Tuesday, September 25, 2012

Thoughts on another difficult practice situation

Please note here that I do not say “how to deal with a difficult patient”.  It is not that patients are simply difficult in themselves, but that we as people find them difficult to deal with.  For practitioners, that is a crucial difference.  As Shakespeare might have said, “the fault lies not in our stars (or in this case our patients) but in ourselves…”

So here goes about this particular difficult situation.  The patient was one who came for treatment as part of a clinical day I spent helping another practitioner with his patients.  She is a woman of 35 and moves around in a wheelchair.  Her medical notes show that she was diagnosed as autistic and with attention deficit problems as a child.  She has a long list of other medical conditions, the main being a spinal accident which left her confined to bed for a year when she was 8 and meningitis when she was 10.

What interested me was noting that she appeared to be quite capable of moving without help from the wheelchair to the treatment couch, nor did she have any difficulty in turning over on the couch.  Her legs, too, did not have the look of ones where the muscles have atrophied from little use.  She was wearing very heavy short boots, much like men’s army boots, which looked incongruous on a wheelchair-bound person by reason of their sheer weight alone.  She brought with her a little doll, the kind a five-year old child might have, which she insisted on tucking next to her on the couch. I also noticed other disconcertingly odd things which made me question how far she was actually incapacitated. 

Having expected from the notes that contact with her might be difficult because of her autism, I was surprised to see how easily she seemed to relate to us, and in particular noticed that she was darting hidden glances at me when she thought I wasn’t watching.

The practitioner is also her medical practitioner, and had started his five element treatment by relying only on her medical diagnosis rather than on a much more extensive five element diagnosis which would not have concentrated so exclusively on her physical conditions.  The distinction between his role as her physician and as her acupuncturist had become understandably blurred.  Initally, I, too, made the mistake of going along with this.  

The practitioner and I therefore assumed all sorts of things about her condition, basing ourselves on very little information about her current medical condition.  Did she in fact need a wheelchair at all, and could she be described as still being “autistic”?   

As is obvious to any five element acupuncturist from what I have written, we decided to treat her with Internal Dragons.  We followed this with an Aggressive Energy drain and the source points of her element which I thought was Fire.  I had a question mark around Inner Fire (Small Intestine), something to do with the quickness of her understanding (even though she didn’t like to show that she did understand) and the sharpness of her glance! 

I felt surprisingly angry at the end of the treatment, as though she had got under my skin and had outmanoeuvred us.  And I went so far as to tell the practitioner that I wasn’t sure there was any point in continuing treating her with acupuncture because she appeared to be manipulating the situation in a way that made treatment impossible.

It was my anger which brought me to my senses, and I told the practitioner later that I did not think I had dealt properly with the situation.  I had failed to take the right steps to get her treatment back in the correct five element groove.  We should have done a proper Traditional Diagnosis after the treatment in whatever time we had available, to be continued at the next treatment.  She should be asked to demonstrate how far she can stand and walk by herself, and the practitioner should get some answers to more detailed questions about her life.  We were not even clear about her living situation.  Does she live alone or with her family?  Does she have friends?  What does she do with her time?    

But all is not lost.  I have suggested to the practitioner that he should now start as though from scratch, trying to forget the wheelchair and the label of autism. Nor must he allow himself to be manipulated back into the old relationship where she appeared to be dictating how she wanted him to treat her.  My mistake was to allow her to do the same to me.

This is the only way in which we can help this patient.  And we should try to do that, rather than walk away.  She is really crying out for help, and has probably been crying out for this help all her life in the only way she knows how.   

It may be helpful to read this blog in conjunction with my blogs of 13 September 2011 “Losing control in the practice room” and of 9 October 2011 “Regaining control in the practice room”, which complement this blog and deal with other problems in the practice room. 

And so my learning continues!


1 comment:

  1. I have just received this comment from a reader of this blog: I find it very helpful to see how you deal with difficult patients and that, despite all your experience, you could still have been outmanoeuvred in this way. This has encouraged me work out a way of dealing with my own emotional responses to patients.