Hello Blog group. I am doing my Rheumatology placement (my elective) at Shenton Park and I have come across a patient case that I have found a little tricky. The patient is actually physically not that difficult, she is an inpatient with osteoarthritis and mild rheumatoid arthritis and is medical reasons. She is independent with all mobility and ADLs and only needs general strengthening and some specific strengthening for her shoulder. The problem then is the things she says.
A consult from clin psych has already been requested because she expressed suicidal intentions. I have read the results of their assessment and they are concerned but don’t feel suicide is an immediate concern. During my assessment and treatment time with this patient she has repeatedly expressed desires to kill herself. She also says things like she would like to take a hammer and bang her joints back into place.
Obviously I am very worried about her behaviour and I always detail these incidents in the notes. I am sure clin psych will manage her psychological condition but in the meantime I am unsure how to react to these comments. It has been reported in the notes that she feels she is being attacked because the staff are not respecting her religious views on her rights to suicide. So presently I am just trying to ignore these comments, just saying “that’s not the way you should be thinking” etc and changing the subject because I don’t want to antagonise her.
But is this acceptable? If I don’t jump in strongly and say “no that is a terrible idea” will she think I am offering my support? Or is it just an attention seeking behaviour that is best ignored? Should clin psych be giving the other health professionals advice on how to handle this behaviour in the way that we give other staff advice on how to handle an individual’s mobility and transfers? Any suggestions would be greatly appreciated.
1 comment:
Yeah, it is a pretty hard situation: whatever we say is wrong in one way or the other... I think if I was in this situation, I would ask this patient to reclarify her stateman ie "so do you want to hammer your joint back?", in most of the time, they would just laugh it off if they are not serious(the statment is pretty funny). Sometimes patients who make a comment like that is just trying to get your sympathy. However, if they are serious, then I would ask her: "I think physio is better than that, dont you think so?" This question should be respectful to her because I am listening to her and I am offering her an alternative option. If she said "No", then I would say, "OK, I really want to make you feel better, but physio is the best thing that I can offer to you."
I hope this will help?
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