Then, though, things start becoming a little more difficult, because we have to decide whether there has been sufficient improvement to make it sensible to space treatments a little more widely. I usually discuss this carefully with my patients and ask them whether they feel that they can manage a wider gap between treatments. I think this kind of discussion between us gives very useful feedback as to how patients really feel treatment is going, and gives them the opportunity to tell us if thing aren’t progressing as they would like. We should never rely only on our own judgement of this, because many patients are reluctant to tell us how they really feel.
The important thing here is always to include patients in our deliberations about the spacing of treatment. Later on, when we have spread treatments even further apart, I will ask patients to tell me when they feel they would like to come back for their next treatment. And it is here that my two patients this week have taught me such a lot. Both are very long-standing patients, one having come for at least 15 years, the other for more than 20 years, and until quite recently I would leave it to them to contact me when they felt they needed a treatment. When I look at my notes, I realise that they both tended to do this at very infrequent intervals, one perhaps once or twice a year, the other often a longer intervals. And, then again from the notes, I notice that they would arrive very low in energy and needing at least a further 2-3 closely spaced treatments to get back on track. One of this week’s patients, in particular, always left it far too long to get in touch with me, and would arrive very depressed and in need of a great deal of support.
About 18 months ago, I decided that I would look at things from a different angle, and instead of feeling that it would be inappropriate after so many years to suggest more frequent treatments, I would suggest that one of these patients would benefit from regular treatments every 2-3 months which we would arrange at each visit. This he accepted readily, particularly because, finances being a problem, I offered a reduced rate for each treatment, to suit his financial pocket at the time (he is a freelance artist). Once I had put this new regime in place, he immediately benefited from the more regular treatments, and told me this week that he was sure it was because of this that none of his physical symptoms had recurred and he had felt so well that he was able to accept more challenging work.
I then did the same with my second patient, and she, too, this week, told me how much this regular treatment had helped the changes in her life, which she ascribed, as did my first patient, to her frequent treatments. She now comes for a surprisingly brief booster every two months and feels her life has turned around since we have done this, mainly, I think, because the regular treatments have removed her feeling that she should be able to cope on her own.
Each patient’s needs will be different. Some will clearly know exactly when they need a treatment, but in my experience such patients are rarer than those who are not sure themselves when they should phone us. Most of us will wait too long before we look for help, so I see it as the practitioner’s task to decide with which patient to take a more active role in deciding when the next treatment should be and which patient we can leave to make the decision themselves.
I suspect that if I had introduced such a carefully graded plan for long-term treatment earlier on in my practice, I might have helped many more of my patients in the past. Looking back, there are many who I think would have benefited if I had been a bit firmer and clearer about the benefits of such a plan. So even at this late stage in my practice I find I learn new things.