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
>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
>Perhaps we need to take a second look at how we talk to our patients,
>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!<<