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Family Medicine—A Clinical and Applied Orientation
CS Madgaonkar
PART I: BASIC PRINCIPLES
1:
The Philosophy of Family Medicine
2:
The Scope of Family Medicine
3:
Family Medicine: The Rising Discipline
HISTORY
AGE OF SPECIALISATION
REVIVAL OF FAMILY MEDICINE
FUTURE
FAMILY MEDICINE—NEED OF THE HOUR
4:
Definitions
GENERAL PRACTICE/FAMILY MEDICINE
Leeuwenhorst Definition–19743
WONCA Definition–1991 (World Organisation of Family Doctors)5
Olesen Definition-20006
The European Definitions–2002 (WONCA Europe Definition–2002)7
Definition of a General Practitioner
FAMILY PHYSICIAN
Attributes of a Family Physician
Nine Principles that define the Discipline
FAMILY PRACTICE
Difference—Family Practice and General Practice
Advantages of Family Practice
PRIMARY CARE
What is Primary Care?11
Definition
Primary Care
Primary Care Practice
Primary Care Physician
Non-Primary Care Physicians Providing Primary Care Services
Non-Physician Primary Care Providers
Use of Term
HOW DOES PRIMARY CARE DIFFER FROM OTHER LEVELS OF HEALTH CARE?12
Is Primary Care the Same as Ambulatory (MOBILE) Care?12
Is Primary Care the Same as Managed Care?12
Role of Primary Care Provider in Common Managed Care Arrangements12
ENGLISH LANGUAGE DEFINITIONS13
5:
The “Family” in Family Medicine
FOCUS ON FAMILY
WHAT IS A FAMILY
FAMILY HEALTH
CHARACTERISTICS OF A HEALTHY FAMILY
CHARACTERISTICS OF A DISTURBED FAMILY3
THE FAMILY LIFE CYCLE AND ROLE OF FAMILY DOCTOR
Stages
FAMILY DYNAMICS AND ILLNESS
Risk Factor Estimate
Assessment of Family Dynamics/Illness3
FAMILY IN CRISIS
RISK FACTORS FOR CRISIS
Doctor's Role in Family Crisis3
FAMILY-BASED MEDICAL COUNSELLING—THE ‘BATHE’ TECHNIQUE 6,7
Using the ‘BATHE’ Technique
Working with Families–Avoiding Pitfalls
PART II: HEALTH FOR ALL
6:
The Alma-Ata Declaration
THE GENESIS OF ALMA-ATA
PRIMARY HEALTH CARE TAKES CENTRE STAGE
DECLARATION OF ALMA-ATA
I
II
III
IV
V
VI
VII—Primary Health Care*
VIII
IX
X
7:
Primary Health Care Approach to Health for All
WHAT IS ‘HEALTH FOR ALL’?
HFA does not mean that:
HFA does mean that:
THE FUNDAMENTAL PRINCIPLE GOVERNING HFA MOVEMENT
THE CONCEPT OF PRIMARY HEALTH CARE (PHC)1
THE PRIMARY HEALTH CARE (PHC) APPROACH
INGREDIENTS OF PHC
A Clinically Competent Profession
A Caring Profession
A Cost-conscious Profession
A More Organised Profession
HOW PHC WORKS2
In Developing Countries
In Developed Countries
CONCLUSION
PART III: CLINICAL APPROACH
8:
The Spectrum of Clinical Diagnosis
CLINICAL PROCESS—SYMPTOMS
Analysis of Symptoms1
Limitations of Symptoms
Patient—Symptoms Variables
Skills in History Taking
Patient as an Individual
THE CLINICAL PROCESS—PHYSICAL DIAGNOSIS
SEQUENCE IN CLINICAL EXAMINATION (Fig. 8.1)
CLINICAL DECISION MAKING
THE DIFFERENTIAL DIAGNOSIS
CHANGING CONCEPTIONS OF HEALTH, DISEASE, AND DIAGNOSIS
9:
Investigations: General Principles
THE REASON FOR THE TEST
INTERPRETATION OF TESTS (Table 9.1)
GOLD STANDARD TESTS
RIGHT CHOICE OF TEST
Slightly Abnormal Results
Importance of Chronological Data
PART IV: THE PRACTICE OF FAMILY MEDICINE
10:
Communication Skills
INTRODUCTION
DEFINITION
IMPORTANCE OF EFFECTIVE COMMUNICATION
KEY TASKS IN COMMUNICATION WITH PATIENTS2
KEY COMMUNICATION SKILLS NEEDED TO PERFORM KEY TASKS2
Eliciting Patients’ Problems and Concerns
Open-ended Questions
Giving Information
Discussing Treatment Options
Being Supportive
VERBAL COMMUNICATION
What are the Important Aspects of Verbal Communication?
Where Verbal Communication is Helpful?
NON-VERBAL COMMUNICATION (BODY LANGUAGE)
BARRIERS IN COMMUNICATION
COMMON COMMUNICATION PITFALLS
ACQUIRING NEW SKILLS
11:
Rapid Access to Improving Communication Skills
INTRODUCTION
Refining the Basics
Greeting the Patient
Don't Appear Rushed, even if you are
Keep Conversation on Track
Listen Without Interrupting
Relate with your Eyes
Organise Your Interviews
Be Aware of Changing Dynamics
Provide More Information in Less Time
Going that Extra Mile
Give all Patients a Welcome Letter/Biography
Use Internet/Computers Creatively
Educate Your Staff
Follow-up
CONCLUSION
KEY POINTS
12:
The Consultation
INTRODUCTION
OBJECTIVES FOR THE CONSULTATION
For Patients
For Doctors
CONSULTATION STRATEGIES
Tasks in the Consultation
Three Doctoring Tasks
Two Understanding Tasks
Four Operational Tasks
The Consultation Process
Doctor-centered Method
Patient-centered Method
Pendleton's Consultation Analysis3
Stewart and Others’ Patient-Centered Method
The Critical Steps in the Consultation Process
Interviewing Skills
The Beginning
The Main Part of the Interview
Ending the Interview
Details of Techniques used in Main Part of Interview
Common Pitfalls when Interviewing Patients
Consultations as Routines, Dramas and Ceremonies
Patient Satisfaction with the Consultation
Troublesome Consultations5
13:
The Patient-Physician Relationship
CONCEPTS AND CHANGES
TYPES
SCOPE OF PATIENT-PHYSICIAN RELATIONSHIP
Establish Rapport (Implied Consent)
Be Attentive and a Good Listener
Avoid Interruptions
Guide the Patient
Avoid Criticism
Avoid Emotional Reaction
Avoid Parenting Your Patient
Non-Judgmental
Be Gentle and Concerned when Examining the Patient
Explain the Nature of Illness
Be Clear and Discrete
Avoid Presenting Yourself as an Embodiment of Noble Profession
Confidentiality
Referrals
Relatives and Friends4
Non-verbal Aspects
Closure
CONCLUSION
14:
Balint Group
HISTORICAL ORIGINS1
BALINT DISCOVERIES
The Doctor as Therapy
The Diagnostic Process—Multi-axial Diagnosis
Advice and Reassurance
Influence of the Doctor on the Diagnosis
The Doctor–Patient Relationship
CONCLUSION
15:
Designing a Patient-Friendly Practice
DESIGNING THE CLINIC
THE WAITING ROOM AND RECEPTION
THE CONSULTATION ROOM
STAFF
GREETING PATIENTS—CHECKING IN AND CHECKING OUT
INCORPORATING NEW TECHNOLOGY
Patient Information
Appointments
Online Consultation
Recalls
Build a Website
CONCLUSION
16:
Counselling Skills
INTRODUCTION
COUNSELLING
Family Physician as an Effective Counsellor2
Individuals Counselling
Family Counselling
Counselling Procedure
The Approach
Counselling Strategies3
Explore Patients’ Beliefs and Concerns
Inform Probable Time Duration and Outcome
Piecemeal Approach
Be Specific
Add New Behaviour
The Use of Combination of Strategies
Involve Office Staff
Get Explicit Commitment
Follow-ups
Refer
CONCLUSION
17:
Patient-centered Care
THE ROLE OF FAMILY DOCTOR
EVIDENCE BASE FOR PATIENT-CENTERED CARE (PCC)
PATIENT'S CHOICE
PATIENT-CENTEREDNESS–WHAT DETERMINES THE PHYSICIAN'S CLINICAL BEHAVIOUR?
PATIENT-CENTERED CARE MODEL
HYPOTHETICAL CASE SCENARIO: AN ADULT DIABETIC12
MANAGEMENT: DISEASE-CENTERED
MANAGEMENT: PATIENT-CENTERED
TEACHING POINTS
CONCLUSIONS12
18:
The Team Approach
WORKING WITH COLLEAGUES
COMMUNICATION STRATEGIES4
Be Respectful and Professional
Listen
Try to Understand the Other Person's Viewpoint
Acknowledge the Other Person's Thoughts and Feelings
Be Co-operative
Look for Shared Concerns
State Your Feelings
Don't Take Things Personally
Learn to Say, “I was Wrong”
Don't Feel Pressured to Agree Instantly
Think about Possible Solutions before Meeting
Think of Conflict Resolution as a Helical Process
THE DOCTOR AND THE EMPLOYER 5
THE DOCTOR IN INSTITUTIONAL AND PUBLIC PRACTICE5
MEDICAL COVER3
CONCLUSION
19:
Leadership
CHARACTERISTICS OF LEADERSHIP
Leaders Change Things
Leaders Define Reality
Leader Takes Initiative—Take Risks
Leaders Like Colleagues, Professional and People
Leaders are Self-confident
Leaders are Courageous and Decisive
Leaders Maintain Integrity
Leaders are Preservers
Leaders are Teachers
TOOLS FOR LEADERSHIP
Create Your Vision (or a mission statement)
Establish an Advisory Board
Establish Network
Become an Excellent Communicator
Group Discussion
Learn the Rules and Obey them
Develop and Maintain a Support System
Leadership and Power
Maintain Balance in Your Life
WHAT PHYSICIANS SHOULD DO WHEN ASKED TO LEAD?1
Assess the Task
Get to Know Your Customers
Physician–Patient Relationship
Share Your Vision
Visit with Your Team
The Limits of Spoon Feedings
Drive Out Fear
Improve Yourself
CONCLUSION
Ten Leadership Action Steps3
20:
Reducing Medical Error
INTRODUCTION
MEDICAL ERRORS—FOCUS ON PRIMARY CARE
DEFINITION6
CLASSIFICATION
UNDERSTANDING ERRORS IN FAMILY PRACTICE
WHY SHOULD DOCTORS DISCLOSE MEDICAL ERRORS?8
WHY DOCTORS DO NOT DISCLOSE ERRORS?8
SYSTEM REDESIGN IN FAMILY PRACTICE
Reduce Reliance on Memory
Improve Information Access
Strive for an Error-proof System
Standardize Processes of Care
Emphasise Error Avoidance when Training Medical Staff
APOLOGY AS A SYSTEM OF MEDICAL ERROR DISCLOSURE
ELIMINATING ERRORS IN FAMILY PRACTICE–CURRENT TRENDS
Taxonomy of Errors in Primary Care
The AAFP has Established a Patient Safety Center4
Computerised Disease—Specific Health System
Electronic Medical Records (EMRs)11
CONCLUSION
21:
Medical Records
CONTENT AND STYLE
WEED SYSTEM: PROBLEM ORIENTED MEDICAL RECORD (POMR) AND SOAP1,2
Patient's Observation
FROM SOAP TO “SNOCAMP”4,5
MEDICAL COUNCIL OF INDIA (MCI)—IMPORTANCE OF MEDICAL RECORDS6
Medico-legal Records
22:
The Difficult Patient
INTRODUCTION
TERMINOLOGY AND INCIDENCE
CHARACTERISING THE DIFFICULT PATIENT
WHOSE FAULT?
PROBLEMS IN THE PHYSICIAN
PROBLEMS IN THE PATIENT-PHYSICIAN RELATIONSHIP
DISORDERS TO CONSIDER
STRATEGY TO HANDLE DIFFICULT PATIENTS
Acknowledge
Schedule Time
Cultivate a Sense of Partnership
Obtain the Patient's Perspective
Review
Assess for Potential Personality Disorder
Family Involvement
Schedule Regular Follow-up Visits
Referral
COPING SKILLS FOR PHYSICIANS
Empathy
Non-judgmental Listening
Improve Communication Skills
Develop a Positive Attitude Towards Patients
Harness the Power of Self-control
Make a Conciliatory Gesture
COPING SKILLS FOR FAMILY PHYSICIANS
THE CALMER APPROACH16
Catalyst for Change
Alter Thoughts to Change Feelings
Listen and then make a Diagnosis
Making an Agreement
Education and Follow-up
Reach out and Discuss your Feelings
CONCLUSION
23:
Medical Professionalism
INTRODUCTION
THE EVOLUTION OF PROFESSIONALISM
DEFINING PROFESSIONALISM
FUNDAMENTAL ETHICAL (MORAL) PRINCIPLES9
The Principle of Ultruism
The Principle of Autonomy
The Principle of Beneficence (do good) and Non-maleficence (do no harm)
The Principle of Social Justice
A SET OF PROFESSIONAL RESPONSIBILITIES6
Commitment to Professional Competence
Commitment to Honesty with Patients
Commitment to Patient Confidentiality
Commitment to Maintaining Appropriate Relations with Patients
Commitment to Improving Quality of Care
Commitment to Improving Access to Care
Commitment to a Just Distribution of Finite Resources
Commitment to Scientific Knowledge
Commitment to Maintaining Trust by Managing Conflicts of Interest
Commitment to Professional Responsibilities
MODEL BEHAVIOURS OF PROFESSIONALISM11
UNPROFESSIONAL BEHAVIOURS11
THE EDUCATIONAL CHALLENGE
CONCLUSION
PART V: ADOLESCENT HEALTH
24:
Adolescent Care
ADOLESCENT CONSULTATIONS
CONFIDENTIALITY
HISTORY
ADOLESCENT COMMUNICATION
Communication Techniques
KISS—Keep it Simple and Sweet
VAK—Principle
Sandwich Technique
PHYSICAL EXAMINATION
COUNSELLING
Councillor Qualities
Goals of Counselling
IMPROVING EXISTING SERVICES—ADOLESCENT CARE CLINICS (ACC)3
OBJECTIVES
Guidelines for ACC
CONCLUSION
25:
A Problem Adolescent
BEHAVIOUR PROBLEMS
SUICIDAL RISK
Indicators of Disturbed Adolescent
PHYSICIAN'S ROLE
A SCHEME FOR FORTIFYING THE PARENT-ADOLESCENT RELATIONSHIP
Teach Parents about Adolescent Development
Teach Teenagers about Adolescent Development
Teach Parents and Teenagers to Communicate with Each Other
INDICATIONS FOR PSYCHIATRIC REFERRAL
GUIDANCE AND COUNSELLING TO PARENTS
ADVICE TO PARENTS/FAMILY MEMBERS
WHAT AN ADOLESCENT EXPECTS FROM PARENTS?
CONCLUSION
PART VI: GERIATRIC HEALTH
26:
Aging and Geriatric Concepts
CHARACTERISTICS OF DISEASE IN ELDERLY
Non-specific Presentation of Disease (Table 26.1)
Early Symptom Manifestation
Multiple Causes
Multiple Pathology
Delayed or no Reporting of Diseases / Dysfunctions (Hidden illness, Table 26.2)
Even Mild Disease may Result in Serious Dysfunction
Certain Patterns of Presentation of Diseases Peculiar to Elderly
Many Findings that are Abnormal in Younger Patients are Relatively Common in Older People
Both Therapeutic and Preventive Measures
27:
Comprehensive Geriatric Assessment
MEDICAL ASSESSMENT
HISTORY TAKING AND ITS PITFALLS
IMPORTANT SPECIFIC AREAS
PHYSICAL EXAMINATION AND ITS PITFALLS
MENTAL STATE EXAMINATION
FUNCTIONAL EVALUATION
ADVANCE DIRECTIVE
CONCLUSION
28:
Management of the Elderly
GERIATRIC MANPOWER
GENERAL CONSIDERATION
PHYSICIAN'S ROLE
DISEASE CONDITIONS COMMON IN THE ELDERLY
Neuro Psychiatric Problems
Psychological Problems
Cardiovascular System
Respiratory System
Digestive System
Urogenital System
Endocrine System
Skeletal System
Vision
Hearing
Nutrition
Accident Prevention
Exercises
ATTITUDES FOR A SUCCESSFUL GERIATRIC PRACTICE6
CONCLUSION
29:
Practical Prescribing to the Elderly
FIRST ORDER SUGGESTION
Non-drug Therapy
Begin Therapy with Clear Endpoints in Mind
Start Low Go Slow
Attempt Reducing Doses Regularly
Review the Drug Profile at Every Visit
NON-COMPLIANCE IN THE ELDERLY
Measures to Enhance Compliance2
PART VII: PALLIATION AND BEREAVEMENT
30:
Communicating Bad News
WHAT IS BAD NEWS?
WHY IS BREAKING BAD NEWS SO DIFFICULT?
IMPORTANCE OF DISCLOSURE
WHAT PATIENTS VALUE?9
HOW SHOULD BAD NEWS BE DELIVERED?
Advance Preparation
Build a Therapeutic Environment/Relationship
Communicate Well
Deal with Patient and Family Reactions
Encourage and Validate Emotions
COMMUNICATION IN SPECIFIC SITUATIONS
Using the Telephone
Using a Translator
A FRAMEWORK FOR CONSULTATION/DISCUSSION11
THE FUTURE
CONCLUSION
31:
Palliative Care—Principles
THE SPECIAL ROLE OF THE FAMILY PHYSICIAN
WHAT IS PALLIATIVE CARE ?
PRINCIPLES OF PALLIATIVE CARE4
NEEDS OF THE DYING5
Physical
Psychological
Social
Spiritual
THE NEED FOR PALLIATIVE CARE6
TASKS IN PALLIATIVE CARE AND CARE OF THE DYING
WHEN DEATH IS APPROACHING–DIAGNOSING DYING10
Patient-Family Involvement–Broadening Decision Making
Identification and Management of Symptoms
Support for Family and Carers
Support after the Death
THE LIMITS OF CARE AT THE END OF LIFE14
SUMMARY OF TASKS FOR THE PATIENTS IN THE DYING PHASE10
Physical (Comfort) Measures
Psychological Issues
Religious and Spiritual Support
Communication with Family and Family Doctor
32:
Palliative Care—Practice
DEFINITION
IS THERE A NEED?
HOME—THE PREFERRED CHOICE
INVOLVEMENT OF FAMILY PHYSICIAN
How to Get Started and Keep Going3
Nursing Services
CLINICAL ISSUES
Controlling Pain
Controlling Other Symptoms
Copying with Emergencies
PATIENT ISSUES
Financial and Legal Aids
Nutrition
Respite Care
Bereavement Support
Medical Supplies and Equipment
Back-up Services
CONCLUSION
33:
Families and the Grief Process
WHAT IS GRIEF?
COMPONENTS OF GRIEF
PATTERNS OF REACTION 2
RISK FACTORS FOR COMPLICATED GRIEF2
FAMILY PHYSICIAN AS COUNSELLOR
Relationship
Diagnosis
Prognosis and Treatment
Referral
GUIDELINES TO MANAGE A GRIEVING PERSON AND FAMILY MEMBERS
Drug Therapy
CONCLUSION
PART VIII: PREVENTION AND HEALTH CARE
34:
Prevention in Family Practice
INTRODUCTION
LEVELS OF PREVENTIONS AND SCREENING
Primary Prevention
Secondary Prevention
Tertiary Prevention
Screening
OPPORTUNITY FOR PREVENTION4
SCOPE FOR PREVENTION
HEALTH PROMOTION AND DISEASE PREVENTION (Table 34.2)
HEALTH EDUCATION
PATIENT EDUCATION
Benefits of Patient Education
Barriers to Patient Education
Physical Check-up
CONCLUSION
35:
Preventive Care Delivery: Barriers and Remedies
BARRIERS TO PREVENTIVE CARE DELIVERY4,5
Organisation of Practice
The Patient
Cultural Factors
Absence of Symptoms and Motivation
Doctor Shopping
Anxiety about Procedures and Possible Results
Costs
The Doctor
Lack of Training
Lack of Clear Guidelines for the Local Population
Communication Skills
Lack of ‘Self Efficiency’ or Confidence
Unrealistic Targets
Acute Care Focus
Others
SOLUTIONS TO BARRIERS
PART IX: EDUCATION AND RESEARCH
36:
Clinical Audit
MEDICAL AUDIT IN FAMILY PRACTICE
DIFFERENCE BETWEEN MEDICAL AND CLINICAL AUDIT
DIFFERENCE BETWEEN CLINICAL AUDIT AND RESEARCH
DEFINITION
AIMS
The Audit Cycle (Fig. 36.1)
STEPS IN CLINICAL AUDIT IN ANY PARTICULAR GENERAL PRACTICE3,4
Identifying Problems, Choosing a Topic
Setting Priorities
Setting Criteria (i.e. what should be happening)
Observing Practice (i.e. what is happening)
Setting of Standards
Evaluate Information
Implement Changes—Repeat the Cycle (when changes are needed)
Final Stage
KEEP A RECORD
CONFIDENTIALITY
CONCLUSION
37:
Evidence-based Medicine: Principles
A CASE SCENARIO
INTRODUCTION
WHAT IS EVIDENCE-BASED MEDICINE (EBM)?
Distinguishing Features of EBM
Where did EBM Come from?
The Rationale for EBM—The Paradigm Shift (Table 37.1)
Definition of EBM
EBM10
Evidence-based Practice (EBP)11
Steps to Practicing EBM12 (Fig. 37.2)
Formation of a Clinical Questions (Table 37.2)
Search the Literature for the Best Available Evidence
Critical Appraisal of Studies
Applying Evidence-based Data to the Clinical Problem
Evaluation of Performance
Advantage of EBM
Limitations of EBM
Misconceptions about EBM
It's What we have Always Done
It will Replace Clinical Judgment
It will Foster ‘Cook-book’ Medicine
I don't Have Time for it
CONCLUSION
38:
Evidence-based Medicine: Practice
CONCERNS ABOUT EBM IN PRIMARY CARE PRACTICE
ESSENTIALS OF EBM IN PRIMARY CARE PRACTICE
THE FUTURE OF EBM IN PRIMARY CARE
CONCLUSION
39:
Research in Family Medicine
INTRODUCTION
BACKGROUND OF RESEARCH IN FAMILY MEDICINE
WHAT CONSTITUTES FAMILY/GENERAL PRACTICE RESEARCH?
TYPES OF RESEARCH METHODOLOGY
Quantitative Research
Cross-sectional Study
Case Control Study
Cohort Study
Randomised Controlled Trials (RCTs)
Qualitative Research
Limitations of Quantitative-Qualitative Research
GOOD RESEARCH IN FAMILY PRACTICE13
Consultation with Primary Care Groups
Good Research should take Account of the Participants
Be Aware of Competing Interests
Consider all Potential Settings
Cultural Issues
Adequate Resources
Ethical Considerations
Team Approach
RESEARCH STRATEGIES FOR FAMILY MEDICINE2
AIMS AND OBJECTIVES OF RESEARCH IN FAMILY MEDICINE2
METHODOLOGY OR LOGISTICS OF RESEARCH9 (Fig. 39.1)
WHAT CAN FAMILY PHYSICIANS DO?
SUGGESTED RESEARCH TRAINING AND ITS INCENTIVES REWARDS2
CONCLUSION
APPENDICES:
FELLOW OF THE COLLEGE OF GENERAL PRACTICE (FCGP)
Part I: Theory Consists of Four Papers
Part II: Clinical and Practical Examination
DIPLOMATE OF NATIONAL BOARD (DNB)—FAMILY MEDICINE
Part-I MCQs
Part-II
MEMBER OF THE ROYAL COLLEGE OF GENERAL PRACTITIONER (MRCGP)
DIPLOMA IN FAMILY MEDICINE (DFM)
CONSTITUTION OF WONCA
What is WONCA'S Mission?
Who Runs WONCA?
What does WONCA do?
Relations with Other Bodies
World and Regional Conferences
Publications
WONCA Website www.globalfamilydoctor.com
Individuals can join WONCA—Direct Membership
THE FUTURE
AS PER THE ALMAATA CONFERENCE DECLARATION:
ESSENTIAL CHARACTERISTICS
1. A small group
2. Defined group leader who is one of the following
3. Group members are in clinical contact with patient
4. The material of the group is based on the presentation of current cases giving the presenting clinician cause for thought
5. The discussion focuses on the relationship between the presenting doctor and his patient
6. Case notes should not be used
7. The groups are not for personal therapy
8. Standard rules for small group working apply
9. The purpose of the group is to increase understanding of the patient's problems, not to find solutions (Paraphrased from Campkin, 1986)
10. The leader takes ultimate responsibility for trying to ensure mat the group functions as described above
DESIRABLE CHARACTERISTICS OF A BALINT GROUP
1. The group is ‘ongoing’
2. The group is closed
3. There is a co-leader
4. The leader has psychoanalytical training
5. The group does not have to include all-comers
MICHAEL BALINT
Associated Eponyms
Balint group
Biography
INDEX
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