From the Downhill Slope


EVALUATING THE HELPING PROCESS :  David’s crisis has me thinking a great deal about the helping process and how it can be improved.

First a quick update. He remains in the hospital “On hold” for surgery as his pancreas has to “Be quieter” before his gall bladder can be removed.  He is in pain and of course that all has to be balanced against the fact that pain medication compromises his breathing. Hope is sooner than later, but maybe not until Monday or Tuesday.  For me the support of family and friends and being in charge of Ben off and on keeps me strong.

My thoughts about evaluating professional and other helpers. I am involved in a  conversation on an Email group of postmodern therapists discussing how to know if what they do is  helpful.  I am also involved in a parallel discussion on another list—The International Center for Clinical Excellence (ICCE). The ICCE consists mainly of therapists who are trying to develop specific feedback tools to help improve clinical skills.

I am an advocate of making certain anyone trying to help you asks you for feedback.  That means in one way or another asking you “Is what I am doing helpful?”  If the reply is “No” explaining what or why you are doing what you are doing is important.

I asked members of the postmodern therapy group how they obtained feedback mostly I was lectured about the uselessness of feedback. It was not a conversation that left me feeling good and was a replay of my experiences every time I have suggested to a group of therapists that feedback from clients mattered.

Reluctance to ask for feedback, is not, however, limited to therapists.  People want to do their thing and prefer to believe what they do is helpful.    Few people are willing to invite on-going evaluation of whether what they do is helpful or not.  This certainly applies to what I see at the hospital as people try to help David.

David is rather vocal about his needs.  So he gives feedback whether asked to or not.   That doesn’t mean  helpers listen:in fact, often the opposite happens.  Watching the various helpers in the hospital strengthened my belief  feedback matters.   Sadly, it also strengthened my belief that few helpers want such feedback.

Everyone from the maids to the doctors want to help, that is clear.  Unfortunately, most do their thing without listening to seeing or hearing what David wants.  One maid lectured David on faith in Jesus Christ, not the thing to comfort a Jewish man.  David was patient with her.  Some  of the nurses, smile and seem to listen, but apparently don’t hear for they do nothing different nor do they explain why what he wants is impossible.

So far only two people hit the top of my list for hearing  and responding to David.  One was a transport person—probably very low on the totem pole of hospital power.  She asked him how he wanted to be helped from the bed to the gurney and then helped him do it his way.  The other a male nurse. The nurse listened; the nurse also explained why he couldn’t do some things, but did take action where ever he could.   . Fortunately, this  nurse has been on for two days in a row and David is finally getting the proper pain and sleep medication.

Those on the bottom of my list are the ones who apparently just see a cranky patient who wants to tell them what to do; they pretty much ignore him.  Fortunately, only one or two are this bad.

Another  reminder for me has been how the best doctors can be blinded by pre-existing beliefs.  Because David had sciatica at one point, the assumption has been his current pain was orthopedic or muscular when probably it has been pancreatitis all along. Medicine is art and science and pre-existing beliefs can keep the best blind to something else.

I am particularly grateful that our HMO Kaiser Permanente is so top-notch.  They build a team around a patient and both share findings quickly—they have an electronic medical chart.  They also check each other out.  And yes, it has taken them a while to figure out what is going on, but without a team collaborating and sharing ideas, it could be a lot worse.

I am also grateful David’s brother is a doctor and serves as an added person to David’s care team.  He can talk in a way to David’s doctors that neither David nor I can.

If you are caring for someone dealing with a downhill or any other medical crisis or chronic condition, watch carefully for those who will listen to what you or the one you care for say.  He or she is your best ally and is a useful  member of  your Added Care team.  No one should go it alone with a chronic illness or when heading down hill.  An Added Care team is necessary.   Professional helpers are part of your added Care Team but when  you are lucky,  you have lots of other people helping you including people who help you and not just the patient.   Our family, friends, and internet connections are an important part of our Added Care Team.  They help me and they help David.  They keep us both strong.

Speaking of feedback, I am not sure how much this helps anyone else.  Enough people do let me know that someone reads some of what I write almost every day.   I know the  writing helps me.

Stay strong and if you are reading this, thank you for helping me stay strong.

Agree or disagree, comments are always welcomed.

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