Dealing with Angry/Upset Patients

[WisNeuro]

In SoCal, about $500 -$750 per hour for the eval and prep, $750 - $1200 an hour for court time with or without testimony.

No go for me, not even close to my 3X multiplier 🙂

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[Shiori]

I got yelled at by a patient for the first time in a while and this thread came to mind. I reflected that I understood the reason for the anger, but explained my actions and remained firm in my decisions. They were still unhappy and that part sucks. It's hard to see someone suffering and not want to help alleviate that. One of my final hurdles as a trainee is really practicing doing the therapeutic thing and not the thing that makes them feel better in the moment. I imagine it'll be a lifelong practice.

 

[AcronymAllergy]

I got yelled at by a patient for the first time in a while and this thread came to mind. I reflected that I understood the reason for the anger, but explained my actions and remained firm in my decisions. They were still unhappy and that part sucks. It's hard to see someone suffering and not want to help alleviate that. One of my final hurdles as a trainee is really practicing doing the therapeutic thing and not the thing that makes them feel better in the moment. I imagine it'll be a lifelong practice.

Sorry to hear about that, but it sounds like you did your best to manage the situation as was possible. Sometimes, there's just no getting around people being upset. I don't know if it ever gets easier necessarily (maybe a bit), but you'll likely at least feel more confident with it over time.

 

[Therapist4Chnge]

Yeah....there isn't enough money for me to do that kind of work. Give me an IME where I have to review the treatments and opine about the case. It can still be a PITA, and it's common for stuff to pop up that you just need to deal with (e.g. quick turnaround rebuttal to a new report or addended report from the other side). My fav cases are a few thousand pages of review, interrogatories they need answered, and enough time that I can dig into the materials.

 

[Sanman]

I got yelled at by a patient for the first time in a while and this thread came to mind. I reflected that I understood the reason for the anger, but explained my actions and remained firm in my decisions. They were still unhappy and that part sucks. It's hard to see someone suffering and not want to help alleviate that. One of my final hurdles as a trainee is really practicing doing the therapeutic thing and not the thing that makes them feel better in the moment. I imagine it'll be a lifelong practice.

I often liken myself to a physical therapist or personal trainer. There will be pain, but I have the skills to make you better in the long-term. It is up to the individual if they want to engage and put themselves through the pain. If not, come back when you do.

 

[cara susanna]

I often liken myself to a physical therapist or personal trainer. There will be pain, but I have the skills to make you better in the long-term. It is up to the individual if they want to engage and put themselves through the pain. If not, come back when you do.

I always tell my patients that I'm going to be pushing them to do one more sit up!

 

[Fan_of_Meehl]

I always tell my patients that I'm going to be pushing them to do one more sit up!

I always liked that line from the movie 'Hoosiers' where the basketball coach (Gene Hackman) responds to a complaint about the grueling nature of their practices with something like, "Gentlemen...my practices are not designed for your enjoyment." LOL

 

[Fan_of_Meehl]

When you make the statement that kids with autism are different than kids without autism, that just strikes me intuitively as being inaccurate. Some of the reasons and rationale that I am able to give are part of that, but I wouldn’t challenge this perspective if I didn’t feel that it is actually more problematic than just being incorrect. I just haven’t been able to fully think this one through yet. Trust me, when I am working with individuals who meet the diagnostic criteria, I use similar thinking and language myself because that is all we have.

I have a similar, yet less problematic issue probably because the treatment is fairly similar and also we get a few extra terms to use, with Bipolar with Psychotic feature verses schizoaffective verses schizophernia. Are they on a spectrum of severity or a progression of illness or are they different manifestations of they same underlying vulnerability or is it sometimes the same and sometimes not? Sometimes the patients fit a category neatly and it seems to make sense to use the label, but more often than not I’m thinking the label is limiting all of our thinking.

The "I can't do this because of my diagnosis" (or, "I DID this (bad thing) because of my diagnosis") is almost always completely circular (tautological) 'reasoning.' In fact, it's not 'reasoning' at all. It is simply a re-statement (twice) of an observation of the exact same behavior using different words. For example, if someone says, "I hit him because I have Impulse Control Disorder NOS (or PTSD, or Antisocial Personality Disorder, or...)." Well...how do we know that you 'have' Impulse Control Disorder NOS? Because I tend to impulsively hit people. Circular reasoning. A re-description of the behavior. Not a causal statement. Not an explanation. So much addled thinking in mental health around diagnosis (and implications of diagnosis) involves offering a description (or re-description) of symptoms as an 'explanation.'

Now, not ALL explanatory models (or case formulations) involving a diagnosis and observed symptoms/behaviors is circular reasoning. Those that aren't actually invoke intermediary constructs such as lack of 'distress tolerance' skills which may lead to specific interventions targeting specific deficits that may lead to therapeutic improvement. Thus, these case formulations create actual specific testable clinical hypotheses which can be used to design interventions, operationalized and 'measured,' and--at least in a clinical context with an individual patient--corroborated or refuted (at least with enough precision to provide utility for scientifically-informed clinical work). The scientific tasks of description and explanation are two different things and the distinction is critical, especially when considering the relevance of diagnosis in assessment, treatment planning, and hypothesis testing.

 

[Pragma]

Agreed. I'd even say that it's the OPPOSITE of our job to tell people what they want to hear. People telling them what they want to hear is what got them into our offices, lol.

Past few years I feel like I am doing feedbacks deconstructing social media autism/adhd/neurodivergent misinformation. I’m so tired of it but have to keep at it and try to screen out all that BS.

 

[Fan_of_Meehl]

Past few years I feel like I am doing feedbacks deconstructing social media autism/adhd/neurodivergent misinformation. I’m so tired of it but have to keep at it and try to screen out all that BS.

The truth is a powerful ally...

...but it has many enemies

 

[Sanman]

Past few years I feel like I am doing feedbacks deconstructing social media autism/adhd/neurodivergent misinformation. I’m so tired of it but have to keep at it and try to screen out all that BS.

I understand you're a doctor and went to school for many years, but someone with enough money to afford a smart phone and start a tik tok account said different. I'm just not sure who I can trust anymore. Can you deliver my testing feedback in 10 min or less while performing the nae nae? It would go a long way to ensuring that you are credible.

 

[ClinicalABA]

Can you deliver my testing feedback in 10 min or less while performing the nae nae?

Challenge accepted! I've delivered feedback while juggling and blowing bubbles, so this shouldn't be too difficult.