Therapeutic lies and false promises…

I have spent the past few days feeling bad –

It is strange, when you discover that something you have been doing, that you had considered ‘right’ is explained to be wrong; it is a little like breaking the law when you don’t know something is illegal … I can’t think of an instance (or, I don’t want to confess), but I am sure everyone knows what I mean. As with the courts, not knowing the law is not an excuse for breaking it and so, as with me, I carry the can.

It is quite easy when I am walking about, doing my job and patients are behaving like patients – they are assuming the role of people who wait to be asked questions, who submissively do what is asked of them and don’t complain.

When this is flipped and patients throw off the shackles of ‘suffering’ either because they know their rights or, because, they don’t know that there are rules, for, why would there be rules when you are not sure where you are, when those around you don’t know what is going-on and even those who seem to be in charge are doing their best to not treat you like patients – they are participating in the undoing of the sick-role, making those in our care feel like people not patients.

And here is the challenge; when a patient, or a person, who is on my ward calls me over and asks when they are going home, I have lots of options open to me, from the honest, ‘I don’t know and even though I am your doctor, it is others such as social workers, the availability of carers and people in back offices who will determine when you will get home.’ – to what I often say, ‘We will get you home very soon.’

This works for most people, but those people who don’t think there is anything wrong and see no reason why they can’t be at home, will then say, ‘I want to go home now. Call me a taxi’ – how do you respond in this situation?

Very often, explaining that they will need help which isn’t available or, we are still treating them for condition x, y or z, doesn’t work. ‘I want to go home now, please get me a taxi’ – and sometimes we end-up in circular arguments – ‘I don’t care if I need help, I feel fine, get me a taxi’

It is now that I usually invoke the martial art of dementia – when distraction, ‘would you like a cup of tea?’ and, diversion, ‘Where is it that you live?’ fail, I often, and usually because I have other things to do will say, ‘I will ask sister where your taxi is, I am sure it is coming shortly.’ This is usually met with acceptance and I am allowed to flee.

This, I understand is a therapeutic lie. (This is sort of OK)

False promises, which I make – yes, I admit it, are when a patient who, as a consequence of their dementia or delirium asks repeatedly, ‘When can I go home?’ – this can happen every few minutes for hours at a time, despite all the techniques and strategies we can think to employ and the patient who has caught my eye and called me over, who has me trapped, and I respond, ‘I’ll go and see, I’ll be back in a second’, or ‘I’ll get you a cup to tea,’ – never to return.

And this is a false promise. (And that, is not OK)

And, I am guilty.

Sometimes it is so very hard managing the competing demands of investigating, diagnosing and treating, different people with different needs, meeting the expectations of relatives and carers and staff, fitting-in too many things in not enough time, that I lapse into these false promises.

So, I ask forgiveness and promise to stop.