Let’s not enable our patients

This is my last post of 2011. Wow.  What a year it has been, both personally and professionally.  I gave birth to a beautiful little boy, our second (and most likely, last) child and my practice transitioned to EMR.  Just as the year winds down I feel I am finally getting back into the groove of family medicine I was in before I left on maternity leave.

Here are some final thoughts for 2011.

Family medicine chose me.  How exactly is the subject of another post.  I love being a family doctor because it truly is the only field of medicine where you can have an impact on every stage of a person’s life.  From infancy, through to old age, everyone needs a family doctor.   Family doctors are specialists in all aspects of medicine – as I like to put it, we know a little bit about everything.  One of the prime mandates of family medicine is preventive care.  Family doctors manage illness, of course, but we are also educators.  Most of my day is spent educating patients on how to keep healthy and how to prevent disease.  Family doctors do a lot, but it wasn’t until residency when I learned that we can also do something else – we can enable our patients; and I don’t mean this in a good way.

enableverb (used with object), -bled, -ing; to make possible or easy

If there is one type of patient/person I really have a hard time with, it’s the type that can’t take responsibility for their own actions and blame everything bad in their life on someone or something else.   A person who blames their crappy life on their boss, their abusive parent or spouse, their fucked up childhood.  If we’re not careful, we can unknowingly enable these behaviours.

Take, as an example, a 40-something working mother of two who comes in to renew her SSRI that was prescribed by a psychiatrist 2 years ago.  She’s relatively new to my practice, so I’m still getting to know her.  She’s booked a 15 minute visit.  She tells me her SSRI has “stopped working”.  She can’t sleep, has no motivation, lacks concentration, can’t engage with her kids, etc.  You get the picture.  She’s depressed, but not suicidal.  Rather than increase her dose and send her on her way, I’m curious as to why she’s depressed.  After all, her SSRI was working, right?  What’s changed?  I spend the next half hour (remember, her appointment was for 15 minutes!) finding out that her marriage is in trouble, her son is undergoing tests for Autism and she’s up for partner at her law firm .   Would an increase in her SSRI have helped her?  Maybe, but probably not.  After some more probing, it’s pretty obvious that she wants an easy fix.  She doesn’t want to do marriage counseling (“It’s just too much work”); she doesn’t want to acknowledge that her son’s emotional withdrawal began shortly after she started fighting with her husband.  She wants me to make it easy for her, to increase her medicaton and send her on her way.   I counsel her that she’s on the road to burn out; that she needs to focus on her son’s health and her marriage; that she needs to re-evaluate her priorities if she wants to get better.  I give her a list of marriage counselors and therapists.  I renew her medication and ask her to come back in a few weeks.

I didn’t enable her behaviour.  I gave her something to think about.

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