Whose Team Are You On?
Whose Team Are You On, Anyway?
Sometimes our frustration with our patients is because they won’t take our suggested course of action. They are non-adherent. They nod yes, but don’t do it. They eat the wrong foods and discontinue their medications themselves, and sometimes put themselves in real danger. Or, they won’t engage in what you and I know could fix the problem. Especially in the hospital setting, they are admitted and we are here, armed with knowledge and evidence and experience, ready to shower that upon our charges.
Why don’t they follow the program?!
I think sometimes we make the mistake of believing that we take care of the patients. In the most extreme cases, where a patient has no ability to care for themselves, that may be true. And if we believe that we take care of them, then when patients don’t behave the way we want them to, the patient is tantamount to disobedient. And we, who believe we are the primary caregivers, can become frustrated, sometimes angry.
But: who is actually looking after our patients the majority of the time?
In most cases, we need to remember that patients take care of themselves – and we help.
Let’s say that again: even in a hospital room, patients take care of themselves 24 hours a day – and we come in at intervals to help them, rounding daily or hourly. Certainly in the outpatient setting, we may see them spaced by weeks or months. The vast majority of the time, patients take care of themselves.
How does that help us, the providers, flip the script?
When we appreciate that the patient is offering us the opportunity to be a trusted member of his or her or their team, everything changes. In fact, I have a number of useful analogies that help me mentally stay happily in my lane:
· I may liken myself to an athletic coach whom a person has engaged to help run a marathon. I will ask them to challenge themselves or do something uncomfortable, in order to help them run the race. If they don’t want to run it, or are happy with their present performance, then I don’t take it personally. It’s their race to run.
· Another analogy is that of an architect on a home renovation. I present them with drawings of what we want to build, fully aware that the patient will ask to add or subtract things from the final result. They may want it just so, and not that way. I may have a different opinion, but they have to live in the final product.
This approach has so many benefits: the patient does not have to please me, though they want to. The patient does not have to struggle with me. I’m a trusted adviser on their team.
In psychiatry, we deal in thoughts, feelings and behaviors which are influenced from a wide variety of sources. We want the patient to be whole and authentic with the life that they grow, or the path toward death that they walk. In urgent or crisis situations, taking the patient out of pain or addressing the life-threatening moment is great. But on an ongoing basis, coaching them to run their chosen race or helping them build the house of their spirit that they dream of is really the prize to me.
Grateful for the Opportunity to Serve
For years, I end the interviews with my patients by saying, “Thank you for letting me serve you today, I’m really glad (or honored) to be a part of your team.” And often I’ll add, “I’m so glad our paths crossed,” or, “It was a blessing to me to see you today.” I’m always amazed that they look so surprised. I am glad to be on their team. I am glad that our paths crossed. And usually, even the difficult situations give me something important.
Peace,
Tony