Therapeutic lies and false promises…

gull

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.

5-man

2 thoughts on “Therapeutic lies and false promises…

  1. Ooh… this is a tricky one.

    Question is, if persons in your care are aware enough about going home, and ordering taxis, then shouldn’t they understand the fact, the reality, that they won’t be going home any time soon? If care staff tell one wee white lie, then won’t that lead to other, bigger lies?

    I don’t envy this aspect of your job for a minute…

    Nigel

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  2. I guess the ‘lying’ aspect of care is not something that is routinely used – as with most occasions in life, telling the truth, no matter how good or bad is the only way to engage, interact or communicate with other people.

    What I describe here is a slightly different situation, people to whom we offer these lies have by definition of their situation lost mental capacity – they have been assessed as not being able to understand, retain, recall or balance information that is relevant to their lives, hence, the request for ‘home’ is not something a capacitated person is asking. (In which case, we would have to oblige, otherwise we would be jailers not carers;)

    To most of us – i.e. those who retain mental capacity, were we to find ourselves in this situation, our response would not be similar to that of some of the patients I describe (who are in a significant minority of those we overall treat) – I suspect, if I were in that situation, after asking to go home, I might get angry, frustrated, upset and depressed (I personally, like to think I would hatch a Mission Impossible style escape) – this is probably what is happening internally to many of our patients; this smaller group I describe here, are not responding in that way (although they do get angry, frustrated and upset) – they adopt what is a maladaptive behaviour which doesn’t hasten their return home or make their stay in hospital any more bearable.

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