Friday, December 16, 2005

The patient who Does. Not. Want. To See Me.

And she sits. She can hardly meet my gaze, or say "hello." How anguished she looks! She would rather be almost anywhere else. If only the floor would open up and swallow her, right now...

Perhaps her family led her to my office. Something happened at home, or at work, or at school...something that scared them. How did they get her here?

Did she come from home, or from a doctor's office? Did she come from a courtroom, or a jail? A nursing home, a homeless shelter, an alley?

Is this her first time in a psychiatrist's office...or her thirtieth? What can she possibly expect from me?

My first task is to slow down, and search for ways to help her tell her story. Sometimes it helps when I say,
"It must have taken a lot of courage, for you to see me here today."


Blogger Medicoglia, RN said...

I would be the patient that does. not. want. to see you. Really wish I could put a blushing icon on here. I have actually wished the floor would open up and swallow are reading my mind...THAT would be why I don't want to see you! All levity matter how many times we go, or how nice, caring, compasionate (etc) the psychiatrist is, you guys are scary because (for me) the thought that is foremost in my mind is I DO NOT want to go to the hospital and I still can not get my mind around the fact that I won't be going there unless I am truly a danger to myself or others...I know it, but I am still terrified, every single time I go, that my pdoc is going to have me carried off to the hospital. Irrational...probably...but I have panic attacks about it before my appointments. :P


9:17 PM  
Blogger Greg P said...

I guess that's the difference with psychiatry and neurology.
When my patient's indicate they don't want to see me, it's usually a very short visit.
Or at best what I like to call "veterinary neurology."

7:32 AM  
Blogger Joel said...

When I'm in that shape, I probably would shake my head while never taking my eyes off the floor and faintly mutter "no".

Out of curiosity, what would be your next step?

6:10 PM  
Blogger aafan said...

I usually start explaining who I am and what I do. Then I start with very general questions about whether they understand the purpose of the exam. Then I ask them to tell me what sorts of things they've been going through lately, whether they've been going through anything difficult, and whether there's anything they might want some help with. And "was this your choice to be here today?" If they don't want to talk about any of that, then I try to find out what they do want to talk about.

8:59 PM  
Blogger Maurice Bernstein, M.D. said...

I suspect some patients are old timers and have been to many psychiatrists as we have old timers changing internal med doctors. And that might mean they are "sophisticated" if not potentially manipulative patients.
What if that patient said to you ""It must have taken a lot of courage, for you to see me here today." What would be your response? .. Maurice.

9:27 PM  
Blogger aafan said...

Actually, I have been told things like that! ("You must be brave to see me, doc!")

Of course, that gets my attention right away, and I want to know what they mean by that. It sounds like the beginning of an interesting interview.

9:40 PM  
Blogger Joel said...

I was thinking of you folks last night when I was at my DBSA support group meeting. Especially of the patients who don't want to see you.

We had a couple of people who I marked as "interesting". Well, FOUR. One of them had discovered the Kaballah and was going to go off his meds.

Another had discovered Zen Meditation. After many years of being called a bipolar, her therapist had told her that she suffered from major anxiety disorder. She also decided that she could go off her meds.

A third was confrontative and interrupting every time you tried to speak to him. He has decided to not take the meds his pdoc has prescribed for him because he doesn't think he needs them.

And the last told us that he was feeling depressed. When we asked him to rank himself on a scale from 1 to 10 with 1 being so depressed that he had to be in the hospital and 10 being so manic that he had to be in the hospital, he called himself a 5. He then went on to tell us about how Satan was making him depressed by messing up his life. He is also not taking his meds.

Sigh. Thank God for my friend next to me. I could wiggle my eyebrows at her and roll my eyes.

Damn. You shrinks have a tough, tough job.

12:19 PM  
Anonymous Anonymous said...

I wish my sister would go to a psychiatrist/psychologist with a temperment like yours. I've been on meds since '98 and in therapy since '94, and I know it's helped me a lot.

I'm glad you're blogging...come visit me sometime!


12:49 PM  
Anonymous Anonymous said...

I wonder if anyone can share some successful stories of encouraging/convincing a teenager to visit a shrinkette/shrink whom he didn't want to see.

- a very worried father

9:20 AM  

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