Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Trauma in America

“There is a difference between angry people who become injured and injured people who become angry.

The simple truth is that we do not know a great deal about a patient until that person is injured and enters care. Even then, we only know the injury. We cannot make the assumption that each case is pure and individuals have no baggage. And we can manage the baggage that each case my carry.

A patient may be angry, inappreciative or even unruly due to pain, lack of progress and/or a sense of helplessness. However, there is also a strong possibility that the patient was an angry, rebellious and negativistic person who has now sustained a work injury. We do not know which is occurring based simply upon a description of how the injury occurred and/or the nature of the physical damages.

The patient whose home life and personality were stable, prior to injury, may act out due to fear and pain, but he/she can still listen to reason and logic, and will calm with reassurance.

But there are patients who remain angry despite the best of care provided, and arguably the person who most often catches the fallout is the nurse case manager. I hear from these frustrated nurses because no matter how hard they work to coordinate health care, arrange transportation, and act as an intermediary between the patient and his physician, employer and insurer, the worker often remains unappreciative. The nurse feels personally betrayed by the lack of loyalty shown by this individual who is belligerent, argumentative, or just accusatory.

The tools needed to help this patient are most often found in the knowledge of who this patient was prior to injury. It is deceptively easy to hide fear of the future in a false sense of bravado, blaming others for the plight which must now be confronted. Blamefulness can become a tool to protect the individual from self-accountability. A careful examination of the history, past decisions and relationships, will reveal how this has unfolded in this patient’s life and how consistent these behaviors have been in the past.

What healthcare providers must remember is that there is a limit to how much help can be offered to anyone. An injury cannot be undone, and neither can all the contributing factors that predate the injury. In the attempt to help a patient, it is a mistake to allow a patient to make your own life miserable.

Life for this patient did not begin at the moment of injury, nor will it end when the injury resolves. Do the best you can for every patient while keeping your own life intact, and when even the “best” patient lets you down, know that the problem lies within their history, which should never be confused with your own.”

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