Adult Psychiatry

It has been agreed upon in the medical community that substance use disorder is a legitimate medical illness, not just a battle of wills. However, the consequences of behaviors that result from substance use can affect us personally and professionally. It’s easy to say that we would treat everyone with unconditional positive regard and always instill hope, but ‘real life’ practice can often make that easier said than done. It is an ongoing challenge to set our own boundaries and monitor our own counter-transference. Below are examples of three patient situations you could encounter in the clinical setting. Please respond to these questions for each example: How would you feel taking care of this patient? How would you prevent your own counter-transference? Please do NOT refer to literature — these questions are your feelings and how you might approach these patients. These patients may touch a nerve with you personally, and I apologize for that in advance. However, know that in the real-life clinical setting, we will encounter patients who strike our Achilles tendon and we have to figure out how to handle those situations. That is the primary purpose of this Discussion Board. 1. You and your spouse are struggling with infertility and have taken out a second mortgage on your home to finance expensive fertility treatments. You encounter a female patient in your office under court-mandated care. She is 4 months pregnant with her sixth child, admits to active drug use even though she is pregnant, and has lost custody of her previous five children due to drug use. 2. Your father was killed by a drunk driver when you were 9 years old. Although it is years later, you continue to struggle with grief. You are asked to prescribe a detox protocol for a patient in the jail where you work. The patient was been arrested for DUI after hitting and killing a pedestrian. His BAL was 0.41 at the time of his arrest and he had previously had his license suspended. 3. You are a PMHNP on a consultation/liaison service in a large teaching hospital. You were called to consult on patient on the medical floor for a patient that was admitted for cellulitis after injecting heroin. He has hepatitis C and is HIV positive. The nurses on the unit tell you that he is a “lost cause.” When you see the patient, he patient tells you to “F*** off!” and that he is not interested in quitting drugs. At discharge, you provide him with information about a clean needle exchange in the community, where users can earn gifts cards in exchange for turning in used syringes. The nurses on the floor express frustration with you because they feel that you are perpetuating his drug use, and that this intervention will only incentivize him to keep using drugs.

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