Things I Learned From My Patients

Slow here too. Two no-shows to start a Monday morning. Maybe I won't have to work this week.

 

No veteran of the armed services knows how to sleep.

 

1. Dr. Google is more trustworthy than multiple prior specialists.
2. Quality sleep is a huge problem across most patient populations.
3. Lawyers know better than providers.

 

The malingering stuff….oh man, all over the place.

 

The folks who are trying to completely fake (or maybe just overreport/exaggerate) PTSD symptoms usually don't make it past session 2-4 of a structured workbook/protocol.

I routinely offer cases whose presentations appear suspicious a structured workbook/protocol for their presenting issue (anger, insomnia, depression, etc.) complete with handouts, worksheets, a healthy dose of self-monitoring, and between-session assignments.

If they are characterologically so lacking in industriousness that they are trying to fake a mental disorder in order to get on disability then no way are they going to exhibit the hard work necessary to fake their way through a structured treatment protocol. They just move on to another therapist.

Kills me on my 'no-show' rates for a short time but they are often lost to follow up.

Seriously, in the post-deployment clinic it's like garlic/crucifix/holy water to a vampire.

 

2 year olds are really good at getting their needs met in the most efficient manners possible, regardless of expressive language ability or diagnostic status. Also- it's really fun to fling rubber duckies from metal spoons- totally deserving of a good giggle.

 

No matter how bad you have it, there is always someone who has it worse. I have had a couple of patients who I thought were tied for "worst childhood" until a patient came in with both of their experiences. To top it off, this patient functions at a higher level than the other two. So I also learned that. I matter how bad the stuff that happened, some people can still cope. Other side of that one is that some people can't cope even when nothing bad has happened.

 

If you're worn out after testing someone, it just might be ADHD.

 

If you are cognitively exhausted and incredibly confused after testing or interviewing someone, it might be a thought disorder.

 

On the flipside, "bad" can be really subjective. I consider myself to have had a pretty privileged, relatively easy life. My friend, who I consider to have had a really difficult life, has told me that I inspire her for overcoming what she views as my... really difficult life. I think the same of her, so go figure....

 

.

 

Well...I learned the names of a whole bunch of dinosaurs I had never heard of before, along with their eras, from a toddler with ASD.

 

I guess I'd like to know more about this. I have a friend with serious health issues who can't keep track of appts or even find his keys some days. he legitimately has concussive-related migraines, memory dysfunction and probably PTSD. Every VA doc, from psych to neuro to clinic who's looked at him says, "Dude, you're SICK!"

The social worker says he's faking, capable of so much more and we're all babying him.

I have to wonder if his complete inability to track basic appointments and records played a part of that "diagnosis."

 

Either of these could also indicate a somatoform disorder for me!

I actually feel like I've seen some great resilience over the years that has been inspiring - in the face of tough diagnoses in a variety of settings (e.g., AMC, private hospital, public hospital, VA) - some patients take awful news in stride and really make an effort. Support systems too. Seeing those cases, even when the prognosis is poor, really gives me some faith and helps keep my jadedness in check.

 

was told yesterday that I was the "King of Carmania," and that I had subjugated the defendant I was evaluating's family's land.

 

1. There are a lot of really crappy providers even at really good places.
2. The chances of a protocol being perfectly implemented as written is only effective for clients that never come in.
3. The ethics codes are far simplier in urban settings.