The Doctor-Patient Relationship in Pharmacotherapy: Improving Treatment Effectiveness

The Doctor-Patient Relationship in Pharmacotherapy: Improving Treatment Effectiveness

by Allan Tasman, Michelle B. Riba, Kenneth R. Silk, Kenneth R. Silk
     
 

Pharmacotherapy is the cornerstone of practice for many psychiatrists today. The busy clinician may have only 20 minutes with each patient t o prescribe, monitor, and initiate changes in the medication regimen.Y et even as the field of psychiatry evolves, the doctor-patient relatio nship still plays a critical role in clinical course and outcome of tr eatment. This

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Overview

Pharmacotherapy is the cornerstone of practice for many psychiatrists today. The busy clinician may have only 20 minutes with each patient t o prescribe, monitor, and initiate changes in the medication regimen.Y et even as the field of psychiatry evolves, the doctor-patient relatio nship still plays a critical role in clinical course and outcome of tr eatment. This invaluable book shows prescribing clinicians how to make the most of limited time with patients to establish a strong therapeu tic relationship and maximize treatment adherence. Concise guidelines are provided for rapidly building the therapeutic alliance; conducting a thorough diagnostic interview; eliciting open, honest reports from patients on the effects of medications; and helping patients address i nterpersonal issues that may be hindering treatment. Also explored are ways to enhance collaboration between professionals when the treatmen t is split between a psychotherapist and a prescribing physician.

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Editorial Reviews

From the Publisher

"It's the relationship that matters! That message encapsulates this volume's critically important lesson for psychiatrists. Even when medications are the primary modality of treatment and sessions are brief, the psychiatrist-patient relationship is the hinge on which the efficacy of treatment depends. Attention paid to our patients as unique individuals rewards them as well as ourselves." --Paul S. Appelbaum, MD, Zeleznik Professor and Chair, Department of Psychiatry, University of Massachusetts Medical School

"This very valuable book emphasizes ways to improve clinical outcome through attention to developing and maintaining a therapeutic alliance through all phases of medication management, from the initial interview through the later stages of medication maintenance. The book is full of rich clinical examples that highlight both the opportunities and dilemmas that occur in the doctor-patient relationship. The authors place particular emphasis on using various interview techniques and understanding of transference and countertransference themes to improve outcome when the treatment is primarily pharmacologic. In this era of managed care and the rapid, 15-minute 'medication check' interview, psychiatrists need to be expert in using every tool in the clinical armamentarium. This book contains necessary information that will help every psychiatrist do a better job of treating patients." --Jeffrey A. Lieberman, MD, University of North Carolina School of Medicine

"At last someone has written a practical work to help clinicians better manage pharmacologic treatment. The authors provide expert advice in a down-to-earth, easily understandable way on how to understand and use the doctor-patient relationship to improve compliance with treatment and enhance overall clinical outcome. This book should be required reading for psychiatrists at every stage of their careers, from residents through senior practitioners. A 'must' for every clinician's office." --Charles Nemeroff, MD, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine

"Understanding and managing the doctor-patient relationship in pharmacologic management is a critically important issue for every clinician. This is a well organized, easy-to-read, practical text. Using case examples, the authors expertly provide the reader with ways to better understand the interplay between psychopharmacology and the therapeutic relationship. This very useful book should be required reading for every clinician. I have no question that clinical outcomes will be improved when psychiatrists apply the materials in this book to their practices." --Alan F. Schatzberg, MD, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University

"It is clear that this book was written by physicians who accept themselves and their patients as part of a biopsychosocial system. By listening and asking specific questions, the prescriber who appreciates the biopsychosocial system provides comprehensive care, not just a quickly written prescription. The book is readable, well referenced, and provides multiple clinical examples of what works and what doesn't work. I would recommend this book to anyone who prescribes psychiatric medications. It also should be required reading in pharmacology courses at all levels." --Patricia Mares Miller, RN, CS, NP, Clinical Nurse Specialist, Department of Psychiatry, University of Michigan

Doody's Review Service
Reviewer: John K. Larson, MD (Rush University Medical Center)
Description: This is a slim but persuasive book. It is a first edition authored by three clinicians with a career-long interest in the integration of psychopharmacology and psychotherapy. Extensive use is made of case examples and the personal experience of the authors.
Purpose: This volume is intended to serve as a guide for novice and experienced clinicians in developing and nurturing the therapeutic alliance and aiding compliance; especially in treatment settings that necessitate relatively short face-to-face encounters with patients.
Audience: The primary audience includes psychiatrists at all levels of experience. It can also serve as a basic text for medical students and residents. General medical practitioners who prescribe psychotropics, psychiatric nurses, and non-MD therapists will also find it useful.
Features: This is an extremely encouraging response to the dilemmas faced by clinicians who increasingly use brief follow-up visits as a primary treatment intervention. In a concise, highly readable form the authors distill years of practical wisdom regarding the formation of a therapeutic alliance, the importance of collaboration, enhancing compliance, managing split treatment, and transference/countertransference issues. There is also an excellent chapter on managing difficult cases, which alone is worth the price of this volume. The pages are filled with illustrative case examples and clinical dialogue.
Assessment: This text should find its way to the shelves of every practicing psychiatrist. The volume will also help persuade critics of current practice patterns that quality care can be still be provided by skillful, concerned clinicians even in the context of a 15-minute "medication check." However, its value goes far beyond that of the usual how-to-survive-managed-care guide. Anyone interested in the nuances of a helping relationship will find this an excellent place to start.
4 Stars! from Doody
Journal of the American Medical Association
Learning to understand and to participate in the patient-physician relationship authentically and skillfully is important not only for psychiatric residents and practicing psychiatrists but for all physicians who want to increase their success in prescribing medications by enhancing the therapeutic value of their relationships with patients. This book provides some very useful guidance for that journey.
John K. Larson
This is a slim but persuasive book. It is a first edition authored by three clinicians with a career-long interest in the integration of psychopharmacology and psychotherapy. Extensive use is made of case examples and the personal experience of the authors. This volume is intended to serve as a guide for novice and experienced clinicians in developing and nurturing the therapeutic alliance and aiding compliance; especially in treatment settings that necessitate relatively short face-to-face encounters with patients. The primary audience includes psychiatrists at all levels of experience. It can also serve as a basic text for medical students and residents. General medical practitioners who prescribe psychotropics, psychiatric nurses, and non-MD therapists will also find it useful. This is an extremely encouraging response to the dilemmas faced by clinicians who increasingly use brief follow-up visits as a primary treatment intervention. In a concise, highly readable form the authors distill years of practical wisdom regarding the formation of a therapeutic alliance, the importance of collaboration, enhancing compliance, managing split treatment, and transference/countertransference issues. There is also an excellent chapter on managing difficult cases, which alone is worth the price of this volume. The pages are filled with illustrative case examples and clinical dialogue. This text should find its way to the shelves of every practicing psychiatrist. The volume will also help persuade critics of current practice patterns that quality care can be still be provided by skillful, concerned clinicians even in the context of a 15-minute "medication check." However, its value goes farbeyond that of the usual how-to-survive-managed-care guide. Anyone interested in the nuances of a helping relationship will find this an excellent place to start.
Booknews
Shows how prescribing clinicians can make the most of limited time with patients and demonstrates how a strong therapeutic relationship can maximize medication adherence and facilitate treatment. Gives guidelines on building the therapeutic alliance, conducting a diagnostic interview, educating patients, and addressing interpersonal issues that may be hindering treatment. Essential elements of psychotherapy are discussed as they relate to the psychiatric setting. Tasman is professor and chair of the Department of Psychiatry and Behavioral Sciences at the University of Louisville. He served as president of the American Psychiatric Association from 1999 to 2000. Annotation c. Book News, Inc., Portland, OR (booknews.com)

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Product Details

ISBN-13:
9781572305960
Publisher:
Guilford Publications, Inc.
Publication date:
05/17/2000
Edition description:
New Edition
Pages:
182
Product dimensions:
6.23(w) x 9.24(h) x 0.71(d)

Meet the Author


Allan Tasman, MD, currently Professor and Chair of the Department of Psychiatry and Behavioral Sciences at the University of Louisville, served as President of the American Psychiatric Association in 1999-2000. Dr. Tasman is a nationally known psychiatric educator, psychoanalyst, and cognitive neuroscience researcher. He has a longstanding interest in the clinical integration of biological, psychological, and psychosocial treatment approaches.

Michelle B. Riba, MD, MS, is Clinical Associate Professor and Associate Chair for Education and Academic Affairs, Department of Psychiatry, University of Michigan. She is currently Secretary of the American Psychiatric Association; President of the American Association of Directors of Psychiatric Residency Training; and President-Elect of the Association of Academic Psychiatry. Dr. Riba is a consultation-liaison psychiatrist and is Director of the Psycho-Oncology Program at the University of Michigan Comprehensive Cancer Center. Dr. Riba has authored or edited over fourteen books, 10 chapters, and 20 papers, and lectures nationally and internationally on topics on education and combining psychopharmacology and psychotherapy in clinical practice. She serves on national guideline committees on various aspects of psycho-oncology.

Kenneth Silk, MD, is Associate Professor and Associate Chair of Clinical and Administrative Affairs in the Department of Psychiatry, and Chair, Faculty Group Practice Board, at the University of Michigan Health System, Ann Arbor, Michigan. Dr. Silk obtained his medical training at Albert Einstein College of Medicine and his psychiatry training at Yale. He is an active clinician and teacher whose research interests are in the area of personality disorders. He is the editor of two books.

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