So Many Ailments, So Little Time! (Was Re: ? Epilepsy?)

Zeda Ass'n [Ralph Burr] arbor at ix.netcom.com
Thu Jun 8 10:54:20 EST 1995


In <3r1qjm$3ho at aladdin.iii.org.tw> siupakmd at pc2.hinet.net (Siupak Lee,
M.D.) writes: 
>
>rkeysphd at nyc.pipeline.com (Ronald B. Keys J.D. Ph.D) wrote:
>
>>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.  
>
>I cannot but agree with you wholeheartly here. Epilepsy up to now
>still carries along with it some sort of stigmata in our society.
>Patients and families, especially in the rural areas, may still seek
>folk "treatments" and turn to other "explainations" of their problems
>rather than follow medical advice. 
>
>>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.

>> 
>I don't know much about the biobehavioral medicine model. Do you think
>you may further elaborate on this? What I do here in difficult cases
>is to try to identify the most susceptible one in the family and work
>on that person; hoping that with some "inside" force from the family
>side, the job of persuading the patient to seek proper treatment may
>be make easier.  If it is the patient himself who is denying the
>problem or who does not belive he needs treatment or further workup, I
>just have to spend more time discussing with him again and
>again....sign!
>>Perhaps we need to take a second look at how we talk to our patients,
>>altogether. 
>> 
>Yes. A lot of doctors don't know how to communicate properly,
>including me. :)
>
>Siupak Lee, M.D.
>siupakmd at pc2.hinet.net
>
>>>I need a 25 hours day!<<
>                ************** READ and HEED **************
Permit me to correct you, doctors -- MOST doctors do not know how to
communicate with their patients. And, never will! DELEGATE some of that
activity to your assistants. They are closer on a peer level to your
patients, anyway. For the specific patient with high self-importance,
you may have to be the one, but very seldom otherwise.  

Take a page from the military (where I spent a lot of time). The medic
or corpsman with combat experience has amputated, sutured, toweled guts
back inside, closed skull flaps, etc. He is RESPECTED and treated well
by all doctors I have ever seen. (He wouldn't tolerate it otherwise! He
is certain of his medical value.) Today's average patient sees many MDs
"crap all over" their RNs. LVNs, etc. Consequently the secondary care
giver is demoted in the patient's mind. "He doesn't think much of her;
she's not very good/important." The practicing physician loses his/her
best professional ally and the patient loses someone who CAN take that
extra minute to "talk about it".

Train your staff to intercede and then "praise in public, damn in
private" with your para-professionals and professional assistants! Your
office will run smoother, your workload magically lighten (a bit) and
the atmosphere will sweeten markedly.

Let your staff cope with convincing the recalcitrant patient to eagerly
seek the answers, not avoid you like the plague! They can "toot your
horn" for you; you can't. After all, the Pt doubts _you_, doesn't he?



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