CONFRONTATION

Welcome to the current issue of Advances in Medicine
(AIM). Today, I want to talk to you about the value of
CONFRONTATION, and how it pertains to coping with pain.

Feel free to send me an e-mail with your own thoughts
and experiences. Email: timsams@mypainreliefdoc.com.

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              CONFRONTATION

“I think you’re burned out and you don’t like sick
people,” Delilah said.

She was a very angry, blaming, complaining, hostile patient who
was being treated by me after chewing on the bones of one of my
psychologist colleagues. We were having one of our noncompliant
discussions, where I confront her on being noncompliant. Then
she explains why she was being noncompliant.

I said, “So you were being noncompliant, but you had a good
reason.”

She became very, very angry that I continue to call her
“noncompliant.”

I made it worse by pointing out that she wasn’t sick; she had
chronic pain. People are not used to being confronted about
their behavior in an objective manner. They are used to being
able to squirrel out of being confronted by the truth, because:

** Other people are too uninterested or chicken to confront
them

** Other people don’t want to break the “must be polite at
all costs rule”

** Civil discourse requires acceptance of little white
lies—to get along, and go along

** Other people don’t want to be confronted about their
stuff, either.

People get used to bald-face lying to others—white lies or
not—and getting away with it. Often, the normal rules of
discourse frown on confronting people about their lies or
deceptions. From Delilah’s perspective, as long as she had a
reason for being noncompliant, she wasn’t noncompliant. In
point of fact, 99% of the time, either you are compliant with a
contract or not. If not, you may have a perfectly good
reason—the first pill put me into a coma, doc, and being
unconscious and all, I couldn’t take the second pill. But
still, you were noncompliant.

How can you work with your doctors effectively if you lie to
them? How can you squeeze out the best treatment if you are
dishonest with your doctors? More importantly, how can you
manage pain effectively if you make it a habit to lie to
yourself? Being honest with yourself is the cornerstone of an
effective Personal Pain Paradigm.

I shouldn’t take the easy way out and collaborate in deception
and lies. I believe in honesty, courage, and integrity above all
things, and struggle mightily to practice them—especially in a
therapeutic setting. This means being willing to mirror or
reflect reality to my patients. It may mean reflecting how they
are perceived by others. It means saying things that would not
be considered nice in normal conversation, and accepting the
consequences when the conversation turns ugly.

When I am confronted by a patient, I do not play the therapist
game and automatically turn it back on the patient—“How does
it make you feel when I do that?”

With Delilah’s comment, I thought for at least thirty seconds
about whether or not I was burned out. I realized that I was
less tolerant—less tolerant of lies, of verbal abuse, of
collaborating in the game, and acting like it was okay. I was
much more inclined to, “call a spade a spade.” Fifteen years
ago, I could have had a discussion about these same issues in a
way that eased through the anger and defensiveness.

Unfortunately, I discovered that the message was often lost in
the subtlety and compassion. As my style of confronting has
changed over the years, I’m certain that some people could
perceive it as being burned out. I was honest and I explained to
Delilah that I was less tolerant and compassionate with open
hostility and dishonesty in my patients. I told her that it
might seem to her that I was burned out or didn’t like sick
people. I assured her that neither one was not the case. She did
not appear mollified. 

I have often commented humorously in lectures to pain
psychologists that if at least one in twenty of your patients
don’t dislike you, you aren’t trying hard enough. Pain is
too horrible, the treatment too passionate, and the stakes are
too high for the shrink to simply be a good listener. At 3:00
a.m., there is no one there to help you but you. You need to be
armed with more than simply the knowledge that your doctors are
nice people. You need to know what to do. I promise to do my
very best to help alleviate your pain and improve your function.
If that means you hear something you don’t want to; so be it.

Good light,

Dr. Tim
                   

Dr. Tim Sams
E-Mail: timsams@mypainreliefdoc.com     
My Pain Relief Doc
www.mypainreliefdoc.com
Copyright 2007. Dr. Tim Sams. All rights reserved.

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