MANAGING THE DIFFICULT PATIENT: HERE, IT IS EPILEPSY AND THE PROBLEM OF
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.
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
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.
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.
Engel, GL. The Need For A New Medical Model: A Challenge for Biomedicine.
Krumboltz, JD, Thorensen CF. The Effects of behavioral Counseling in Group
and Individual Settings on Information-Seeking Behavior. J COUNSEL PSYCHOL.
Perhaps we need to take a second look at how we talk to our patients,
Smith RC, Hoppe RB. The Patient's Story: Integrating the Patient and
Physician-Centered Approaches To Interviewing. ANN INT MED.
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