?? epilepsy ??

Ronald B. Keys J.D. Ph.D rkeysphd at nyc.pipeline.com
Sun Jun 4 08:31:05 EST 1995


MANAGING THE DIFFICULT PATIENT: HERE, IT IS EPILEPSY AND THE PROBLEM OF
DIAGNOSIS 
 
 
Dear Dr. Lee & Interested Colleagues; 
 
 
CAN WE CREATE INFORMATION-SEEKING BEHAVIOR IN A PATIENT AND PATIENT'S
FAMILY? This patient who refuses to see a physician or get necessary
testing sounds like a very difficult patient. With this type of problem,
the first step should be to counsel, educate, fight with and if necessary,
try to drag the patient in for an MRI for which in this case, would be a
MRFN (magnetic resonance functional neuroimaging). This patient needs it.
Patient education is an important part of a clinician's job.  
 
 
See 
 
 
Turner, R. Magnetic Resonance Imaging of Brain Function, ANNALS OF
NEUROLOGY, (June) 1994;35:6:637-638 
 
 
Tranter, J. The Use of Magnetic Resonance Imaging in Diagnosis. NURSING
TIMES,(March) 1995;91:13:38-39 
 
 
Cohen, BM, Renshaw, PF, Yurgelun-Todd, D. Editorial: Imaging the Mind:
Magnetic Resonance Spectroscopy and Functional Brain Imaging, AM J
PSYCHIATRY, (May) 1995:152:5:655-658 
 
 
Breaking down a patient's defenses against treatment in order to treat the
patient is not an easy matter. I don't have the answers other than to have
all of the necessary and potential information on treatment at hand and to
be patient with the patient by talking and spending time with them, 
perhaps in a client or patient-centered context. Within the context of a
BIOBEHAVIORAL MEDICINE MODEL, the idea here is to create
information-seeking behavior in the patient and the patient's family. 
 
 
See 
 
 
Brody, DS. Physician Recognition of Behavioral,Psychological and Social
Aspects of Medical Care. ARCH INTERN MED. (1980):140:140: 1286-1289   
 
 
Danskin, DG. A  Role-ing Counselor Gathers No Moss. 1957;J COUNSEL PSYCHOL.
4:41-43 
 
 
Engel, GL. The Need For A New Medical Model: A Challenge for Biomedicine.
BIOSCIENCE, (1977):196:129-136 
 
 
Krumboltz, JD, Thorensen CF. The Effects of behavioral Counseling in Group
and Individual Settings on Information-Seeking Behavior. J COUNSEL PSYCHOL.
(1964):11:325-333 
 
 
Perhaps we need to take a second look at how we talk to our patients,
altogether. 
 
 
See 
 
 
Smith RC, Hoppe RB. The Patient's Story: Integrating the Patient and
Physician-Centered Approaches To Interviewing. ANN INT MED.
(1991:115:470-477  
 
 
Rogers, CR. CLIENT CENTERED THERAPY, Boston, Houghton-Mifflin, 1951 
 
 
Galland, L. Patient-Centered  Diagnosis: A Guide to the Rational Treatment
of Patients as Individuals. PREVENTIVE MEDICAL UPDATE, (audio: Bland J,
Moderator) 1994, 1995 
 
  


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