Maintaining the Therapeutic Relationship

A first principle of management is so fundamental that it merits attention only because these patients can render it so difficult: even as doubts grow, it is crucial to maintain the patient's confidence that you are his doctor and that you will continue to care for him. At times, these symptom-enhancing and symptom-creating patients make it very difficult to sustain compassion and doctorly commitment.They consume precious time and resources over "nothing" in an era of encroaching scarcity. We have undertaken to care for them, and they violate their one simple and essential obligation: to tell us the truth as they know it. In this sense, they refuse to be patients, and yet they (and everyone else) expect us to continue to be their doctors. Indeed, this is the essence ofabnormal illness behavior.

Psychiatric consultation should be undertaken as early as possible when such a behavioral component is suspected, especially in this era when outpatient visits may be rationed and hospital stays are brief. At this point, some of these patients may become increasingly vocal about what they will and will not do. Some may become hurt or indignant at the introduction of a psychiatrist or psychologist. Some will refuse psychiatric referral, insisting that the problem is in their bodies and not in their heads. Some may respond positively to euphemisms about their being "under stress," but others will see this approach as a ruse. Some will have declined this recommendation in the past, and others may have accepted it with disappointing results for a variety of reasons. In all cases, it is crucial to provide firm assurance that you will do what is necessary to care for them and consultation is an essential part of that care.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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