 Keywords: pedagogics, the abstract, the doctor, the teacher, psychology, the patient, mutual relations, therapy, a psychotherapythe Author: Poljanskaja O.V.THE DOCTOR AS THE TEACHERthe Person is secret. It should be solved, A problem of therapy from the point of view of influence of the doctor on a self-consciousness of the patient is improvement of his ability to conscious purposeful managements of a mental self-regulation, to active counteraction of illness. The doctor as the teacher at dialogue with the patient most completely realizes a principle " a recovery through comprehension " and that position known to much clinicians, that frequently it is necessary not only to treat the patient, but also to learn and bring up. To learn - means to add to the person of knowledge which relieve of the big scale of experiences, high level of alarm and feeling of pavor. Education provides repeated, patient, easygoing repetition of some positions with which help patients get rid of delicacies, the mistakes, harmful habits, from prejudices, tendentiousness, biases and superstitions. The role and value of a pedagogical psychotherapy have been marked still by V.M.Behterevym. V.N.Mjasishchev, his pupils and followers successfully applied and put into practice this method. The pedagogical psychotherapy is natural continuation of a rational psychotherapy, answering completely to modern problems of psychoneurological and somatic clinics. It stimulates flexibility and efficiency of clinical thinking of doctors, enriches principles of a complex psychotherapy, allowing in the form of an individual or collective psychotherapy to solve the pressing questions of intensive treatment and prophylaxis. With the help of this method which can successfully be applied in medical establishment of any structure, the following problems are solved:
During sessions of a pedagogical psychotherapy mutual encouragement and encouragement to convalescence, use so-called " a psychotherapeutic mirror ", anonymous discussion of a drawing of behaviour of experiences of patients, partnership, empathy and easygoing stimulation practise. In the present conditions the doctor should be by all means the psychologist because it will allow it to be guided more precisely in a characterology, personal reactions of people, will help to study features of thinking of the patient, and also to find out his moral - ethical and social installations. The doctor should be also the teacher freely owning didactics because many positions of a psychohygiene demand from people of steady skills, performances of obligatory rules, references without which this activity becomes abstract and even ephemeral. The culture of people is shaped and reaches the big heights only then when 4 following aspects are united: education, training, knowledge and constant perfection of the person. Education leans on continuity of human experience which develops and improved from generation to generation. The doctor engaged in medical pedagogics, constantly uses collective experience and by way of the trade, and in the field of interfacing sciences. For successful work in the field of medical pedagogics, a psychohygiene, a psychoprophylaxis and a psychotherapy it is necessary to bring up in itself some professionally important qualities of the person:
Sessions of medical pedagogics is, certainly, not simply lectures, occupations, educational conversations of the doctor with patients. It is synthesis of the mentioned above forms of dialogue of the doctor, the psychologist and the teacher with students. This such emotional and intellectual dialogue when the attention of the student is grasped entirely as such data which are vital are informed. A basis of good resistibility of illness, in N.I.Rejnvalda's (1978) opinion, properties of an organism, nervous system, and their concrete diffraction in requirements inherent in the given person, aspirations and in activity induced by them are not in themselves. The active vital position and, accordingly, intensive counteraction of illness, as a rule, are based on the account of interests of a society. Patients for whom appreciable social interests are characteristic, actively cooperate with the doctor during treatment. At their absence before the doctor, in parallel with medical, there are also медико-pedagogical problems. The major precondition of successful treatment is development of conscious motivation on active overcoming of illness. Many researchers surveyed various aspects of a problem " the person and illness ", putting forward the concepts connected to emotional - personal reaction of the patient on disease: " experience of illness ". At this E.A.Shevalev in concept " experience of illness " included attitudes to, to the morbid condition, to associates, to that form of activity which was up to illness and has anyhow changed in connection in it. The problem "patient - illness", knowledge represents patients of the illness the big interest, however thus it is necessary to take into account influence of psychogenic factors, an emotional condition of the patient, a constant mutual induction of the patients discussing each sign and illnesses each other, possible complications, character of treatment, the forecast, etc. Formation of an estimation of illness is influenced with contact to seriously ill patients, the data gathered from conversations with relations and familiar, with the personnel and other persons. Quite often thus patients tendentiously interpret " cases from practice ", the data received from educational films and magazine " Health ". Negative influence hospital conditions, original isolation from habitual social medium render also, an abruption from labour activity, infringement of former contacts to family, various vital impressions. At the analysis of an autoplastic picture of illness of R.Konechnyj and M.Bouhal (1974) result the following typology of the attitude to illness:
The strongest positive takes of a psychotherapy are reached, wrote V.I.Mjasishchev (1970) if it is possible not only to change the attitude of the patient to immediate psychotraumatic circumstances, but also his vital positions as a whole. It is conditionally possible to allocate the certain sequence in forms of behaviour of the doctor during a psychotherapy. At the first occurring with the patient he (doctor) is minimally active, not directive, promotes sincere disclosing of emotional experiences of the patient, creation of confidential contact. Then, raising the activity, the doctor starts finding-out of " an internal picture of illness ", to verbalization by the patient of all of his representations connected to comprehension of illness, expectations from treatment and prospects of convalescence. Carrying out correction of "concept" of illness at the patient, the doctor discusses with it the data of his inspections, convinces, that the reasons of illness are covered not in organic changes, helps to catch connection of emotional factors with a symptomatology. During this period the doctor gives the patient the corresponding information and acts in a role of the expert. Mutual relations with the patient go deep, the doctor becomes the assistant in a hard work of the patient above his private world. At the final stage the doctor again strengthens the activity and even a direct in test and fastening by the patient of new ways of experience and behaviour. For effective realization of any suggestions are necessary:
Main principles of simple psychotherapeutic treatment:
The iatrogenia is not short-term reaction of the patient to the wrong statement or action of the doctor, and the fixed neurotic frustration having usually true reasons in the person of the patient and character of their attitudes with the doctor. It represents some kind of the negative placebo - effect connected to certain expectations, fears and installations of the patient concerning illness, the doctor and treatments. An iatrogenia can cause:
For many blepharons patients have accustomed doctors to keep obligatory ritual: to write out the prescription. Doctors know, that frequently only one form of the prescription operates more strongly, than the registered medicine, he can help to get rid to the patient of excruciatings. Medicines are obligatory not in all cases, and the belief in convalescence is necessary always. Therefore the doctor can write out a placebo when support and encouragement will bring more advantage to the patient, than the most well-known and expensive pills. The placebo is an imitation of the medicine, the harmless tablets of dairy Saccharum packaged and packed the same as the present medicine. Researches have shown, that 90 % of people addressing for the help to doctors, suffer from the malaises subject to salutary forces of an organism. The doctor sees, that his experience and support is more important than the registered medicines, and he tries to not prevent natural process of convalescence. That to the patient was quieter and for some therapeutic influence, the doctor can appoint a placebo. The placebo, hence, is not so much tablet, how many during - from origin of belief in the doctor before complete inclusion in work of immune system of an organism and all his protective forces. Процеcс this occurs not because the tablet has any magic action, that is why, that a human body - the best doctor and the druggist: he "writes out" the most successful prescriptions to itself(himself). If the patient knows, that to it give a placebo it does not render any physiological effect. It once again confirms: the organism of the person is capable to transform hope for convalescence to palpable biochemical changes. The placebo proves, that it is impossible to part mentality and physiology. Illness can strike mentality and affect a physical condition, or, on the contrary, deterioration of a physical condition will be reflected in mental equilibrium. But a placebo effectively not always. It is considered, that the success of application of a placebo directly depends on mutual relations of the doctor and the patient. As the doctor concerns to the patient; whether he can convince the patient, that seriously perceives his disease; whether there Is a trust and mutual understanding - всё it it is essential not only for treatment, but also considerably strengthens action of a placebo. When there is no good human mutual relations between the doctor and the patient to apply a placebo it is useless. In this sense the doctor is, perhaps, the most important figure and process under the name "placebo". The most serious problem presently is an influence on health of a stress. We are oppressed not with an abundance of ideas, disagreements, opinions, and failing to understand, separate important from minor. We suffer from excess of the information which simply is not capable to acquire. In result - chaos and confusion, set of strong sensations and a disadvantage of the present feelings. " It is impossible without consequences for health day by day to prove disgustingly to that you feel, to be humiliated with that you do not like, to be pleased to that brings to you misfortune. Our nervous system not an empty phrase, not an invention. It - a physical body consisting of fibers. We throttling takes a place in space and is located in us, as a teeth in a mouth. It cannot be forced endlessly unpunishedly " (B.Pasternak "Doctor Zhivago"). From this point of view doubtfully, that a placebo (or any other medicine) renders effect if not will be to live at the person of passionate aspiration. Will to live a window in the future. It adjusts the patient on perception of treatment and bridges this help internal ability of an organism to struggle against illness. The placebo transforms will to live to a physical reality and guiding force. the Literature:
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