Hi, I have a question for those who are experienced with schizophrenia, bipolar disorder, and other serious psych issues.
I work in a primary care clinic and spend the majority of my day helping our patients with Type 2 diabetes. So, this mostly boils down to the people who have the highest blood sugars, the highest a1c levels, the most hospitalizations, the most difficulty coping with stress, the most social issues. My most time-consuming patients (and the most emotionally draining for me) are the patients with the psych conditions I've mentioned as comorbidities.
Depression is a big one too, but not such a baffling component- it just seems more straightforward.
What I have trouble with is reigning in the rambling talk, getting to the heart of what the issues are, identifying needs when a person is kind of talking in circles and not getting to the point, or changing the subject to a favorite tangential fixation.
Any pointers, ideas, tips?
Yes, I didn't mean at all that I associate psych with violence- I know that that is a very unfair stereotype. However, we do have a couple of patients that escalate and both also have substance abuse issues.
We have diabetes registries that we work off of, that alert us to the patients that are overdue for care, and part of my job is to get people care that are not actually seeking it! It seems absurd when I lay it out there like that.
"They are at the clinic for care. They know they need what you bring to them. They want what you are giving them." This applies to some, but not the majority. It may be that the patient is there looking for a letter for disability, or a sore throat, or something else, but doesn't want to address their estimated average blood sugar of 300...or noshows many appointments that we schedule when I am able to reach him or her. Or, the patient might have a period of coming in for appointments and then disappear again for a year or more with no contact information- homeless, transient, whatever. Sometimes I hear about an ED or psych crisis visit but there might be no clinic followup, and no phone number.
I guess I am rambling too. In a way this seems like an unfair assignment, unfair in the sense that I could help many more people with pre-diabetes in the time it takes me to work with 20 psychiatrically complex patients.
Last edit by SHGR on Feb 5, '12