Balint training makes GPs thrive better in their job

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Abstract

In this study, we examined Balint group participants’ sense of control and satisfaction in their work situation and their attitudes towards caring for patients with psychosomatic problems.

Forty-one GPs filled in a questionnaire with a 10-point visual analogue scale. Of these, 20 had participated in Balint groups for more than one year and 21 were a reference group.

The Balint physicians reported better control of their work situation (e.g. taking coffee breaks and participating in decision making), thought less often that the patient should not have come for consultation or that psychosomatic patients were a time-consuming burden, and were less inclined to refer patients or take unneeded tests to terminate the consultation with the patient. These results might indicate higher work-related satisfaction and better doctor–patient relationship.

Introduction

The doctor–patient relationship is the core of the general practitioner’s (GP’s) profession; while it is often gratifying, it is also a source of severe emotional risk [1]. The work as a GP includes emotionally difficult situations, witnessing suffering, anxiety and death, as well as many contacts with despairing or demanding patients that cannot be satisfied [2]. Balint groups may provide the coping strategies the GPs need.

Balint groups are named after Michael Balint (1896–1970), the British psychoanalyst, born in Hungary, who in London during the 1950s developed a method of training GPs in the implementation of basic psychodynamic principles with special attention to the doctor–patient relationship [3]. The aim is to improve the physicians’ skills in handling their patients while simultaneously controlling their personal involvement and being aware of their own feelings during consultations with the patients. Balint saw the GPs’ central role in the health care system in general and he specifically emphasised the importance of the doctors’ personal impact on the outcome, looking at the doctor as a “drug”, whose “pharmacology” he wanted to study in the groups.

The method involves groups comprising six to 10 GPs who seek to improve their relationships with their patients. The groups meet regularly (every one or two weeks) during several years. During these group meetings, the physicians’ spontaneous reports of patient encounters are discussed in the presence of one or two leaders that have undergone psychoanalytic or equivalent training. In the discussions technical and medical details are avoided; focus is on the story of the encounter and the feelings it arouses in the participants, in order to facilitate new ways of understanding the doctor–patient relationship. This means that it is not a course in consultation-techniques.

A central aspect in the Balint group is the conception that the patients are human beings presenting a problem to the doctor; that the patients are integrated in their social environment, not just carriers of symptoms. This patient-centred approach calls for the doctor’s ability to communicate and adjust the consultation to the needs of the patient [4], [5]. Even if the evidence that patient-centred consultations lead to better patient outcomes is inconclusive to date [6], several other authors show the importance of this approach [7], [8]. An important circumstance enhancing the patient-centred consultation is that the physician is free from distressing emotions and feels safe in letting the patient take centre stage. Michael Balint talked about creating “a limited though considerable change of his [the physician’s] professional personality” [3]. A change of personality takes time; according to Michael Balint’s own evaluation, at least two years are needed [9].

The literature is limited on the Balint group’s training effects [10]. Most previous studies refer to a single group [11]. No comparison between trained and untrained GPs has been published. We therefore compared physicians who have been in Balint groups with physicians without such experience. We chose to examine the GPs’ working life from their own perspective, their specific difficulties because of stress and inability to always solve the patients’ problems, and their general feelings toward patients with psychosomatic illness. (The term psychosomatic has been used in different ways; here it defines conditions of uncertain origin, displayed in both body and mind of the patient, which often has no objective signs of disease.)

The aim of this study was to determine if and how GPs participating in Balint groups differ from other GPs with regard to coping capacity, satisfaction with their entire work situation and perceived capability to take on patients with psychosomatic problems. We hypothesised whether Balint group participation in addition to improved capability to attend to patients also makes the physician feel better generally.

Section snippets

Sample and setting

The study was carried out 1999 in south-eastern Sweden in the counties of Jönköping, Östergötland and Kalmar. The number of inhabitants is almost 1 million and the number of GPs about 450. The conditions in the primary health care were at the time of the study rather stable. Most posts were occupied by GP-specialists, but the workload was considered high and many GPs felt overburdened.

Four Balint groups were active in the region and we recruited all 26 GPs that had participated in the groups for

Results

The results of the RPs resemble those of the GPs in the county of Jönköping with regard to how they experience their work environment. We therefore considered them representative of the GPs in the region and acceptable as a reference group (Fig. 1).

Experienced BPs had significantly higher scores that the RPs on questions predominately about feeling of control of working situation and dealing with psychosomatic patients (Table 2). The answers of the young BPs are displayed in this table too,

Discussion and conclusion

In the present study, we examined the various experiences of the Balint group participation among the GPs, their view of their working conditions and their relationship to patients. We found that the BPs reported more positive feelings about their work in general and their relations to the patients in particular than the RPs. In “A Study of Doctors” Michael Balint had group leaders (all psychoanalysts) evaluate the personal development of the participating physicians [9] without asking the GPs

Acknowledgements

We would like to thank the participating GPs and the leaders of the Balint groups, Ann Malmqvist, Lena Svedin, Sven Andersson and Kerstin Wijkmark. Also thanks to Henning Pedersen and the other colleges at Eksjö Primary Care Centre, for daily support. Grants were received from FORSS, The Health Research Council in the South-East of Sweden.

References (23)

  • Ottosson J-O, editor. SBU rapport nr 144: patient-läkarrelationen. Swedish Council on Technology Assessment in Health...
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