The trial ended yesterday. It involved stalking, breaking a restraining order, a childhood romance and the use of psychotropic drugs to control delusions. The defendant served as his own attorney, ostensibly so he could cross-examine the witness he had been illegally stalking!
Throughout the testimony, I couldn’t help but notice that most of the problems were caused by misinterpreting what others were saying and doing. Second guessing what others mean, or creating little stories to explain this or that, seems to be our nature. Naturally, there’s a sizable difference between misinterpreting the action of a patient who discontinues care without warning, and misinterpreting a restraining order requested by the 9-year old neighbor girl who now, thirty years later, has her own family and children!
Nevertheless, both scenarios are pathological. It’s merely a matter of degree.
When patients choose to ignore your recommendations or discontinue care, it’s not an attack, it’s not a vote of “no confidence” and it probably has very little to do with you. But there’s a strong pull to make it about you.
“What did I say wrong?”
“What should I have said?”
“What should I have done differently?”
“How can I avoid this in the future?”
If you find yourself frequently being sucked into this delusional state, realize that not only is this line of thinking unhelpful, it actually creates a form of tentativeness and approval-seeking that patients find off-putting. Equally distasteful is when you attempt to overrule their free will, using your social authority to impose your recommendations for continued care. Are you inclined to call the patient when told by your staff that a patient has announced that they’ve had enough?
This form of retaliation is a sign that you have either mistaken the amount of influence you actually have, or falsely believe the patient’s confession of “I want fix care” extracted at the beginning of the relationship was to be believed. Your call is rarely “market research” or motivated by an authentic desire to improve your procedures. Instead, it’s about you either needing closure or worse, a pathetic attempt to talk the patient out of their decision. These, and several related issues, are sure-fire ways to suppress referrals and virtually eliminate reactivations. This creates the new patient problem you have. Which prompts the calls. And so it goes.
Exhausting and unsustainable.
It’s not about you. Never has been. You can make it about you if you wish. Just remember that if you won’t discipline yourself, something or someone else will. That’s what I and the other 11 jurors did yesterday. Guilty on all seven counts.