A Needy Patient, Lots of Meds
Posted: Sun Jun 01, 2003 5:22 pm
Dear List:
I need some help re-establishing my perspective on a difficult patient with
a difficult case. She came to me
two years ago with a lengthy list of medical problems (you know you’re in
trouble when the patient checks
almost every box on your intake form!). The initial intake took 5 hours; I
just shut up and let her talk
because it was obvious she needed to do so.
PC: memory problems from head trauma from a fall at work (she was in the
process of seeking
disability). Other problems: knees needed surgery (joint replacement),
fluid retention (idiopathic edema),
psoriatic arthritis, fibromyalgia, recurrent UTIs, [spell out], sudden
urinary incontinence, etc. Lots of
hospitalizations & operations, including tonsillectomy, urethrotomy,
C-sections, arthroscopy, replacement
of both knee joints, and the removal of a pilonidal cyst, bony growths, and
a mole. Allergies to numerous
foods, medications (or contrary reactions to meds). If she eats spicy or
hot foods, she develops a rash on
her buttocks that burns and bleeds. She was given a single huge dose of
penicillin for a nasty gonorrhea,
and developed an allergy to penicillin as a result. Obese, affable,
somewhat distractable; would go off topic
suddenly (not in the faster-than-the-eye-can-see way of Lach., but more sort
of a drifting off, as if she could
not maintain the thread of a conversation).
She claims she was never heavy until age 40, when she was given inimical
diuretics that poisoned
her and screwed up her metabolism. Her problems with idiopathic edema,
however, started much earlier,
when her father abducted her and forced her to have an abortion. Hx of
assaults, sexual and physical,
starting at age 8 and continuing through her two marriages (she’s been
divorced for years). A distant mom,
strained relations with siblings.
Over the years, she’s had a number of remedies, such as Thuja,
Staphysagria, Sepia, Med., Coloc., and
Nat-m., all of which helped enormously with one problem or another, yet I
don’t feel I’m getting to the heart
of her case & for numerous reasons I’m starting to feel resentful and
“used.” She has attempted to turn me
from her homeopath into her friend, a transformation I have deliberately
resisted. There is much about her
that is likable, but I feel wary around her and see myself withdrawing
increasingly from contact with her. A
lot of the work I’ve done has been for free because she’s strapped, but I
don’t think that’s at the root of my
reaction: I’d probably still feel used even if she were paying top dollar.
Karen Cohen, in a presentation to the IFH, wrote that “The more patients
believe that their
physical sxs and diagnosis ... are the major problems or root cause, the
more they are likely to be estranged
from the true cause or true disturbance within the organism.” I keep
reminding myself of that with this Px,
who is very needy and who focuses minutely and obsessively on her physical
problems. At first she wanted
to get off her many meds, but now she’s balking; I think they and her many
physical problems are tools she
uses to keep people around & catering to her needs.
I feel that she’s on far too many meds (probably over a dozen at this
point) and that it’s impossible
to treat her properly until she starts shedding some. She counters that she
doesn’t want to give up her
methotrexate (immuno-suppressant) for a natural alternative like CMO because
1) it will be painful to go
off the methotrexate; 2) the CMO is too expensive, and she can get
methotrexate thru her insurance for only
$2. Sounds to me like a patient who talks the holistic talk but doesn’t
really want to walk the walk. I’m no
longer comfortable applying homeopathic bandaids here, especially since no
matter how much I try to educate, she continues to see each problem as a
discrete entity that needs attention NOW!
She wants attention (but naturally doesn’t see that in herself), and she
can be demanding. E.g., she
got upset recently because I saw another patient before her upon returning
from a trip; she also got upset
when I was delayed in dropping off a remedy at her house & accused me of
delivering an “unspoken
message.” (I was delayed because a visit to another patient took longer
than expected; I was not playing
passive-aggressive games.)
So my question is, how would others treat this patient? Give her Palladium
and be done with it
[MIND, delusion she is neglected], or try to see a complex case through to
the end?
Let me add that the last remedy she received, Nat-m., she felt made an
immediate difference.
Yeah, she probably should be on repeated doses of a remedy because there’s
so much continued
suppression going on. But it seems to me poor, even unethical, homeopathy
to keep repeating a remedy that
has some good effect but doesn’t feel like the simillimum. It doesn't even
feel like palliation; it feels like placation. But what do you do if the
constitutional picture is obscured by all those meds?
With a sigh,
Cinnabar
I need some help re-establishing my perspective on a difficult patient with
a difficult case. She came to me
two years ago with a lengthy list of medical problems (you know you’re in
trouble when the patient checks
almost every box on your intake form!). The initial intake took 5 hours; I
just shut up and let her talk
because it was obvious she needed to do so.
PC: memory problems from head trauma from a fall at work (she was in the
process of seeking
disability). Other problems: knees needed surgery (joint replacement),
fluid retention (idiopathic edema),
psoriatic arthritis, fibromyalgia, recurrent UTIs, [spell out], sudden
urinary incontinence, etc. Lots of
hospitalizations & operations, including tonsillectomy, urethrotomy,
C-sections, arthroscopy, replacement
of both knee joints, and the removal of a pilonidal cyst, bony growths, and
a mole. Allergies to numerous
foods, medications (or contrary reactions to meds). If she eats spicy or
hot foods, she develops a rash on
her buttocks that burns and bleeds. She was given a single huge dose of
penicillin for a nasty gonorrhea,
and developed an allergy to penicillin as a result. Obese, affable,
somewhat distractable; would go off topic
suddenly (not in the faster-than-the-eye-can-see way of Lach., but more sort
of a drifting off, as if she could
not maintain the thread of a conversation).
She claims she was never heavy until age 40, when she was given inimical
diuretics that poisoned
her and screwed up her metabolism. Her problems with idiopathic edema,
however, started much earlier,
when her father abducted her and forced her to have an abortion. Hx of
assaults, sexual and physical,
starting at age 8 and continuing through her two marriages (she’s been
divorced for years). A distant mom,
strained relations with siblings.
Over the years, she’s had a number of remedies, such as Thuja,
Staphysagria, Sepia, Med., Coloc., and
Nat-m., all of which helped enormously with one problem or another, yet I
don’t feel I’m getting to the heart
of her case & for numerous reasons I’m starting to feel resentful and
“used.” She has attempted to turn me
from her homeopath into her friend, a transformation I have deliberately
resisted. There is much about her
that is likable, but I feel wary around her and see myself withdrawing
increasingly from contact with her. A
lot of the work I’ve done has been for free because she’s strapped, but I
don’t think that’s at the root of my
reaction: I’d probably still feel used even if she were paying top dollar.
Karen Cohen, in a presentation to the IFH, wrote that “The more patients
believe that their
physical sxs and diagnosis ... are the major problems or root cause, the
more they are likely to be estranged
from the true cause or true disturbance within the organism.” I keep
reminding myself of that with this Px,
who is very needy and who focuses minutely and obsessively on her physical
problems. At first she wanted
to get off her many meds, but now she’s balking; I think they and her many
physical problems are tools she
uses to keep people around & catering to her needs.
I feel that she’s on far too many meds (probably over a dozen at this
point) and that it’s impossible
to treat her properly until she starts shedding some. She counters that she
doesn’t want to give up her
methotrexate (immuno-suppressant) for a natural alternative like CMO because
1) it will be painful to go
off the methotrexate; 2) the CMO is too expensive, and she can get
methotrexate thru her insurance for only
$2. Sounds to me like a patient who talks the holistic talk but doesn’t
really want to walk the walk. I’m no
longer comfortable applying homeopathic bandaids here, especially since no
matter how much I try to educate, she continues to see each problem as a
discrete entity that needs attention NOW!
She wants attention (but naturally doesn’t see that in herself), and she
can be demanding. E.g., she
got upset recently because I saw another patient before her upon returning
from a trip; she also got upset
when I was delayed in dropping off a remedy at her house & accused me of
delivering an “unspoken
message.” (I was delayed because a visit to another patient took longer
than expected; I was not playing
passive-aggressive games.)
So my question is, how would others treat this patient? Give her Palladium
and be done with it
[MIND, delusion she is neglected], or try to see a complex case through to
the end?
Let me add that the last remedy she received, Nat-m., she felt made an
immediate difference.
Yeah, she probably should be on repeated doses of a remedy because there’s
so much continued
suppression going on. But it seems to me poor, even unethical, homeopathy
to keep repeating a remedy that
has some good effect but doesn’t feel like the simillimum. It doesn't even
feel like palliation; it feels like placation. But what do you do if the
constitutional picture is obscured by all those meds?
With a sigh,
Cinnabar
)