Teaching session worksheet
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GPs often manage patients where difficulties arise due to underlying personality factors in the patient. These can lead to problems in assessment and management for that patient. This teaching session looks at an approach to understanding and managing the various difficulties and frustrations that can arise whilst managing patients with personality disorders.
The registrar should have prepared a 100-word essay on “what is personality” as part of their pre teaching session work. They also should have thought about a case that they have seen recently where personality factors played a significant role in the encounter. They have also been asked to briefly review the various Personality Disorders.
Teaching Session
Have a brief discussion at the outset on their essay and case. Perhaps you might like to try and think of some famous public figures who may have various personality traits or disorders. Is Kylie Minogue histrionic? Is Malcolm Turnbull narcissistic?
How do you identify PD in general practice?
- What classification systems are used for Personality Disorder?
- Why are classification systems used?
- What are the potential benefits/risks of diagnostic labelling in practice?
- When does personality become pathological or maladaptive?
Do you need to understand the patient within their developmental context?
- What factors in the patient’s life previously have contributed to their personality?
Do you need to understand the patient within their family context?
- Discuss the impacts a personality disorder may have on the patient’s immediate family?
- What implications does this have for your clinical interactions with the family? (especially if you also care for other family members?)
- Eg. confidentiality, self harm, mandatory reporting of abuse/neglect
How do you best manage the patient’s overall health care?
- What impacts can Personality Disorders have on a patient’s health?
- How does it alter our general practice treatment and management?
- What implication does this have in your consultations?
Dealing with patients with personality disorders such as the one referred to in the accompanying vignette can be difficult, challenging and emotionally complex.
Read the vignette together now, and answer the questions that accompany it.
It has been said, “Doctors all have a narcissistic need for omnipotence”. Medical training is focused around trying to quickly and concisely identify a problem and give effective treatments. A doctor’s self esteem is positively affected by this. Likewise when we feel hopeless doctors can despair. It is from this desperation that “rescue fantasies” can arise when dealing with patients who trigger this need within us.
- Have you ever tried to rescue someone?
- What are the danger signs?
- How much can you do? Consider - Boundaries / realistic expectations / even failure
How and when do you access other care/resources?
- With whom can I work collaboratively?
- What resources are accessible locally and elsewhere for the patient?
- With whom can I debrief, and how can I be supported to best handle these difficult patient interactions?
Describe the elements a GP can implement to reduce/minimize harm
- How do you put in place an effective containment strategy?