Screening Patients, Part 4: The Seekers

 This is Part 4 of a multi-part post series on various types of potential new patients to screen for, the characteristics of these types, and the importance of screening for them, if for no other reason than to have prior notice regarding what you (as a doctor) could be facing when working with them.

This post series is indeed intended for doctors, although I’m putting it out in the open, which means that anyone could read it.  Some of the people (doctors or patients alike) who come across this post series could start thinking to themselves, “what a judgmental prick.”  But I promise that’s not my intent, nor is it the attitude I take.

Rather, due to the intense, in-depth nature of my particular work, I am simply cautious about who I work with and I find it helpful to have a heads-up and be forewarned about who and what I’m about to form a therapeutic relationship with.  The (surprising) fact is, not everyone who comes through your doors is there for the reasons one would assume.  There are LOTS of reasons one might seek care at your office and there are lots of different people whose motives are less-than-straightforward.

Today, I’m going to delve into various types of “seekers”, and by that I don’t mean those who are just there for the straightforward pain relief or relief of other symptoms.  I’m not referring to the chronically ill who genuinely need help (which happens to be my own subspecialty, and I’m very compassionate when it comes to these people and their situations).  I’m referring to people who might genuinely need help, but that’s not necessarily why they’re there.

My categorical grouping today will focus on three main types of “seekers” that I recommend being aware of – I wasn’t, and I learned the hard way about a few of these, and I simply don’t want others to get caught in the same fishnet as I did.  And if you already have, I want you to know that you’re not alone.

Here we go…

Attention-Seeking Patients:

I alluded to this type in a previous post, as a sub-type of those who take on a “martyr” role.

As mentioned before, the martyr-like personality can be divided into two subtypes.  One is the genuine caretaker, whether they’re taking care of one person (usually someone who is close to them and either elderly, disabled, or chronically ill), or they have a more generalized caretaking personality (where they want to take care of everyone, and they put themselves last).

Either way, that personality type ends up neglecting themselves.  That was one of the topics of the last post.

By contrast, there’s a second type of martyr-like personality.  This is someone who might indeed be taking care of someone else, or they might indeed have a caretaking personality, and on the surface, they can look much like the “genuine” type I mentioned above and in the previous post.

However, in the case of the second martyr sub-type, there is a more self-centered undercurrent.  These people might appear to run themselves ragged, but what they really want is to be able to say, “look at me, look at all I do for you (or everyone)”.  The implication here is that now those around them owe them something in return for all of this energy expenditure.  Or, they seek admiration, praise, or attention from other people, those who might not be involved in the caretaking situation, for their efforts.  They want to be able to boast about their efforts to anyone who will listen, and receive a proverbial pat on the back for the burden they carry every day.

What this means to their doctors, and what their doctors should know, is that it’s all about them.  Of course a patient’s care is all about them, but sometimes some of these people take that fact to a new and different level.

Like the “genuine” caretaking type, these folks might actually be running themselves down, becoming exhausted by everything they’re doing.  But make no mistake; everything they’re doing TO BE NOTICED by whoever will notice.  In my personal experience, I have found it important to briefly acknowledge the efforts they’re making (it would otherwise be the elephant in the room), but then move on to more proactive topics, keeping the conversation strictly professional and avoiding the temptation to feed into the trap by over-consoling, over-empathizing, or even sympathizing excessively.  We might say, “you poor dear” or “bless your heart for all you do!” here in Texas, but that is not the best strategy here.

I find it useful to have a heads-up that I’m about to work with someone of this personality type because not only is there the excessive energy depletion, but there’s also a potential underbelly of narcissism, too.

Drug-Seeking Patients:

I never thought our office would be the target of drug-seeking people–we’re a non-prescribing chiropractic office, after all–but it happens.  It’s rare, but it happens.

At first I puzzled over this.  Why would anyone come to our office seeking drugs?  Everyone knows that DCs don’t prescribe medications in Texas, and this is true in all but a handful of states.  So what gives?

And then it hit me.  We had just encountered our first drug-seeking patient.  All the signs were there.  A stay-at-home mom of healthy school-aged children, with a kind and supportive husband, who otherwise had a pretty fortunate life…and she rated her stress levels between 8 and 9 on a scale of 0-10.  And…she had mysterious pain.  And…she brought us a spreadsheet of all the doctors she’d been to, with names, dates, diagnoses, treatments rendered, the whole nine yards–none of whom had helped or made any positive impact whatsoever.

And…she was on an opiate prescription.

At first, her husband accompanied her to her visits.  He was fairly certain that these other doctors had somehow neglected her, scammed her in a way, and at the very least, failed her.  He was forever standing by her side, trying to make sure that it didn’t happen again, that she was actually going to get helped this time.  He was a very nice man and once he was satisfied that we were trustworthy (which took all of two or three visits, just to be sure), he stopped accompanying her.

It took us a while to figure out her root problems.  She was receiving care from both the spinal/joint manipulation and the Functional Medicine branches of our office.  My partner and I put our heads together to “play detective” and figure out–and solve–her problem, once and for all.

We delved into Janet Travell’s trigger point manuals and lab test marker databases.  We isolated her problems to 1) low stomach acid (chronic), and 2) an odd trigger point referral pattern that was not elucidated on any of the wall charts that mention the “usual suspects”–the most common trigger points.

This patient indeed had genuine issues.  And we had just solved them.  She had been coming to us for a few months, we’d been throwing everything we could think of at the problem, trying to stamp it out.  Nothing had worked, or so she said.

And then, we cornered her.  This was unintentional; we did not have any snarky sentiment or ulterior motive here.  When she met with me, I assigned her three simple tasks involving digestive function, and scheduled her next checkup for 1-2 weeks from that date.  Meanwhile, my partner went to work on the hidden, secret trigger point that was covered in the Travell books but not the wall charts.  My partner managed to work out this patient’s pain very effectively.

Too effectively.

And my three tasks were destined to work too well, too.

The moment of truth occurred on this patient’s next checkup.  She actually sat across from me and said that she didn’t think this path was worth the money.  For real??  We had just solved both of her more pressing problems.  She’d been coming to us, ever faithful, for several unfruitful months before that, and the moment we finally figured out the problem…poof!  She disappeared immediately.

Now I know the backstory: she had her husband completely snowed, and she wanted to be able to go back to him and say, “those doctors weren’t working for me, either.  I need to go back to my pain doctor to get more Vicodin.”

This type of patient had us scratching our heads trying to figure out the problem, and then this person tried to pin it on us, implying that we “weren’t worth it”, when really, all she wanted was a cover story–to make it seem like she was going to yet one more doctor who couldn’t help her mysterious pain so that she could continue to justify her opiate addiction.

We had been fit to pull our hair out, working late into the night to help bring relief to this patient.  Only to find that she wanted a symbolic “doctor’s note” for her husband so that he wouldn’t question her desire for another addictive drug refill.  Un-freaking-believable.

And then, I thought back to all the other doctors listed on that spreadsheet.  At the time this patient initially came to us, we thought, “oh my goodness, I never thought we had so many incompetent doctors in this town!”  And now, I wondered.  How many of them actually had gotten to the root of her issue and laid out a proper treatment plan?  How many of them had found a solution?  A solution that she didn’t want because it didn’t get her high?

I’m sure that since she disappeared, we’re just another name on that spreadsheet list.  And I wonder just how long that list has gotten since then.

Which got me thinking about a broader category of patients I needed to screen for…

Active (Alcohol/Drug) Addicts:

This may or may not be as much of a sticking point for those doctors who predominantly practice spinal/joint manipulation, but this can be a real humdinger for those who also practice Functional Medicine.

People who are addicted to alcohol or drugs have a lot going on, and this can overwhelm the Functional Medicine specialist.

First, it’s important for me to say that I do not demonize addicts one iota.  In fact, I feel for them.  People who are addicted to a substance are not pieces of trash, underachieving losers, or any other such nonsense.  These people are typically self-medicating, trying to numb themselves to some kind of pain in their past and/or present.  So, compassion is crucial here.

This is all the more reason you want to screen for them.  Not only is the alcohol going to overpower any Functional Medicine efforts undertaken (and possibly any spinal/joint manipulation efforts, as they may not “hold” their adjustments well), but there’s also a deep psychological/emotional pain and/or stressor that is incredibly profound.

I found that I can throw the cleanest diet, the highest-quality supplements, and the most comprehensive care plan at these people and if they are harboring severe stress, resentment, pain, fear, anxiety, PTSD, depression, anger, rage, etc, at someone or something, then they will never get better until it is resolved.  Their chemical addiction serves as a temporary band-aid, a short-lived numbing agent that helps them forget about it or not care, not be so sensitive or affected by it, but it’s always there.

And since the substances they resort to are toxic in themselves, I found that even the most competent doctor using the most powerful remedies can’t so much as make a dent in their neuropathy, abdominal issues, pain, headaches, whatever…until their psychological pain and the resulting addiction are dealt with effectively.  Until they face the fact that they have an addiction, and that that addiction is an instinctive attempt to numb or drown out something deeper, something that hurts and hurts bad, they won’t be able to take their first step forward.

Personally, I will only work with patients who have been clean and sober for at least six months.  But that’s just my stance; others may have different success rates with different time frames, and that’s OK.

I think there’ll be at least two or three (give or take) more posts on this screening topic; there’s a lot to be aware of.  It’s a jungle out there.

 

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