How to communicate with patients

un chemin qui descend vers la mer entre les arbustes en Corse
Each patient has a path.

Already as a doctor, I believe that you shouldn’t put too much pressure on yourself. Even for a person with schizophrenia, it is difficult to understand another delirious schizophrenic person.

I think you have to be polite like you have to be with everyone.

I also caution against insisting on understanding what the patient is thinking at all costs. It can be very badly lived and even more if it is by the family. That’s why, as a caregiver, you have to ask questions, but not insist too much. Indeed, as I explain at the bottom of this page: it is disturbing to share your fantasies. Sharing your ideas can be difficult in schizophrenia when you are feeling bad.

It is also difficult, sometimes impossible, to persuade a patient to seek treatment if he does not want to. Don’t blame yourself for failing to persuade your patients. You shouldn’t harass your patients too much in general either. If they are very very badly and risk being dangerous for themselves or for others, then we can insist. I think the ethic is to let people do their thing and just have a conversation as equals. Rest assured as a caregiver, without being completely sure of my knowledge, it seems to me that a patient must really be going very badly for him to be dangerous for himself or others. A schizophrenic patient who is just angry enough is unlikely to do any harm. You don’t lock up someone with no pathology that’s pissed off enough. You shouldn’t lock up a schizophrenic patient just because he’s too upset. It doesn’t make sense.

A few tips for communicating with the patient:

Some patients would not be aware that these ideas are parasitic

Apparently some patients with schizophrenia are not aware that their slightly crazy ideas are parasitic ideas. I don’t want to stigmatize these people either, I don’t know this subject of schizophrenia. This is called anosognosia. As a result, they would not understand how to treat themselves. This is what is explained in this document which also gives advice: “Anosognosia in schizophrenia”.
I really believe that I am aware of my problems and I know that they need to be treated. This domain of anosognosia is unknown to me. I don’t want to talk nonsense about these people.

Understanding what the patient is feeling

Try to understand how he feels. I think he won’t mind you asking what he thinks and feels. Except perhaps if he is in a period without treatment or a period where he is really bad and he can be too touchy. And so he would feel this question as if he were taken for a madman. I’ve felt that before when I was too touchy.

Explaining to a newly ill person that it can be cured

Another element when faced with a patient without treatment and never treated: I think it is necessary to tell him that the problems he feels are known. What he saw happens in some people. There is a treatment even if each patient has different thoughts, a different experience. So giving him treatment will really solve his worries. It helps other people and it will allow him to see things more clearly.

Explore some symptoms if it doesn’t bother

Especially for psychiatrists or psychiatric caregivers, I think you should ask the patient for certain symptoms. I think most patients won’t talk about themselves being shy or tying themselves up in fear of being part of the wrong group. I experienced this symptom of wanting at all costs to hide what I felt that I was ashamed of. What I imagined to be shameful. Afterwards, it is not useful to highlight this, if there is no treatment 🙁 . I had it passed following bactrim, but it is not a recognized treatment.

Ask what does not satisfy the patient in his life

I think that as a doctor, you have to ask the patient if there are things that do not satisfy him in his life, precisely in order to be able to improve. For example, it was only recently that my psychiatrist understood that I sometimes felt too paranoid, that it bothered me to be too fat because of the treatment, that I had trouble working and carrying out my projects. Yet I have seen it for a long time. Although I really like my psychiatrist and find him very good, he kinda missed it. Finally the doctor and especially the psychiatrist is there so that the patient is satisfied in his life, suddenly it is important to ask him.

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