Olvido de los fenómenos psicológicos en la relación médico-paciente anciano (página 2)

RESULTADOS

La búsqueda inicial produjo
424 artículos. No se tuvieron en cuenta 367 porque no incluían pacientes
ancianos o no eran estudios de investigación. Así, pues, se trabajó con 57
artículos.

Una proporción considerable
de los artículos de investigación 19 (33%), se referían a las actitudes14-32;
14 (25%) a los resultados de la relación33-46; y 13 (23%) a los
patrones de comunicación47-59. Algunos pocos 9 (16%), trataban con
asuntos éticos60-68 y una cantidad mínima 2 (3%), con los fenómenos
psicológicos de la relación médico-paciente anciano69,70.

DISCUSION

El encuentro entre el
médico y el anciano tiene varios factores que intervienen en el desarrollo de
una relación profesional adecuada o inadecuada.

Las actitudes, estereotipos
o mitos en ambos protagonistas, médico y anciano, pueden afectar este
encuentro. La gerofobia por parte del médico, o las falsas creencias acerca de
la enfermedad en el paciente, también lo pueden alterar. Asimismo puede haber
barreras culturales que afectan la relación. En cambio, por lo general, las
actitudes positivas la facilitan2,3,5,6,14-32.

Para entender la dinámica
de la relación médico-paciente anciano, se necesita un conocimiento más
específico acerca de los fenómenos psicológicos entre el médico y el anciano.
En esta relación humana y profesional hay respuestas emocionales bilaterales
conscientes o inconscientes que pueden facilitar o entorpecer su desarrollo.
Los fenómenos psicológicos descritos son la transferencia, la contratransferencia,
el "rapport," la empatía, y la resistencia. Las contratransferencias
son las reacciones emocionales del médico hacia el paciente anciano, como
sentimientos (frustración) y conductas (rudeza, acortamiento del encuentro).
Cuando el médico no reconoce esta clase de respuestas, afectan en gran forma su
relación con los pacientes. Las transferencias son las emociones del paciente
anciano hacia el médico (sentimientos positivos o negativos). La empatía es la
habilidad del médico para recibir y decodificar la comunicación afectiva de su
paciente anciano, ello puede permitir el entendimiento de los sentimientos del
paciente. El "rapport" incluye el estado de mutua confianza y respeto
entre el médico y el paciente anciano. Las resistencias son las reacciones del
paciente anciano en contra de la relación con el médico o del tratamiento. Por
último, el entendimiento de estos fenómenos psicológicos es esencial para una
adecuada relación profesional con los ancianos2,3,5,6,10,11,69,70.

La comunicación entre el
médico y el anciano es compleja. Incluye la comunicación verbal y el lenguaje
no-verbal. Se necesitan habilidades relacionales, verbales y sobre todo
no-verbales por parte del médico. Un número importante de ancianos tiene
dificultades auditivas, visuales, o del habla que conducen a estrategias
especiales para comunicarse con ellos2,7,12,47-59.

En las decisiones clínicas
con los ancianos se presentan dilemas éticos. Los mayores dilemas tienen que
ver con las medidas para tratamientos de sostén de la vida o en pacientes
terminales. En esto es preferible comprometer al mismo paciente, cuando es
posible, y a la familia o a sus representantes legales60-68.

Los resultados definitivos
del encuentro se pueden reflejar en la satisfacción por parte del médico o del
paciente, en el seguimiento del paciente, y en el cumplimiento o no por parte
del anciano de la terapia que recomienda el médico2,33-46.

Para terminar, la relación
médico paciente anciano se ha estudiado poco, y sus fenómenos psicológicos se
entienden todavía menos. Se necesitan más trabajos investigativos en esta área
para poder clarificar esas relaciones tan importantes y así poder mejorar su
calidad.

SUMMARY

To assess publications on
the physician-aged patient relationship, we searched MEDLINE (1966-1995) and
made a systematic review of publications. We looked for research articles
related to the components of the physician-aged patient relationship. Of the 57
articles that were included, 33% focused on attitudinal barriers, 25% on
out-comes, 23% on communication skills, 16% on ethical issues, and only 3% on
psychological phenomena. These phenomena such as transference,
countertransference, and empathy are essential to understand the physician-aged
patient relationship. We concluded that the psychological phenomena between
physicians and their aged patients are often not included in research.

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Carlos A. Reyes-Ortiz, M. D. 2, Sylvia
Gheorghiu, M. D. 2, Thomas Mulligan, M. D. 3
1. Trabajo presentado en el Congreso Anual de la Sociedad Americana de
Geriatría, en Chicago, Illinois, EE. UU. , mayo de 1996.
2. Fellows in Geriatric Medicine. Department of Internal Medicine, Medical
College of Virginia, Virginia Commonwealth University, Richmond.
3. Chief, Geriatrics Section, Department of Internal Medicine, Medical College
of Virginia, Virginia Commonwealth University, and Hunter Holmes McGuire
Veterans Affairs Medical Center, Richmond, Virginia, EE. UU.