One corollary to the Fluorescent Therapy outlined in my previous post is what is commonly called "Boredom Therapy." This is most commonly applied to patients with complaints which are factitious or derived from personality disorders, or those with complaints most likely related to drug-seeking behavior, or other presentations in which there is clearly little to no medical urgency coupled with a patient interaction which is likely to be difficult, complex, and confrontational.
Theses cases differ from fluorescent therapy in that there is no obligatory time delay built in by reasonable and justifiable medical tests. Patients view such a time interval and its attendant fluorescent exposure as valuable and itself therapeutic.
Boredom therapy is that in which the physician provider simply ignores the patient and leaves them neglected in the room for an extended time, while nothing happens. Although this may seem callous or even abusive, it is usually not, nor is it even deliberate in most cases. For example in a typical busy ER, the doctor is likely juggling coordinating the care of several critically ill patients, and simply does not have the spare time to sit down and explain to the patient with Chronic Recurrent Abdominal Pain why, in this the seventh ER visit in two months, we will not be able to provide a definitive diagnosis for their pain. Or perhaps the doctor is simply scared of what is certain to be a challenging confrontation and "ducks" the problem patient, paying attention instead to all his other patients until the nurses, who cannot avoid the increasingly annoyed glares from the patient, who is now standing in the doorway of their room, force the doctor out from his hiding spot to go discharge the patient.
In some rare cases, with patients who clearly are abusing the ER, deliberate boredom therapy is applied, with the intent of making the patient understand that the ER is not a fun or productive place to be, and to negatively reinforce the behavior that brought them in.
In all cases, "Boredom therapy" facilitates the discharge of the patient, by wasting enough of their time that they simply don't want to be in the ER any more and want to go home. The value is that these patients would otherwise be resistant to discharge, either because they had unrealistic expectations of what could or would be accomplished in the ER, or because they somehow enjoy coming in. The cost, which must be balanced, is that the patient, who really didn't need to come into the ER in the first place, ties up a bed for several hours, and makes your nurses hate you. If the waiting room is full, it's generally better to forgo the boredom therapy and just discharge them directly, even though that usually means an ugly fight.
[Please note: if you ever came in to the ER as a patient and had to wait a long time, it was most likely because ERs are busy and inefficient. Boredom therapy as described above is reserved for patients who are clearly abusing the ER. This is in all likelihood not you. Please don't rant in the comments about how long it took when you went in for "x" -- I've heard it a million times, and really, we're sorry about it, but it's off-topic. On the other hand, if you are a malingerer or psychologically disturbed person who has been abusing the ER, then by all means, go right ahead and flame on! (dons asbestos underpants)]
25 March 2008
Posted by shadowfax at 11:28 AM