Iatrogenesis

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Also reminds of how some patient's, likely due to influence from society and/or docs self-handicap. "My PTSD or "my Bipolar", etc. I used to always tell patients to not refer to [insert dx here] as their pet dog.

I cant be in crowds, I cant drive in traffic, my pain is a 10/10 all the time everyday, etc.

I once had a patient ask me what would happen if someone pissed him off and he ended up killing them because once hes "sees red", he never knows what could happen. I told him he would go to jail for murder. Thus, its best that we engage in some legitimate treatment before this happens. Because once that happens, you cant expect me to help you. I think he was expecting me to give a different reply, but I have no idea why?
 
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Of course patient's own views add to this. But, the power of that being reinforced, or suggested in the first place by one of their providers, who they see as an authority figure on the issue of their health, is just that much more powerful. I spend more time in psychoeducation with physicians than I do with patients, especially when it comes to mTBI and epilepsy, than I do with patients. It's our responsibility as providers, across the spectrum of care, to be cognizant of this effect. Unfortunately, far too few in the field ever give this any thought.
 
PSYDR said:
IMO: too many idiot providers equate diagnosis with disability because it feels good and requires less work. Plenty of people work with severe mental illness work and obey the law.
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They also conflate not being able to do [prior job] with not being able to do ANY job. It’s really frustrating trying to fix the bad info given prior to consult. This is most problematic with mTBI, PNES, fibro, and PTSD.
 
Do people have a particular approach or style they have in dealing with these patient or provider perceptions? And do they buy your psycho-ed? Curious as to what others do.
 
Kadhir said:
Do people have a particular approach or style they have in dealing with these patient or provider perceptions? And do they buy your psycho-ed? Curious as to what others do.
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In the past tense, because I am not seeing patients right now:

I tell (most) people that "cant" is not something we say here (in terms of their psychiatric symptoms). This is not a SMI population, mind you.

I tell them their PTSD, Bipolar, depression, anxiety, Borderline Personality Disorder, etc is not their pet cat, and if they want to treat themselves (and recover), they should stop referring to it in this manner.

I discourage the wearing of clothing or regalia that celebrates/glorifies veteran disability ("disabled veteran") if they want to actually improve and believe in themselves.

I exhaustively explain the difference between indicative vs pathological anxiety.

If doing therapy, I try to change their relationship with anxiety (if that's the primary issue) so that the fear is lessened and they know it wont kill them. And, I work with them to understand the fact that they are capable of bearing/coping with adverse emotional experiences/feelings, as is almost anyone with a reasonable IQ and a working frontal lobe no matter their psych dx.

You are (legally and morally) responsible for your actions, as most other human beings are, and your psychiatric dx is not to be thought of as an "excuse" to act like an ass--ole.

Your "sleep problems" can largely be ameliorated if you either make changes to your habits/behaviors/routines, and/or if you treat PTSD. "Short sleepers" do exist though, and in that case we should probably focus on functionality/functional impairment more so than your anxiety about number of hours of sleep or the number of middle of the night awakenings.

Dreams, even bad/scary dreams, are relatively normal. Dreaming about your military experiences/career is NOT abnormal in and of itself. We all dream about our life experiences and our work. You we in the military, so some of these may not be pleasant dreams. This may just be a just a natural consequence of your chosen occupation over the past 10-20 years. Sorry for your luck/choice.

Your "memory problems" are equatable to "the cough of psychiatry" and are likely attributable to about 2 dozen different things/conditions rather than your mTBI. Lets start with how much you sleep and/or if your home life is hot ****ing mess?

I am sure I can think of a few more....
 
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1. I try and take an educational approach. I love when family comes who realize what is going on. Enabling family is a bit more challenging.
2. I steer away from psych terms, which can feel loaded at times. I use “stressed”, “down mood”, etc.
3. Whenever I hear “my [bipolar]/other dx is coming out” I cringe on the inside, but on the outside we talk about how behaviors/thoughts/feelings influence each other. We talk about accountability and increasing insight and awareness as ways to gain more control.
4. 95% of the time when I get someone using all of the jargon it is definitely a red flag. I don’t specifically see a psychiatric population, so prevelance rates are about right, minus most of my chronic pain patients and “gotten worse” mTBI folks.
 
Big fan of this thread - I'll come back and post more later on this topic but it is one of the things that drives me crazy in my professional life.
 
I personally hate it when the docs give the patient a diagnosis that reinforces disability and decreases personal agency. Sometimes I will explain to patients that these diagnoses are not real in the same way that many medical illnesses are and that they are symptoms of the other problems in their life that need addressing. I have an anxiety disorder and I have major depressive disorder are two examples. The flip side is my patient with schizophrenia who I actively encourage to attribute some of her thinking to “my schizophrenia”.
 
I'd say from personal experience, it's hard to get some of these types of patients to buy into our feedback as neuropsychologists. Generally, we see them 1-3 times for interview, testing, and feedback. So, it's basically us as a new provider, who is telling them a fairly hard truth, against a provider that they see regularly and have built a kind of relationship with , telling them an easy, comfortable lie. Why take the hard road (which leads to better long term outcomes) when you can just take the easy road and keep the status quo.
 
Psychological healing is a lot like exercise. People know that if they listen to their provider they will get better..but it`s a lot of work.
 
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