treatment”, as teaching the skills of self-management. It should be noted that the “internal picture of the disease” is widely discussed among physicians, 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) 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 complex 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 activity can improve the quality of the diagnostic and treatment process.
The listed socio-psychological problems, if not solved, can reduce the quality of treatment, the income of the medical institution and, ultimately, the earnings of the doctor himself.
The expanded introduction of courses in general, developmental and social psychology into the practice of training doctors of all levels contributes to the formation of a doctor's socio-psychological competence. This allows:
1) better recognize and respond more correctly to verbal and non-verbal signs of patients and extract more relevant information from them;
2) more effective diagnosis, since effective diagnosis depends not only on the establishment of bodily symptoms of the disease, but also on the ability of the doctor to identify those somatic symptoms, the causes of which may be of a socio-psychological nature, which, in turn, requires other treatment plans;
3) seek patient compliance with the treatment plan, as studies have shown that communication skills training has a positive effect on patient compliance with the prescribed medication;
4) provide patients with adequate medical information and motivate them to follow a healthier lifestyle, thus enhancing the doctor's role in health promotion and disease prevention;
5) influence various forms of reflection of the disease (em emotional, intellectual, motivational) and activate compensatory mechanisms by increasing the psychosomatic potential of the patient's personality, help him reconnect with the world, overcome the so-called "learned or trained helplessness", destroy the stereotypes created by the disease and create patterns of healthy response;
6) Physicians are more effective in particularly sensitive aspects of the doctor-patient relationship that are often encountered in practice, such as the need to inform the patient that he is terminally ill, to tell the patient's relatives that he must die, or other examples of bad news.
This course of lectures is primarily focused on the theoretical socio-psychological training of medical students. It is based on the system 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 view of the medical student about mental activity a person, which will allow him to purposefully carry out a medical and diagnostic process in his future professional activity (A.L. Tserkovsky).
The use of examples from medical practice in lectures equips students with concrete knowledge in the field of practical interaction skills. This is especially important now that there is a growing need to increase the number of family doctors.
conflict medical temperament ability
CHAPTER I. PSYCHOLOGY IN MEDICINE
LECTURE 1. THE SIGNIFICANCE OF PSYCHOLOGY IN DOCTOR TRAINING
1. The relevance of the psychological preparation 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, by changing the nosocentric approach to the patient (subject-object relationship between a doctor and a patient) to anthropocentric (subject-subject interaction in the dyad "doctor - patient") and the need for psychological training of doctors in connection with this (V.P. Dubrova).
Consequently, the implementation of the program for the formation of the psychological competence of a doctor is one of the most urgent both psychological and social problems of our time.
AT last years the state of the general problem of psychological analysis of medical activity has changed for the better. Studies have been carried out (V.A. Averin, A.G. Vasyuk, M.I. Zhukova, L.A. Tsvetkova, N.V. Yakovleva, etc.), a number of monographs and articles devoted to various aspects psychological analysis of the 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 vocational training at the university (N.V. Yakovleva, 1994).
The need for such training is obvious and due, according to V.P. Dubrova, for several reasons:
1) recognition of the role of the psychological factor in the occurrence and course of the disease;
2) professional attitude towards the “average patient”, which leads to ignoring the individuality of the patient’s personality and serious medical errors;
3) the specifics of medical activity, which consists in the fact that this is an activity in the field of communication, in the sphere of "person - person" and an important aspect of the success of the doctor's activity is not only the high level of his special medical training, universal culture, but also the socio-psychological aspects of his personal potential;
4) communication problems in the 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 connection with this, to maintain a high level of efficiency for a long time and make quick decisions in extreme situations.
Partially, the tasks of the psychological training of a doctor are solved by the clinical and general humanitarian departments of a medical university, where, depending on the interests and level of erudition of the teacher, one or another amount of psychological information is included in special courses (L.A. Bykova, V.S. Guskov, N.V. Yakovleva and others).
However, it should be noted that the main way to form the psychological competence of a doctor at a university is the study of psychological disciplines (general and social psychology, "Medical ethics", "Pharmaceutical ethics", elective courses"Psychology of communication", "Practical conflictology", "Psychology of management", etc.). Only in this case can we talk about the formation of a psychological anthropocentric worldview of a doctor and a sufficient level of his socio-psychological culture (V.P. Dubrova).
The socio-psychological culture of a doctor implies that he has certain professional views and beliefs, an attitude towards an emotionally positive attitude towards the patient, regardless of his personal qualities, and the whole complex communication skills and skills necessary for a doctor for medical communication.
A more adequate understanding between the patient and the doctor allows you to optimize the professional activities of the latter.
The purpose of psychological training is to expand the humanitarian training of a medical student in the field of fundamental human sciences V.P. Dubrova).
Based on the goal, the following tactical tasks are solved, aimed at the formation of a psychological anthropocentric worldview and a sufficient level of socio-psychological culture of medical students:
The development of medical students' ideas 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 communicative competence and skills of optimal medical communication (socio-psychological culture);
Development of "clinical thinking" and a professional position that provides person-centered medical interaction (personality-centered attitude to the object of one's activity, awareness of one's self-worth and another person, and attitude to the patient as an active participant in medical interaction).
Such a view of the tasks and nature of teaching students in 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. Klarin, A.I. Piskunov, A.I. Prigozhiy, 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) focus on the active development of human methods of cognitive activity;
4) adaptation educational process to the requests and needs of the individual;
5) orientation of learning to the student's personality, providing opportunities for his self-disclosure.
Thus, the most important feature of modern education is its focus on preparing specialists not only to adapt, but also to actively master situations of social change.
At present, science has formulated ideas about the main types of learning, understanding learning in the broad sense of the word - as a process of gaining 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, which is aimed at maintaining, 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 learning and educational activities, which stimulates, to make innovative changes in the existing culture, social environment. This type of training (and education), in addition to maintaining existing traditions, stimulates an active response to emerging frontiers. individual and problematic situations before society.
Designing training sessions with students based on ideas " innovative learning» changes the didactic construction of the educational process in a medical university in a specific special discipline and influences socially significant results, forming the "I-concept" of the future doctor.
2. Psychology and medicine
2.1 Current understanding of the disease
At present, 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 Charter, 1946).
Currently, health is interpreted as: 1) the ability to adapt and adapt; 2) the ability to resist, adapt and adapt; 3) the ability to self-preservation, self-development, to more and more meaningful life in an increasingly diverse habitat (V.A. Lishchuk, 1994).
According to the WHO definition, health consists of three components: physical, mental (or mental) and social.
In medicine, due to the positive definition of health, along with the pathocentric approach (the fight against diseases), the sanocentric approach (focus on health and its provision) is also being established.
The emergence of the sanocentric approach is changing the paradigm of medical thinking, which until recently dominated in modern culture, and based on the principle of "pathology", on what is wrong in a person.
There was a stereotype in the public mind, according to which it was considered a success if a person becomes “better” with the help of medicine. At the same time, "better" was understood as the absence of disease. A rarity was the focus on the full realization of all the possibilities of the body or on the optimal lifestyle.
Until recently, culturally accepted beliefs suggested 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 looking for and removing weeds and ignoring the planting, care and cultivation of fruit plants (D. Gershon, G. Straub, 1992).
2.2 Socio-psychosomatic 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.
Departure from the dualism of body and psyche, affirmation systemic organization person led to the adoption systems approach in various fields of activity: in politics, business, sports, education. Including in medicine. Consistency prescribes to keep in mind the integrality of man.
Claimed for international level a systematic approach to health involves the inclusion of the "Body-Psyche" system into the supersystem "Man and Others", "Man and Family", "Man and Society", 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 long been known. The somatogenic effect is carried out through intoxication effects on the central nervous system, and the psychogenic effect involves an acute reaction of the individual to the disease and its consequences.
The range of possible changes in the psyche of 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 a somatic disease;
Experiences caused by the consequences of the disease, changes in working capacity, marital status, total social status a sick person;
The restructuring of the entire personality of the patient, expressed in the formation in the conditions of the disease of new attitudes, protective and compensatory personal formations, changes in the life orientation and self-awareness of the patient (Nikolaeva V.V., 1987).
However, the influence of the somatic sphere on the human psyche can be not only pathogenic, but also sanogenic.
2. Influence psychological factors to the somatic realm. There is no less data today about the influence (pathogenic and sanogenic) of psychological factors on the somatic sphere of a person. At the origins of this approach is the school of Hippocrates, who interpreted illness as a disorder in the relationship between the subject and reality. The term "psychosomatics" originated in 1818 (R. Heinroth).
Emotional overload can lead to both mental illness and physical illness. A convincing example of this is a gastric ulcer caused by the constant secretion of gastric juice during great excitement.
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 a feeling of depression, depression, hopelessness, helplessness, is prone to cancer. A person prone to coronary artery disease in a stressful situation demonstrates a sense of hostility, aggressiveness, and openly shows his feelings.
Psychosomatic pathology is a kind of somatic resonance of mental processes. “The brain is crying, and the tears are in the stomach, in the heart, in the liver ...” - so figuratively wrote the famous domestic doctor R.A. Luria. According to domestic and foreign authors, from 30 to 50% of patients in somatic clinics need only correction of their psychological state.
True psychosomatosis include: bronchial asthma, hypertension, coronary heart disease, duodenal ulcer, ulcerative colitis, neurodermatitis, nonspecific chronic polyarthritis.
Unlike these diseases, the occurrence of which is determined by mental factors, other diseases are influenced by their dynamics by mental and behavioral factors that weaken the nonspecific resistance of the body, involving the autonomic and endocrine systems.
Psychosomatic medicine solves the following theoretical problems:
a) the question of the triggering mechanism of the pathological process and the initial stage of its development;
b) the question of the different influence of the same superstrong stimulus on emotional reactions and vegetative-visceral shifts in different people;
c) the question of why mental trauma can cause different localization of the disease (in some of the cardiovascular system, in others of the digestive apparatus, in others - of 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. In particular, we are talking about a positive impact on the course of somatic disease. These include: 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.
So, some experiments have shown that the immune system is more stable when a person who finds himself in a stressful situation has a good relationship with others (O. Dostalova, 1994). WHO has paid serious attention to the "system of social support against stress."
3. Family. Like other immediate environment, 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 of gastric ulcer, ulcerative colitis, diabetes, asthma, coronary heart disease, anorexia, migraine requires a family approach (MV Avsent'eva, 1994).
2.3 Systems to be analyzed in the study of disease
When studying health and disease, certain dynamics are revealed in the change of systems to be analyzed:
a) from the study of individual organs to the study of body systems and the whole organism as a whole,
b) from the study of the organism to the study of psychosomatic and somatopsychological relationships,
b) from the study of the relationship between the body and the psyche to the study of the influence of the psychosomatic characteristics of a person on his behavior and social life (as well as the reverse effects of social life on the psyche and body).
Indeed, the most important factors influencing health are (Noack, 1987):
a) biological system and physical and 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, health culture and practice, health services, etc.).
2.4 Palliative care
One example of a sociopsychosomatic approach to a person in medicine is palliative care with the aim of creating the most High Quality life for both the patient and his family.
Palliative care supports the patient's desire for life, while considering death as a natural process. Palliative care makes it possible to control pain and other symptoms that disturb the patient, as well as to carry out a complex psychological, physical and social support, which allows the patient to lead an active lifestyle for a longer time until death.
Palliative care also involves a support system for the patient's family both during the illness of the patient and after his death (WHO).
3. Psychological aspect of the disease
The study of a person's personal reactions to his psychosomatic state implies consideration of both the psychological component of the disease and his health.
In the event of psychosomatic diseases, not only the activity of the systems and organs of the human body is disrupted, but also the self-consciousness of a person changes.
Self-consciousness, being inextricably linked with the intensity of stimulation of both interoreceptors and exteroreceptors, forms an idea of physical condition, which is accompanied by a peculiar emotional background (A.V. Kvasenko, Yu.G. Zubarev, 1980).
3.1 Sensory 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 single out the sensorological stage (from Latin sensus - feeling).
At this stage, there are vague unpleasant sensations of varying severity with uncertain localization. Being early symptoms of the threat of the disease, they cause a condition referred to as discomfort.
In addition to indefinite diffuse subjective feelings discomfort, local discomfort is possible, for example, in the region of the heart, stomach, liver, etc. Discomfort is an early psychological sign of morphofunctional changes. It can turn into pain.
Pain can have a positive or negative meaning. In a positive sense, pain is seen as an important and effective signal of danger to 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 signal function in some cases makes it difficult to diagnose (progressive pulmonary tuberculosis); 2) discrepancy between the strength of pain and the nature of the disease (toothache); 3) a conditioned reflex decrease in pain sensitivity is possible:
US soldiers suffered less severely from severe injuries during World War II because they knew they were being evacuated from the front;
Of the two participants in the fight, the winner bears the pain better;
The masochist perceives pain positively, since it is a form of sexual pleasure;
Thanks to training, the boxer perceives pain more easily.
Thus, pain, being information about the violation of the activity of organs and systems, being processed in the mind, can form the basis for the patient's assessment of his psychosomatic suffering.
Pain can be assessed not only as a symptom of the disease, but also as a threat to life (changes in position in the family, in professional activities, etc.).
There are 3 levels of pain manifestation:
1) the level of physiological feelings (dilated pupils, blanching of the face, cold sweat, tachycardia, increased blood pressure);
2) emotional and motivational level (fear, desires, aspirations);
3) cognitive level(rational, rational attitude to pain and assessment of its role in one's life).
In addition to discomfort, pain sensations at the first stage, the occurrence of deficient disturbances in biosocial adaptation (decrease in creative activity, weakening of incentive motives for activity, etc.) is also possible. There is a feeling of constrained freedom, limitation of one's former capabilities, a feeling of one's own inferiority.
Thus, the sensorological stage includes the following components: 1) discomfort component (feeling of discomfort); 2) algic component (experience of pain); 3) a deficit component (experiencing feelings of one's own inferiority, limiting 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” is formed. This concept is important in medical psychology, since the objective picture of the disease and its internal picture, as it is perceived by the patient, are different.
Fear and anxiety about the disease, which 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 of this. Therefore, the doctor needs to be able to measure and harmonize the internal picture of the disease with the objective state of the patient.
The internal picture of the disease is the inner world of the patient, everything that the patient experiences and experiences, his ideas and feelings about the disease and its causes (RA Luria, 1944).
The evaluation stage has the following structure: 1) vital component (biological level); 2) social and professional component; 3) ethical component; 4) aesthetic component; 5) a component related to intimate life.
The main elements of the internal picture of the disease are:
The sensations of the patient, the perception and experience of symptoms, that is, the protective actions of one's own body;
- emotions associated with illness: fear, pain, anxiety, depression, eif oriya, organic sensations;
Understanding the origin and causes of the disease, that is, the concept of the disease;
Forecast of its further development and hope for recovery;
The scheme of the body and its violation.
The internal picture of the disease, refracted in each case in its own way and acquiring an individual color, depends on the following factors:
1) premorbid personality traits (as it was before the disease): age; degree of general sensitivity to pain, factors external environment(noise, smells); the nature of emotional reactivity (emotional patients are more prone to fear, pity and to a greater extent fluctuate between hopelessness and optimism); nature and scale of values (attitude towards 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 insecurities that the disease brings (cost medicinal product, the degree of disability, possible changes in family relationships and at work, etc.) the environment in which the disease develops (at home, abroad, at a party, with friends and relatives); the causes of the disease (whether the patient considers himself the culprit of the disease or others: if he is to blame, he recovers faster).
3.3 Stage of attitude to the disease
At this stage, the attitude towards the disease manifests itself in the patient in the form of experiences, statements, actions, as well as general pattern disease-related behavior. The main criterion of the stage is the recognition or denial of the disease.
Types of attitude to the disease. Somatognosia is an attitude to the disease, which is formed at the stages of a person's personal response to his disease state.
Normosomatonosognosia is an adequate assessment by patients of their condition and prospects for recovery. The patient's assessment of his disease coincides with the doctor's assessment. The attitude to treatment and medical procedures is positive.
Variants of activity in the fight against the disease: 1) adequate assessment of the disease and high activity in the fight against the disease; 2) an 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, enumeration of doctors and medicines; 2) hypertrophied interest in medical literature, lowered mood (lethargy, monotony), pessimistic forecast for the future, scrupulous fulfillment of all doctor's requirements.
Hyposomatonosognosia is an underestimation by patients of the severity and severity of the disease in general and its individual signs.
Options: 1) decrease in activity, external lack of interest in examination and treatment; unreasonably favorable forecast for the future, downplaying the danger; a deeper analysis reveals the correct assessment of one's health; adherence to the regime, the implementation of the recommendations of the doctor; in the chronic course of the disease, they get used to the disease, are treated irregularly; 2) unwillingness to see a doctor, negative attitude to the treatment process, denial of the disease.
Dyssomatonosognosia- denial of the presence of the disease and symptoms. Complete denial 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 from consciousness of thoughts about the disease, especially with a predicted unfavorable outcome.
Factors influencing the formation of types of attitudes towards the disease.
1. Individual psychological characteristics of the personality (personality premorbid). Normosomatonosognosia is formed in strong, balanced people.
People with hypersomatognosia are characterized by such premorbid personality traits as rigidity, stuck on experiences, anxiety, suspiciousness.
People with the first variant of hyposomatognosia are characterized by superficiality of judgments, frivolity. In the second variant, purposefulness, “hypersociality” stands out among the premorbid features.
2. Age factor.
In all forms of somatognosia, 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, dyssomotonosognosia is most often characteristic.
In old age, due to the underestimation of the forces and capabilities of the body, there is a tendency to hypersomatognosia. Hyposomatonosognosia at this age is associated with a decrease in overall reactivity.
Pathological types of attitude to the disease. The pathological reaction to the disease is based on the following reasons:
The reaction does not correspond to the strength, duration and significance of the stimulus;
The impossibility of correcting ideas, judgments, as well as the behavior of the patient.
Duration of pathological reactions: from several hours to several weeks. In the chronic course of the disease, it is possible for a pathological reaction to develop into a pathocharacterological development of the personality.
depressive reaction. It includes:
1) anxiety-depressive syndrome, which occurs, as a rule, at the initial stage of the disease. It is characterized by: concentration of attention on the experiences associated with ailments, suicidal tendencies.
2) Astheno-depressive syndrome, which occurs at the stage of the height or outcome of the disease. This syndrome is characterized by: lowered mood, depression, confusion, slow motor skills.
phobic reaction. The 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 waiting for the impact of a traumatic stimulus (fear of heights that occurs in the room leading to the balcony); 3) the appearance of phobias in an objectively safe situation (on the street, in the entrance).
hysterical reaction. The hysterical reaction is characterized by: a sharp change in mood; demonstrativeness; theatricality; propensity to acts of self-harm in a state of passion; exaggeration of complaints.
Hysterical reactions include such pseudosomatic disorders as psychogenic pains (pseudo-rheumatic, phantom, abdominal), psychogenic suffocation.
hypochondriacal reaction. With this reaction, the patient stubbornly holds on to the idea that he is ill with another, more serious disease, even in spite of objective situation convalescence.
At the slightest indisposition, patients begin to think about the danger to health and life. Hypochondriacal reactions include psychogenic suffocation, psychogenic nausea and vomiting.
Anosognosia. Anosognosia - 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 is not aware of the fact of the disease and therefore denies it. Sometimes the slightest somatic disorders are given importance and the symptoms of another very dangerous disease are not noticed.
4. Significance of psychology in the preparation of medical students
To implement an integrated approach to a person and develop a strategy and ways to achieve health, a doctor needs, along with a deep knowledge of biomedical disciplines, an equally deep knowledge of psychology.
Knowledge of psychology is necessary for a doctor not only to influence the picture of the world of his client (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 their relationship belongs to the doctor. This model states that the disease follows certain laws, the laws of the life of microbes, the accumulation of cholesterol, the increase in blood pressure, etc., and the attitude of the patient to the disease has some, but not the main significance.
The disease can be endogenous or exogenous and comes because a person has become a “victim” of foreign bodies (viruses, bacteria, microbes). Some hint of responsibility in this approach falls on the person if he does not follow his doctor's prescriptions. When a person gets better, it is because he has a good doctor and medicines, or, thanks to a genetic "accident", he has a strong constitution that helped him recover (V. Shute, 1993).
4.2 Choice model
However, there is another model - the choice model. According to the latter, a person himself chooses his disease 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.”
At 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) increase. An increase in the content of glucocorticoids adversely affects the function of lymphocytes, which is manifested in the suppression of the immune response. It was also found that the immune response depends on how a person psychologically perceives difficult situations (O. Dostalova, 1994).
If a person unconsciously decides to get sick, then he weakens his body, poorly removes waste, creating a toxic environment for viruses. It suspends the action of the immune system, allows external substances to infiltrate and becomes ill (R. Glasser, 1976). His decision regarding diseases is made during 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 awareness of the causes of the disease; the doctor helps to accept a conflict-free desire to be healthy, introduces techniques, ways of acquiring health. It is more than symptom suppression; it's about creating a health mindset. The model of choice does not exclude standard medicines. It only suggests additional directions for improving health.
One can argue about the positive and negative aspects of both the traditional medical model and the model of choice. However, it should be recognized that the doctor’s tactics can be aimed both at manipulating the patient’s sociopsychosomatic relationships, and at bringing 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 stays healthy.
CHAPTER II. PSYCHE AS A SYSTEM OF SELF-MANAGEMENT
LECTURE 2. PSYCHOLOGY AS A SCIENCE ABOUT HUMAN
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, unhappy that her son, a celestial, wants to join fate with a mere mortal, forced Psyche to go through a series of trials. 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 true love, the highest realization human soul. Therefore, Psyche - a mortal who has gained immortality - has become a symbol of the soul seeking its ideal.
The very word "psychology" from the Greek words "psyche" (soul) and "logos" (study, science) appeared for the first time only in the eighteenth century (Christian Wolff).
1.2 Psychology as an independent science
Psychology has short story formed at the end of the last century. However, the first attempts to describe the mental life of a person and explain the causes of human actions are rooted in the distant past. So even in ancient times, doctors understood that in order to recognize diseases, it is necessary to be able to describe the consciousness of a person and find the reason for his actions.
1. Psychology as a science about the soul. Until the beginning of the 18th century, the presence of the 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 inexplicable force itself, which was the root cause of all processes in the body, including its own "spiritual movements."
Psychology as a science of the soul arose more than two thousand years ago, developed within philosophical science, as its integral part.
2. Psychology as a science of consciousness. At the end of the 17th century, in connection with the development of the natural sciences and the strengthening of a strictly causal worldview, the concept of the soul, which is hidden behind the observed phenomena, was excluded from science. From the 18th century, psychology began to be regarded as the science of consciousness. Moreover, consciousness was called the ability to feel, think, desire. The place of the soul was occupied by phenomena that a person finds “in himself”, turning to his “inner mental activity”. In contrast to the soul, the phenomena of consciousness are something not supposed, but actually given.
FROM late XVIII century, psychology first appeared as a relatively independent field of knowledge, covering all aspects of mental life, which were previously considered in various 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, although mechanistic, worldview to the “realm of the spirit” led to the idea of the formation of all mental abilities in individual experience.
The study of consciousness sharply raised the question: how does the human body react to information received from the senses? All our knowledge was supposed to come 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 ideas of perception, which underlie even more complex ideas.
In 1879, at the University of Leipzig, Wilhelm Wundt (Wundt), began to study the content and structure of consciousness on scientific basis, i.e. combining theoretical constructions with a reality check. He entered the history of psychology as the founder of scientific psychology, since he legitimized the right of experiment to participate in the study of consciousness.
In contrast to the associationist, 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, feelings. The role of psychology was to give as detailed a description of these elements as possible. Structuralists used the method of experimental introspection (subjects who underwent preliminary training described how they feel when they find themselves in a particular situation).
At the same time, there appeared new approach to the study of consciousness. Since 1881 in the United States, William James, inspired by the teachings of Charles Darwin, argued that "conscious life" is a continuous stream, and does not consist of a series 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 one to adapt to different situations, or repeating already developed forms of behavior, or changing them, or mastering new actions. He made the main emphasis on the external sides of the psyche, and not on internal phenomena. The main method of study has remained introspection, which allows you to find out how the individual develops awareness of the activity in which he indulges.
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LECTURE 6. DOCTOR'S COMMUNICATION AND BEHAVIOR
Psychological aspects of communication between doctor and patient.
Socio-psychological portrait of a doctor's personality.
Features of the patient's personality.
To become a doctor, one must be an impeccable person. It is necessary not only to be able to adhere to such ethical categories as duty, conscience, justice, love for a person, but also to understand people, to have knowledge in the field of psychology. Without this, there can be no question of the effectiveness of demonological influence on the patient.
Often the question 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 inborn psychologists who have become them mainly intuitively, thanks to their personal moral and ethical qualities. However, it by no means follows from this that in order to communicate with the patient, it is not enough to have only intuition or experience. In addition, the doctor also needs special training. It is known that the profession of a doctor has certain psychological characteristics. The doctor cannot dogmatically adhere to certain postulates and instructions, not only from the point of view of the nature of the course of the disease, but also from the point of view of psychological and other factors and the causes of its occurrence. Every 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 the work of doctors 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 the doctor's work. In fact, not everyone is capable of this work, therefore, when choosing the profession of a doctor, professional orientation is important.
It is impossible to become a good doctor without love for your work, for a sick person. A doctor who is indifferent to the patient, to people, 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 activity, 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 the process of human interaction. 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, treatment and diagnostic methods are inextricably intertwined with personal relationships. Therefore, it is so important to study the moral and psychological aspects of the doctor's work. The communicative competence of a doctor is based on knowledge and sensory experience, the ability to navigate in situations of professional communication, understanding of motives, intentions, behavioral strategies, frustration of both his own and communication partners, the level of mastering the technology and psychotechnics of communication.
Competence in the implementation of perceptual, communicative and interactive functions of communication;
Competence in the implementation, first of all, of subject-subject interaction with communication partners (it is clear that communication is by the type of orders, orders, instructions, requirements, etc.) (subject-object model of interaction) must also be mastered;
Competence in solving both productive and reproductive tasks of communication;
Competence in the implementation of both behavioral, operational-instrumental, and personal, deep levels of communication.
The determining side of the communicative competence of a doctor in modern conditions is the competence in the subject - subjective communication, in the decision production tasks, in mastering the deep, personal level communication with other people.
In the structure of the communicative competence of a doctor, we single out:
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 features of one's own communicative style; background knowledge, that is, general cultural competence, which, not having a direct relationship to professional communication, allows you to catch, understand hidden hints, associations, etc., that is, to make understanding more emotional, deep personal; creative thinking, as a result of which communication acts as a kind of social creativity);
The conative component (general and specific communication skills that allow you to successfully establish contact with the interlocutor, adequately cognize his internal states, manage the situation of interaction with him, apply constructive strategies of behavior in conflict situations; speech culture; expressive skills that provide adequate expression of mimic-pantomime accompaniment, perceptual-reflexive skills that provide an 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 evaluating and, especially, disciplining);
Emotional component (humanistic attitude to communication, interest in another person, readiness to enter into personal, dialogic relations with her, interest in one's own inner world; developed empathy and reflection; a high level of identification with professional and social roles; positive I - concept; psycho-emotional states adequate to the requirements of professional activity).
Here are the main communication skills required in the practice of a doctor:
1. the ability to communicate with the patient;
2. ability to manage their 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 inner world of the patient;
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 the components of one's activity 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 prejudice, over-criticism. Based on the above, let us pose a problematic question: what should a doctor of the 21st century be like, what is his professionalism?
2. Socio-psychological portrait of a doctor's personality
Professional qualities of a doctor's personality:
Professional training of a doctor, the presence of a set of all professional skills and abilities.
Psychological preparation of the doctor. The specificity and complexity of this training lies in the fact that the doctor must have a deep knowledge of psychology and related scientific disciplines.
The professionalism of a doctor 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, home improvement, etc. A lot is required of a doctor, he is responsible for a lot, but he himself is largely defenseless : society represented by the state does not adequately provide worthy and necessary conditions life. This applies to both material and legal, social security of a professional. But, despite the different living and working conditions, despite the individual personal characteristics of specialists, the profession of a doctor has significant professional values that should be present in his 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, in the full sense of the word, doctor.
The profession of a doctor is a unique profession that must contain a set of such characteristics: a constant desire for self-improvement, vast practical experience, knowledge of the specifics of this activity, the ability to work as a doctor, and knowledge of the prospects for the development of the medical industry.
We single out 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, adherence to principles, disinterestedness, ability to keep one's word.
2. Communicative qualities of a doctor: personal attractiveness, politeness, respect for others, willingness to help, authority, tact, attentiveness, observation, being a good conversationalist, sociability, accessibility of contacts, trust in others.
3. Volitional qualities of a doctor: self-confidence, endurance, risk-taking, courage, independence, restraint, poise, determination, initiative, independence, self-organization, perseverance, purposefulness.
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 predetermined, 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 mutual influence of two equal subjects - the doctor and the patient is carried out. An indicator of the effectiveness of such mutual influence is the predominance of positive aesthetic feelings, humanity, and creativity. The doctor must have certain qualities that contribute to the effectiveness of the doctor. First of all, it is the ability to control oneself, to control one's behavior. It is quite clear that the doctor needs to be prepared for this.
We will offer a few rules for optimizing the doctor's communication with patient which will optimize the treatment process:
1. Greet the patient cheerful, confident, energetic.
2. The general feeling in the initial period of communication with the patient is vigorous, productive, confident.
3. There is a communicative mood: the readiness for communication is pronounced.
4. When communicating with the patient, an appropriate positive emotional mood is created.
5. Manage your own well-being (smooth emotional mood, the ability to manage well-being, despite adverse circumstances, etc.).
6. Achieve communication performance.
7. Speech should not be oversaturated with medical terms.
8. Expressive facial expressions are emotionally expedient, that is, they must correspond to the emotional state of the patient.
Great importance should be given to the well-being of the doctor. It is not a personal matter for the doctor, because his mood is reflected both in the patient and in his work colleagues, which creates a certain atmosphere in the treatment process. To achieve such an optimal internal state is extremely difficult, since to some extent the work of a doctor has aspects of routine.
The doctor must be able to maintain efficiency, master 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, decisive.
The activity of a doctor should be based on a positive emotional attitude towards himself, his patients, and his work in general. It is positive emotions that activate, inspire the doctor, give him confidence, cause a feeling of joy, positively affect relationships with patients and work colleagues. And negative emotions, on the contrary, inhibit activity, disorganize behavior and activity, cause anxiety, fear, and suspicion in the patient.
A doctor needs to be able to play like an actor, and not only from the outside.
The facial expression of the doctor should be friendly not only in order to tune in to a good mood, but also to change the methods of behavior. Therefore, a doctor should not walk in front of patients with a gloomy, bored face, even when his mood is bad. If, nevertheless, a bad mood does not leave you, you should force yourself to smile, hold back a smile for a few minutes and think about something pleasant.
In addition to the fact that the doctor must be in control of his internal state, he must be able to control his body, which clearly reflects the internal state, thoughts, feelings. The elements of the doctor's external technique are verbal (speech) and non-verbal means. It is through them that the doctor discovers his intentions, it is through them that the patients “read” and understand.
The appearance of the doctor should be aesthetically expressive. You can't be careless about your appearance. The main requirement for clothing is modesty and elegance. Aesthetic expressiveness is also manifested in the friendliness and friendliness of the doctor's face, in composure, restraint of movements, in a stingy, justified gesture, in posture, gait. Fussiness, artificiality of gestures, their flabbiness are unacceptable. Even in how to receive a patient, look at him, say hello, how to push a chair, there is a power of influence. In movements, gestures, look, the patient should feel restrained strength, complete self-confidence and a benevolent attitude.
Body plasticity, or pantomime, allows you to highlight the main thing in the appearance of a doctor, draws his perfect image. The effectiveness of communication is helped by open postures and gestures of the doctor: do not cross your arms, look into the patient's face, reduce the distance, which creates an effect of trust.
The facial expression of the doctor affects patients the most, sometimes even more than his word. It is gestures and facial expressions that increase the emotional significance of information. Patients "read" from the doctor's face, remembering his attitude, mood, so the face should not only express, but also hide some feelings: you should not transfer the burden of household chores and troubles to the patient. It should be shown on the face and in gestures that which concerns the case, contributes to the treatment.
The facial expression of the doctor should always correspond to the nature of the speech when talking with the patient. The doctor's face should express confidence, approval, dissatisfaction, condemnation, joy, interest, enthusiasm, that is, express a wide range of emotions, which indicates the moral strength of the doctor's personality.
The doctor in his professional activity must reach the pinnacle of communication skills, namely, the possession of his own body and the ability to influence the patient, the power of his body. Here the doctor can come to the aid of biomechanics - the science of the formation of motor coordination of behavior, the ability to control one's body, which was developed by the Czech theater director Meyerhold. Its final task is to subordinate its motor behavior to the expression of a certain effect on the patient, to make it automatic, to turn it into a perfect technique of communication, an internal need.
An important basis for a number of professionally important qualities of a doctor's personality is emotional stability, anxiety, and a propensity for risk are features of neurodynamics.
For professional psychology, it is very important that the features 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 in activity, etc. For individuals with very high strength indicators nervous system increased likelihood of establishing inflexible, inappropriately high self-esteem.
Emotional stability as the ability to maintain optimal performance under the influence of 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, professionally significant in many types of activities, which are noted in many types of regular professional activities. A similar relationship is most often observed between the success of activities and emotional stability. In many activities, emotionality is important - the integral ability to emotional experiences. Particularly serious requirements for this area are made by professions that require high emotionality and at the same time emotional stability, for example, the activity of a doctor.
The property of extra-introversion is considered to be professionally important, first of all, for group activities or professions related to communication, working with people. But this quality can also be important for individual work. There is some evidence that introversion is associated with higher levels of cortical activation at rest, so introverts prefer activities that avoid excessive external stimulation. Extroverts strive for external stimulation, prefer activities that enable additional movements, emotional and motivational support. It is known that introverts are more resistant to monotonous work, better cope with work that requires increased vigilance and accuracy. At the same time, in stressful work situations, they show a greater propensity for anxious reactions, which negatively affect the success of their activities. Extroverts, on the other hand, are less accurate, but better oriented in stressful work situations. In group work, it is necessary to take into account the greater suggestibility and conformity of extroverts.
Responsibility is most often mentioned as a universal, professionally important quality among personal qualities. Responsibility is considered as one of the properties that characterize the orientation of the doctor's personality, affect the process and results of professional activity, primarily through the attitude to their work duties and in their professional qualities.
Most other personal qualities are more specific and important only for certain types of professional activities. Summing up 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.
The abilities of a doctor are usually considered as individual personality traits that contribute to the successful implementation of his activities.
Two large groups of special abilities of a doctor can be distinguished:
1. perceptual-reflexive (perception - perception) abilities that determine the possibility of the doctor's penetration into the individual identity of the patient's personality and understanding him (these abilities are leading);
2. projective abilities associated with the ability to act on another person, on the patient.
Among them, the main ones are:
1. The ability to correctly assess the internal state of the patient, sympathize, empathize with him (the ability to empathize).
2. The ability to be an example for those who are being treated, in thoughts, feelings and actions.
3. Ability to adapt to the individual characteristics of the patient.
4. The ability to instill confidence in the patient, to calm him down.
5. The ability to find the right style of communication with everyone, to achieve his location and mutual understanding.
6. The ability to earn respect from the patient, to enjoy (informally) his recognition, to have authority among those who are being treated.
3. Patient personality traits
The personal characteristics of the patient include the following qualities: temperament, character, abilities, intellect, etc. The doctor must take into account all these groups of properties when establishing psychological contact with the patient.
Different types of patients come to see a doctor. The doctor sometimes does not know about his personality and, as a result, may not be prepared to meet him. Subconsciously, the doctor always tunes in to the image of the “ideal patient”. This term is sometimes used to refer to such patients who consciously came to be cured of the disease, they have no doubts about their strengths and skills as a doctor, a willingness to fulfill all the doctor's prescriptions, the ability to briefly state their problems and complaints, and little awareness in 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 in treatment. Therefore, the doctor needs to take into account all the characteristics of the patient's personality for effective formation contact with him.
Patients vary in their personal characteristics. Let's consider them.
External patients tend to be more outside world, which 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 ailments and illnesses. Such patients usually show aggression and anger, both to the doctor and to other patients. The main tactic that a doctor should use is, first of all, establishing emotional contact with such patients, and only then moving on to the informational aspects of the conversation.
Patients-internals. For them, their inner world, their experiences, are of greater interest, and the external environment is not essential. Such patients are “closed in themselves”, uncommunicative, they are never bored with themselves, it is difficult to adapt to changes in the external environment, they are prone to introspection, and a mistrustful-skeptical type of communication prevails. For internals, there are no trifles in their health. They lay the blame for their lost health only on themselves and lay responsibility for the events in their lives only on themselves. Such patients are extremely responsible, executive, demanding both to themselves and to the doctor. Therefore, the doctor, while working with such patients, should discuss all issues in as much detail as possible, otherwise the patient may experience a feeling of anxiety. There is no need to economize on time by conducting a consultation, because the pace of thinking of internals is slow. The doctor must come to terms with this and be patient, calm. In this case, the tactics with the patient should be opposite to those previously given, namely: contact with such a patient should begin with a neutral, informational contact, and only then form a positive emotional attitude towards the doctor.
There are some prerequisites for creating a certain relationship between the doctor and the patient, which are in place 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 health care in general and the medical institution where the patient comes is also important. The tension, dissatisfaction and anger of the patient, who was forced to get to the doctor by uncomfortable transport and wait a long time in the waiting room until his turn comes, 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 in the image of a doctor generalized personal experience interactions with authoritarian persons for him at different periods of life. Theoretical foundations in the field of the relationship between the doctor and the patient were developed by 3. Freud in his concept of "transfer" ("transfer"). 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 relationships once prevailed during the patient's contact with the father, in the actual attitude towards the doctor, the trend is either negative (hostile) or positive (feeling of love, trust). In the opposite direction there is an "anti-transfer" ("countertransfer").
This is currently the original understanding 3. Freud is considered too narrow and artificial, but sometimes rational, which indicates 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, it can be grandparents, uncles and aunts, brothers and sisters, teachers, close friends. And not only in the relationship with the doctor, but in every new contact that occurs between people, it makes sense to think about why someone whom we, quite likely, see for the first time in our lives, causes us quite expressive feelings of like or dislike, who from our past than they resemble. If we keep in mind such a "burden of the past", it can help us to more realistically understand and deal with situations related to relationships with other people.
In this context, it is worth mentioning also the possibility of action "transfer aesthetic stereotype. Namely, what beautiful people rather cause sympathy and trust, ordinary - rather antipathy and uncertainty. This element traditionally appears already in fairy tales in the figures of an ugly witch and a handsome prince. The concept of beauty is associated with good qualities, disgrace - with evil. Although this prediction is unfounded, it subconsciously has a rather strong effect: a seemingly attractive patient makes the doctor more sympathetic, even if in reality he requires less help than the patient, which excites his appearance antipathy. Conversely, a doctor who acts aesthetically positive 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 a better psychological contact between the two of them.
The doctor will gain the patient's trust if he, as a harmonious personality, is calm and confident, but not haughty, and if his demeanor is quick, stubborn and decisive, which is accompanied by human participation and delicacy. When making a serious decision, the doctor must imagine the results of it for the health and life of the patient, and thereby strengthen in himself a sense of responsibility. The need to be patient and self-controlled makes special demands on him. He must always consider the various possibilities of the development of the disease and not consider ingratitude, unwillingness, 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 in the work of a doctor with the necessary determination, composure, optimism, critical attitude and modesty. 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 do not tolerate humor even with good intentions and understand it as disrespect and humiliation of their dignity.
The balanced personality of the doctor is for the patient a complex of harmonic external stimuli, the influence of which takes part in his recovery. The doctor must educate and shape his personality, Firstly, observing the reaction to his behavior directly (by talking, evaluating facial expressions, gestures of the patient), and, secondly, indirectly, when he learns about his behavior from his colleagues. The colleague himself can also help his colleagues direct their behavior.
There are facts when people with unbalanced, uncertain 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 taken for granted.
A young doctor, about whom patients know that he has less life experience and less qualifications, is at a disadvantage compared to his older colleagues, but he will be helped by the realization that this shortcoming 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. Trust is a key component of the patient-physician relationship. But the acquisition of trust does not follow only from the psychological side of the relationship between the doctor and the patient, but also has a broader, social side. The doctor can win the patient's trust and establish a mostly positive relationship with him if he satisfies his unreasonable demands for treatment. He can contribute to this so that patients will turn to him and "confidence" in him will increase. The development of such relations, of course, follows from the mutual satisfaction of interests on the one hand of the doctor, on the other hand, of the patients, who can do some service to the doctor, for example, using their profession (repairmen, artisans, employees of the distribution network, etc.). If there are too many such cases, then the current and actually necessary examination and treatment of all patients suffers, which should be carried out according to their disease, and not social status or opportunities.
In practice, a psychological problem arises when 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 try to gradually win the patient's trust with calmness and understanding. Thus, we create the correct experience, that is, the negative manifestations of the patient should be corrected with the help of their own positive manifestations, for example, patience, tact and tolerance. And, on the contrary, the stereotypical, until now, unfortunately, often spontaneous, "natural" reaction - anger for anger, irony for irony, helplessness for helplessness, depression for depression - reinforces the "sinful" and problematic attitude of the patient and the possibility of conflicts, misunderstandings are growing. Such behavior can be characterized by the expression: "pour oil on the fire." At the same time, it is precisely such a “natural” reaction that is a waste of time, while the opposite approach, that is, accepting a person as he is, saves the time of 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 as a result of 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, these patients have an anxious personality type. They are cowardly, submissive, unsure of themselves, during diagnostic and therapeutic procedures they can lose consciousness, various vegetovascular reactions occur. In dealing with this type of patients, 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 about the treatment process, with caution. Before agreeing with the doctor, they will think it over a hundred times, and then they will 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 distrust and alienation of the patient.
Patient offers. This type of patient is trying to get the attention of 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, exaggerates the description of his complaints. While working with such a patient, the doctor must give the patient a certain amount of recognition of his "heroism", the stability of his character.
Depressed patient. Such a patient is depressed, isolated from others, refuses to talk with other patients and staff, poorly reveals his inner world. He is extremely pessimistic because he has lost faith in the success of treatment and recovery. Effective advice for the doctor is his optimism, faith in the recovery of the patient, which are of great importance to him; it is worth involving him in the care of other patients, performing simple tasks for him.
neurotic patient. This type of patient is overly attentive to his health, is interested in the analyzes of all laboratory tests, unreasonably assumes the presence of a wide variety of diseases, and reads special literature. When communicating with such a patient, the main thing is to keep a distance, that is, “not to follow the patient’s lead”, to explain the importance of the treatment process prescribed by the doctor, its effectiveness, by methods of persuasion and suggestion.
To develop the ability to communicate with a patient, in particular a psychotherapeutic approach to him, any doctor needs to have information about his professional type of behavior.
To understand the peculiarities of one's communication capabilities, to help the doctor see himself "through the eyes of the patient", gives personality classification doctors for I. Hardy (1973).
Robot doctor. For his activities, the most characteristic is the mechanical performance of his duties. These doctors are meticulous, technically well-qualified, and carry out all orders accurately. However, working strictly according to the instructions, they do not put psychological content into their work. Such a doctor works like an automaton, he perceives the patient as a necessary supplement to the instructions for his care, their relationship with patients is devoid of emotional sympathy and empathy. They do everything, letting 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.
Soldier doctor. This type of doctor is well served in popular comedies. Patients already from afar learn about him by his gait or loud voice, quickly trying to organize their bedside tables and beds. This doctor is resolute, uncompromising, persistent, instantly reacts to the slightest violations of "discipline". With insufficient culture, education, 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 physician ("mother" and "doctor"). He transfers his warm family relationships to work with patients or compensates for their absence in his work. Working with the sick, taking care of them is an essential condition of life for him. He has a good command of empathy, the ability to empathize.
Medical expert. ego doctor - narrow specialist. Due to the high need for professional recognition, he shows a special curiosity in a certain area of professional activity and is proud of his importance in his industry, where sometimes he even “overshadows” 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, they are not interested in anything except work.
"Nervous Doctor". This type of unprofessional behavior of a doctor should not be in a medical institution and indicates a poor-quality professional selection of personnel, errors in the work of the administration. Emotionally unstable, quick-tempered, irritable, he constantly gives neurotic reactions, is inclined to discuss personal problems and can become a serious obstacle in the work of a medical institution. A "nervous doctor" is either a pathological person or a person suffering from a neurosis. Such people themselves often 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 himself must clearly define his professional goals, develop an adequate style of communication with the patient.
Thus, if the main principle in the doctor’s activity is “the patient 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 vocational training, but also in the psychological foundations for therapeutic activities.
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very necessary
THE YOUTH INSTITUTE
As a manuscript
VLSSH Andrey Grigorievich
SHISHOGICHISIE PECULIARITIES OF SHMYSHUNMSHOGO FORMATION OF THE DOCTOR'S PERSONALITY
Specialty - 19.00 "II - personality psychology 13.00.01 - theory and history of pedagogy
Moscow - 1993
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The work was carried out at the Kaluga State Pedagogical Institute named after K.E. Tsialkovsky.
Supervisor - Candidate of Pedagogical Sciences, Associate Professor Bogdanov Evgeniy Nikolaevich.
Scientific consultant - Doctor of Psychology, Professor Anatoliy Alekseevich Derkach.
Official opponents:.
Doctor of Psychology, Professor Petr Korchemny
Antonovich,
Candidate of Psychological Sciences, Associate Professor Zhmyrikov Alexander
Nikolaevich.
The leading organization is Moscow State University.
The defense will take place in 1993 at 14.30
at a meeting of the specialized council K-I50.0I.04 for the preparation of dissertations for the degree of candidate of psychological sciences at the Institute of Youth at the address: 111442, Yoskva, Yunosti st., 5/1, building 3..
The dissertation can be found in the library of the Youth Institute. *
Scientific secretary of the specialized council, candidate of pedagogical sciences ^ £.KTUR0VA
The urgency of the problem. The growing role of applied psychological research in the period of restructuring the socio-economic structure of society and attitudes towards man, the need to improve the system of professional training of specialists and the problem of retraining a large number of people give particular importance to the study of the professional development of specialists. This is all the more important since it is known that failure vocational training often associated not so much with the actual training, but with the difficulties of professional development. Only a deep understanding of its processes and mechanisms will ensure their effective management.
The study of the problems of professional development and training of Erach shows that the improvement of the quality of their professional growth is characterized by a constant change of extensive and intensive approaches, their mutual transitions. An increase in the content of the necessary caps for practitioners and future doctors of information-theoretical knowledge, professionally significant practical skills and abilities, resulting in an increase in the required time for mastering knowledge, as well as a decrease in the amount of time spent on rehabilitation activities lead to a drop in the effectiveness of training -educational process in a medical university, professional activities of doctors, not from significant positive changes^ □ improving the quality of training of specialists. Researchers note the formalism of the insights of students, practitioners, and the need to apply them in specific situations, poor mastery of basic functions.
Thus, the main contradiction has matured to replace the demands made by society on present stage its development to the level of activity (the degree of mastery of professional and practical actions) of doctors, and the actual practice of its functional training. To remove this contradiction, it is necessary to resolve the problem of intensifying the process of professional development of doctors.
As the analysis of complaints received by the health authorities on the quality of the work of medical institutions shows, they are more often associated with the personal qualities of "" the professional skills of doctors and other medical workers, most often appears 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, most of all 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 is, first of all, a real, very acute socio-economic and psychological problem. Obviously, in this regard, the question of the appropriate improvement of the professional development of the doctor's personality is of particular importance.
So, the sharpness of real contradictions, “as well as the theoretical and practical undevelopedness of these issues, allow us to formulate the research problem: what are the psychological features of the professional development of a doctor's personality?
The purpose of the study is to investigate personal characteristics, the level of development of professionally significant, typological personality traits and the psychological readiness of a doctor for professional activity, the conditions and factors that ensure its productivity.
Object of study - the main psychological characteristics personality and professional activities of a doctor, their development and relationship at different stages of professional development. ,
The subject of the study is the psychological features of the process of professional development of a doctor's personality.
Research hypothesis. The success of the professional development of a doctor is determined not only by the degree of complexity of the profession itself, but also by the formation 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, skills, and necessary personal qualities that determine the productivity of the doctor's professional maturity ...
Research objectives:
I) to develop a critical review of the existing ideas in psychology about the activity-mediated development of the personality and the professional development of a specialist;
2) to analyze the psychology of personality, substantiate psychological structure and sodrr.chmnia professional activities of a doctor;
3) identify the conditions and factors for the productive professional development of a doctor: the formation of a professional orientation, professional aspirations, professional consciousness, authority, professional creativity and his experience creative activity;
The methodological basis of the study was: 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 continuing education, modern socio-psychological theories, methodology active methods learning. When studying the problem, methodological and philosophical literature, relevant state documents, general and special scientific literature of domestic and foreign authors, and the current press were used.
The theoretical basis of the study was the work that reveals the basic principles of applying a systematic approach (P.K. Anokhin, N.V. Kuzmina, V.I. Sadovsky, A.I. Uemov, etc.); personal approach (K.A. Abulkhanova-Slavskaya, L.I. Bozhovich, A.I. Kovalev, A.N. Leontiev, A.V. Petrovsky, A.U. Kharash and others); conditions for the manifestation and development of the creative potential of the individual, issues of optimizing the activities of personnel (Yu.K. Babansky, A.A. Derkach, I.A.Z:! M-nya, Ya.A. Ponomarev, etc.); concepts of social perception (A.A. Bodalev, V.A. Labunskaya); theory of relations (A.A. Bodalev, V.N. Myasishchev, E.B. Starovoygenko); value orientation (E.N. Bogdanov, O.I. Zotova, I.S. Kon, A.I. Krupiov, V.V. Stolkn, A.3. Petrovsky); social return of the individual (.. A. Abulkhanova-Slavskaya, A. A. Kokorev, V. G. Krksko, R. G. Gurova). Considering the slec;f-;ku of the object of research, the works that reveal the psychology of the personality and work of a doctor (A.P. Gromov, I.N. PURVich, Y.I.! $u-kova, A.M. Izutkin, B.D. Karvasarsky, V.P. Petlenko, G.N.
rodtsev, etc.), as well as foreign studies: R.N.
In accordance with the dialectical logic that prescribes to study all life processes in the unity of the general, particular and singular, the "I - concept" was adopted as a methodological construct in the study of the psychology of the personality of a doctor and his professional development. This made it possible to implement a holistic approach in the analysis of the psychological structure of the personality, as well as to focus on the subjective activity of doctors, i.e. to represent the dialectical relationship of general and specific human properties at the experimental level and theoretical interpretation.
Research methods. The work used a set of methods for the preparation and organization of the study (theoretical analysis of the literature on the problem; generalization of domestic and foreign work experience; system-structural analysis; modeling); in order to collect information (questionnaire; press survey; interview; conversation; observation; content analysis; expert assessment and self-assessment; scaling; psychodiagnostic methods; rating); for processing and interpreting data (mathematical processing on the ESh - SM 1420 according to the program, including the calculation of the mean values of features; correlation, factorial and cluster analysis of variance).
The sample of the study was 200 people, incl. 680 doctors and 1300 patients of Donbass.
Reliability and authenticity scientific results and conclusions is provided by the clarity of the initial methodological portions, a set of methods adequate to the goals, objectives and subject of the study, confirmed experimentally.
Scientific novelty and theoretical significance of the study.
It has been established that among the psychological characteristics of the personality of doctors that determine their phenomenology, one can include: self, criticality; unexpressed positivity of the integral "I", self-respect, self-sympathy; orientation towards a positive attitude towards others; high level of self-interest; average level of sociability; emotional stability and endurance; adequate self-assessment and realism; average level of credulity, etc. -
The self-concept of physicians is generally positive and tends to increase in positivity with length of service. The level of positivity in the views of rural and urban doctors is based on different centroci. In the first eye, it is provided with more effective components of one's "I" (attitudes and expectations of a positive attitude towards others, self-acceptance, self-interest, self-esteem, etc.). City doctors, on the other hand, support self-consistency, self-respect, self-interest, self-accusation, etc., ie. cognitive and behavioral components of the "I" image.
A system-structural approach to the study of the personality and professional activity of a doctor has been implemented. Factor analysis of personal characteristics and the level of implementation of the components of professional activity by doctors made it possible to identify the states of psychological readiness of the personality of doctors and indicators of the effectiveness of their professional activities. In all 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 psychological involvement of the doctor in professional activities.
The professional readiness of srach as an integral quality, reflecting the emotionally positive attitude to the activity and the state of the doctor's adaptation to professional activity, was substantiated, which, in turn, made it possible to single out. system of indicators" (professional interest, professional self-awareness, professional vocation, professional orientation, authority) and to develop diagnostic methods that allow fixing external and internal (psychological) dominant manifestations of readiness.
The process of formation of readiness is considered as the goal of optimizing the professional development of a doctor. It has been found that such personality traits of an authoritative doctor as attentiveness, kindness, interest in one's business, fairness, and a generally high cultural level have a positive effect on patients. It has been established that the personal and professional properties of a doctor and his professional skills are the basis of his authority. In the course of the study, data were obtained on a high assessment by patients of the ability of an authoritative doctor
take into account the psychological characteristics of patients. It was found that the self-esteem of reputable doctors is adequate, but somewhat underestimated, and the self-esteem of non-authoritative doctors tends to be overestimated.
The expediency and effectiveness of the implementation of certain psychological and pedagogical conditions for the formation of individual experience of creative activity among doctors is proved. 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, strengthen1 the desire of the individual for self-development and self-improvement, and create prerequisites for the formation and development of an integral personality of a new type of doctor. In addition, the acquired experience of creative activity will significantly improve the preparation of doctors for their future professional activities. The results obtained create a scientific and psychological basis for determining the prospects in the development of the psychology of the personality of a doctor, and are also the contribution of a new psychological direction ecmeology - development of productive models of doctors of various specialties, optimization of their professional training.
The practical significance of the work. The results of the study can become theoretical guidelines in the implementation of a number of practical tasks: compiling a doctor's qualification; assessment and certification of a doctor; consulting a doctor in case of difficulties; building a program of self-education and self-education of individual doctors and a team of doctors; determining the forms, methods and content of advanced training of doctors and the implementation of their continuous education.
Research materials can be used in vocational guidance 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, psychology of the Kaluga Pedagogical Institute. The dissertation material was presented at the Scientific and Practical Regional Conference on the Problems of Restructuring Professional Activities (Lugansk, T991), psychological readings of the Russian Academy of Management (1992). Dissertation materials
Provisions for protection.
The state of the doctor's psychological readiness for professional activity is determined by the basic (in particular, characterological) and programming (motivational and intellectual) properties of the personality, with the leading role of the active-positive attitude of the individual towards himself as a specialist, reflecting the formation of self-consciousness.
The structure of professional self-knowledge of doctors with positive attitude to the profession of a doctor (high, medium, low levels) is characterized by integrity and fully connectedness.
The interaction of procedural and content 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 - volitional substructures (middle level); 3) in the partial development of cognitive and emotional substructures (low level); 4) in the partial development of cognitive (very low level).
The formation of professional aspects of the "I-image" in the course of professional activity and self-education is ensured by developing the doctor's ability for self-observation, reflection, introspection and self-control in the process of modeling professional situations, including methods of direct and indirect knowledge of one's own activity.
An indicator of the development of a doctor's professional self-knowledge is his ability to adequately and differentiatedly realize his own actions in accordance with the normative model of his professional activity.
The defining feature of the professional orientation of the personality of a doctor is wildness, i.e. its ability to over-rebuild based on internal conditions. The main condition is the professional activity of the doctor. The level of a doctor's professional activity is determined by a number of factors: the dominant connection between professional orientation and Gnostic,
kativnshi and reflexive skills and emotional qualities of the individual; a positive emotional background of the process of professional activity, in which overall satisfaction with work is due to satisfaction with the content of work, results, and the process of activity itself; the presence of a developed motivation for activity at all stages of professional self-determination and the formation of authority (when choosing a profession, when mastering it, when assessing a professional perspective).
Assimilation by doctors of knowledge about the specifics of the activity and characteristics of their personality from the position of professional orientation allows to form an adequate idea of the professional activity of a doctor, the requirements for his personality and professional skills. professional excellence- this is a concentrated indicator of the personal-activity essence of a doctor, due to the measure of realization of his professional and civic maturity, responsibility and professional duty. It consists of a combination of general cultural, special and psychological knowledge, skills in high level productivity to solve professional problems.
The developed methodology for a comprehensive study of the individual characteristics of the personality of doctors allows for the differential diagnosis of their psychological readiness for professional activity and creative development.
Readiness for professional creativity is an important 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, predictive ability, cyproeization, technological innovation.
The step-by-step nature of the formation of the experience of creative activity, arising from the essence and dynamics of its formation, makes it possible to ensure timely correction 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 affect the intensity and quality of the process of forming the experience of his creative activity.
At each stage of the professional development of a doctor, conditions are created for his creative professional self-expression. External conditions include a professional orientation to the development of readiness for professional creativity, orientation this process on the individuality of the doctor, taking into account professional claims, the need for self-knowledge, self-discipline, self-affirmation and self-creation in all types of his work.
Internal conditions (that is, depending on the doctor himself) include: a) idiv: 1 dual features of memory, imagination, thinking; b) enpathy that arose on the basis of emotional identifications with the personality of the patient and the medical team; c) komu-nipativity and! * the culture of communication; d) the ability to self-control and evaluate one's activities, predictability as a way of selling the results of one's activities.
Dissertation structure. It is determined by the tasks and logic of the study and consists of an introduction, 2 chapters, conclusion, literature and applications.
Basic sode.saanke disseortation
About the starting point in the study of the problem of the psychology of the doctor's personality, as well as the conditions for its formation and the perfection of seniya, we took the methodological characteristics of the subject of personality psychology, given by Leontiev A.N. (1987). From this point of view, the perspective of a person is researched from the place of a person-yae, behind him; temperament traits, other typological properties, acquired skills, kaedya, etc.). That for refers l to the external gaping gap, and obg ^ ktistp.-! rewards to satisfy human needs.
Deploying Survey Description Methodol
personal honors; 3) the study of the typological properties of the personality; 4) study of the motivational foundations and psychological involvement of doctors in professional activities.
Secondly, specific conditions were identified that ensure the professional development of the doctor's personality: the formation of a professional orientation, professional interest, professional vocation, authority and experience of his creative activity.
The general characteristic of the structure of activity serves as the basis for the study of the professional activity of the doctor's personality.
Professional medical activity usually consists of diagnostic, therapeutic and preventive activities (according to V.P. Andronov, 1992). Diagnostic activity includes the following actions and operations: drawing up a plan for examining a patient, taking into account the necessary and sufficient amount of data obtained and the optimal sequence of examination activities; collection, analysis and evaluation of anamnestic data; selection and implementation of adequate and gentle examination methods; analysis and evaluation of data from clinical, laboratory and instrumental methods of examination, etc. Medical activities include: providing first aid in case of emergency; determination of indications for emergency surgical or therapeutic intervention; drawing up a treatment plan; determination of treatment tactics and a complex of therapeutic measures; determination of indications and contraindications for various methods and methods of treatment, etc. Preventive activities include: the identification and elimination of pathogenic factors of the environment and the human body, the implementation of preventive and recreational measures, medical examination, etc.
In general, medical activity corresponds to the following logic: identification of the syndrome and symptoms - identification of the most important anutrisivdromic symptoms - identification of the general pathological process - determination of the etiology and nature of this pathological process - differential diagnosis of similar nosological units - diagnosis of a specific nosological unit - determination of treatment tactics - treatment - implementation of preventive measures .
Professional medical activity is mediated by the doctor's professional thinking. Therefore, professional medical thinking should be considered as an ideal reproduction of real medical activity, i.e. diagnosis, treatment and prevention of diseases.
The doctor in his clinical activity primarily solves all professional problems. The most common types of professional medical tasks are: differential diagnostic, therapeutic (defining strategies and choice of therapeutic tactics), preventive (building a plan of preventive measures), analysis of diagnostic and therapeutic and tactical errors.
The content of professional activity is determined by the very specifics of the medical profession, which provides for interactions built on the subject-subject relationship. Moreover, the nature of these relationships, the development of which the doctor must manage, is built in such a way as to maximize the mobilization of the patient's internal resources, strength and will for a successful recovery, without which it is extremely difficult to carry out the treatment process.
Describing the structure of pedagogical activity, N.V. Kuzmina (1967) singled out five components: gnostic, design, constructive, communicative, organizational. The named components can be attributed to almost any other profession. They are part of the activities of a juener, an agronomist, a doctor, a researcher. With regard to the profession of a doctor, the most felt component of activity is gnostic skills.
The need for an in-depth study of the dependence of professional skill on the personal characteristics of a specialist, the insufficient development of this issue of psychological science made it possible to pose the following research problem - improving the professionalism and increasing the level of productivity of a doctor based on the development of personality traits of a doctor that determine his skill.
In the study of the professionally important properties of the personality of doctors, we proceeded from the fact that the doctor acts as an integral person, however, his professional activity imposes a number of specific requirements on him, forcing him to develop certain personal qualities as a professionally significant person.
chimy. The complex of such professional and personal qualities is quite wide. In addition, in different studies, various concentrations are revealed, depending on the whole and the tasks that were set in them.
It is noteworthy that many authors of scientific publications on the problem of the personality of a doctor (A.P. Gromov, )988; I.N. Gurvich, 1981; 11.I. Zhukova, 1990, etc.) the levels of development of the studied personality traits of doctors are associated with indicators of the most complex process of their socialization, which allow them to successfully fulfill their social role.
Based on the purpose of this study, we limited ourselves to studying and analyzing the level of manifestation of those personal qualities and properties of a doctor, which, being social in nature, most adequately reflect his psychology as a professional. The typological properties of the personality of doctors were also examined. At the same time, the whole complex of typological properties of the doctor's personality was not studied, but those that characterize their individuality in a professional way, and at the same time have a significant impact on the manifestation of their psychology, were examined. Thus, the results of a study of doctors' self-attitude gave certain assumptions about the content of doctors' ideas about themselves, which are then transformed into affective and behavioral components of the personality.
Significant differences in the integral "I" are found between rural and urban doctors (p/.0.1). Rural doctors have a lower integral feeling "for" their "I" than urban doctors. An analysis of this situation leads us, first of all, to the social nature of the "I" of the doctor.
It is noteworthy that doctors with work experience from 5 to 10 years showed lower “for” their “I” than doctors with experience - work up to 5 years (p. ^ 0.1), They are expressed in terms of 11.0 and 10.7 points. Apparently, the effectiveness of preparing graduates of medical universities for practical work, including the level of psychological preparation, is insufficient. Graduates of medical universities, not receiving the required level of professionalism, project insufficient competence onto their "I", cause a negative trend in self-esteem. It is alarming that this trend is intensifying, the indicators "for" their "I" among doctors with experience
work from 5 to 10 years en\e fall more. It is no coincidence that “it was precisely during this period that the greatest “screening out” of doctors who were disappointed in their choice of profession was observed. A significant part of them begin to engage not in medical work, but in administrative, sanitary and hygienic, etc.
However, it remains to work, he is not an accidental person in medicine, but a doctor by his vocation, who can later become a master of his craft. And indeed, the indicators "for" one's "I", starting with doctors with work experience from 10 to 25 years, are increasing. At the same time, at a significant level (p ^ 0.1), the indicators of doctors with work experience from 5 to 10 years and from 10 to 15 years differ. In the latter, the indicators "for" their "I" are much higher. They are highest for 1 "speech with work experience of 20-25 lots.
It was revealed that the integral "I", self-respect, self-discipline, self-intoros, expected attitude from others incorporate 38 significant correlations of doctors' self-attitude out of 80 available. 42 significant correlations fall on the share of other 7 factors reflecting the level of internal actions in ad-ros of oneself or readiness for such actions.
The level of self-attitude "for" the integral "I" of doctors is generally positive. Of particular importance in maintaining the I-lonception of doctors at a positive level are indicators of the level of self-relationship according to the expected positive attitude of others to themselves, self-interest, self-respect and autosympathy.
Based on the multidimensionality of the self-relationship and the additivity of the global self-relationship, which makes a decisive contribution in general to the doctor's self-concept, we can state the fact that it is maintained at the level of positivity and high levels of expectations and attitudes regarding self-confidence of the guests, expectations of the relationship of others, misunderstanding, self-consistency, self-management and
Understanding the self-concept "as a dynamic totality of attitudes inherent in each individual, aimed at the personality itself", suggests that the doctor's self-concept comes from a positive attitude towards oneself, self-respect, and self-acceptance.
The internal contradictions of the doctor's self-concept are characterized by the interpretation of individual experience, which in its entirety and in the most generalized form is expressed in the doctor's self-assessments, self-relationships.
Self-esteem, positivity of the self-concept of a doctor increases depending on the length of his work. Increased self-esteem and positivity of the self-concept of doctors is associated with the accumulation of work experience. The latter does not mean that over time, the level of claims among doctors loses its significance. However, the emphasis on the success of their work is indicated more clearly, changing the standards and values against which doctors evaluate their success in work, which will be more thoroughly described below, based on the study of the motivational foundations of doctors' activities.
In the case of an increase in the values of the level of claims, with a limited possibility of achieving success, due to some loss of personal and professional competence, as well as a number of other socio-psychological, psycho-physiological reasons, the level of self-esteem and positive self-attitude of doctors decreases, which is confirmed by indicators "for" the integral "I" physicians with over 25 years of experience.
A thorough analysis of the results of doctors' self-attitude shows that the importance of any aspect of doctors' attitudes towards their own personality should not be underestimated. Convincing proof of this is that all components of the integral "I" of doctors are in correlation, and - 9 of II self-relationships at the level of positive (h - 0.01) dependencies. We should not ignore the negative correlation of self-blame with the integral "I" of the doctor (-0.45 at h ■ 0.01).
Among the special factors that affect the manifestation of self-attitude and, in general, the self-concept of a doctor, one can include factors: regional. expressed in the professional competence of the doctor (poor training in medical universities and IUV; backwardness of the material and technical base of polyclinics and hospitals (especially in rural areas); lack of information due to lack of scientific and methodological literature, etc.).
Of the results of the examination of doctors on the 16-factor personality test of R.B. Kettel, the thesis interprets only 10 factors that have a significant impact on the doctor's self-coception.
Interpretation of indicators of doctors depending on the length of service proves that the sociability of doctors is at the level of average marks. However, significant differences in sociability (p< 0,10) между врачами со стажем работы до 5 лет (5,54) и от. 5 до 10 лет (5,7) свидетельствуют о возрастающей аффектомии в первые годы их работы. Вместе с тем, у врачей со стажем работы от 10 до 15 лет устойчивость к аффективным переживаниям возрастает, что выражается в некотором снижении оценок по фактору общительности (5,29). В дальнейшем, с увеличением стажа работы (от 15 до 25 лет), у врачей оценки уровня общительности стабилизируются (5,1), находясь в пределах средних оценок, обеспечивающих устойчивость к вовлечению в состояние аффекта.
Indicators of emotional stability of rural and urban doctors do not differ significantly. At a significantly significant level, there is a decrease in the level of emotional stability of doctors about the dependence on the herd of work: the longer the length of service, the lower the emotional stability becomes, while remaining at the level of average values. This gives us reason to believe that the strength of the "I" of the doctor (although it remains positive) is negatively affected by the increasing psychological involvement in activities, causing a decrease in the threshold of the doctor's mental activation and the accumulation of fatigue. With the increase in work experience, multifaceted and intense professional activity, the ever-increasing social order of society contributes to the fatigue of the neuropsychic sphere of the doctor.
In modern conditions, the doctor has to work at the expense of the reserves of the psyche. Emotional stability, which is additive in nature, is reduced.
Doctors do not lose a sense of self-control, but it should be noted that the preservation of the strength of the "I" and the emotional stability of doctors with a long work experience is achieved through frustration tolerance - accumulated over the years and especially actualized in activity after 15 years of work.
It is noteworthy that in doctors with more than 25 years of experience, the resistance of the individual to the effects of adverse life factors increases. But it is for this group of physicians that their motivational and value orientations are of particular importance.
The personality of a doctor can be formed under the condition of a certain development of each of them: some properties of the personality of doctors, . such as sociability, self-control, social courage, independence determine their behavioral components; others (dominance, gullibility, confidence. - attitudes towards one's "I"; others (emotional stability, social maturity, excitability, tension) - the emotional-volitional components of the I-concept of doctors, etc.
Correlation analysis of professionally significant personality traits and self-attitude of doctors, presented in Table I, also testifies to the additivity of the self-concept.
So, out of 41 identified correlations, 22 are negative and 19 are positive. Based on the results of the correlation analysis, it can be assumed that for a more positive I-koktsesh;:sh the doctor needs: greater strength of the "I" (emotional stability); pronounced independence (dominance); less suspicion (gullibility); a higher level of self-control.
Personal centering in the professional activities of rural and urban doctors in the basis! coincide, with the exception of accentuations on some of them 8 of the process of practical work, namely: on dominance, social maturity, excitability, tension - by rural doctors; sociable, "social courage, trust, confidence and independence - city doctors.
Depending on the length of service, the studied personality traits of doctors also manifest themselves, but equally. So, sociability, emotional stability, dominance, confidence, self-control role, excitability and tension steadily increase up to 15 years of work, and then some of them stabilize and remain practically at the same level (self-control, confidence, etc.); others weaken (emotional stability,
Correlations between self-relationship and professionally significant properties of a doctor's personality
I1) Self-relationships, "Common-1 tel-Emotion-Domi-| Social;
pp: seniority and place! ! nantes-> naya
doctors work! stability 1stability-»-|stability, ness; mature
I. Length of service -0.3 -0.34 -0.04 0.3x
2. Place of work -0.17 0.10 0.45х* 0.16;
3. Integral "Yang 0.05 0.07 -0.25x -0.9
4. Self-esteem -0.04 0.07 -0.21х -0.03
5. Autosympathy 0.07 0.03 0.04 -0.17
6. Expected ratio - 0.23x
difference from others 0.02 0.07 -0.05
7. Self-interest 0.03 -0.09 -0.05 -0.09
8. Self-confidence 0.09 0.16х* -0.11 -0.03
9. Ratio of others -0.03 0.09 -0.25x 0.02
10. Self-acceptance 0.С6 0.01 -0.05 -0.12
II. Sakoposledova - 0.17xx 0.01
Value -0.06 -0.09
12. Self-accusation -0.09 -0.07 0.04 0.14
13. Self and "^ are; 0.04 -0.03 -0.21x -0.11
I "..Sachopokdaaniye 0.03 -0.13*** 0.12 -0.07
j) ¿- = 0.01; xx) c = 0.05;
"Social-!Doeer-"UEV- -Self-Self- "Excitable |chivo-!ren-"standing-"kont-) bridge,! ¡|| st 1 (st
0.06 0.04 0.15хх -0.01 -0.05 -0.44х
0.21 0.53 0.34 -0.46 0.02 0.19х
0.09 0.29 -0.11 0.04 0.13xxx 0.01
0,02 -0,23 -0,04 -0,11 0,26 0,04
0.09 -0.04 -0.25х -0.02 0.06 0.15хх
0,10 -0,23 -0,13 0,12 0,08 -0,01^
0.04 -0.06 -0.01 -0.06 -0.04x o, uhh
0.04 -0.15 0.09 -0.11 0.31x 0.15xx
0.06 -0.23x_0.03 -0.02 0.24x 0.01
0.10 -0.12 -0.21х 0.01 0.11 0.11
0,04 -0,10 0,12 -0,16 0,12 0,06
0,11 0,11 0,13 -0,07 0,07 -0,10
0.03 -0.21х-0.10 0.16 -0.04 -0.05
0.06 -0.14xxx 0.06 0.01 0.07 -0.03
XXX; c "3 \u003d OD.
excitability, tension, dominance); the third - again manifest themselves in even greater meanings (consciousness, social courage, independence).
Among the features of the psychology of the personality of doctors, which determine their phenomenology, are: the prevailing internality; self-criticism; unexpressed positivity of the "integral "I", self-esteem, self-sympathy; orientation to the positive attitude of others; a high level of self-interest; an average level of self-confidence, etc.
The paper analyzes the evolution of views on the category of readiness for professional activity. Formation of readiness in the dissertation is considered as the goal of optimizing the professional development of a doctor.
The development apparatus for a comprehensive study of the personality of a doctor made it possible to carry out a differential diagnosis of their psychological readiness in order to implement a personal approach to their professional training (V.L. Yarishchuk, K.K. Platonov). The method of cross-sections (comparative method) was chosen as the principle of organizing the study, the advantage of which lies in the possibility of quickly obtaining a large amount of empirical data and building on their basis the so-called syndromes of states and personality traits that characterize certain stages of life and professional activity (B.G. .Ananiev).
The general conclusion about the change in the motivational, intellectual and characterological components of psychological readiness is that professional development in the process of work occurs non-linearly and heterochronously. The relationship of the components of psychological readiness with the success of professional
activities of doctors and with expert assessments of their professional development at different age periods was determined on the basis of correlation and regression analysis. The results of the analysis revealed differences in the structures of these relationships. At the same time, the following have the greatest positive relationship with success in professional activities and with expert assessment at all stages of professional development: among intellectual indicators - logical thinking; among the characterological ones - realism, practicality, emotional stability, accuracy, commitment, isolation; among the motivational ones is the attitude to the profession, to oneself and to research activities. An increase in the relationship between the indicators of the subjective attitudes of doctors and the expertly assessed level of their professional development was found.
Content analysis of the content of the responses of doctors of different specialties in the block "attitude towards oneself" made it possible to single out four types of orientation (classification according to E.P. Korablina, 1990): I) a specific focus on the profession of a doctor; 2) a general focus on the business, on the one associated with the implementation of a certain pa-bot; 3) focus on personal achievements and satisfaction of personal needs; 4) situational orientation, which determines either an orientation towards increasing the level of productivity of professional activity, or reflecting an uncertain attitude towards one's future. Based on this, four groups of doctors were identified, differing in the type of attitude towards themselves as a specialist, conventionally called "professionals" (the first type of orientation), "generalists" (the second type); "individuals" (third type), "situational" (fourth type). The percentage distribution of doctors in these groups showed that the groups of "professionals" (PE) and "generalists" (U) increase among doctors with 10-15 years of experience; the group of "individuals" (I) decreases, the percentage of the group "situational" (C) remains at the same level. From this we can conclude that the number of doctors focused on mastering a high level of professional skill is increasing.
The conducted research made it possible to single out a fairly wide variety of personality traits of a doctor, which
Factor analysis made it possible to identify groups of personality traits of doctors (according to L.L. Lytneva, 1989), most closely related to his authority in patients. The total awareness of the four identified factors is $67.4. The analysis of the identified factors and the content analysis of the patients' judgments showed that the qualities of the doctor's personality have only a general psychological meaning. All of them are filled with functional content characteristic of the doctor's social role and act not just as traits of his character, but as features of his gnostic and blasphemous activity.
In order to identify the most significant characteristics of the doctor's activity related to his authority in patients, a factor analysis was carried out, which led to the introduction of five factors with a total information content of 87.3%.
I factor (d4=< 32,4$) условно назван "уровень профессиональной деятельности врача", т.к. объединяет о себе показатели, характеризующие осознание врачом цели деятельности, структуру профессиональной деятельности и ее результативность. П фактор (» 21,7%)-включает показателя, определяющие профессиональную направленность личности врача. ¡11 фактор с шфорыативностья
18.5$ sums up the mix characterizing the doctor's professional training and activities. The experience of the doctor stood out as an independent 1U factor, which has a scarcity (for 4 ®> $ 9.8. The factor *> 5.6%) indicates the enatheism of communicative
The work carried out a qualitative analysis of the selected factors and their relationship with the authority of the doctor. The results of the study made it possible to characterize three levels of doctors' activity - low, medium and high. Comparative akahiz showed that a high level of authority characterizes doctors with an average level of activity 4/* sokum, and not a single doctor with a low level of activity has a high socio-psychological status.
In addition, 79% of patients named the doctor's authority as one of the most interesting. The authoritative doctor has the greatest influence on the formation of interest in the course of treatment, and by influencing interest, he increases the patients' interest in their state of health, which contributes to increased: ® of their health.
Correlation analysis of the relationships between the indicators of the interested attitude of patients to health made it possible to identify a direct positive relationship between this process and the average assessment of personal qualities (Id "0.49) and the skills of an authoritative doctor (A" - 0.38). Direct positive relationships of the doctor's professional skills with indicators of influence on the interested attitude of patients to health ((* * 0.3). The critical value of the sample correlation coefficient is P o 0.23 at t - 0.05; T* - 0.30 at t - 0.01.
The results of the analysis indicate that the attention of patients to their health, formed by an authoritative doctor, is the result of the influence of both his personal and professional qualities, and professional skills. However, despite the importance of the personal "qualities of the doctor and the formation of interest in treatment, the doctor's professional qualities and skills play an important role.
Of interest are the results of self-assessment of the motives of satisfaction of doctors with their professional activities. They show that reputable doctors have a higher need for professional activity, the ability to snuggle with their favorite work. they feel nervous exhaustion.The reasons for this lie in a more rigorous analysis of their shortcomings and in illnesses of high demands on self-reported doctors.
The study made it possible to determine the main factors influencing the formation of the doctor's authority. These include: I) a high moral level of development of the personality of arecha; 2) deep knowledge of their business; 3) an informal approach to the performance of their duties; 4) a positive attitude towards patients and the desire to communicate with them; 5) customized g.odhsd and le-
based on deep knowledge of each patient; 6) a high level of general culture; 7) high level of doctor's professional skills.
The main means of maintaining authority are: I) tireless concern for raising the moral level; 2) observance of tact in solving various health problems - in the process of interaction with patients; 3) professional development.
It was revealed that the increase in professional experience (experience) does not directly affect the formation of skills for adequate knowledge of the patient's personality by the doctor. The patient's professional cognition skills are almost never spontaneously formed. The high motivation of a doctor's professional activity is a necessary, but not an exact condition for the formation of these skills. Pokaza ™ existence for: feasibility (but not rigid) between the individual psychological characteristics of the doctor himself and the adequacy of his knowledge of the patient's personality. Some specific professional stereotypes that affect the doctor's knowledge of the patient's personality have been identified.
It has also been established that the discrepancy between the available professional abilities of a doctor and the requirements of his profession almost inevitably leads to stress and overwork, and of course, to dissatisfaction with work in this workplace. Mismatch of expectations with real conditions and the nature of professional activity, and, in turn, entails frustration stress and the inclusion of mechanisms of personal professional protection. The discrepancy between "personal" values, real motives and the purpose of activity brings to life "motivations" of various kinds of "substitution" in relation to the actual content of labor, etc.
It has been proven that important professional components come to the fore. An integrative and component-by-component consideration of the readiness of doctors for professional activity made it possible to identify the main reference points, the main factors that determine such readiness. They formed the basis of the developed system of advanced training for doctors by developing their professional orientation, professional interests, professional attraction, increasing authority, and forming the experience of creative activity. This preparatory work has created a basis for considering the problem of modeling professional
other situations and the development of a structural-functional model of professional activity.
It has been determined that the development of professional self-knowledge of the doctor's personality contributes to its effective formation as a goal of professional self-improvement. The ability of the doctor's personality to differentiate the difficulties encountered in the process of professional activity serves as the central psychological formation that determines the effectiveness of this development.
Readiness for the professional creativity of a doctor is defined in the study as a multidimensional multilevel personality characteristic, including a system of needs, motives, psychological qualities, attitudes and states, professional knowledge, skills and abilities that allow successful professional activity. Of particular importance is the motivational-value attitude to professional activity. In the structure of this relationship, the core education is professional orientation. It is a link in the relationship of psychological, theoretical and practical readiness.
Experimental work confirmed the working hypothesis that the formation of the gotostost: to the professional creativity of a doctor is due to the functioning of such components e as the ability to set goals, improvisation, combinatoriality, reflexivity, predictability, generating the need and ability to innovate.
In the conditions of professional training of future doctors, there is a real opportunity to use creativity as a motivating force for self-acquisition of knowledge and their creative application. With this approach, the future doctor acts as an organizer of his own activity in the formation of knowledge and the assimilation of ways of creative activity. And this implies a constant reorganization of the educational process on a diagnostic basis.
The conducted research confirmed the originally put forward hypothesis, the objectives of the research and the theoretical positions submitted for defense.
Those results. theoretical and experimental research made it possible to formulate a number of practical recommendations regarding the optimization of the professional development of the doctor's personality. The effectiveness of the formation of a doctor's professional self-knowledge can be ensured by: expanding the information basis of activity, introducing active forms and methods of work, which provide an opportunity for a young specialist to gain maximum information about their professional and practical activities from their own experience; stimulation of the cognitive activity of the individual, aimed at improving oneself as a subject of labor, cognition and communication, the formation of skills to observe, record, analyze and generalize one's own experience; taking into account the specifics of professional activity, the very essence of which opens up wide opportunities for self-correction and self-improvement. It is only important to teach the future specialist to develop criteria for determining the productivity of his work; overcame the psychological barriers that stand in the way of an adequate assessment of the activities of young professionals.
In the process of adaptation in young doctors, the level of pr.; sno-nal claims are gradually freed from diffuse-nosgi, gravitate towards relative certainty, while remaining inadequate. This circumstance has been brought to the fore, since an inadequate level of professional claims can cause young doctors to develop lack of initiative, unprincipledness, can reduce their desire to improve professionalism in a particular type of work and become an obstacle to the formation of a professional position among doctors. That is why it is important not to lose sight* of the process of formation and development of the level of professional aspirations of doctors.
To change the level of claims of medical students, doctors, it is necessary to change their perception of themselves as professionals. The level of professional aspirations can be formed and, if necessary, changed with the help of a program-targeted system of advanced training, in which it is necessary to take into account age X, individual and professional characteristics of students, doctors.
When working with doctors with an inadequate level of professional claims, it should be borne in mind that a change (decrease) in high
which level of claims is much more difficult to change (increase) the low level of claims. It should also be borne in mind that doctors with a high level of professional claims in situations of frustration, in order to maintain the same level of claims, more often use the psychological defense mechanism of rationalization than other doctors.
The conducted studies open up new prospects for studying the psychology of a doctor's personality and his psychological readiness for professional activity: elucidation of the structure and content of a doctor's professional abilities; experimental study of the psychological characteristics of doctors of various specialties (therapist, surgeon, urologist, etc.) using methods that diagnose the functional and psychological characteristics of professional abilities;
1. Experience in restructuring the activities of personnel in a new political situation. - M., 1930. - 124 p. (and co-authorship).
2. Psychological prerequisites for the professional development of a doctor. - Kaluga, 1992. - 25 p.
The personality of a doctor, his individuality is the object of close attention of society, the subject of public discussions and study in the professional field, in educational organizations, in healthcare management structures. The increased interest in this is quite justified. Despite the technologization of medical activity, all the best equipment of doctors with the latest diagnostic and treatment tools, a person, a doctor with his individuality, remains at the head of this process. Character, psychological characteristics. And if you ask any patient who he would prefer to communicate with if he were given a choice: with the smartest diagnostic machine that does not fail, or with a good doctor, then the answer can probably be predicted with a high probability. The choice will be made in favor of human communication.
Each patient draws the image of an ideal doctor for himself. But in many ways, this image is the same. Students of the Karaganda Medical Academy in the classes on psychology and communication skills answer this question for the most part in the same way. In their view, a doctor is a humane, kind person, disinterested and attentive, well aware of his profession, constantly improving in it. Students endow the doctor with such character traits as adherence to principles, purposefulness, sense of humor, ability to compassion. Interestingly, first-year students mainly talk about the volitional properties of the doctor's personality. Senior students focus on the intellectual, cognitive properties of the individual. In one of the universities of Belarus, a study was conducted, in which students of the medical and preventive faculty took part (Dubrova V.P., Elkina I.V., 2004). A qualitative analysis of the data obtained in the course of an empirical study made it possible to state that future doctors invest in the content of the concept of "ideal doctor" characteristics that reflect the specifics of the professional role and individual psychological characteristics of the individual. These characteristics relate to various areas of personality psychology: emotional-volitional, effective-practical, need-motivational, interpersonal-social, existential-existential, moral and cognitive-cognitive.
The largest share in the characteristics of the ideal doctor is assigned to interpersonal-social sphere of personality (29%), which usually includes interpersonal information exchanges, interactions, relationships, etc.
Future doctors note the following qualities of an ideal doctor:
- providing psychological support (23%);
- empathy, understanding (18.2%);
- the ability to establish a therapeutic alliance (13.8%); ,
- the ability to find an approach to any person (12.3%);
- sociability, flexibility in communication (8.5%);
- excellent relations with colleagues, mutual assistance (7.7%);
- openness, sincerity, friendliness (5.3%);
- the ability to see a personality in a patient (4.4%);
- the ability to explain to the patient the diagnosis and method of treatment in an accessible way (3.1%);
- respect from others, authority (2.6%);
- the ability to heal the body and soul (1.1%).
Among the qualities associated with moral sphere (21%), which includes moral states, actions, deeds and personality traits, most often students note such personal qualities as benevolence, intelligence, responsibility of a doctor. To effective-practical sphere (21%) refer to the manifestations of a person as a figure who practically realizes himself in the world around him, and in the description of the ideal doctor this area is represented by professional skills. Cognitive-cognitive sphere (12%) is presented as receiving, storing, recognizing, reproducing and transforming information, it should include cognitive-cognitive states, processes and personality traits. In the views of students, this area is filled with characteristics related to the professional knowledge of an ideal doctor. In the content of the concept of "ideal doctor", students also include professional self-improvement, love for their profession, full dedication to their profession, passion for their work, value and respect for their own life and health, for the life and health of others. Researchers refer to these characteristics as need-motivational sphere (7.6%), which includes various needs (needs experienced by a person in certain conditions of life and development), motives (associated with the satisfaction of certain needs, motivation for activity) and orientations. Existential-existential sphere (3%) manifests itself in states of self-deepening, experiences of one's self, personality traits, due to participation in one's being in the world. The following qualities of the “ideal doctor” identified by students can be attributed to this area. It seems to us extremely important the observation of our colleagues from Belarus on this aspect of the doctor's personality, which was highlighted by the students. Despite the rapid age, the practicality of young people, they consider them to be the necessary personality traits of a doctor.
- self-confidence (31.9%);
- positive self-concept (24.5%);
- autonomy and acceptance of the autonomy of another (22%);
- integral locus of control (4.8%);
- the ability to reflect (4.8%);
- possessing a bright personality (4.8%);
- self-sufficiency (2.4%);
- self-esteem (2.4%);
- high self-esteem (2.4%), -
that is, those properties that do not allow a doctor to be one hundred percent conforming for the sake of gaining benefits and building a career. Evaluate the statements of Belarusian students and compare them with your opinions. For example: "The ideal doctor should have a sense of self-respect, because if a person respects himself, he will always strive to be on top." Or: “A doctor who is independent in making decisions and respects the independence of other people, understands the impression he makes on the patient and has high self-esteem, can be called an ideal doctor.”
The researchers note that students assigned a certain role in the concept of "ideal doctor" image medical specialist. According to some of them, the ideal doctor should be a man, which indicates the attitude towards a male doctor as a carrier of business qualities. In addition, the ideal doctor should be neat, in a snow-white coat, have an attractive appearance and pleasant manners, lead a healthy lifestyle, have a stylish car, his own home and an excellent income. “A man dressed in an expensive suit, tie, expensive shoes. With neat hair and expensive watches. Having a stylish car." “Non-smoker and light-drinker, always in a white shirt, polished shoes and a starched dressing gown.” “The appearance of a doctor should not cause negative emotions in the patient. For example, when seeing a doctor’s long nails, the patient first of all thinks: “How does the doctor help with such hands?” A doctor who promotes cleanliness should be in a clean coat and have order on the table.
Based on the above study, its results, our observations and reflections, summarizing the statements that we receive in the classroom from KSMA students, we consider the authors' conclusions to be fair that students, first of all, single out the interpersonal and social sphere of the personality of an ideal doctor. This is due to the postulate of medical ethics, according to which the professional activity of a doctor is an activity in the field of communication, and one of the sides of the success of this activity is a sufficient level of development of interpersonal and social qualities aimed at the ability to establish therapeutic cooperation with the patient. This postulate serves as a starting point for the public assessment of the success of a doctor as a specialist and as a person.
It is also important for future specialists to have a sufficient level of knowledge and skills that allow them to experience their own value as a specialist, to feel ownership of what is happening. The presence of moral, need-motivational and emotional-volitional qualities allows the doctor to achieve self-actualization, be successful in his professional activities, and make a certain contribution to the development of medicine.
Summing up the analysis of the image of the ideal doctor in the views of students of higher medical school, we can draw the following conclusions:
1. In the content of the image of an ideal doctor, medical students include individual psychological characteristics of the personality and features of the professional role of a specialist related to the following areas of personality: interpersonal-social, moral, effective-practical, cognitive-cognitive, need-motivational, emotional- volitional, existential-existential.
2. The largest share is given to the interpersonal-social sphere of the individual. Moreover, many of the qualities listed by students speak of the need for an ideal doctor to comply with the doctrine of informed consent, the principles and norms of medical ethics, the "Code of Medical Ethics".
3. The dominance of the interpersonal-social sphere, which reflects the peculiarities of the interaction between the doctor and the patient, made it possible to determine the general standard of the ideal doctor as “cooperating” and ready to establish a therapeutic alliance with the patient in the treatment process. We consider this circumstance as a result of students' assimilation of the main provisions of medical ethics, methodological foundations and theoretical problems of medical interaction, the basic rules of communication in the dyads "doctor - patient", "doctor - other medical specialists", "doctor - relatives of the patient".
4. The image of a collaborating doctor as ideal in the views of students of a higher medical school creates conditions for the formation of professional value orientations and professional self-improvement.
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