The Mindful Medical Student by Spiegel Jeremy;Siegel Bernie;

Author:Spiegel, Jeremy;Siegel, Bernie;
Language: eng
Format: epub
Publisher: University Press of New England

THE DEMANDING HELP-REJECTER

The demanding help-rejecter demands medical help, but what he really requires for better health is absent from his message to you: a different scenario from that of a noncompliant patient, such as an insulin-avoiding diabetic who nevertheless eats Milky Way bars for breakfast. For example, the demanding help-rejecter might insist you make him feel better but only by using a certain method that he claims works for him, such as the administration of OxyContin, Valium, or some other abusable prescription medication. You know that his history of substance abuse makes use of such medication inadvisable, so you offer a host of alternatives, including more benign pharmacological and nonpharmacological remedies, but all seem unacceptable, making possible treatment not only difficult but frustrating as well.

This type of med-seeking behavior frequently occurs in connection with a habit the patient has no intention of changing. For example, after delineating a litany of techniques you know would help a patient’s sleep problems—such as increasing her body temperature so that as she cools she experiences sleepiness or keeping her bedroom dark—you see that her eyes are glazed over and you are being ignored, making you frustrated that your wisdom is being purposefully rejected.

Experiences like this force you to accept that you will not be effective with everybody and will succeed in some cases only at a later time, after the patient has absorbed your words and really wants to be healed. Recognizing that your patient is the one with the problem—or two problems: the presenting issue and a self-destructive hidden agenda—will help you stay balanced so you can provide effective care to the next patient, who may be more receptive to new ideas.

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