Adjustment to Illness
Patients cope with a serious illness in different ways. Severe depression, anxiety, and denial are only the more common ones in a vast array of emotional reactions. However expectable and appropriate a psychological response to illness might be, it is often demoralizing for the patient, and can worsen the underlying condition even further. It also makes the physician’s task harder to accomplish. Dr. Bonner works with patients to assess the need for psychological/psychopharmacological interventions, and continues to follow them as indicated. She also consults with physicians regarding ways to communicate with patients at particularly difficult times.
In a busy practice one rarely has time for an in-depth evaluation of psychological overlays of somatic conditions. When the patient’s symptoms don’t quite fit the findings, or when the mood fluctuations exceed what one ordinarily observes, or when it is hard to distinguish wishful thinking from mild delusions, it can be useful to have a diagnostic opinion from a colleague who is familiar with both somatic and psychological sides of the spectrum.
Physicians often receive patients who are already taking psychoactive medications, often in combination with several other agents. Sometimes, relatively simple cases of moderate depression prove resistant to the first few medication trials. Whether it’s a one-time pharmacological consult or an on-going involvement, Dr. Bonner welcomes opportunities to collaborate with colleagues in the community to optimize treatment approaches.
It can be demoralizing to “find yourself trying to give help with no way whatever of giving it.” (W. Bion) When a patient agrees with the doctor’s recommendations and then proceeds to not follow them with a striking consistency, when another patient dismisses recommendations and demands treatment that is contradicated, when a third patient shows up for appointments just late enough to make evaluation barely possible, it does not make sense to lecture or preach the same themes. Though it is sometimes useful to have patients undergo a psychiatric evaluation, it is often more practical to have doctors adopt a different approach. Dr. Bonner consults with solo physicians and practice groups regarding challenging practice situations.