In Which I Noodle About My Job

Every now and then, I rant about my job.  Ranting is kind of my default form of discourse.  Usually, my friends push back against some of the details, often pointing out that they do these exact same things, and why they do them.  I want to thank everyone who's done that, as it has made me better at my job. Often, there was a new perspective which helped me understand what my patients were trying to say.  The rest of the time, it was just useful to put things back in proportion.   I/ve learned a lot about how to phrase questions and elicit useful answers and not sound aggressive or judgmental.  In particular, I've really improved the way I ask questions about people's normal habits for bedtime and rise time, and have been able to  both get better information and set my patients at ease at the same time.

I have now started screening all my female patients for PTSD, anxiety, or depression.  If any of those conditions appear in the chart, wherever possible, I take that patient.  I have just had one too many female patients express relief that their tech was also female, and mention a history of sexual violence.  I always tell them that they can, in the future, request a female tech.  I try to assure them that they will not be asked to disclose why they prefer a female tech.  From  these conversations, it's very clear that a lot of women do not disclose and do not want to disclose past sexual trauma.  

There's another thing I've noticed which suggests unpleasant back stories.  Occasionally, I get patients who live in supervised environments.  The ones who have spent most of their lives in group homes typically have either serious physical or mental challenges which prevent them from independent living.  They tend to be extremely friendly, highly cooperative, and painfully eager to please.  They are a dream to work with.  They do what I ask them to do, they don't complain, they never yell, they are cheerful and friendly.  And I have begun to realize how this is a survival strategy.  I can see the edges of how they do this because they are dependent upon the grace and kindness of staff, and if they make the people who care for them uncomfortable or unhappy, their quality of life, or possibly even their life, is at risk.  And it troubles me, to think of these people who must live in a way that they are never angry, never make anyone else angry.  People with serious challenges and limitations who must put a significant portion of their available energy and skill into making people around them happy.  The people who have lived most of their lives in a supervised environment contrast with the ones for whom this is a recent occurrence, like rehab from a stroke or drug use.  Those patients, too, often have significant cognitive and physical limitations, but are not nearly as focused on people-pleasing, presumably because it was not a major survival strategy.

 I think I have also noted, in the past, the way doctors and others tend to assume that social competency translates to physical competency.  I had a very nice gentleman who literally could not stand up without aid, who could only walk a very few steps, but was incredibly good at social interactions.  His chart noted that he was fully independent and mobile.  He was not.  But because he was very good at talking and being friendly and socially ept.  he was also very capable of convincing people that he was just fine.  People with dementia whose social skills remain intact are frequently also assumed to be much more independent and competent than they actually are.  My disabled friends tell me the reverse is also true.  People in wheelchairs, using a cane, or otherwise visibly physically limited are assumed to not be fully socially competent, are cut out of conversations and decision-making and social gatherings.  And it isn't just an accessibility issue, it's actually that they are treated as less socially aware, less capable of interacting with other people.

TL;DR : people are weird, people have bodies, bodies are weird.