WORKFLOW FOR IBH
-Update is my last day is 10/23 as BHCM.. job is posted with a few candidates in mind
In the meantime there's no reason these steps can't be used and I would recommend thinking about these steps after your residency.
-Acknowledge their feelings without opening up their metaphysical scar tissue..
...if they don't want a therapist why are they essentially starting the catharsis/venting cycle with their PCP?? Seems odd from a therapist point of view.
- Ask what coping skills they've used in the past that have helped them.
-Ask what obstacles patients have to get to therapy (i.e. Transportation, Co-Pay, Stigma, Motivation to call... maybe they don't believe in therapy..).. maybe they don't want therapy
-Use ".LCR" dotphrase under patient instructions so Lancaster County Resources can print with AVS.
-Make a plan. Ask them what day they can call..without a firm day/time typed in their google calendar on their phone ... they may not remember or feel it's necessary
- Psychiatry Referrals don't go anyway by the way.
-Think about checking out the Integrated Behavioral Health page on the residency portal &or the Departments section of the intranet for additional resources/psychoeducation.
Resources to Spark Creativity
The Paradox of Choice
1) Could this be related to giving patients too many choices in their aftercare plan?...
2) Maybe that's why our brain always has an "easy button"
The Secret Powers of Time [Time Perspectives Psychology]
I use this with patients with addiction/impulse control issues to help them understand that they can't take anything away without replacing it.. for cigarettes it's harder to quit cold turkey if you don't replace it with a different but equally as satisfying behavior (i.e. present focus----exercise, chocolate, human connection of some sort...)
The power of vulnerability- Brene Brown
1) Would being vulnerable within your field help or hurt you?
2) Would finding ways to allow patients to be vulnerable without feeling that they would have judgemental consequences help or hurt?
BOOK: The Farther Reaches of the Human Nature - Maslow https://drive.google.com/file/d/0B1YShFulVkjERTk1SzQwdU1BYWM/view?usp=sharing
PODCAST LINK for Motivational Interviewing: https://www.psychedpodcast.org/blog/2017/3/4/psyched-episode-2-treatment-of-depression-with-dr-sidney-kennedy-7gxwm-xgjyc-ta48k-rltkf-enjef-jx432-w6mba-x5dfe-kdjrm-cmdzj-h2ztc-lz5f9-974xj-pxlpw-whjjs-pdtzg-fhzt6-28spn-4hxxy-feb5x
PODCAST LINK FOR MEDITATION - https://www.stitcher.com/podcast/deep-energy-music-for-meditation-relaxation-massage-and-yoga/deep-energy-20-music-for-sleep-meditation-relaxation-massage/e/77231870?autoplay=true
-Amazon Prime Student (free 6 month trial) works with UPMC.EDU email!
New Narrative (& how can we spin it into something else using a different perspective?”)
- Awkward/“Larry David -esk” moment during Microsoft teams
- Was yelled at by a Pain Patient and I started to react...
- Moment of Zen from the crowd
PSYCHO-EDUCATION/PERSPECTIVE - Balint Model
At the center of medicine there is always a human relationship between a patient and a doctor - Michael Balint
[Balint Model] is a general approach which may throw light on the doctor-patient interaction and add depth to our understanding of it. (https://slideplayer.com/slide/2548820/) How are the Residents doing?
VIDEO/ Facilitated group discussion of a difficult patient interaction (not quite a Balint Group)
Group Model Example:
Have a Provider present a case then let that Provider step outside of the case & let the group “work the case” by asking :1) If I were this provider, I might do 2) If I was this patient I would wonder. 3) If I were this parent/nurse, I would wonder.
What am I wanting, feeling, fearing, worried about with this case.
Dissociation of provider in the case.
Let us think about the interactions of the case from an outside perspective, NOT let’s talk about the exact Plans for the case/Treatment Team.
Techniques:
- Use narrative activities related to pain/cystic fibrosis/liver disease
- ABC’s of CBT
Results:
-Witnessing others, processing the case can provide interpersonal insight of the provider/patient dynamic.
-Creating a space for Professional Development & creating a community/communication pathways in treating the patient
IBH Care Teams, Vignettes, Balints &or Chart Reviews
Eating Disorder Patient - 19 year old, Hispanic Male
Sublocade Patient - 21 year old Caucasian Female with OUD & Mood Disorder NOS
Anger Management Patient - 35 year old Caucasian Female with PTSD/Mood Disorder NOS
Alcohol Abuse - 46 year old Caucasian Male with GAD; F10.11Abuse in remission
Pain Management Patient - 58 year old Caucasian Female with multiple medical issues.. likes to call staff and yell at them!
BALINT TOOLS/RESOURCES
SLIDES/ An Introduction to Balint Work/ https://slideplayer.com/slide/12878882/ WEBSITE/ https://www.americanbalintsociety.org/ VIDEO: Tutorial: Converting Balint Groups to Online / https://www.youtube.com/watch?v=7U_jY2o4ySE&feature=youtu.be SLIDES/ Balint Groups- https://prezi.com/leffkyryrcij/balint-groups/ SLIDES/ Balint Groups as a Care Team- https://slideplayer.com/slide/13453618/ SCHOLARLY JOURNAL/Balint groups A tool for personal and professional resilience - Michael Roberts, MD FCFP- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303639/ SCHOLARLY JOURNAL/ The Doctor, his Patient and the Illness (Quick Summary)- James Curran, GP locum, Glasgow/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048858/ WEBSITE/ A very short introduction to balint groups/ https://balint.co.uk/about/introduction/ WEBSITE/ The Schwartz Center (processing patient interactions & how they influence providers) https://www.theschwartzcenter.org/programs/schwartz-rounds
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