Repeat Offenders

I don’t like being told what to do. 

Those of you who know me, know that about me. ( I was told by a friend today that I have mellowed considerably in the last several years, but bear with me for the sake of this post, please)

Talk to me, give me the information I need, reason with me about it, let me think it over, then get the hell out of my way. 

I will make my own decision, I will make it on my own way and in my own time. And yes, I will own it. The consequences, whatever they may be, are mine and mine alone. I get that. 

Huh. 

Funny.

The theme for the day was readmission. 

Like, how many times can I possibly get myself admitted to the hospital, sometimes the same hospital, in the shortest amount of time? How many times can I stop my medication, the same medication that got me stable the first and second and third times I was admitted to the hospital, and relapse? How many times can I threaten to attack a police officer, kill my uncle or threaten to poison my family with kerosene-tainted food before someone either takes me out or locks me up and throws away the key? ( no fear of the latter, at least in the state of South Carolina-we no longer have enough long term hospital beds to do that to people)

Most of the eight patients I saw today for probate court evaluations had issues with noncompliance, or nonadherence in politically correct speak, relapse, not taking medications, lack of insight, or just pure stubbornness. 

Huh.

Funny.

Patients come to see me complaining of many kinds of symptoms, including depressed mood, anxiety, insomnia, hallucinations, paranoia, suicidal thoughts, and lack of energy. We talk. We brainstorm. We swap ideas. I advise. They question. We compromise. We devise a treatment plan that we can both live with. In my case, that plan often involves the prescription of medication therapy. I prescribe it. They agree to take it.

And then they don’t.

Even though they still feel miserable. 

They get admitted again.

Huh.

Funny.

Maybe my patients don’t like being told what to do. 

Maybe they want to tell me, “Talk to me, give me the information I need, reason with me about it, let me think it over, then get the hell out of my way. 

I will make my own decision, I will make it on my own way and in my own time. And yes, I will own it. The consequences, whatever they may be, are mine and mine alone.”

I get that. 

Maybe that’s exactly what I need to do with more of my patients.

Discuss.

Empower.

Support.

Repeat.

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6 thoughts on “Repeat Offenders

  1. Good plan. Try it, Greg! Can include it’s going to be hard to follow, think you can do it? I’m not so sure. Let’s see what happens. Good thoughts for that! In some of my patients it worked, they took on the “challenge.” In some, forget it! 💛 Elizabeth

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  2. Interesting that I read this today. I’m getting irritated at changes in my pain management regime being made and dumped on. Since I respect the talks on the palliative committee I probably would have little to contribute, but much to learn. I do not appreciate having a medicine cup of unfamiliar meds plunked in front of me and then needing to pull teeth to get an explanation. I’m not a psychiatric patient; I’m an end of life cancer patient in a palliative and hospice hospital unit, but the ideas you put forward here apply equally, I think.

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  3. Yes.

    You are also an extremely intelligent woman who needs and wants to know, has an opinion, and wants to be directly involved in her own care.

    See also today’s post.

    It will give you permission to do what you need to do today (as if you ever needed that!)

    Good luck!

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  4. If only the meds weren’t so sucky though.
    Akathesia, sedation, fogginess, weight gain, constantly feeling hungry……
    And by taking the meds you are admitting that you have a psychiatric problem – not something many people are comfortable with. And most doctors just force meds down your throat.
    There are very good reasons why many people are ‘non-compliant’.

    Discuss. Empower. Support. Repeat.
    If only this was done more often in psychiatry.

    One thing I’m interested in, is the change in your identity after diagnosis with a major illness, particularly psychiatric illnesses. I know it took me a long time to be okay with accepting that I was now a person with a major illness. I got help and support for the direct symptoms of my illness, but no one ever addressed the changes in self concept and the grieving process of how my life was now changed. If perhaps your discuss, empower, support, repeat was done more often it would allow this change in self concept and acceptance of ones illness and thus enable the person to be able to accept and choose to take the medication?
    I know I’ve just reiterated your point, but it just resonated with me so much.

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