CBI Health Group Staff Education Sessions Psychosocial Issues

2 Purpose Explore the process of how patients become mired in negativity and the different forms that it takes Identify strategies that all healthcare professionals (clinicians and administrative staff) can adopt so that we can achieve the best possible results with our treatment

3 The “Us versus Them” Mentality “There’s no way I could ever act that way”  We have a tendency to see patients as being distinctly different from ourselves  We see trends in client attitudes and behaviours as evidence of inherent character flaws  We see clients who act a certain way, and we slot them into a certain category  We find it difficult to imagine ourselves on the other side of the table being as uncooperative

4 The “Us versus Them” Mentality Role of environmental factors  Often situational factors play a role in the patient being the way he/she is when showing up for treatment  Injuries serve as stressors that can impact every area of an individual’s life: – Marriage-Family Life-Friendships – Work-Hobbies  Genetic vulnerability that can emerge when triggered by environmental factors  This does not serve as a justification for poor attitudes and behaviours displayed by patients, but to stress an understanding of why this is taking place

5 Patient Factors Angry/Defensive Patients  You can spot these patients from physical cues  They often want to argue about issues that may not be directly relevant to treatment  Don’t get drawn into unhelpful argumentation of this sort, it won’t be constructive

6 Patient Factors Angry/Defensive Patients  Be on the alert for signs that you find yourself emotionally wading into the conflict  Use reflective statements (“I understand why you might feel that way”) and then move on to what it may take to resolve the situation: For example, a new WCB patient may appear angry and voice her frustration that it has taken so long for her case manager to set up the assessment For example, a patient may talk about how his therapist at the last clinic constantly brushed aside his concerns during treatment

7 Patient Factors Manipulative Patients  Manipulative patients play on the guilt that health care professionals may feel  They may threaten rage, legal action, or suicide, if they don’t get what they want: For example, a WCB client may threaten that he is willing to talk to his Member of Parliament to express his outrage at being expected to return to work at discharge from treatment For example, a private client may try to withhold paying for treatment until the end of the month, explaining how she won’t be able to pay for groceries if she has to pay for treatment up front every time.

8 Patient Factors Manipulative Patients  Be aware of your own emotions and vulnerability to accommodate their demands  Attempt to understand their expectations Be prepared to say “no” if it is beyond your control or if the request is unreasonable

9 Patient Factors Somatizing Patients  Injury and its symptoms takes over the way the individual talks about his/her life  Regardless of conversation topic, somatic patients will connect it with their injury: For example, you may ask them about their week-end, and they will talk about how they used to enjoy playing hockey on Friday evenings, but now all they can do is sit around and watch TV

10 Patient Factors Somatizing Patients  Often a history of requesting multiple diagnostic testing, with certainty that something is wrong, despite objective proof otherwise  Treat these patients with compassion, don’t suggest that it’s all just in their head  Avoid falling into the trap of recommending whatever tests they are certain will “find the problem” and instead emphasize how regular scheduled treatments visits will help  Know your facts and use CBI research findings to back up your treatment recommendations