Anxiety by Jim Rowe Flickr
At GRC we like demonstrations and interactive learning. Sometimes we practice ‘being’ a patient: trying to increase our empathy by pretending to be a patient in some typical health care interactions.
In this medium, of course, we have to imagine a little harder.
For this example, imagine the Nurse offering pills in The Cup:
“Take your meds”
First, imagine you have significant Dementia: you lack the ability to remember much of anything past five minutes, so moment to moment you have to surmise as best you can where you are. At the moment, you think you’re in your own home, minding your own business. Suddenly a young stranger approaches without warning offering an odd little plastic cup: “Take your meds.”
Who are they?
How did they get in here?
Are they dangerous?
Would you trust this strange uninvited intruder into YOUR home?
Would you accept the pills? What if it was some nasty-tasting powder (crushed meds) mixed in applesauce?
What if you asked them to explain themselves and they insisted you were in a nursing home or hospital, that you were sick, that they were taking care of you, they were in charge here?
Or “Doctor’s orders”?
Or they got angry and said they tell you to stop asking the same things over & over? (you don’t remember any previous times, not at all: what are they talking about?)
How cooperative would you be? How long would this simple interaction take to complete?
Second, imagine your memory if fine, but you have paranoid delusions: You’re on the run – there are government agents after you because of what you know. The Conspiracy managed to get you locked up in this so-called Psych Ward. You don’t know who you can trust. A stranger – an agent perhaps? shows you some pills in a cup: “Take your meds.” They could easily be poison, or some sort of mind control, or who knows what.
Would you take them?
Perhaps fake taking them while you figure out an escape plan?
There are many ways we could approach either patient, any of which would offer better results than blunt directions. If we can even vaguely see things from patients’ point of view, we can find ways to win their trust and coöperation.
If we ignore their point of view, everyone suffers for it, including us.
Make sense? Any ideas?
Relationship, relationship, relationship! Getting your paranoid patient to take their meds starts the moment they arrive on the unit… build trust by tending to simple needs. Think of the new patient as a weary refugee who’s arrived at your home after an arduous journey (that’s not much of a stretch from the truth). Invite them in, offer food and drink, a shower, clean clothes, a warm dry bed. Be a good host. Provide those simple things that have nothing to do with YOUR clinical agenda – there will be plenty of time for that. Find something they’ll accept from you that’s non-threatening and build up a bank of positive experiences they have with you. They need proof they won’t suffer at your hands.
Engage your patient in general conversation – don’t make it all about their symptoms and illness. ASK them what they need or want and provide it whenever possible. We have no idea what their perceptions are – maybe our new patient thinks the med window is actually a portal to a terrifying alternate universe. No wonder he’s afraid to approach and take his meds!
Most of all, remember why you’re there… it’s not to get your tasks done, it’s to help your patient feel better. You have to start at their beginning, not yours.
Absolutely! The time to start building rapport is on first meeting them, and the time to address crises or resistance is well before you know if either will actually arise. Being good to people, all people, is not only the right thing to do, but the wise thing to do: everyone benefits, especially you. Also, patients talk about you, more than you may realize, and your reputation greatly affects the outcome of all clinical interactions. Thanks for the great comment!