Who hasn’t encountered, in their working lives, a patient who comes to a healthcare appointment having done so much tireless outside research that somewhere along the way he or she has stopped being particularly open to new ideas or prescriptions? Those patients are what some professionals might call “resistant.”
But are they really resisting, or just mired in copious, conflicting, and sometimes inaccurate information? As providers, we typically know how to separate the reliable information from the rest, but does your average patient have that same training?
Who hasn’t encountered, in their working lives, a patient who comes to a healthcare appointment having done so much tireless outside research that somewhere along the way he or she has stopped being particularly open to new ideas or prescriptions? Those patients are what some professionals might call “resistant.”
But are they really resisting, or just mired in copious, conflicting, and sometimes inaccurate information? As providers, we typically know how to separate the reliable information from the rest, but does your average patient have that same training?
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To illustrate the dilemma, let’s look at mental illness. Although the widespread availability of information has helped break many stigmas associated with it, not everything that is online can be trusted. Many of the so-called “expert” websites or forums are run by non-professionals who wish to promote themselves or their products. Moreover, even though it can be useful for patients to browse these forums and talk to others, there is no such thing as a one-size-fits-all treatment. Every patient is unique, and requires a thorough diagnosis and a specialized treatment.
I once had a patient who had spent 20 years convinced that she suffered from Bipolar Disorder. She was already taking medication for it, knew absolutely everything there was to know, and brought a lot of material to our session for me to read. When I first started questioning her diagnosis, she almost left therapy. So I began taking a more subtle approach, valuing her knowledge and her decision to go further into treatment. Together we explored and analyzed her symptoms; when I spoke with her as a collaborator she became much more open. In this case, over time, we determined that she did not have the condition, and we were able to work together to find a therapy that better addressed her symptoms. Here, I’ve collected some points that were important to that case, and to many others I’ve encountered.
Offer hope
It is important to see the situation from the patient’s perspective: It’s comforting to have an explanation for his or her symptoms – something that seems to give an explanation and answer pressing questions. And then you, the professional, barge in and disagree with the information which afforded that comfort? No wonder that such patients often resist your diagnosis.
This in mind, let’s start by scrapping the term “resistant patient.” It’s not as if your patient doesn’t want help – he or she is just scared, confused, overwhelmed or all of the above. He or she needs to feel safe in your office, so one of your challenges is to earn trust and to foster belief that there is hope in treatment.
Remember that your patient is suffering and has requested your help.
Reading about symptoms may help patients realize that they need professional help, but it may also create some fear and confusion. They must, for example, understand that if they post a question on a forum, no-one can guarantee that it will be a qualified expert answering their question.
Helping patients sort through information is therefore critical. Beneath all the “been there, seen that,” there is a patient who hasn’t found his answer yet and is still suffering. The healthcare professional should ignore what’s on the surface and start listening to what the patient is really saying. If he or she has explored every treatment in the book without success, it’s time to think outside the box, and come up with the creative angle that will finally make headway.
Make the patient your co-expert.
Don’t discredit your patients – no one knows more about them than they do. Their challenge is that they lack the professional knowledge to help themselves, and that’s why you are there. To this point, I had a colleague who called herself a “think tank” for her patients, meaning that she was just a small part of all the work that they did in therapy.
Don’t let your ego get in the way.
Don’t try to prove yourself or your worth; that will come through entirely on its own when the patient begins to improve. Rather, it is better to be humble and accept that you might have something new to gain from your patient. A good healthcare provider considers every case as an opportunity for learning.
Help guide your patient to the right information.
If a patient is keen enough to do research on his or her own time, why wouldn’t you want to use this for therapeutic benefit? Do you know of a good book or website with reliable information? Why not give it to your patient and discuss what he or she has read during the session? Ask probing questions, too. Together, asses the veracity and potential of the information he or she has gathered.
Referring to other sources is not a sign of professional incapacity – it is a sign of responsibility. Moreover, if your approach is not working for your patient, it is prudent to refer them to a colleague that may be able to help. Treatment should not be a burden to patient or the provider. When used properly, it is a useful and powerful tool that changes lives.
Dr. Tali Shenfield is a clinical director of the North Toronto Psychological Center. She is an avid blogger and you can read many of her articles in the “Journey into the Brain” blog. You can follow her on Twitter at @DrShenfield.
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