A friend suggested that I should share on this blog more actual conversations with patients, and observations about what I (or another doctor, or a patient) did well or poorly - and how to do better. I did some of that in my book, albeit it is hard to do much of this without modifying the identifying characteristics of the patient and the subject of the discussion.
I will talk today about a fictionalized incident which has been repeated, in various forms, a number of times in my practice. Sarah, a 68 year old woman with chronic back pain, tells me about the terrible shooting pains she has down both legs, and the problems she has had walking over the past few months. We work up the possible causes, doing a number of blood and nerve tests, and come to the tentative conclusion that the nerve roots in her back are causing this nerve problem in her legs.
However, once we have this discussion, it rapidly becomes clear that this explanation is not uppermost in her mind, or not the most relevant. She reports that she had an operation to her lower back about five or seven years ago, and the doctor told her that there had been some error during the operation. It turns out that the error was not significant and not related to her current nerve or gait symptoms. However, at the point of these visits where we discuss the causes and potential therapies of her nerve problems, she can discuss nothing but that operation and the error.
This is of course to be expected, and I cannot ask her - nor should I - to leave this be. On the other hand, it keeps us from approaching the potential causes of her nerve pain. How do I get us past this conversation? I have done the commonsensical thing, and said, more or less, "I know this error was committed, and you have every right to feel taken advantage of, and yet...." but the message has not gotten through. I don't feel like being more confrontational would do the trick.
Before going more into (confidentiality-respecting) detail about our relationship, and the solution I eventually embarked upon, I would like to get your thoughts. How is this impasse to be breached?
I will talk today about a fictionalized incident which has been repeated, in various forms, a number of times in my practice. Sarah, a 68 year old woman with chronic back pain, tells me about the terrible shooting pains she has down both legs, and the problems she has had walking over the past few months. We work up the possible causes, doing a number of blood and nerve tests, and come to the tentative conclusion that the nerve roots in her back are causing this nerve problem in her legs.
However, once we have this discussion, it rapidly becomes clear that this explanation is not uppermost in her mind, or not the most relevant. She reports that she had an operation to her lower back about five or seven years ago, and the doctor told her that there had been some error during the operation. It turns out that the error was not significant and not related to her current nerve or gait symptoms. However, at the point of these visits where we discuss the causes and potential therapies of her nerve problems, she can discuss nothing but that operation and the error.
This is of course to be expected, and I cannot ask her - nor should I - to leave this be. On the other hand, it keeps us from approaching the potential causes of her nerve pain. How do I get us past this conversation? I have done the commonsensical thing, and said, more or less, "I know this error was committed, and you have every right to feel taken advantage of, and yet...." but the message has not gotten through. I don't feel like being more confrontational would do the trick.
Before going more into (confidentiality-respecting) detail about our relationship, and the solution I eventually embarked upon, I would like to get your thoughts. How is this impasse to be breached?
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