全科醫(yī)學：主觀題

全科主觀題

1.Whatarethepatient'sexperienceofillness?

1)Patientsbecomeverymuchawareofthebodyandthelimitationsitimposes.Theyhaveto

thinkofactivitiesthatwerebeforecarriedoutbelowthelevelofawareness.

2)Chronicdiseaseespeciallyifitringssuccessivelossesofindependenceandcontrol,often

engendersprofoundsensationsofgrief.Withgriefareassociatedthefeelingsofsadnessand

anger,guiltandremorse.Iftheillnesscarriesstigmalikeepilepsy,cancerorAIDS,thenthe

feelingsofrejectionmaybeaddedtogrief.

3)Whenthepatientfeelsresponsibleforhisowndisease,theangerturnedinwards.

4)Fearandangerareeverpresentinillness,eveninminorillness.Fearsaremanyandvaried,

rationalandirrational.

5)Illnessmayimpairthefacultyofreason.Patientmaybecomeirrationalandeven

superstitious.

6)Thethreatstoselfthatbringsdisruption,lossofautonomy,lossofcontrolandlossof

confidence,makesthesickpersonvulnerable.

7)Thenaturalrhythmsofthebodylikeeating,sleeping,working,restingaredisturbed.

8)Severaldisabilitiesleadtodecreaseinspaceandincreaseintime.

9)Inmentalillness,thethreattoselfisterrifying.Theexperienceofdementia,depression,

schizophrenia,oranxietymayproducethemostintensesuffering.

10)However,peopledotriumphovertheirdisabilities.Thebodyhasremarkablepowersof

compensationandadaptation.

11)Thesituationisdifferentforthosewhoarebornwithadisability.Inthese,thedisabledbody

isthelivedbody,fromtheverybeginning.Sothebodywithdisease,ratherthanbeingalien,

becomesself.

Theexperienceofillnessalsovarieswiththecoursetheillnesstakes,asuddenorgradualonset,

aone-timedisabilitylikestrokeorinjury,whichthenremainsstatic,aprogressivelydownhill

course,oraprocessofremissionandrelapse.

2.PewHealthProfessionsCommission(PHFC)

CreatedbyThePewCharitableTrustsin1989,thePewHealthProfessionsCommissionhas

developedrecommendationsforchangeinhealthprofessionseducationandadvocatedthe

developmentofpolicieswhichrespondtothenation'shealthcareworkforceneeds.

3.Describetheroleofafamilyphysician

Thefamilyphysicianisamanagerofresources.Asgeneralistsandfirst-contactphysicians,they

havecontroloflargeresourcesandareable,withincertainlimits,tocontroladmissiontohospital,

useofinvestigations,prescrip-tionoftreatment,andreferraltospecialists.

Inallpartsoftheworld,resourcesarelimited—sometimesseverelylimited.Itis,therefore,

familyphysicians'responsibilitytomanagetheseresourcesforthebenefitoftheirpatientsand

forthecommunityasawhole.Becausetheinterestsofanindividualpatientmayconflictwith

thoseofthecommunityasawhole,thiscanraiseethicalissues.

4.Shaman

Theshamanisapersonsetapartinhissocietyasamanifestationofthesacred,apersonwho,by

unusualmeans,has''experiencedthesacredwithgreaterintensitythantherestofthe

community”(Eliade,1964).

5.Whatarethethreesensitiveandspecificquestionnairesareavailableinalcoholism?

thetwenty-five-orthirteen-itemversionsoftheMichiganAlcoholismScreeningTest(MAST),the

four-itemCAGEquestionnaire,andthe10-itemAlcoholUseDisorderIdentificationTest(AUDIT)

developedbytheWorldHealthOrganiza-tion.

6.Symptoms

Symptomsarethepatient'sdescriptionofwhatheorsheperceivestobeabnormalsensations.

Bydefinition,theyaresubjectiveandnotopentoverifica-tionbyempiricalmethods.Thereisno

objectivetestbywhichwecanverifythatapatientisactuallyfeelingapain.

Symptomsareaformofcommunication—thewayinwhichapatientconveysfeelingsofillness,

distress,ordiscomfort.Symptomsaretheinformationonwhichwebaseourunderstandingof

thepatient'sproblem.

7.Whatarethethreescreeningmeasuresareavailableinglaucoma?

Threescreeningmeasuresareavail-able:

1)Tonometry.Thisisofdoubtfulvalueasacase-findingmethod.Manypeoplewithincreased

pressuredonotgoontodevelopocularpathology.Moreover,upto35percentofpeople

withoculardamagehaveanormalpressureonasinglereading[CTF(C)].

2)Visualfieldtesting:Thisisbothsensitiveandspecific.TheHumphreyVisualFieldAnalyzeris

90percentsensitiveand91percentspecific.Theprocedure,however;isslowandthe

equipmentcostly,twofactorsthatmakethemethodimpracticableformostfamilypractices

[CTF(C)].

3)Ophthalmoscopy.Whenperformedbytrainedobservers,thisisbothsensitiveandspecific.

However,familyphysiciansrequiretrainingandexperiencetodevelopthisdegreeofskill.

Forfamilyphysicianswholackthenecessaryskillorequipment,thewisestcourseistorefer

elderlypatientsforperiodicscreeningtoanophthalmologistoroptometrist.

8.Anxietyexpression

Anxietyisnotexpressedinwords,itmaybeexpressedinbodilyways—facialexpression,gestures,

heartrateandsoon.Anobservantphysicianmayrecognizetheemotionfromthesesigns.The

anxietyresultsinavisittothedoctor.

9.“Exitproblem"or"doorknobcomment”

Theonethatisnotmentioneduntilthepatientisgettinguptoleave,sometimesintroducedby

thewords"Bytheway,Doctor/'Theexitproblemisusuallythemainreasonforthepatient'svisit.

Ifthecontextisavisitforanotherproblem,mentionofthemostsensitiveproblemislikelytobe

lefttothelast.Thishasbeencalledthe“exitproblem"or"doorknobcomment".

10.Dogmatization

Thisisdefinedastheprocessbywhichemotionsaretransducedtobodilysymp-toms,forwhich

medicalaidissought.Initsoriginalformulation,somatizationwasrelatedtothepsychoanalytic

conceptconversion:thetransductionofapsy-chologicalconflictintobodilysymptoms.

Thetermsomatizationisunfortunateinthatitsuggeststhattheprocessisabnormalandthatthe

patientistheagentofthetransduction.

11.ICES

InstituteforClinicalEvaluativeStudies

12.WhatarethemainCategoriesofAlternativeMedicine?

1)AncientmedicaltraditionssuchasChinesemedicine:acompleteparadigm,theory,and

rangeoftherapeuticpractices.

2)Shamanistichealingintraditionalsocietiesthatretaintheirlinkswiththepast.Although

usingherbalmedicines,theshamanisdistinguishedbyaninitiationthatisbelievedto

conferpoweroverthespiritworld.Thehealingprocessofteninvolvesalteredstatesof

consciousnessandincludesmembersofthepatient'sfamilyandcommunity.

3)Folkmedicine:lorehandeddownthroughgenerations,oftenaboutmedicalpropertiesof

plants.Somemoderndrugsandpracticeshadtheiroriginsinfolklore-forexample,

smallpoxvaccination,quinine,digitalis,ergotamine,andcolchicine.

4)AlternativeparadigmsandpracticeswithrecentrootsinWesternsocieties:homeopathy,

osteopathy,chiropractic,anthroposophicmedicine,naturopathy.

5)Nutritionaltherapies,rangingfromherbalmedicinestodietaryregimes.

6)Bodytherapies,includingmanykindsofmassage.

7)Spiritualhealing,eitherwithinthemainstreamreligionsorbyindividualsclaimingtohave

specialpowers.

8)Individualtherapieseitherborrowedfromothertraditionsordevelopedautonomously:

acupuncture,biofeedback,hypnotherapy,meditation,andimaging.

13.Whatadviseshouldthephysiciangivethepatientsontheuseofherbalproducts?

1)Ifyouaregoingtotakeherbs,seeapractitionerformallytrainedinbotanicalmedicine.

2)Buyherbalremediesfromtrustedandreliablesources.Avoidherbsinwhichthepurityand

qualityaresuspicious,especiallyimportedherbs.

3)Mostherbs,likedrugs,shouldbeavoidedduringpregnancyandlactationandshouldnotbe

giventosmallchildren.

4)Considerdrug/herbinteractions.

5)Startwithlowdosagesandbewareofthedosages:twopillsfromthesamebottlemayhave

completelydifferentstrengths.

6)Toavoidpossiblechroniceffects,donotuseherbalremediesforlongperiods.

7)Ifyouareunwell,discontinueuseimmediatelyandseekmedicaladvice.

14.Whatdowemeanbythetermdescriptiveresearch/

Descriptiveresearch,alsoknownasstatisticalresearch,describesdataandcharacteristicsabout

thepopulationorphenomenonbeingstudied.Themethodsinvolvedrangefromthesurvey

whichdescribesthestatusquo(currentstateofaffairs),thecorrelationstudywhichinvestigates

therelationshipbetweenvariables,todevelopmentalstudieswhichseektodeterminechanges

overtime.

15.Whatarethenecessaryconditionsforcontinuingself-education?

1)Thereshouldbesomestandardagainstwhichtomeasurefrmone/sperformance.

2)Onemusthavethecapacityforacceptingcriticism

3)Makechangesinmethodsofpracticeifnecessary

4)Informationonone'smethodofpracticeandoutcomeshouldbeavailableinpractice

records.

5)Shouldbeabletoreviewallcasesofconditionbeingstudied

6)Theinformationshouldnotbeavailablebutalsoaccessible.

16.Whatarethecuestocontext?

CuestoContext

Thefollowingcuesshouldalertthephysiciantothepossibilitythatheorsheshouldbeworking

inthepersonalandinterpersonalratherthantheclinical-pathologicalcontext:

1)Frequentattendanceswithminorillnesses.

2)Frequentattendancewiththesamesymptomsorwithmultiplecomplaints.

3)Attendanceswithasymptomthathasbeenpresentforalongtime.

4)Attendancewithachronicdiseasethatdoesnotappeartohavechanged.

5)Incongruitybetweenthepatient'sdistressandthecomparativelyminornatureofthe

symptoms.

6)Failuretorecoverintheexpectedtimefromanillness,injury,oroperation.

7)Failureofreassurancetosatisfythepatientformorethanashortperiod.

8)Frequentvisitsbyaparentwithachildwithminorproblems(thechildasapresenting

symptomofillnessintheparent).

9)Anadultpatientwithanaccompanyingrelative.

10)Inabilitytomakesenseofthepresentingproblem

17.“HeartSinkPatients”

Itistheothernamefor“Thefatenvelopsyndrome/'Itisidentifiedbythefeelingtheyevokein

thedoctor.ThisisduetotheunhelpfulConsultationswithspecialists.

18.Definedifficultpatientandclassifythem.

Westondefinesadifficultpatientasonewithwhomthephysicianhastroubleformingan

effectiveworkingrelationship.Thelongtermrelationshipswithpatientsingeneralpracticemake

thisaparticularproblemforfamilyphysicians.Asthetherapeuticsuccessdependssomuchon

therelationshipbetweendoctorandpatient,theinabilitytoformatherapeuticrelationshipis

usuallyasourceofmuchfrustrationforthedoctor.Paradoxically,failureoftherelationshipdoes

notnecessarilyleadtoitstermination,sothatdealingwiththeproblemisacontinuingstruggle.

DifficultpatientsfallintoaNumberofcategories:

Patientswhohavedevelopeda“somaticfixation/thatis,expresspersonaldistressintheformof

somaticsymptomsandrefusetobelievethatnoorganicdiseaseispresent.Thesearepatientswe

perceiveasworkinginthewrongcontext.Theyseekanswersfromthemedicalsystemandthe

answerstheygetarenegative:negativetestsandfailedtherapies.Thesekindofpatientsendup

withunnecessarysurgery.

Patientswhoabusethemselveswithdrugsoralcohol,orwhousetheirdiseasesinaself

-destructiveway.

Patientswhobecomedependentonprescriptiondrugs.

Patientswhomakeexcessivedemandsonusbyfrequentvisits,out-of-hourscalls,pressurefor

tests,medications,orreferrals.

Patientswhomovefromdoctortodoctororwhogotoseveraldoctorsforthesameproblem,

perhapsplayingoneofagainsttheother.

Seductivepatients.

Angrypatients.

Somepatientsfallintomorethanoneoftheabovecategories.

Certaincuesmayalertthephysiciantoaproblem-orapotentialproblem-inhisorher

relationshipswithapatient.Someofthesepatientshavebeendescribedascuetoacontext

error.

Anewpatientwhocomesafterleavinganotherphysicianandisextravagantinhispraiseforyou,

whileexpressinggreathostilitytowardstheformerdoctor.

Frequentvisitsforproblemsthatneverrespondtotreatment;persistentcomplaintsof

symptomswithrepeatedlynegativetestsandunhelpfulconsultationswithspecialists.Thisis

calledasfatenvelopsyndromeandthesepatientsarecalledasheartsinkpatients.

Disagreementsoverprescriptiondrugs.

Cuesfromourownfeelings.

Whatpatientsfearmostabouttherelationshipiswhattheyinvitebytheirbehavior.Thedoctor

fallsintothetrapofrespondingautomaticallytothebehaviorratherthantothepatientsneeds.

Whatthepatientfearsmostistherejection.Buthisorherbehavior,paradoxically,invites

rejection,andthedoctor;ifunreflective,respondsaccordingly.

Thereisnoeasysolutiontothesedifficulties.Physicianswhocancorrectlyidentifytheproblem,

howeverandavoidmanypitfalls,maynotonlysavethemselvesfrommuchfrustration,butalso

insomecaseshelptheirpatients,ifinnootherwaythanprotectingthemfromharm.

[Herearesomeguidelines:

1)Trytoavoidsomaticfixationbydealingwithitwhenitfirstoccurs.

2)Becautiousinprescribingnarcoticsforchonicorrecurrentpain.

3)Trytoprotectpatientsfromharminamedicalsystemthatisorientedtowardsphysical

pathology;fromunnecessarytests,medicationorsurgery.

4)Bealertforcounterferencereactionsinyourself.

5)Donotoverreactifapatientteststherelationship.

6)Bepreparedtosetlimits.

7)Involvecolleaguesinyourmanagementplan.

8)ifconflicyualrelationshipbecomespersistentandpervasiveinyourpractice,seek

consultationorsupervision.

DONOTmakethingsbybeinga'difficult'doctor.Sometimesthepatientseemstobedifficultbut,

thedifficultyisreallywiththedoctor.]

19.Normalanxiety

Normalanxiety-thanxietythatapersonnaturallyfeelswhenfacedwiththethreatofdeathor

disability.

20.Whatisempathy?

Empathyisthecapacitytoenterintoanotherperson'sexperience.forthephysicianitisthe

capacitytosensewhatitisliketobethepatient-toexperienceillness,disability,depression,andso

on.onotheroccasionsitmaybethecapacitytosensewhatitisliketobethepersoncaringfor

thepatient.thismayseemlikeanimpossibletask.

21.Iatrogenicfatigue

Itiskindoffatiguewhichproducedbyoneofthemanydrugs

22.Inthepatientswhodonotreceiveaspecificdiagnosisforthecauseoffatigue,inthese

patientsfatiguewillberelatedtoaspectsintheirwayoflife.Pleaselistfouroftheseaspects?

1)Insufficientsleep

2)Overwork

3)Poverty

4)Toolittleexercise

23.Thefirstpartoftheassessmentofpatientspresentingwithfatigueincludes?

1)Listeningtothepatient'saccountofthesymptoms

2)Tryingtounderstandthesymptommeaningforthepatient

3)Followingupanycuestothesymptomcause

24.Ifthediagnosisoffatigueisnotapparent,thenconditionalprobabilitieswilldependto

someextenton:

a.Ageofpatient

b.Sexofpatient

c.Lengthofhistory

d.Alloftheaboveanswersarecorrect

25.Whichcausesresultinthefactthatpatientswithdepressionrarelycomplainoffeeling

depressed?

1)Lackofinsightintotheircondition

2)Difficultyinputtingtheirfeelingsintowords

3)Assumptionsaboutwhatcomplaintsarelegitimateinamedicalcontext

26.fatigue

Definedasanoverwhelmingsenseofexhaustionanddecreasedcapacityforphysicalandmental

workregardlessofadequatesleep

27.whatarethefourclustersoftasksfortheGP?

1)Acknowledgementofthemultiplesymptoms,recognitionofthepatientssufferingand

diagnosis.thegroupwouldhavefoundithelpfultoknowmoreabouttheprocessofcoming

toadiagnosis.

2)Morehelpwithsymptomcontrol.tobeholdeachtimethat"it'sjustcfs“wasnotenough.if

thetreatmentinvolvedlifestylechanges,suchasrest,thisshouldactuallybeprescribedby

thedoctortomakeitacceptabletofamilyandcolleagues

3)Avoidrigidadherencetothe“diseasemodel“andthedualisticdistinctionbetweenphysical

andpsychologicalillness.

4)Preventionofrelapsesbyencouragingpatientstowatchforwarningsignals.

28.Pleaseexplainthelatterphrase"Depressionisnoteasytoidentifyinapersonofwidely

differentculturefromtheobserver"?

Awesternphysician,forexamplemayfinditdifficulttoknowwhenanAsianorAfricanpatientis

depressed.However,manyfamilyphysicianshavepatientsfromdifferentcultures

29.Accordingtothefeaturesofthepatient-centeredclinicalmethod,listthedescriptionofthe

physicianwhoismorelikelytorecognizedepression?

1)Whomakemoreeyecontactwithpatients

2)Whoisagoodlistener

3)lesslikelytointerruptpatients

4)Whoismorelikelytoexplorepsychologicalandsocialissues

30.Afamilyphysicianswitnessedwhichkindofsadness?

1)Thesadnessofdisappointment

2)Thesadnessofloss

3)Thesadnessaddespairofoverwhelmingmisfortune

4)Thesadnessofoldageandmortality

31.Pleaselistthesiximportantprincipleswhichshouldberememberedtosuccessesinthe

managementofchronicheadache?

1)Theoriginalreasonfortheheadachesisnotnecessarilythesameasthereasonthatmakes

themchronic.

2)Completeremovaloftheheadachesisnotarealisticobjectiveoftherapy.Successshouldbe

measuredbypatient'sabilitytofunction,theirassessmentoftheseverityandfrequencyof

theheadaches,theiruseofmedication,andtheextenttowhichthepainceasesto

dominatetheirlives.

3)Thepatientshouldbecomeanactiveparticipantinthetreatment.

4)Unresolvedfamilytensionsmaybeamongtheinitialcausesofthepatient'sproblemand

reasonforitschronicstate.

5)Overmedicationisacommonfeatureofchronicheadache.

6)Treatmentmustbeindividualized.

32.Pleasewritedownthethreereservedbasicgroundswhichrestricttheuseoftheopioid?

1)Lackofknowledgeaboutthepathophysiologyofheadache.

2)Fearofdrugdependencyandaddiction.

3)Theriskofadversesideeffects.

33.Nociceptivepain

Itisthatpainarisingfromorganicdiseasesuchascancer

34.Definetheterms“thepersoninthefamily"and"thefamilyintheperson"

Thepersoninthefamilyrepresentstheinterpersonalrelationshipsinthefamilygroup.The

familyinthepersonrepresentstheindividual'sexperienceofhisorherfamilyoforigin.Therefore

apersonisraisedandnurturedinafamilyfortheearlyyearsoflifebutthefamilyremainsina

personuntildeath.

35.Familysystem

Afamilyisasocialorganizationorsystemandhasfeaturesincommon.Asystemisdefinedasthe

numberofpartsandprocessesstandinginmutualinteractionwitheachother.Thefamilysystem

changesovertimeasitsmembersgrowolder.

36.Whatdoesitmeanto"Thinkfamily"?

1)Thinkingfamilyisbeingawareofaphysiciansresponsibilityforprovidinggoodinformation

andbeingvigilantforcommunicationblockswithinafamily

2)Thinkingfamilyisbeingsensitivetotheunmentionedfamilystressesthatoftenliebehind

depressionandsomaticsymptomssuchasheadaches,dyspepsiaorrecurrentabdominal

pain.

3)Itisalsobeingawareoftheeffectsonthefamilysystemofthephysiciansownactions-

admittingsomeonetohospital,makingaseriousdiagnosis.

4)Thinkingfamilyisbeingawareofcertaintrapsthatawaittheunwaryphysician:being

enlistedbyonesideofafamilyconflict,acceptingthefamily'sviewsofatroublesomechild

ordisclosingconfidentialinformationtootherfamilymembers.

37.Whatarethesixmaineffectsthatthefamilyhasonthehealthofitsmembers?

1)Geneticinfluences.Everyindividualisaproductoftheinteractionbetweenhisgenotype

andtheenvironment.Knowledgeofgeneticaspectsofadiseasemakesitanimportant

subjectforthefamilyphysician.

2)Childdevelopment.Thereisalotofevidencesupportingtherelationshipbetweenfamily

dysfunctionandchildhooddisorders.Parentaldeprivationisassociatedwithpsychological

problems,includingsuicide,depressionandpersonalitydisorder.

3)Somefamiliesaremorevulnerabletoillnessthanothers.Fore.g.inyoungfamiliesthere'sa

significantcorrelationbetweenmorbidityratesinmembersofthesamefamily.Inolder

familiesthere'safamilialincidenceofdisordersoftheskin,respiratorytractandofnervous

disorders.

4)Infectiousdiseasespreadsinfamilies.Ithasbeenshownthatstreptococcalinfectionis

relatedtoacuteandchronicfamilystress.Virusinfectionshaveastrongtendencytospread

fromtheindexcasestootherfamilymembers.Studiesshowthatthenumberofinfectionsis

directlyrelatedtofamilysize.

5)Familyfactorsaffectmorbidityandmortalityinadults.Mortalityissignificantlyincreasedin

widowersandwidowsinthefirstyearafterbereavement.Maleswithseverefamily

problemsare3timesmorelikelytodevelopanginathanthosewhohaveminorfamily

problems.

6)Thefamilyisimportantinrecoveryfromillness.Familysupportisanimportantfactorinthe

outcomeofallkindsofillness,butmoreespeciallyinchronicillnessanddisability.

38.Sensitivity

Sensitivityistheproportionofpatientswiththediseasewhohaveapositivetestresult,which

hasbeencalled“positivityindisease”.Boxesa+cgiveusthosepatientswiththediseaseandbox

agivesusthosewiththediseasewhotestpositive.

Anotherwayofputtingthiswouldbeasensitivityvarieswiththestageofthedisease"

39.Whatarethefallaciesthatshouldbementionedbeforeleavingthehypotheses?

Beforeweleavehypotheses,twofallaciesmustbementioned.Thefirstisthatthefamily

physicianalwaysthinksofcommondiseasesfirst.Thisisnotneces-sarilyso;itdependsentirely

onthecues.Ifthecuesarehighlyprobabilistic,suchasfatigue,thiswillholdtrue.If,ontheother

hand,thecueindicatesararediseasewithrelativecertainty,thiswillbethephysician'sfirst

hypothesis.

Thesecondfallacyisthatdiagnosisinfamilypracticeisdifferentfromdiag-nosisinotherfieldsof

medicinebecauseitisprobabilistic.Allclinicaldiagnosisisprobabilistic.Wherefamilypractice

differsisintherelativelylowlevelsofprobabilityatwhichmanydecisionshavetobemade.This

isbecauseoftheearlystageatwhichdiseaseisseen,not-assometimessuggested-becauseof

lackoftimetopursueamorespecificdiagnosis

40.WhatisaRapidlatexagglutinationforthestreptococcalantigen?

ARapidlatexagglutinationforstreptococcalantigenareteststhatareperformedonasolution

madefromathroatswabandtheendpointisredinthesamemannerasthelatexpregnancy

test

41.Forchildrenwithacutesorethroatdecisionanalysisusedtoevaluatefivestrategies,what

arethey?

1)Symptomatictreatment,bytreatingthepresentacutesorethroatsymptoms

2)Directtreatmentwithpenicillin

3)Agglutinationtest;Ifpositivetreatwithpenicillin

4)Culture;ifpositivetreatwithpenicillin

5)Culture;starttreatmentimmediatelywithoralpenicillin,stoptreatmentifcultureis

negativeTransference

42.Thehospicemovement

Thehospicemovementhasfosteredintegratedhomecareservicesfortheterminallyill.Besides

nursing,theseoftenincludetheservicesofachaplainandvolunteervisitors.In1992therewere

anestimatedonethousandhospiceprogramsintheUnitedStates.

43.Egoism

Egoismcanbeadescriptiveoranormativeposition.Psychologicalegoism,themostfamous

descriptiveposition,claimsthateachpersonhasbutoneultimateaim:herownwelfare.

Normativeformsofegoismmakeclaimsaboutwhatoneoughttodo,ratherthandescribewhat

onedoesdo.Ethicalegoismclaimsthatitisnecessaryandsufficientforanactiontobemorally

rightthatitmaximizeone'sself-interest.Rationalegoismclaimsthatitisnecessaryandsufficient

foranactiontoberationalthatitmaximizesone'sself-interest.

44.Transferenceandcountertransference:

Inpsychoanalysis,Transferenceintheclinicalrelationshipdenotesthepatient'sdisplace-ment

andexternalizingofinternalissuesontotheclinician;countertransferencedenotesthereverse"

(Stein,1985).

45.Whatisdifferencebetweentransferenceandcountertransference?

Transferenceisapsychoanalytictermreferringtoundifferentiatedassociations,inwhichpast

issuesarereflectedintocurrentrelationships.Freud(1927/1972)suggestedthatthetransferring

ofbothfeelingsandthoughtscouldoccurbetweenpeopleandsettingsandoccurunconsciously.

Animportantfeatureoftransferenceisthatitisconsideredtobemanylayered,sofeelings,

thoughts,andattitudeslinkedtomorethanonepersonandtopeopleofdifferentgenderscan

showthemselvesincurrentrelationships.Transferenceisconsideredaformofresistanceanda

mentaldefense,calledontoprotectoneselffromunresolvedchildhoodmemories.Yetitisalso

thoughttobeinvokedtobringaboutpositivechanges.Freuddescribedtransferenceas"new

editionsandfacsimilesofimpulsesandphantasies"(1923/1953,p.82)originatinginthepast.

Insteadofremembering,thepersontransferattitudesandconflictsareenactedincurrent

relationships,sometimeswithunfortunateresults.Manifestationsarelikelytooccurinallhuman

encounters;feelingstowardthesignificantotheroftenbegintoemergeearlyoninrelationships.

Countertransferenceisaresponsetotransferencethatcancomplicateorimpaircommunications

invarioussituations.Countertransferenceisinvokedbyaspectsoftransferenceandisagain

typifiedbyfeelings,thoughts,orattitudesunfittingtoaspectsofthecontemporaryrelationship.

Countertransferencecanalsomanifestinpositiveornegativeways.Themainfeaturesofboth

transferenceandCountertransferencearetheintensityoffeelingsexperiencedbyaperson

towardanotableother,feelingsthatareunfittingtothecurrentrelationship(Koo,2001).

Nonetheless,Rolf(2001)recommendedthatapractitionershouldidentifyrepeatedand

divergingpersonalfeelingsinordertodiscerneffectivelyCountertransferenceissues.