A resident physician is finishing up her shift when she receives a page that reads, "Patient in Room 121 asking to leave." The patient was admitted 2 hours ago for worsening dyspnea. On entering the room, the resident attempts to engage in a discussion about why the patient is requesting to leave. In response, the patient pulls out his nasal cannula and breathlessly says, "You don't know anything; you're not even a real doctor!" The resident is reminded of her father, who has frequently belittled her accomplishments. She angrily informs the patient, "You can't leave and I'm ordering haloperidol to calm you down." Which of the following best explains the resident's response to the patient?

Question

A resident physician is finishing up her shift when she receives a page that reads, "Patient in Room 121 asking to leave."  The patient was admitted 2 hours ago for worsening dyspnea.  On entering the room, the resident attempts to engage in a discussion about why the patient is requesting to leave.  In response, the patient pulls out his nasal cannula and breathlessly says, "You don't know anything; you're not even a real doctor!"  The resident is reminded of her father, who has frequently belittled her accomplishments.  She angrily informs the patient, "You can't leave and I'm ordering haloperidol to calm you down."  Which of the following best explains the resident's response to the patient?

Quizplus · Accepted Answer

The resident's response to the patient is illustrative of countertransference, which consists of the physician or therapist's conscious and unconscious reaction toward a patient (eg, attitudes, thoughts, feelings, behaviors) that is based on past personal relationships. Countertransference reactions can be positive (eg, physician takes extra time with a patient who resembles a beloved grandmother) or negative (eg, physician avoids a patient who resembles a critical parent). Countertransference can interfere with medical judgment. In this case, the resident's negative emotions toward her father are activated when the patient dismisses her training and credentials. The resident acts on her negative countertransference reaction and adopts an inappropriately authoritarian approach by terminating the conversation and ordering a medication. Awareness of countertransference may prevent responses and behaviors (eg, yelling at a patient, ordering unnecessary medications/restraints, cutting an interview short) that could be harmful to patient care. (Choice B) Passive aggression is a defense mechanism in which anger is expressed in a nonconfrontational manner. Examples of passive aggressive behaviors include sarcasm, procrastination, and purposeful inefficiency. (Choice C) Projection is a defense mechanism that involves misattributing one's own unacceptable feelings to another person (eg, a woman who is angry with her mother accuses her mother of being angry with her). (Choice D) Reaction formation is a defense mechanism in which uncomfortable feelings are unconsciously transformed into their extreme opposites (eg, if this resident was excessively gracious to the patient to defend against underlying anger). (Choice E) Regression is a defense mechanism that involves returning to an earlier level of functioning to alleviate psychological distress (eg, a child starts sucking his thumb after a sibling is born). (Choice F) Transference refers to the redirection of a patient's emotions from a significant person in the past to that patient's current physician or therapist. It may explain some patients' emotional responses to their physicians (eg, an elderly patient who feels an immediate sense of comfort and familiarity with a physician who resembles her daughter). Transference is distinguished from countertransference by describing the patient's reaction to the provider, whereas countertransference refers to the provider's reaction to the patient. Educational objective: Countertransference consists of a provider's response (eg, attitudes, thoughts, feelings, behaviors) toward a patient based on past personal relationships. Countertransference can be positive or negative, conscious or unconscious; if unrecognized, it may have detrimental effects on patient care. __________ References: Shift, interrupted: strategies for managing difficult patients including those with personality disorders and somatic symptoms in the emergency department. (http://www.ncbi.nlm.nih.gov/pubmed/26493524)

A Resident Physician Is Finishing Up Her Shift When She