Digest Number 1874

[Theresa Partington]

Ellen wrote:
I tend to have anxiety of conscience and I am telling the patient all of the
worst that I can think of or expressing my own anxiety about the remedy not
progressing as I feel it should. Of course, because I am not a confident
beginner, I am sharing more of my personal emotional immaturity than a
professional assessment of the case. Luckily I talk to my teacher and he
generally tells me to slow down and stay the course. This high level of
honesty is good for some people. For those sensitive souls, they can
distinguish between me and objective assessment. Also, telling them
something about what I am thinking helps them to participate in their own
care, as Catherine so nicely described. For some, even professional
assessment adds to their own anxiety.

Don't have to answer here, but in your article which I hope you will share,
how to balance out between sharing your personal anxiety, professional
honesty and fellowship in the healing process and professional case
management will be addressed. When do you decide that you really are not
helping the patient and he should not waste precious time with you? Do you
prepare him gradually or do your level best, keep up your smiley face and
then drop the bomb? Obviously the gradual approach would be better, but how
is that done with grace?

Hi Ellen,
the article is more a survey of how *patients* view the process - and I am
open to modifying my approach and ideas depending on what comes up. The
whole thing is a gamble especially as I am committed to publishing the
results! It may well be throat slitting time!
If results of treatment are disappointing but I think I can sort something
out, or it is early days, then that is what I say. However, if I feel after
a while that I am scratching around for remedies and there is an obvious
alternative eg herbalism, counselling, osteopathy, I will suggest the
alternatives before the patient disappears back to the GP, but will give the
option of hanging in with me while I consult and try different tactics.
There is no question of 'dropping bombs' - that also implies that I am
somehow the 'boss' in the relationship. I wouldn't make a unilateral
decision to cease treatment and I really like it when a patient who is
deciding to move on feels they can discuss that with me without
embarrassment, although the decision is always ultimately theirs in a way in
which it is never going to be mine.
I thoroughly enjoy practice and the times I remember when I haven't were
times when I felt I had let myself get drawn into acting beyond my
competence, or was 'bull-shitting' - basically because of my own lack of
experience and confidence.
I would get into that kind of situation because other people told me it was
OK and it would be alright - and I knew in my heart of hearts that it
wasn't. I know it is easier now partly because I don't have to admit to lack
of experience. That really is a tricky one when everyone has to start
somewhere and there may be a (misguided, in my view) reluctance to be
treated by a self-confessed beginner. I am sure there are ways round this,
though. Group practices? I don't know.

BW

Theresa