Dynamic Interactions in the Primary Care Consultation, and an Introduction to Balint Groups

@#Physicians in the primary care setting, such as General Practitioners and doctors working in polyclinics, will encounter patients with varying expectations of the consultation process, especially with regards to their emotional needs. These interactions, shaped by transference and counter-transference, will often induce varying emotional reactions in the physicians, both positive and negative. Understanding the dynamics which drive these interactions, and reflecting upon the physician's own emotional responses, can often lead to a more holistic appreciation of the patient and the therapeutic relationship, and consequently in improved patient care, and enhanced satisfaction for both the patient and physician. This article highlights the above dynamic interactions, and introduces the Balint Group, a platform whereby such themes and processes can be further explored. The processes of the Balint Group, and its benefit for attending members, are discussed.

A review of patients managed at a combined psychodermatology clinic: a Singapore experience

<p><b>INTRODUCTION</b>Recognising and appropriately treating psychosomatic factors in dermatological conditions can have a significant positive impact on the outcomes of patients. Treatment of psychodermatological patients requires a multidisciplinary approach that involves dermatologists, psychiatrists and allied health professionals.</p><p><b>METHODS</b>This was a retrospective case series of patients seen in our psychodermatology liaison conferences from November 2009 to July 2011. We reviewed all the case notes and analysed data such as age, gender, dermatologic and psychiatric diagnoses, treatment and outcome.</p><p><b>RESULTS</b>The majority of patients in our cohort were diagnosed with either a psychophysiologic disorder or a primary psychiatric disorder. The most common diagnosis among patients with primary psychiatric disorder was delusions of parasitosis. Other common primary psychiatric disorders seen were trichotillomania and dermatitis artefacta. About a fifth of our patients had psychiatric disorders resulting from their underlying dermatological conditions. A third of our patients were lost to follow-up.</p><p><b>CONCLUSION</b>Managing patients with psychocutaneous disorders can be challenging, with many patients defaulting treatments. Psychodermatology clinics will benefit both patients and their caregivers. A collaborative approach using a consultation-liaison relationship between two medical departments in a friendly environment would result in more effective, integrated and holistic treatment strategies for such patients. Further studies should be conducted to determine how beneficial such services are to patients. With more experience, we hope to improve this service.</p>