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Breaking the Cycle: How to Turn Conflict Into Collaboration When You and Your Patients Disagree Kindle Edition

4.7 out of 5 stars 7 customer reviews

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Length: 250 pages

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Editorial Reviews

Review

Breaking the Cycle will be of enormous help to physicians of every stripe. The authors present important lessons about shifting from conflict to collaboration gleaned from Salvador Minuchin and other family therapists. They analyze cases in depth to make these lessons vivid, real, and compelling. A special feature of this book is the presentation of both physicians and patients in a narrative, biographical context, which provides more complete psychological insights for problem solving. This humanizes physicians and is also especially respectful to patients. The cases beautifully show us something fundamental about caring for patients: effective care begins with genuine interest in building relationships with patients, and is sustained by genuine curiosity about the patient s perspective. --Jodi Halpern, MD, PhD, author of From Detached Concern to Empathy: Humanizing Medical Practice

As medical paternalism has declined over the past 50 years, doctors have increasingly encountered the refusing patient, both in ambulatory and inpatient settings. Often, such patients frustrate doctors, polarize health care teams, and drive a wedge between the doctor and patient. The authors have developed a practical approach that actually helps physicians, patients and families reduce conflict and power struggles in order to provide the best care for patients. Their creative and original model, amply described with many real case examples from internal medicine and pediatrics, applies a systems approach from family therapy to resolve the kind of real-world challenges that patients and physicians face every day. Speaking as one of the frustrated physicians who has tried to resolve these issues in practice, I am delighted to report that this book by Blackall, Simms and Green is just what I've been waiting for! --Mark Siegler, MD, Author of Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine

Blackall, Simms, and Green provide a valuable map for those of us striving to navigate the murky waters of challenging physician patient interactions. Their model is clearly presented, lucid, and practical. --Dan Shapiro, PhD, author of Delivering Doctor Amelia

Product Details

  • File Size: 1182 KB
  • Print Length: 250 pages
  • Publisher: American College of Physicians (April 30, 2009)
  • Publication Date: April 30, 2009
  • Sold by: Amazon Digital Services LLC
  • Language: English
  • ASIN: B003EO8T0M
  • Text-to-Speech: Enabled
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  • Amazon Best Sellers Rank: #658,587 Paid in Kindle Store (See Top 100 Paid in Kindle Store)
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Format: Paperback
The ten minute doctor's appointment. Medical education teaching "problem-based learning" and the skills to arrive at an answer quickly with the right medicine or therapy for the correct problem. Medical research looking for single mechanisms of action. The culture of medicine teaches that the physician is the expert. In my experience physicians are not very good listeners and it's built into our culture. This is the world of modern medicine. It's no wonder that patients voice dissatisfaction with medical care. And it's no wonder many physicians voice regret regarding the choice of their vocation. Each year I have medical students come to me discouraged about their choice once they experience the rapid-fire approach to seeing patients and they begin to realize their ideal of being a healer is not likely to happen.

There are times in medicine when the problem-focused approach works and works quite well, especially in acute situations. But in complex or chronic situations, the quick fix is not enough. In systems thinking lingo, ala Peter Senge and others, the situations described in Breaking the Cycle by Blackall, Simms, and Green are similar to the systems archetype called "Shifting the Burden". As the quick fix is applied, things don't go well and the quick fix turns to solving the "patient problem" of not complying with the expert. The authors beautifully describe this cycle, so typical of difficult medical situations, as a result of the quick fix, "Physician-As-Expert" model, gone wrong. At its best, the Physician-As-Expert brings the patient back into balance. But when it spirals out of control (as described in their chapter The Harder I Try, The Worse It Gets) a negative symptomatic cycle develops.
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Format: Paperback
Breaking The Cycle: how to turn conflict into collaboration when you and your patients disagree. The sub-title to this book is both attention getting and somewhat misleading. One's ears perk up at the prospect of learning how to turn conflict into collaboration, but the reference to one's patients with whom one is in disagreement misleadingly implies that none but physicians need bother to read this book. Indeed, I hesitated to do so at first and eventually picked it up only because of previous exposure to the thinking of the second author. When I started to read it, it became almost immediately obvious that the sophisticated concepts, principles, and procedures the authors put forth so simply and clearly are widely applicable to any set of professional relationships, and even to non-professional relationships as well. Human nature, it seems, is such that when one's services, advice, or help is solicited, one immediately furnishes the answer. And just as quickly it is human nature for the answer, advice, or help to be rejected, which calls forth more advice, followed by more rejection, the cycle being repeated over and over, until we "see" that the problem for which help was solicited is not the problem after all: the guy asking for our help is the problem. This is the symptomatic cycle of which the authors speak.

As an example, I recently found myself caught up in such a cycle while providing group clinical supervision to a group of three teams of two family therapists in an agency setting. A recent hire introduced to the group the idea of beginning our two-hour sessions with a review of everyone's cases. The group liked this idea, but doing so took up almost the entire two hours, leaving little or no time for clinical supervision.
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Format: Paperback
I stumbled on this book late in my dissertation process. I've been researching patient-physician communication for several years. This book is a gem; it cuts to the chase. I've read thousands of pages in this field and this book is the best. It reduces that literature into a few paragraphs about the value of recognizing the potential contribution of the patient's expertise on the experience and context of their illness. The authors outline a practical method for seeing impasse from a systems perspective and provide principles for addressing the impasse. The book never bogs down in theory or the sprawling evidence in this nascent field. (If that is what you are looking for, the short list of citations at the end of each chapter will give you some of the best resources.) It is a simple way of addressing complexity, a strategy for addressing difficult clinical moments. There are also pearls of wisdom: "Isolation and disconnection from important relationships exacerbates psychological distress." That one rang like a gong.
Though the book is directed to physicians, I think it would have tremendous value to some patients too. We are all patients, and this book provides a wider perspective on the clinical encounter that could be helpful to everyone.
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Format: Paperback
Breaking the Cycle is a must-read for healthcare professionals from primary care offices to intensive care units. The authors provide a very helpful framework for managing a common frustration experienced by healthcare providers: the "challenging patient" or "difficult family member" of a patient. As a psychologist who has worked with several multidisciplinary care teams, too often the difficult patient or challenging family member becomes the focus of the team's interactions. As a result, resolution of the patient's medical needs becomes a secondary issue. In the end, the patient, family members, and medical team are left frustrated and dissatisfied with the lack of medical improvement and effective working relationships between patients and the medical team.

So how can healthcare professionals avoid this "trap"? Blackall, Simms and Green define a paradigm shift that is essential to providing excellent patient- and family-centered care, even to challenging patients and family members. Below is a very brief synopsis:

The authors review the traditional approach to healthcare, the "Physician-As-Expert" model, noting its merits. However, they clearly articulate how this approach fundamentally fails to establish an effective process for resolving common barriers experienced in patient care. For challenges such as medication non-adherence, complex medical diagnostic presentations, and co-existing medical and mental health problems, the Physician-As-Expert model often lacks the ability to effectively resolve these challenges.

The authors offer an alternative model emphasizing a collaborative relationship between the healthcare professional and patient.
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