How do u offer compassionate care to those who are depressed

[Reborn24]

and bed-ridden. I can't think of anything positive to say when they seem to have given up on life

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[Mr. McDuck]

You don't always have to say positive things. Sometimes just being there as someone they can talk to in the hospital where everyone is rushed can help them out a little. Not always, but sometimes it works. Of course, I'm not a med student yet, but that's what I've noticed about the surgical patients I see.

 

[Sondra]

This doesn't always work, but I often ask the person about something in the room with them. Like...who sent the flowers? Are those pictures of your grandchildren? etc. Some people come alive when they talk about their family and friends. It lets them know you care while reminding them that their family also cares.

 

[tiger_lily]

and bed-ridden. I can't think of anything positive to say when they seem to have given up on life

Is the person a patient you don't know well, or a close friend or family member?

 

[Jocomama]

That is your job.

Also - not uncommon and something to consider: very structured, busy people become depressed or "out of sorts" when not working or in their schedule.
Maybe they need a psych referral.
But you still need to put on yoru game face, so you can do your job as a student dr.

and bed-ridden. I can't think of anything positive to say when they seem to have given up on life

 

[TinyFish]

Well...I'm assuming you're talking about people with clinical depression vs. people who are going through grief or who are "just bummed out" (not to belittle being bummed out--that sucks, too).

It's hard to say. From personal experience, I have to admit that during the times I have been depressed, I have never received care that was 100% "satisfying." The problem is, when you're depressed, very little can be satisfying because there really is very little that most people can do to ease the pain.

There's a difference between doing what's necessary and doing what makes the patient happy. As I said above, making the patient "happy" is very difficult. In fact, we will probably all have to do things that will make a patient *unhappy* in order to treat them. During my worst times, the staff at my undergrad health center would force me to stay at the center overnight for my own safety. I resented them greatly for it. I still do, but I am glad they did it, because it was the best thing for me. Keep in mind that your patients don't have to *like* you, and that you need to do what's best for them.

At the same time, I know that you have a desire to ease peoples' pain and make them more comfortable, if it is possible to do so. A couple of things I can say is: don't be patronizing (and def. don't talk to patients as if they were children), don't talk down to people who are depressed, and don't tell them to "snap out of it." If they are mildly depressed, you can suggest an exercise program in addition to medication/psychotherapy/whatever their treatment program is. But don't assume (many people do) that exercise will "snap them out of it." If they are severely depressed, it won't. Don't place any blame on the patient. DON'T assume you know more about the patient or the patient's depression than they do, or at least don't act like you do.

DO speak calmly. DO listen to what the patient says and take it into account, even if you think they're wrong.

***Sondra's suggestion was excellent: ask them about something in the room, their families, etc. This works for many people because (in my experience) distraction is a very, very powerful tool. Many people who are depressed are extremely introspective at the time, and "taking them out of their heads" can help a lot, even if it's only for a little while. The tricky part is that asking someone about her/his life can trigger nasty thoughts and might make them dwell on things that contribute to their depression. If you notice this happening, discontinue the line of questioning and try something else. One excellent "method of distraction" is to encourage patients to do crossword puzzles or math puzzles--these things take one's focus away from his inner world and out onto something that bears no negative associations. To get the patient involved, you can offer to do the puzzle with them, etc.

Good luck!

 

[TinyFish]

Oh, one thing I forgot to mention about the post previous to mine.

Putting on a positive aura is important in some cases, but you have to keep a tight check on what you do and say. Being overly "positive," "cheery," or "chirpy" can be extremely, extremely annoying to a patient who is depressed. They can perceive an overly cheerful person as being fake, and they can take that sort of behavior as an insult. I used to interpet cheery people as phonies who had no respect for my problem, and I associated overly cheerful behavior as saying, "See? It's so easy to be cheerful. Why can't you be cheerful?"

It's okay to smile and be positive, but pay careful attention to patient to see how s/he takes it.

 

[8744]

and bed-ridden. I can't think of anything positive to say when they seem to have given up on life

Ah hell, just be yourself. If you aren't a compassionate person then don't try to fake it. Sometimes there is nothing positive to say and all you really need to do is your usual doctor stuff.

 

[deuist]

Ah hell, just be yourself. If you aren't a compassionate person then don't try to fake it. Sometimes there is nothing positive to say and all you really need to do is your usual doctor stuff.

If you can't be a passionate person, then don't go into medicine.

To answer the OP's question: most research indicates the relationship a physician has with his/her patient provides a better measure of healing than the particular technique. You don't have to say the right things, but you are expected to have the patient's trust. Some counselors refer to "presence" as way of showing empathy and genuineness. You shouldn't try to give positive advice---particularly if it isn't genuine---but you should acknowledge how you're patient feels. You could say, "You feel like everything has been taken from you," and watch the patient's reaction. Talk to psych services if you need some help on developing patient relationships.

 

[8744]

\

...If you can't be a passionate person, then don't go into medicine....

Bull. "Passionate" is one of the most over-used and meaningless words on SDN. It means nothing as it's definition is either so broad as to be encompass everything or so specific that nobody can really live up to it.

If we were truly passionate about medicine we would never go home. We'd burn with the fire to see our patients get well and damn the hours we are forced to spend eating or sleeping.

In fact, most of your fellow residents are going to be extremely happy to sign out to you when they are post call and can not wait to get out of the hospital. It's not that they don't like their job, it's just that there is so much of it.

And I assure you that you are not going to passionate about all of your patients. You're going to like most of them, feel sorry for almost all of them, but feel relieved when they are transferred to another service and no longer on your census. Just less work for you.

It's OK to just like your job. You don't have to swoon and get palpitations thinking about it.

 

[TinyFish]

I'm gonna have to agree with Panda on the passionate issue. Passionate/compassion/sympathy/empathy/dedication/blah blah blah are the most over-used and often most meaningless words used on these boards. Even if the superhuman physician with all the above qualities does, somehow, exist, it would be impossible to ensure that the body of U.S. physicians be comprised of these people. Uncompassionate people would slip through. They do, every year. In fact, I have met very few healthcare professionals that are everything we, as premeds, think they are supposed to be. Many are tired, overworked, underpaid...you name it, and they want to go home NOW. Some are selfish, some have been pushed into medicine by their families, some have gone into medicine for the wrong reasons. We're all going to have to deal with those types, and it's no use telling them that they shouldn't be doctors. A person's passion and compassion don't guarantee that he's going to be a good doctor, and lack thereof doesn't necessarily mean that he's going to be a bad doctor.

I don't know why I wrote that. I'm sure that the topic has been discussed here numerous times.

I do agree with deuist about the role of trust in the patient-doctor relationship, however.

 

[deuist]

Blind compassion without reason is indeed a bad thing. You can show passion without caving into the demands of a drug seeker or a violent patient. I said that you need genuineness; I didn't say that you should get walked over.

 

[OSUdoc08]

and bed-ridden. I can't think of anything positive to say when they seem to have given up on life

Prozac or Elavil

 

[RxnMan]

and bed-ridden. I can't think of anything positive to say when they seem to have given up on life

As someone who has experienced depression firsthand, this is the best advice posted yet:

...distraction is a very, very powerful tool. Many people who are depressed are extremely introspective at the time, and "taking them out of their heads" can help a lot, even if it's only for a little while...these things take one's focus away from his inner world and out onto something that bears no negative associations...

Often the best thing anyone could do was to listen. Sometimes I vented, sometimes I talked about something competely different. You, as the student doctor, won't cure them. You can't solve the problem (clinical, financial, etc) that's making them depressed. But is your job to? Just be there, talk to them, ask them about...anything that pops into your head. If they start getting agitated, then steer away from that topic. Just giving someone a reprieve from their introspection is a wonderful thing.

 

[RxnMan]

Bull. "Passionate" is one of the most over-used and meaningless words on SDN. It means nothing as it's definition is either so broad as to be encompass everything or so specific that nobody can really live up to it.

Amen, brother.

I've been rejected from schools because I wasn't 'passionate' enough. So doing a couple of backflips and a juggling act for your interviewer makes you a better doc? You can bet that the least of my rational, serious, and evidently 'passionless' decisions has more effort behind it than most passionate kiddo who became a doc because daddy did.

 

[sentrosi]

If you prescribe to the school of Dr. Cox, you could try reverse psycology...like in season 4.

 

[BAM!]

Also - not uncommon and something to consider: very structured, busy people become depressed or "out of sorts" when not working or in their schedule.

That happened to me when I quit my job. I felt like I was being extremely inefficient, like it was painful if nothing was accomplished.

It lasted about 3 days. Now I take long showers and sleep in (but don't tell Al Gore).

 

[MossPoh]

Oh, one thing I forgot to mention about the post previous to mine.

Putting on a positive aura is important in some cases, but you have to keep a tight check on what you do and say. Being overly "positive," "cheery," or "chirpy" can be extremely, extremely annoying to a patient who is depressed. They can perceive an overly cheerful person as being fake, and they can take that sort of behavior as an insult. I used to interpet cheery people as phonies who had no respect for my problem, and I associated overly cheerful behavior as saying, "See? It's so easy to be cheerful. Why can't you be cheerful?"

It's okay to smile and be positive, but pay careful attention to patient to see how s/he takes it.

When I was really depressed and right before medications that was my biggest annoyance. People being so damn cheery. Depression is weird because, at least when I had it, people always tried to cheery me up and nothing really helped. I mean a lot of people don't have a reason to be anyway..it just happens. The most comforting thing for me was just to have a nodding head while I might have bitched a bit....too many people gave me the "it is your fault anyway" type attitude which would just send me even further down..I wasn't stuck in bed so I have no idea how that works with it. But it is a tough thing to do..make depressed people happy and it requires a special talent. The psyciatrist and counselors I went to didn't have it and resulted in me being stuck with anti-depressants for a while...till I got the willpower to cut them off.

 

[stoic]

and bed-ridden. I can't think of anything positive to say when they seem to have given up on life

wtf? you're going to see a lot of patients that for one reason or another you don't have sympathy for or whom you find infuriating because they're in bad health as a direct result of their own actions and can't seem to figure that out. get used to the idea of painting a pretty picture you're pretty sure won't come true and staying positive when in reality you know there is little reason to be.

as others have said it really is your job. that's not to say you need to be dishonest or defer the patients responability in their own health, but very rarely is projecting a positive hope for the patients health a bad idea.

and sometimes, you'll be suprised at how people can turn things around. it doesn't happen all that often, but man it's a good feeling when it does. on the last day of my summer rotation (yesterday, actually) I saw my first really inspiring NIDDM case. guy was dx'ed two years ago, with an A1C of 15% and a cc of general malise. started him on an oral agent and a little lantus (low B-peptide) and i'm sure wrote him off when he said "i'm turning things around right now." when i saw him yesterday he'd lost 50lbs, his BS log didn't have a single reading over 140, and his A1C was 5.9. and this is after being able to dc the lantus 6 months ago. i was effing proud of that guy.

 

[Sporky]

and bed-ridden. I can't think of anything positive to say when they seem to have given up on life

As an aspiring medical student (I actually typed "aspirin" before I caught myself)
I say to those of you here who are already doing it, "KBO", which in Churchillese means "don't quit". You are all in positions we aspire to.

As a missionary and minister of many years, I can say that there are times when I have not wanted to be positive and upbeat and I thank you for your honesty. Sometimes it is hard to be upbeat. One thing which helps me remain positive is the knowledge that there is a purpose in everything - we cannot always discern it, but it is there nevertheless.

The ancient Hippocratic oath to "do no harm" actually means a great deal more than just not hurting people. As a physician or student, you are a source of hope and encouragement to those for whom you are caring. Even really crappy doctors initially provide this - it just comes with the package.

Sometimes a simple greeting or touch can be a life-saving entreaty to a depressed or suicidal person. A kind word given in love can deter much anger and hatred. These are simple things which our world often forgets, but which can be powerful tools in the hands of doctors like yourself.

Here's hoping to be in your shoes and keep being honest and real and remember that you are having more impact on your patients than you may know.

Blessings,

 

[tiger_lily]

As an aspiring medical student (I actually typed "aspirin" before I caught myself)
I say to those of you here who are already doing it, "KBO", which in Churchillese means "don't quit". You are all in positions we aspire to.

As a missionary and minister of many years, I can say that there are times when I have not wanted to be positive and upbeat and I thank you for your honesty. Sometimes it is hard to be upbeat. One thing which helps me remain positive is the knowledge that there is a purpose in everything - we cannot always discern it, but it is there nevertheless.

The ancient Hippocratic oath to "do no harm" actually means a great deal more than just not hurting people. As a physician or student, you are a source of hope and encouragement to those for whom you are caring. Even really crappy doctors initially provide this - it just comes with the package.

Sometimes a simple greeting or touch can be a life-saving entreaty to a depressed or suicidal person. A kind word given in love can deter much anger and hatred. These are simple things which our world often forgets, but which can be powerful tools in the hands of doctors like yourself.

Here's hoping to be in your shoes and keep being honest and real and remember that you are having more impact on your patients than you may know.

Blessings,

Nice post Sporky

 

[8744]

As an aspiring medical student (I actually typed "aspirin" before I caught myself)
I say to those of you here who are already doing it, "KBO", which in Churchillese means "don't quit". You are all in positions we aspire to.

As a missionary and minister of many years, I can say that there are times when I have not wanted to be positive and upbeat and I thank you for your honesty. Sometimes it is hard to be upbeat. One thing which helps me remain positive is the knowledge that there is a purpose in everything - we cannot always discern it, but it is there nevertheless.

The ancient Hippocratic oath to "do no harm" actually means a great deal more than just not hurting people. As a physician or student, you are a source of hope and encouragement to those for whom you are caring. Even really crappy doctors initially provide this - it just comes with the package.

Sometimes a simple greeting or touch can be a life-saving entreaty to a depressed or suicidal person. A kind word given in love can deter much anger and hatred. These are simple things which our world often forgets, but which can be powerful tools in the hands of doctors like yourself.

Here's hoping to be in your shoes and keep being honest and real and remember that you are having more impact on your patients than you may know.

Blessings,

Gag.

 

[beefballs]

Gag.

I am going to try tickling them.

 

[Sporky]

I am going to try tickling them.

Tickling works well.

http://www.patchadams.org

 

[8744]

Patch Adams my ass. You will be hated not only by your collegues but also by most of your patients if you try to whip some Patch Adams on them a la Robin Williams.

The medical profession is just not like that.

Laughter is not, repeat not, the best medicine. Vancomycin is.

Sorry.

 

[8744]

And, if you ask, I'll tell you why your collegues will despise you if you follow the Patch Admas model, why they will be right, and why you will slap yourself in the head one day and say, "Gosh, I'm a motard."

 

[stoic]

panda probably knows. i'm pretty sure pts are always asking him to stop making them laugh so much and to ditch the cheery disposition.

there's a time and patient for everything in medicine; sometimes they enjoy cracking jokes and other times you need to be serious like a heart-attack.



hey, i saw my first pt the other day who ask what i thought about Kevin Troudea's "natural cures." now THAT was hard to keep from laughing about. i think "con-artist" only escaped my lips one time.

 

[OrnotMajestic]

hey, i saw my first pt the other day who ask what i thought about Kevin Troudea's "natural cures." now THAT was hard to keep from laughing about. i think "con-artist" only escaped my lips one time.

If I'm bored, I read that crack-pot's books at bookstores. Did you know he claimed that a concoction of Chinese herbs cured his mitral prolapse? Hell, why don't we feed said herbs to amputees to regrow limbs! He's almost as funny as that other late night guy (the super skinny guy with the 70's porn 'stache) who claims everyone has 22 pounds of fecal matter in their colon, poisoning them. I love it.

 

[OSUdoc08]

Patch Adams my ass. You will be hated not only by your collegues but also by most of your patients if you try to whip some Patch Adams on them a la Robin Williams.

The medical profession is just not like that.

Laughter is not, repeat not, the best medicine. Vancomycin is.

Sorry.

VRE would disagree.

 

[Law2Doc]

Patch Adams my ass. You will be hated not only by your collegues but also by most of your patients if you try to whip some Patch Adams on them a la Robin Williams.

The medical profession is just not like that.

Laughter is not, repeat not, the best medicine. Vancomycin is.

Sorry.

Laughter worked well a few decades ago, but the bacteria have since evolved and built up a resistance. I think Roche is working on some second generation laughter but so far haven't showed a benefit over placebo.