CC BY
34
6. Наумов П. Ю., Утюганов А. А. Ценность как разновидность субъектно-объектных отношений (системный анализ)//Вестник Университета (Государственный университет управления). 2013. № 22. С. 246-251.
7. Утюганов А. А. Формирование гражданско-патриотических ценностей и их смысловых детерминант у курсантов военного ВУЗА. Монография. 2015.
8. Фролова Л. В. Ценности военного образования//Воспитание и обучение: теория, методика и практика: материалы V Международной научно-практической конференции. Чебоксары: Центр научного сотрудничества «Интерактив плюс», 2015, - 75-79 с.
9. Фролова Л. В. Военное и гражданское образование: общее и особенное//Современные тенденции развития науки и технологий: сборник научных трудов по материалам VII Международной научно-практической конференции. Белгород, 2015. № 7, часть V. - 81-86 с.
10. Чаплинский А. Ю., Фролова Л. В. Сущность и значение фальсификации истории великой отечественной войны//Историческое наследие Великой Отечественной войны (1941-1945 гг.): методология оценки и значение для профессиональной подготовки будущих офицеров внутренних войск МВД России: сборник научных статей межвузовской научно-практической конференции. Новосибирск, 2015, - 324-327 с.
11. Яницкий М.С, Иванов М. С., Утюганов А. А. Изменения осмысленности прошлого, настоящего и будущего как механизм переживания экстремльных ситуаций.//Социальные и гуманитарные науки на Дальнем Востоке. 2012.№ 2 (34). С. 124-130.
12. Яницкий М. С., Серый А. В. Трансформация представлений об экстремальной ситуации в постнекласической психологии//Личность в экстремальных и кризисных ситуациях жизнедеятельности. 2013. № 3. С. 120-124.
Prykhodko Anna Mykolaivna, Kyiv National University named after Shevchenko, postgraduate student, the Faculty of Psychology E-mail: [email protected]
Psychological traits of doctors and patients researched on base of family planning and medical genetics centres in Ukraine
Abstract: today the patient becomes a consumer; who often chooses the way of treatment by himself/herself, however "consumer" has no necessary knowledge to make a decision. Knowledge of patient's psychological traits helps doctor to involve the patient into medical care. The goal of the study was to choose the psychological characteristics of the patient and the doctor that may influence their interaction and find out the ways in which it can help in optimization of the given medical care in Ukraine.
Keywords: psychological traits, patient's satisfaction, "doctor-patient" interaction, family planning, workplace burnout, defense mechanisms.
Rationale. Today professionals of the different fields of science denote a pressing issue to reform the provision of medical services to the population in order to improve the quality thereof [1; 2]. Notwithstanding the globalizing processes in the world, the level and approaches to provision of medical services vary substantially, as well as the difficulties typical of different countries. Sufficient technical, informational, and pharmaceutical support has its particular problems leading not to involving the patient in the treatment process, but may be regarded as medicalization. Thus it's insufficient to discuss only the economical or informational component to solve all of the problems. The fulfilment of the task to improve the health care should be carried out simultaneously at all levels. However an important place at the micro-level, along with the healthcare institution's state of the art equipment, belongs to a communicative component between the doctor and the patient, which to the great extent depends on the psychological features of the doctor. The patients' mistrust to the doctors,
their bias, and sometimes simple disinformation reduce the motivation to seek medical advice, decrease the number of essential medical interventions, which causes an irreparable harm to the health of the whole population [3; 4; 5].
Today it's hard to deny that a business orientation is formed among the doctors including due to a strong influence and resources of pharmaceutical and insurance companies, as well as simply due to statistical reporting. In these conditions the patients' mistrust increases along with outrage and oppression of the doctors facing the lack of resources in fulfilment of their job (they are forced to find them by their own), reduction of the social status of their profession, with transformation of their life priorities, self-identification, etc. [6].
Analysis of the latest surveys' results. In the opinion of [7; 8], it's quite hard to take any certain situation positively, when a person formed an overall negative self-conception. The self-image and other basic conceptions, motives, and interests of a person, his or her attitude to the people around
and life in general influence the perception and understanding of a situation.
Today the patient becomes a consumer; who often chooses the way of treatment by himself/herself, however "consumer" has no necessary knowledge to make a decision. The estimation of a patient's subjective satisfaction is practically important, which was shown in a survey (Jackson, 2001) with participation of 500 patients examined by their physical symptoms by 38 doctors. The results evidence that an effective communication between the doctor and the patient has a great influence on the patient's satisfaction with the level of medical services provided [9]. Although it's a very subjective phenomenon, it server not only as one of the treatment result characteristics, but also as a factor influencing the further progression of the disease depending on the positive or negative influence on the patient's compliance after dismissal. Sot it allows to forecast the success of a treatment and the frequency of re-admission. The term "patient's satisfaction with the treatment" reflects the correlation between the patient's expectations from the treatment and his impression from the medical care provided. Therefore the approach the doctor finds to his patient is an important factor in involving the patient to the process of medical care provision and satisfaction thereof, which demands additional emotional expenditure from the doctor. Whereas the satisfaction with a treatment is influenced by different factors, the quality of relations between the doctor and the patient is often determinative in forming thereof, and is in many ways decisive for the therapeutic process. The subj ective satisfaction with the treatment was regarded as a part of the following components: satisfaction with the result of the treatment, with doctor-patient relations, with conditions of life and environment, as well as stigmati-zation reflecting the level of hypersensitivity of the patient's status perception [9; 10].
The doctor's satisfaction with his or her professional life may also influence the quality of his or her relations with the patient. The surveys of D. Grembovsky held in the outpatient departments of a clinical hospital show that the doctors' satisfaction with their professional life was connected with a great trust of the patients and confidence in their doctors [11]. The doctors that are more satisfied may be better for decrease of the patients' anxiety [12; 13]. An assumption was made that the doctors satisfied with their professional life may have a more positive effect of treatment which in its turn may influence their communication with the patients which consequently will contribute in increase of the patients' satisfaction [12; 13].
Addressing to the psychological factors of influence one should note that the attitude to the disease is always important therefore it influences the other systems of the personal relations including the protective and adaptive mechanisms [14]. The psychological protection of a subject is turned against the emotional pain evoked by negative information contradicting the person's self-esteem, value orientations, and self-image. It disfigures or displaces the essence of informa-
tion from the subject's conscience, which deteriorates the self-improvement thereof. The action of the psychological defence mechanisms is a powerful aspect of inadequate self-perception and perception of the outer circumstances, and therefore it is one of the ways of full or partial neutralization of their realization. This is particularly dangerous in the profession of a doctor, who is able to fulfil effectively the professional tasks only under condition of a subjective physical and mental welfare; this job by its own content from the very beginning creates a background for development of maladjustment states, arising of inadequate protective mechanisms, and professional burning out of the subject [15-19].
Regarding the doctor's working conditions it should be mentioned that belonging to the subjective-subjective type of professions, his or her activity takes place in the conditions of increased psychological demands and involves high mental and psycho-emotional strain. The doctor's activity in the conditions of professional stress, peculiarities of emotional responding to different situations of the professional activity, the factors influencing the professional and personal development of the treatment process subject, and individual psychological aspects lead to a professional burnout. It appears as a result of inner aggregation of adverse emotions without a corresponding "outlet" or "disposal" of them. The professional activity of the healthcare professionals contains a potential threat of emotional burnout syndrome development due to a high probability of excessive sympathy [20]. In the very sphere of family planning for the women as well as for men professionally involved, a desire for almightiness is noticed
[21], which should be controlled to prevent falling into their own trap. Such a peculiarity demands a stronger realization of the own psychological constitution.
The other peculiarity is that in this sphere one may often come across hyper-expectations of the patients, who read the articles about incredible results and a possibility to have a baby in spite of all the forecasts. The doctor should monitor such tendencies and balance them making them more realistic
[22].
Besides, the reproductive sphere differs from the others by the fact that it's not always about individual needs, it's often about the species. The bipolarity is found in different psychological load of parenthood and sexuality bound on the same physiology [23].
It is proven that communication in healthcare highly correlates with a better patients' compliance as to the treatment prescribed [24]. Therefore, communication is an important factor which gives the doctor some control in helping the patients stick to the prescription. That's why it is essential to introduce the development of corresponding skills in teaching of the specialists for the purpose of increasing the level of commitment, adherence of patients to the treatment schemes, etc. [25; 26].
Objective. To research and discover the particularity of the doctor's and patient's psychological traits to optimize the prevention, diagnostics, and treatment in the sphere of repro-
ductive health (based upon the examples of patients in family planning and medical genetics centres). The treatment of a patient in some cases may be slowed down or even foredoomed to failure, if the disease nature and course is evoked by psychic moments, and the doctor is not able to understand it in time and take it into consideration. Therefore it's clear that the doctor must be psychologically and psychotherapeutically empowered [27].
Separate characteristics don't include the whole diversity of the patient's and doctor's psychological portrait, but on the basis of the theoretical analysis of literature carried out, we regarded them as determinative [28-36]: for the doctors it is availability, structure, and level of professional burnout; main defensive mechanisms; evaluation of cooperation with the patients; satisfaction with the working process; satisfaction with the treatment results; vision of the disease; type of own disease perception. The following is important for the patients: availability, structure, and level of emotional burnout; subjective satisfaction with the treatment; evaluation of the medical personnel work; estimation of the treatment duration; satisfaction with the treatment quality; type of own disease perception; basic protective mechanisms; vision of the disease.
Materials and research methods. For the purpose of doctor's and patient's psychological characteristics investigation in the sphere of reproductive health the following questionnaires and methods have been chosen.
For the doctors: — personality LSI inventory [37]; V. Boyko's "Emotional burnout level diagnostics" inventory [38];
— Bekhterov Institute personality inventory (disease perception type) [39];
— modification of Dembo-Rubinstein method (introduction of scales: «Interaction with patients», «Satisfaction with the working process», «Satisfaction with the treatment results») [40];
— projective method "Vision of the disease" [30].
For the patients:
— personality LSI inventory [37];
— V Boyko's "Emotional burnout level diagnostics" inventory [38];
— Bekhterov Institute personality inventory (disease perception type) [39];
— Bekhterov Institute inventory «Subjective satisfaction with the treatment» [42];
— modification of Dembo-Rubinstein method (introduction of scales: «Medical personnel work», «Treatment duration», «Satisfaction with the treatment quality» [40];
— projective method «Vision of the disease» [30].
The sampling was accomplished by the doctors of inpatient hospitals network of the healthcare system with a graduate medical education. They specialise in healthcare and medical aid provision in reproductive health disorders of population. The patients seeking medical advice in the departments of the chosen hospitals were also involved. The number of respondents was 410 persons.
The data gathered was processed using SPSS 17 software.
The survey was carried out on the basis of the following healthcare institutions of Ukraine:
1. «Antenatal protection of fetus and medical genetics regional centre» of Chernivtsi regional medical diagnostic centre.
2. Communal institution "Kyiv regional mother-child
healthcare centre".
3. «Zhytomyr regional mother-child healthcare centre».
Survey results. Considering the results of the survey
performed, we'll describe the most important facts obtained. Among the three groups of the doctors (the division was territorial and corresponds to the number of institutions) the level of demands as to interaction with the patients is lower than the actual state of things estimation. For the first group the correlation was 3 to 1.8; for the second one — 3.5 to 3.4; for the third one — 3.6 to 3.4. Although the highest difference concerns the first group, it is typical of all the doctors in the sample, which proves the "saving" of emotional resource by the doctors in the process of building up the relations with the clients.
The fact obtained may be indicative of two things. First, it might be a compensatory mechanism, sometimes called "antidepression mechanism", second — reflect the overall compensatory increase of self-esteem and self-satisfaction [41].
In this case it's quite hard to define what exactly is involved, but the level of doctors' demands is quite reduced, which definitely shows the impairment of correlation between the doctors' demands and real capabilities. We also may not speak of a compensatory increase of self-esteem level, whereas none of the results by the scales is in increased or very high level (three or less).
Only according to several scales the "dream level" is higher than the actual state of things. These are "satisfaction with the treatment results", "happiness", and "optimism". Among all the relations estimation scales on interaction with the patient only the mentioned one does not fit under the compensatory cognitive distortion. Whereas this does not involve the contact with patients but the result of a professional activity, the protective mechanisms promoting the saving of emotions influence the respondents' self-esteem to a much lesser extent.
We found a decrease of the demand level among the doctors in comparison to the actual self-esteem; therefore they estimate the actual state of things higher than the desirable one. This may be indicative of pessimism manifestation compensated by an increased self-esteem of the actual state of things (the interval of possible has a negative modality).
Rationalization, projection, and denial are the highest three indications for all three groups. It may show as depreciation, indifference, and rejection. Thus we can conclude that the protective mechanisms structure of the doctors is aimed at distancing from the patient while preserving the initiative and responsible role of a doctor. We found that an average meaning of the stress levels in the groups of doctors equals to 48.0; 36.5 and 36.0 in the first, second and third group correspond-
ingly. The comparison of the general stress level between the three groups shows that the information including that from the patients is perceived more realistically by the doctors of the second and third group. No statistically important differences in the protective mechanisms between the groups of doctors were found.
Quite high showings were obtained by the symptom "reduction of professional responsibilities" (2.4; 1.7 and 2.2), which among the others seems to be important for the possibility of compliance formation between the doctor and the patient, whereas it directly influences their interaction, and together with the general tendency of increase of the "resistance" phase (2.1; 2 and 1.9) regarded as a resistance to the increasing stress exhausting the personality, this is an indicator of professional deformation.
We discovered a specific feature of perception of the own health state by the doctors — it is inattention to their own disease, for due to the peculiarity of the doctors' activity their attention is aimed at the patients and not at themselves. But as we mentioned the self-perception as an expert depends greatly on well-being both psychological and physical (at that not from the objective state of things, but from a subjective vision thereof), and the attention to the doctor's own well-being may become a source of inner confidence and a resource for positive emotions.
We observed that the highest percentage of the doctors had a neurasthenic and sensitive type of attitude to the disease (20.6% each). A considerable number of doctors (17.7%) also had a harmonious, euphoric, and paranoic types of attitude; none of them showed melancholic, apathetic, or egocentric type of attitude to the disease. Among the patients neurasthenic (21%), sensitive (19.4%), and paranoic (18.9%) types of attitude are the most frequent; quite often "obsessive-phobic", "anxious", "hypochondriac" — 13.3%, 11.7% and 11.7% correspondingly, and no melancholic type.
We defined the general stress levels of protective mechanisms of the patients -53.0; 43.4 and 47.0 in the first, second, and third group of the patients. We found a high rate of average level of protective mechanisms manifestation "displacement", "regression", and "replacement" in the first group of the patients in comparison to the other two groups. This means that the patients of this group unconsciously use all the types of information distortion, which influence the quality of their interaction with the environment, including the doctors.
It was demonstrated that in estimation of the patients' satisfaction by the interaction in the scale "doctor-patient relations" the results correlate positively by 99% to the levels of importance with the results in the scales "life conditions" (0.660); "treatment results" (0.654), and "stigmatiza-tion" (0.526). The estimations of "doctor-patient relations" (-0.182) and "treatment results" (-0.140) negatively correlate with the interaction model "loneliness", obtained by the projective method.
The development of features promoting the introduction of a doctor-patient partner interaction, decrease of the doc-
tors' stress should be and must be carried out within special training programmes aimed at medical personnel involved in the sphere of reproductive health. These programmes should consider the psychological aspects of the healthcare workers and should be centred on individual needs of each doctor taking into account his or her psychological features, for the latter are reflected in perception and reacting to the patients and disease. It seems appropriate and even necessary to introduce Balint-trainings [42] in our medical sphere, whereas they are a safe and supporting method stimulating psychological characteristics needed for building up an effective interaction of a doctor with the patient.
As to the interaction models, these differ in the three groups, and we may conclude that the doctors with more oppressed psychological state (group No.1) prefer an expert, authoritative position in the interaction. The other group (group No.2) adheres to a partner interaction, and the doctors there showed a lower level of protective mechanisms as well as emotional burnout. As for group No.3, it actively used all of the models and was characterized by the greatest psychological diversity of the respondents together with a normal level of demonstration thereof.
It was proved that there are a lot of statistically important differences between the patients of different regions, and therefore different doctors.
Satisfaction with the work of the medical personnel in three groups is statistically different but in a pair-wise comparison this connection does not seem to be that strong. Yet the patients who underwent treatment in Kyiv region showed statistically more satisfaction with the medical personnel's work that the patients is Chernivtsi region.
The emotional alienation is more typical for the patients of Chernivtsi (the first group) and Zhytomyr regions (the third group) together. The euphoric type of reaction is more typical for the patients of Kyiv region in comparison to the other two.
A higher level of "depersonalization" was noted in the first (2.4) and the third group of patients (2.1) in comparison to the patients of the second group (1.7).
It was found that self-dissatisfaction and stress correlating negatively with the satisfaction of doctor-patient interaction, also correlates negatively with the patients' subjective satisfaction by the treatment process. This means that a doctor in stress, dissatisfied with him or herself (decrease of self-esteem level) is less likely to establish a positive compliance.
It was proved that the patients' satisfaction with interaction depends not only in the doctors' actions but mostly on psycho-emotional psychosomatic states of the patients, which proves the importance of obtaining and mastering the communicative skills, empathy, etc. by the doctor.
It was ascertained that the protective mechanisms of a personality have a statistically important connection with the subjective satisfaction with the treatment: the more frequent they appear, the lower is the patients' satisfaction with the treatment at interaction of the doctor and the patient. It means that the ability and skill of reflection of the doctors
may increase the index of the patients' satisfaction with the treatment. Forming of this skill needs a long-term training in the training programmes.
It's essential to have a powerful means to control the interaction between the doctors and the patients, and improve it if necessary. For this purpose the Balint-group principle may also be applied; initially it was developed to increase the understanding of what happens between the doctor and the patient, but appeared to be useful for the control of interaction processes in different spheres. The positive experience accumulated allows widening this type of training, and implementing it with the other forms of medical training. But the value of Balint trainings in the programmes concerning the reproductive health remains not really defined. They indeed develop the competence of professionalism and interpersonal interaction skills, and communication in a humanist environment. But considering the fact that the Balint groups are process-oriented it is difficult to measure the results and consider them the direct consequence of Balint training. However it will be fair to admit that Balint training is a safe and supportive method stimulating reflection, brave ideas, and offers alternative approaches to getting rid of complicated relations and building up an interaction with the patients.
It should be emphasized that using interdisciplinary researches or implementing the survey results from the other sphere of knowledge for a new purpose is a quite reasonable feature of the modern scientific approach to studying of any given phenomenon. In this connection it seems timely and possible to extrapolate the results of our domestic psychologists (Elkonin D. B., Zinchenko V P., Vyhotskyy L. S.) as to interaction of a student and a teacher to interaction of a doctor and a patient [43, 226], for in their researches they studied the problem of activation of the student's position with the aim of increasing the level of educational process efficiency.
This very problem of activation arises in the medicine — setting the patient for an active position as to the treatment, and involving in the process of treatment should improve the process of treatment. This approach seems even more necessary considering the fact that the patient becomes a consumer of medical services — a client choosing the ways of treatment, doctors, medications, etc.
The professionals with more developed communicative and interaction skills may define the disease faster and thus
decrease the expenses for treatment, prevent the crisis, and support the patient. All this together may lead to a higher quality of the treatment process, increase its efficiency, increase the patient's satisfaction, decrease the cost of treatment, and improve the patient's understanding of his or her medical problem. As a result the degree of patient's involvement in the treatment process increases [44]. Today the psychology of management considers the approach according to which the workers' notion of satisfaction with the job should be divided from the involvement. It seems appropriate to develop not only the patients' features promoting appearance of satisfaction, but also helping involve him or her in the process of treatment. The medical personnel, as it was mentioned before, should activate the patient's attitude to the treatment and division of the responsibility with the doctor for the decisions made together and the results of treatment.
Conclusions.
The development of characteristics which will promote introduction of the partner interaction model of the doctor and patient and decreasing the doctors' stress may and must be performed in special training programmes for the medical personnel employed in the sphere of reproductive health.
The data obtained are also advisable to use in the educational process in the medical higher educational establishments of Ukraine in teaching of such disciplines as medical psychology, psychodiagnostics, health psychology, psychological consultation.
The patients' satisfaction with the treatment should be periodically checked in the healthcare institutions. Systematic and standardized response from the patients will allow using the data obtained to improve the psychological component of the medical aid.
In decision of the problem of the patient's activation, bringing him or her to an active position as to the diagnostics, treatment, and prevention of the disease the extrapolation of the research results as to student-teacher interaction to the doctor-patient interaction seems to be timely and possible.
The basic clauses and conclusions of the thesis research are recommended for use by the family doctors and in the healthcare institutions involved in the sphere of reproduction and family planning.
References:
1. Ясько Б. А. Психология медицинского труда: личность врача в процессе профессионализации: Автореф. дис. докт. псих. наук/Б. А. Ясько - Краснодар, 2004. - 45 c.
2. Аджиев М. Э. Анализ принципов организации управление качеством медицинской помощи/М. Э. Аджиев//Молодой ученый. - 2013. - № 11. - С. 207-211.
3. Serour M. Difficult Patients or Difficult Doctors: An Analysis of Problematic Consultations/M. Serour, H. A. Othman, G. A. Khalifah//Eur.J. Gen. Med. - 2009. V.6, N 2. - P. 87-93.
4. Майоров М. В. К вопросу о повышении комплайенса в амбулаторной акушерско-гинекологической практике /М. В. Майоров//Медицинские аспекты здоровья женщины. - 2007. - № 1. - С. 68-70.
5. Ненарокомов А. Ю. Проблема медикализации в онкологи/А. Ю. Ненарокомов, Д. Л. Сперанский//Международный журнал прикладных и фундаментальных исследований. - 2013. - № 10. - С. 35-37.
6. Гринхальх Т. Основы доказательной медицины/Т. Гринхальх. - М.: ГЭОТАР-Медиа, 2006. - 240 с.
7. Панок В. Г. Основи практично! психологп/В. Г. Панок, Т. М. Титаренко, Н. В. Чепелева [та ш.] - Ки!в.: ЛибЦь, 199. -533 с.
8. Титаренко Т. М. Життевий свгг особистостi: у межах i за межами буденностi/Т. М. Титаренко. - К.: ДП Спецiалiзоване видавництво «ЛибЦь», 2003. - 376 с.
9. Wong S. Communication Skills and Doctor Patient Relationship/S. Wong, A. Lee//The Chinese University of Hong Kong Editorial Medical Bulletin. - 2006. - V.11, N. 3. - P. 7-9.
10. Аленинская О. А. Психолого-акмеологические условия развития гуманистической концепции пациента у врача: Автореф. дис. канд. псих. наук/О. А. Аленинская. - Тамбов, 2008. - 17 с.
11. Grembovski D. E. Managed care, access to mental health specialists and outcomes among primary care patients with depressive symptoms/D. E. Grembovski, D. Martin, D. L. Patrick [et. all]. - J. Gen. Intern. Med. - V. 17. - P. 258-269
12. Hall J. Physicians' liking for their patients: more evidence for the role of affect in medical care/J. Hall, A. Epstein, M. L. DeCiantis, В. McNeil//Health Psychol. - 1993 - № 12. - Р. 140-146.
13. Hall J. Liking in the physician-patient relationship/J. Hall, T. G. Horgan, T. Stein, D. L. Roter.//Patient Educ. Couns. -2002.- V.48. - Р. 69-77.
14. Карвасарский Б. Д. Медицинская психология/Б. Д. Карвасарский. - Л.: Медицина, 1982. - 272 с.
15. Басин Ф. В. Проблема психологической защиты/Ф. В. Басин, М. К. Бурлакова, В. Н. Волков//Психологический журнал. - 1988 № 3 - C. 30-31.
16. Демина Л. Д. Психическое здоровье и защитные механизмы личности/Л. Д. Демина, И. А. Ральникова. - Изд-во Алтайского государственного университета, 200. - 123 с.
17. Богданова М. В. Психологические защитные механизмы (к пониманию взаимозависимости защитных систем: психологической и иммунной)/М. В. Богданова//Вестник ТюмГУ - 2005. - № 3. - С. 14- 18.
18. Богомолов А. М. Связь интенсивности психологической защиты личности с процессом самореализации /А. М. Богомолов, А. Г. Портнова//Психологическая наука и образование. - 2004. - № 2. - C. 27.
19. Стеблянко Ю. В. Роль и значение защитных механизмов в процессе стрессоустойчивости/Ю. В. Стеблянко//Мир современной науки, 2011. - Вып. 3. - С. 1-4.
20. Cramer J. A. Medication Compliance and Persistence: Terminology and Definitions/J. A Cramer, A. Roy, A. Burrell [et al.]//Value in Health. - 2008. - V. 11, N 1. - P. 44-47.
21. Саймон Г. А. Цит. за: Моргунов Е. Б. Модели и методы управления персоналом/Е. Б. Моргунов. - М.: ЗАО «Бизнес-школа «Интел-Синтез», 2001. - 464 с.
22. Ларичев О. И. Теория и методы принятия решений, а также Хроника событий в Волшебных Странах/О. И. Ларичев. -М.: Логос, 2000. - 296 с.
23. Рябова М. Г. Индивидуально-психологические особенности женщин с различными типами нарушений репродуктивной функции/М. Г. Рябова//Вестник Тамбовского Университета. Серия: Гуманитарные науки. - 2013. -№ 9 (125). - С. 190-198.
24. Kelly В.. Physician Communication and Patient Adherence to Treatment: A Meta-analysis/B. Kelly, H. Zolnierek, M. Robin, Di Matteo//Med. Care. -2009. - V.47, N8. - P. 826-834. [Електронний ресурс]. - Режим доступу: http://www.ncbi. nlm.nih.gov/pmc/articles/PMC2728700/
25. Kruse J. Effects of a psychosocial education programme to improve doctor-patient interaction with cancer patients//J. Kruse, N. Schmitz, W^ler W, Clar B. [et al.]//Z. Psychosom. Med. Psychother. - 2003. - V.49, N3. P.232-245.
26. Kubacki A. What's important in the doctor-patient relationship?/A. Kubacki//J. R. Soc. Med. - 2003. - V. 96, N 6. - P. 314.
27. Christopher R. Then a miracle occurs: focusing on behavior in social psychological theory and research: Purdue Symposium on Psychological Sciences/R. Christopher [et al.]//Oxford; New York: Oxford University Press, 2010. - 452, [58-65, 276-282] р.
28. Водопьянова Н. Е., Синдром выгорания/Н.Е Водопьянова, Е. С. Старченкова. - СПб.: Питер, 2008. - 358 [45-49] с.
29. Карвасарский Б. Д. Медицинская психология/Б. Д. Карвасарский. - Л.: Медицина, 1982. - 272 с.
30. Соколова Е. Т. Проективные методы исследования личности/Е. Т. Соколова. - М., 1980. - 178 с.
31. Осухова Н. Г. Возвращение к жизни: Методические материалы для ведущих тренингов и семинаров по профилактике профессионального выгорания/Н.Г Осухова, В. В. Кожевникова//Помощь помощнику: социально-психологическое сопровождение социальных работников/Под ред. Н. Г. Осуховой. - М.: Изд-во «Амиго-пресс», 2006. - С. 96-112.
32. Юдин С. С. Мысли о медицине/С. С. Юдин - М., 1968. - 80 с.
33. Юрьева Л. Н. Профессиональное выгорание у медицинских работников/Л. Н. Юрьева. - К.: Издательство «Сфера», 2004. - 272 с.
34. Ясько Б. А. Психология медицинского труда: личность врача в процессе профессионализации: Автореф. дис. докт. псих. наук/Б. А. Ясько - Краснодар, 2004. - 45 c.
35. Чумакова Г. А. Синдром выгорания медицинских работников, Г. А. Чумакова, И.Е Бабушкин, Л. А. Бобровская. - М: Владос, 2003. - 76 с.
36. Емоцшне вигорання/упоряд. В. Дудяк. - К.: Главник, 2007. - 128 с.
37. Бойко В. В. Синдром «эмоционального выгорания» в профессиональном общении/В. В. Бойко. - СПб: «Сударыня», 2000. - 32 с.
38. Вассерман Л. И. Психологическая диагностика отношения к болезни/Л. И. Вассерман, Б. В. Иовлев, Э. Б. Карпова, А. Я. Вукс. - 2005. - 32 с.
39. Исследование самооценки по Дембо-Рубинштейн с элементами клинической беседы/Янышин П. В. Практикум по клинической психологии. Методы исследования личности. - СПб., 2004. - 320 c.
40. Кауфман С. Х. Кинетический рисунок семьи/С. Х. Кауфман, Р. С. Бернс. - М.: Изд-во: Смысл, 2006. - 160 с.
41. Демина Л. Д. Психическое здоровье и защитные механизмы личности/Л. Д. Демина, И. А. Ральникова. - Изд-во Алтайского государственного университета, 200. - 123 с.
42. The effectiveness of Balint training for medical students. In The Doctor, the Patient and their Wellbeing - World Wide Proceedings of the 13th International Balint Congress/eds. Salinsky J., Owen H. Ruckzuckdruck, 2003. - P. 104-108.
43. Выготский Л. С. Психология развития человека/Л. С. Выготский. - М.: Изд-во Смысл; Изд-во Эксмо, 2005. - 1136 с.
44. Fong Ha J. Doctor-Patient Communication: A Review/J. Fong Ha//The Ochsner Journal. - 2010. Academic Division of Ochsner Clinic Foundation [Електронний ресурс]. - Режим доступу: http://www.ochsnerjournal. org/doi/pdf/10.1043/T0J-09-0040.1
