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Hi, Can anyone offer any advice on dealing with challenging/difficult patients, patient's with learning disabilities. I am a student and some of our upcoming exam questions focus on these aspects of patient management. I know pretty much what to do (common sense prevails and all that), but just want to find out if there is anything i'm missing!

Thanks

 

Write EVERYHTING down. Get a witness/witnesses in the room to witness what was said/done.

 

In my experience, people with learning disabilities aren't the most challenging ... they're usually very sweet. You just need to be considerate and patient, and phrase things in a way that matches their level of understanding ... but don't patronise them! If they have a learning disability they should come to see you with a carer.

The most challenging patients are usually ones with a psychiatric illness or personality disorders ... or someone who has just had a real bad day and has decided that you're a good target on which to vent. In which case you write everything down, are considerate and patient and that ensure you are prepared in case things get a bit unpleasant.

 

Hi John,

I don't know which part of the country you are in, but Kent branch of SCP is having a talk on Handling Difficult Patients on Wednesday evening this week (18th May) in Maidstone. It is free for students.

If you want further details, feel free to email on Dulwichpod@aol.com

best wishes

Debbie

 

I regulary see a group of 12 patiernts with learning disabilities. The days that I see them are often my most pleasent. I find that they are usually very happy to see you and their visits to the podiatrist is often the highlight of their day. because such a large number come into the clinic at once their carers usually stay in the waiting room to keep an eye on everyone.

I make sure I chat about some genteral topics, and because of their relative kind nature I find that I'm very up beat during their visits. if their are any podiatric issues I explain them to the patient (don't make the mistake and forget that they're human, and deserve to ber treated with dignity and respect), I also fill out an individual treatment plan for each of them stating what occured during the treatment, why the condition occured, and how to address the issue. each of these treatment plans is then copied and givern to the carer so that they know what occured during dreatment and any further action that is required.

The carer/case managers out my end of town find this very useful, as they're required to show documentation of any medical appointments to help with funding.

hope that was helpful johntee721

 

I don't know which part of the country you are in, but Kent branch of SCP is having a talk on Handling Difficult Patients on Wednesday evening this week (18th May) in Maidstone. It is free for students.

I'm in Wales..Thanks for the info though

Ta much for replying everyone

 

I would imagine that you will have a question relating to consent. With that in mind, it may be beneficial to take a fresh look at consent, and what constituates consent, in respect of individuals with learning disabilities. You could also try researching how information can be given to such people (ie: the use of pictures, 3 d models, and other examples) to help them make informed choices. Only the patient themselves can give their consent, and they can't give consent about something they do not understand . A carer or relative cannot give it on their behalf, on the basis that the patient does not understand.
Good luck

 

Unless, that is, the parent/carer is the patients' deputy or has a Lasting Attorney - http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=154

At the end of the day, it's all about respecting the patient (e.g. putting yourself in their position), being aware of legislation and your communication skills. ;)

 

Lusnanlaogh,

I think you are partially correct, in so much as in certain circumstances, a power of attorney can make some health and welfare choices for the relevent individual. However, I think your post possibly makes it seem as if they are able to force a person who refuses consent to have a treatment (that they do not want). The only instance that I am aware of where someone can be made to have treatment is when they are Sectioned (under the Mental Health Act), however, detention under mental health legislation does not give a power to treat unrelated physical disorders without consent. There are one or two instances where care may be given without consent, but you should be prepared to demonstrate that without such care, the individual's health would be at risk.

I obtained the following extract from the Dept of Health document, entitled 'Working with people with learning difficulties'

'If a person is not capable of giving or refusing consent, it is still possible for
you lawfully to provide treatment and care. However, this treatment or care
must be in the person’s “best interests”.

 

I'm sorry if you interpreted my posting that way, footsiegirl. However, by suggesting that someone put themselves in the patients position, I had hoped that I made it clear that clinicians should be considerate of their wishes ... I know I certainly am.

You are correct, of course, about proceeding with treatment if it's in the patients' best interests. However, in my experience there is a very fine line between what is acceptable and what is not acceptable for a patient, if they do not want treatment. I hope you will agree? that you have to strike a balance ... that comes, IMHO, with experience. With that in mind, I think the course that was suggested earlier up this thread is an excellent idea! :D

Sue

PS Btw I wasn't talking about forcing anyone to have treatment ... I was talking about consent for treatment in circumstances where communcation or understanding is an issue. :)

 

You also need to have a good base knowledge of the Mental Capacity Act, if you google it you'll get lots if info.

 

Oh well the exams done now and there was a question on the challenging patient!! I saw challenging as someone with possible challenging behaviour/attitude/personallity or a challenging treatment conundrum. I think i answered it ok from both angles, i did waffle a bit tho. should have posted on here sooner....Got surgery/diagnostic imaging/orthopaedics exam on fri!!

I'd just like it to stop now please so i can be a proper podiatrist..............