The Medical Hammer is my metaphor for the medical model from GRC: A Clinical Model to Get More Done and Enjoy Work: Part 2 | GRChealthcare)
This powerful tool has sharp limits we tend to ignore. For instance, it’s useless when it comes to persuading people to accept treatment and stick with it. What do we really accomplish as providers, honestly, how do we earn our pay, if the patient doesn’t take the pills we offer? On inpatient Psychiatric units, non-adherence directly affects staff members: prompt re-admissions, angry insurance reps, increased time and work, and more psych emergencies: more time, effort, danger, and paperwork.
What can we do about it? The answer consists of many little things, many of them entirely unrelated to mental illness: various ways to build stronger relationships quicker and more easily.
As an example, remember this old saying: “An Ounce of Prevention…. Is worth a pound of cure” ?
Like many proven old truths, it’s old-fashioned, kind of hokey, but surprisingly valuable if you put it to practical use. How, you may ask, can we use this idea to reduce resistance to care?
It’s simple, really, yet not often applied: the best time to start addressing resistance to care is well before any resistance occurs. We can start building rapport from the first moments with a patient, and if we know what’s good for us, we’ll make an effort whenever possible to take advantage of that opportunity. A minute spent on a positive first impression is far more effective than an hour spent later on. You only have one shot at a first impression and if you blow it, it will cost you one way or another. Yet again and again, I see Nursing putting new patients off, making them wait, without considering the cost.
That’s just one approach among many that have a general theme. People skills that apply to all people are very useful in clinical practice and poorly addressed in Medical and Nursing education and training. We’re told to get along with people, but not how to do so. Most people, as nice and well-meaning as they may be, don’t have the knowledge or skills they could, and they suffer for it every day in the form of misunderstandings, distrust, arguments, etc. Work is harder and more frustrating as a result.
Of course we can’t prevent all care resistance or all behavioral crises, not by a long shot. We most definitely can reduce how often they occur, how severe they are, and how difficult they are to mange, more easily than most people think, and more powerfully too. I have years of experience, mine own and that of my students, to back that claim up. Training in people skills makes Nursing work easier and more enjoyable. We can make ourselves more powerful and effective, often ahead of time.
Minutes of prevention up front, at the times and places of our choosing, can save hours of
crisis and other struggles later, where patients decide the time and place for us.
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