The folllowing comments relate to Balint groups for GPs, but the principles of professionalism, reflection and support apply to all healthcare professionals.
The Balint approach to review of patient management is quite different to Continuing Medical Education (CME), which focuses on clinical updates and specific treatments for specific conditions. Instead, Balint groups seek to understand the meaning of a patient’s behaviour and symptoms. Groups achieve this through case presentations; exploration of the felt experience of the patient, the doctor, and what might be going on between them within the consultation.
Specific aims and goals
Balint group training attends directly to the doctor-patient relationship. With respect to some specific skills and competencies within the doctor patient relationship, Balint group training will help clinicians to:
- Listen and communicate more effectively
- Attend to the emotional content of each doctor patient relationship
- Respond compassionately to patients who are suffering
- Have more flexibility in relating to different patients
- Identify and respond to the patient’s thoughts, feelings and emotions
- Identify and respond to their own thoughts and feelings
- Get to know each individual patient as a unique person within their social context.
While many GPs are in ‘peer groups’, most doctors have little or no opportunities to share their professional experiences with each other, particularly their feelings and details of the more challenging situations in clinical practice. Doctors may not articulate how emotionally difficult and complex their work can be and may not be aware that many of their colleagues are facing similar difficulties. Sharing these experiences in a Balint group provides tremendous mutual support.
In Balint groups, participants gradually learn to use their own feelings and responses to the patient to understand their patient better, rather than their responses becoming sources of stress or acted on in unhelpful ways. GPs are able to treat a wider variety of patients than before and do so more effectively with less personal stress. The ‘boring’ patients become interesting and the ‘difficult’ patients become a welcome challenge! Participants often report finding their work more stimulating and enjoyable, and feel their participation has reduced work stress and prevented or reversed potential burn-out.
Balint groups are not therapy groups for doctors, although they are often therapeutic in a wider sense; the growth in participants’ personalities occurs through a focus on their professional interactions and not through explicit disclosure about personal lives.
The focus on understanding each clinical situation rather than offering solutions contributes to a growth in each GP’s personality. The GP may become aware of their particular blind spots which create habitual and unhelpful ways of responding to particular sorts of patients or situations. They become freer to respond more accurately to the needs of the patient. They may also become more aware of their individual strengths.
Balint groups and medical education
Medical education has been profoundly influenced by the Balint approach to understanding the consultation, better acknowledgement of psychological factors in illness and disease, and in general practice training programmes around the world.
Michael Balint was also very influential in the early development of the Royal College of GPs in the UK and the development of general practice as a unique discipline in the UK, Australia, New Zealand and Scandinavia, all countries where health care delivery is based on a primary care model.
General practice is a unique discipline
General practice presents many unique challenges involving:
- complex relationships with patients over long time periods
- psychosomatic or complex mind-body interactions
- time constraints
- patients who do not follow their doctor’s well-meaning advice
- patients who for many reasons the doctor finds emotionally difficult
- patients who seem ‘difficult’ to help
- the GP as gatekeeper and central coordinating point.
Balint group helps participants develop increasing respect for the specialty of general practice. GPs increasingly appreciate the opportunities that general practice offers to engage with patients as people in a wide variety of ways.
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Lichtenstein A. Integrating intuition and reasoning. How Balint groups can help medical decision making. Australian Family Physician. 2006;35(12):987-9.
Wilson H. Challenges in the doctor patient relationship: 12 tips for more effective peer group discussion. J Prim Health Care 2015;7(3):260–263.