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.