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You should feel free to ask about symp- toms and assess any impact on mood or daily activities. Death and the Dying Patient.

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There is a growing and important focus in professional education and the literature on the need to address the issues of death and dying. Topics such as end-of-life decision-making, grief and bereavement, and advance directives are beyond the scope of this chapter.

Basic concepts are appropriate even for beginning students, however, since you will care for patients near the end of their lives. Many clinicians avoid the subject of death because of their own discomforts and anxieties.

You will need to work through your abtes feelings with the help of reading and discussion. At each stage, follow the same approach. Use facilitative techniques to help them to bring out their concerns. Make openings for them to ask questions: Be wary of inappropriate semiologai assurance.

Give them opportunities to talk and then listen receptively, but if they prefer to stay at a social level, you need not feel like a failure.


Remember that illness—even a terminal one—is only one small part of the total person. To communicate appropriately, you have to get to know the patient; that is part of the helping process. Failing to establish this communication is widely viewed as a flaw in clinical care. Even if discussions of death and dying are difficult for you, you must learn to ask specific questions. The condition of the patient and the health care setting often determine what needs to be discussed.

For patients who are acutely ill and in the hospital, discussing what the patient wants to have done in the event of a cardiac or respiratory arrest is usually mandatory. Patients may also be unrealistic about the effectiveness of re- suscitation based on information in the media. Assure them that re- lieving pain and taking care of their other spiritual and physical needs will be a priority.

Ask about how patients spend their time every day, what brings them joy, and what they look forward to.

What ex- actly do you mean by that? Sexuality in the Clinician—Patient Relationship. The emotional and physical intimacy of the clinician—patient relationship may lead to sexual feelings. If you become aware of such feelings, accept them as a normal human response and bring them to the conscious level so they will not affect your be- havior.

Denying these feelings makes it more likely for you to act inappropri- ately. Any sexual contact or romantic relationship with patients is unethical; keep your relationship with the patient within professional bounds and seek help if you need it.


Occasionally, clinicians meet patients demiologia are frankly semiologua or make sex- ual advances.

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Have you been overly warm with the patient? Expressed your affection physically? Sought his or her emotional support?

Has your clothing bated demeanor been unconsciously seductive? It is your responsibility to avoid these problems.

Ethical Considerations You may wonder why an introductory chapter on interviewing contains a sec- tion on ethics. What is it about the process semiopogia talking with patients that calls for responses beyond our innate sense of morality?

Medical ethics, which guide our professional behavior, are not static, but several principles have guided clinicians semiolofia the ages. Usually our ethical approach is instinctive, but even as students you will face situations that call for applications of ethical principles.

Barbara Bates – Semiologia – 8th Edition

Some of the traditional and still fundamental maxims are as follows: Avoiding relevant topics or creating barriers to open communication can also do harm. Bated principle has become increasingly important over time and is consistent with collaborative rather than paternalistic pa- tient relationships.

As clini- cians, we are obligated not to tell others what we learn from our patients. This privacy is fundamental to our professional relationships with.