patients who pursue and abuse health professionals

[nari]

I am interested in how Somasimplers manage their 'nightmare' patients - the ones who keep pestering, are non-compliant and abusive.
In a health centre, I am surrounded by other support staff. but the private PT?

How do you manage such circumstances apart from the usual setting of boundaries, rights and responsibilities?

When do the rights of the clinician collide with the rights of the patients to seek and obtain professional advice/treatment?

Just interested in this psychosocial aspect of being a health professional.


Nari

[Diane]

This is rare, in my world. But it has happened. It is usually someone who I feel is leaning on me and getting impatient with my efforts. USUALLY by the 3rd or 4th visit regular people are saying about how they feel they won't need to come anymore because they feel good, and tell me all the ways they feel good, all the things they can now accomplish painlessly.

By the 3rd or 4th visit the "failures" ask when they're going to not need to come anymore. They don't feel any change. And it's all my fault apparently.

In treating them I feel as if they have walled themselves off behind a bunker somehow, mentally, and they don't allow their body any freedom to respond. They are the foot tappers, the knee wigglers, the key jinglers, the horn honkers. SOMEtimes I can get through to their bodies, and then to them... but when I can't, I don't endure them, I don't waste anymore of their time and money, and tell them I don't think I can help them. I have a little list of practitioners who I refer off to. I send them to someone who I think will be a better match psychologically, with no regret, for I find myself irritated by their irritation, and who needs that in one's life? That's my theraputic countertransference limitation.

It happens to everyone, no one person is a perfect match for all patients. I can deal with the scared people, the shattered people, the battered people, the clingy people, the unsure people, the defeated people. Easily. I can teach them to trust their bodies and their perceptions and themselves again. I can wean them off perpetual treatment that they've been told they'll need forever. But the cranks, the abusers, I fire them. Life's too short.
Cheers,
Diane

[nari]

A recent meeting was held amongst health professionals and admin staff on a Territory-wide policy for dealing with a woman who has and will continue to create havoc with all health providers.
There is no certain diagnosis- brain injury is suspected as she perseverates, has processing problems and executive dysfunctioning. So one could argue it is not her fault and she cannot be denied access.
However the decision was made that staff need protection from abuse, and she needs very firm boundaries with warnings.
She will be told that no-one will speak to her unless she calms down - if on the phone, she will be warned she has thirty seconds before we hang up. One person only will deal with her directly as far as possible, by phone.
Like delinquent children, she is doomed to wander the city, spending her time hassling and abusing; but the difficulty remains that non-professional staff will give in to her to get rid of her. Happily reinforced, she continues.

Diane, I would certainly agree with your general philosophy; no outcome, no treatment. I always give options, but for many. of course, those options cost money - and so are not an option, from their point of view.
The major problem with free health services for all means systems abuse and 'rights of the patient' abuse- but that is easier to handle than my lady whose reputation is cast far and wide.

Me, I am all for protecting the rights of staff, too!!


Nari

[nari]

Bernard, I thoroughly agree. but no-one will touch her, only private psychologists and she willhave to find adequate funding.

She does have pain; right-side arm/wrist/thumb, hip. knee and ankle. As she does not permit adequate assessment and does not follow through with recommendations, I have discharged her twice in three months - but she keeps trying to return. Once I can successfully implant in her brain that I cannot help her, things might change, but it just means she goes off to other physios. That is why it has to be a consistent Alert system that everyone knows about.
So I have to be just a little cautious about 'kicking her out' as she does quite legitimately complain consistently of (R) side pain (which is moving quite ominously into persistent pain).

Her life must be a turmoil, continually raging to people - but I assure you I do not lose any vestige of sleep over her!!


nari :roll: :!:

[Diane]

Sounds like this woman has made her own life/body into a hell. I'd love to have a go at her, to see if I could help her, but if I couldn't, like you I wouldn't hesitate to fire her.

I feel very much empowered by being private. I remember well the days of working in hospitals, where you are stuck. Or for other PTs, where you are slightly less stuck...

I remember treating a woman once, in a private setting, but one of those 5/hour places... She had a huge bruise on her back that her husband and she claimed were from a van striking her back as she sat on a crowded grassy beach watching fireworks. They were sueing for damages.

That was fine, but the guy bothered me. He stayed in the room the whole time I talked to her and treated her, and glowered at me from a corner. He answered for her and asked questions. He acted as though she were an extension of him. Before long it dawned on me that he'd probably given her the bruise and that he was making sure she stuck to "the" story. I actually was stressed to the point of breaking out in a light rash over this creep. I explained to the PT I worked for how freaked out he made me feel, they saw my point, and I refused to treat her/them ever again.
Diane