Screening Patients, Part 1: Readiness & Obstinance

Dear patients of the world, this post series is probably going to sound pretty judgmental.

I assure you, it’s not.  Falling into any one (or more) of the categories I’m about to talk about is not going to get you catalogued, reported, thrown out of an office, or barred from receiving care.

It’s just that some of the people out there present certain challenges to various types of doctors that these doctors need to be aware of, because doctors are human, too, and not knowing about these personality/history types of people can lead to serious physician burnout.

I should know.  I’m a doctor, and within my first two years of practice, I ran into every one of these personality types, without having had so much as a heads-up about what to expect.

When you run blind, you’re bound to knock into a tree or a cement wall; the actual object doesn’t matter; what does matter is that you break bones and sustain injuries.  Although we’re not talking about literal injuries here (well, unless somebody gets violent or something), unwitting encounters can do the same type of damage on a mental, emotional, and/or psychological level.

Call it what you will; it’s A Thing, and it’s real.

Like I said, I speak from (painful) experience.

Doctors, the relevance of this post series to you is likely going to pertain to the depth and intensity of the care you provide.  By depth and intensity, I’m not referring to how much you care; I’m talking about the actual type of care you offer.

For example, if your specialty is Functional Medicine, or neurology or something of similar intensity, then this post series is going to be a lot more relevant to you than if you do straight-up chiropractic care or straight-up family medicine (which is not meant to indicate that your type of care is less important of either of the latter pertain to you, nor is it intended to imply that your job is somehow more simple than that of someone whose role takes a more complex approach).  It’s not a judgment call, merely a matter of semantic labels.

In this post series, I’m going to discuss several types of potential patients, be it a psychological/mental/emotional disorder, ulterior motive, pertinent history, or other personality characteristic.  This series isn’t meant to demonize anyone, assign premature guilt, pass judgment, harshly criticize, or any such thing, toward anyone.  I just want to make that super-clear.

And I would like to encourage doctors to do the same (i.e., Don’t Be Evil).  Whether or not you want to admit these folks into your practice is up to you, and there are certain types that I would readily accept as patients, and there are others that I simply couldn’t handle working with but would readily refer to someone who could, and there are others in which I would have to evaluate on a case-by-case basis.

My agenda, if you will, for writing this post series is to put some information out there about different types of patients that might present a potential pitfall or headache if you don’t know in advance what you’re getting into.

This topic is fresh on my mind because we have just completed an entirely new rebuild of our intake paperwork packet that does indeed screen for each of these attributes.  Like I said, the screenings contained in the paperwork aren’t rejection tools or excuses to boot someone before they get their foot in the door.  That’s not necessarily my intent.  It’s not a practice-builder, that’s for sure.  But at minimum, I find it useful to have a heads-up about who might or might not pose a threat to the sanity or wellbeing of our office and most importantly, our other patients.

It’s also important to repeat here that my primary service is Functional Medicine, taken to the deepest and most complex level, in which the journey can become pretty intense at times, as opposed to spinal and joint manipulation.  (As such, your mileage may vary.)

With that out of the way, let’s get down to business.

Readiness/Motivation:

Certain sections of our new intake forms are designed to identify a potential new patient’s readiness for care.  Many patients believe they’re ready.  After all, they’re calling the office, looking for a healthcare provider!  However, not all are truly ready for everything that a complete health recovery plan would entail, if one were to do it completely, dotting all the i’s and crossing all the t’s.

The ones to be aware of here are those who are wishy-washy, the ones who haven’t done much research, the ones who don’t quite know what they want.  If you (as a doctor) have a clear understanding of what you offer and what you want to do to help a patient, and the patient isn’t even sure what they want, addressing their needs can get tricky.

“Readiness” actually refers to a larger umbrella of sub-types of patients; under this umbrella, there are several categories…

Obstinate (those who have “A Problem For Every Solution”):

These are by far some of the most frustrating and sometimes-heartbreaking cases I’ve come across.  I know how to help, I’m not shy in sharing that information, and I explain it clearly, patiently, and multiple times.  But–and you probably know the type–they buck up against everything you say.  It’s a visible bristle, palpable even if you’re talking with them by phone.

These are the people who claim they don’t have five extra minutes at the end of the day to fill out a basic, user-friendly food journal (aka “diet diary”), despite the fact that they’re a socioeconomically well-endowed stay-at-home mom whose (two) kids are old enough to start school.  Or the people who simply won’t leave their easy chair in the den to walk around the block three times a week (and it’s not due to chronic pain or mobility limitations).

Their favorite phrase is “I can’t”, but when you do a little digging, there’s no reasonable reason why not.

Personally, I haven’t found a great way to handle these types of situations.  The best approach I can come up with is to gently-but-firmly inform them that they have some decisions to make.  Do they want to get better, or do they want to continue along the path they’re on?  Because at some point, they’re going to have to put forth some extra effort.  Maybe that means rearranging their schedule, even just a little, to accommodate some new activities.  Maybe that means doing a little research or meeting with a nutritionist or foodie to come up with some food plan ideas that make their dietary habits less boring or the cooking less cumbersome.

I want to be clear on another point, and that is that when interacting with patients of this type, I do indeed make every resource available to them.  I wrack my brain attempting to come up with solutions, especially those that are easy, fast, low-tech, and inexpensive.  I don’t simply throw my hands in the air and say, “well, you’ve got to do something”; I only do that when I’ve exhausted all possibilities, and I’m a tenacious optimist, trying to give the situation every possible shot before simply giving up.

And if they are facing a hurdle, I do try to help them over that hurdle first.  I often ask them if there’s anything about the recommendations in my prescribed care plan of action that they’re having trouble with, or that I could help them with.  I always seek their input, and I’m always open to their ideas.  They will always get listened to and respected.

But there does come a point where I’m at a loss for any more ideas, because every one of my (reasonable, doable, logical, effective, etc) ideas has been shot down, immediately and flatly, by an unwilling, comparatively unreasonable patient.

These people either eventually straighten up and start thinking more proactively, or they weed themselves out of our office.  Although at this time I’ve never dismissed a patient for acting this way, I might not encourage them to schedule their next follow-up if I’m exasperated enough.

These are often the types of patients I dread seeing the most (yep, it’s true – since doctors are human, too, there are indeed people that most of us dread seeing).  Luckily for me, this doesn’t happen very often, because I refuse to take abuse and trust me, these patients can become abusive in a passive-aggressive or crazy-making way (they’ll try, purposefully or not, to make you feel like you’re the one who’s incompetent).

Stay tuned for the next post!   We’ll cover more.

 

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