Post-Traumatic Stress Disorder and Depression - Essay Example

Thirty-eight year old Captain Rogers was rushed to the hospital after his wife phoned in for emergency after finding him in a very drowsy state. Interview with the wife suggests that the patient has overdosed himself. The main cause of his attempted suicide turns out to be depression and trauma. Depression accounts for Captain Rogers’ low self-esteem. Although Captain Rogers did not sustain major injuries from the explosion apart from minor scratches and burns, it is most likely that he developed depression when one of his two other companions who were badly wounded in the incident died. Captain Rogers also has had complaints of severe pains in his head down through his neck to his back down his left leg and into the sole of his foot that he acquired last year when he and his comrades were involved in a roadside explosion set by insurgents in Afghanistan. The feeling of pain accompanied by a sensation of crawling ants indicates strong evidence of his brains’ initial reaction to trauma, as diagnosed by Dr. Davies. Captain Rogers sought for medical attention to his condition many weeks after he first experienced the pain but the medical tests showed no significant physical injuries or issues that may have caused the pains. Captain Rogers has declined the pain medications recommended to him by his doctors. Three weeks afterwards, Captain Rogers became irritable and agitated as he was unable to eat normally, sleep, or carry on his task due to the pain he felt which was becoming worse. He was medically discharged from service after he is seen physically and mentally unfit for his job after an outburst with an officer of higher rank. (Q1) Two effective verbal communication strategies exhibited in the case study are (a) sympathetic listening and professionalism (Mock 2001; Macleod-Clarke 1984) and (b) ODPHP-approved accuracy of the relayed information and evidence-based communication of medical information (2001) both exhibited by Dr. Davies towards Mrs. Rogers and Captain Rogers respectively. Dr. Davies has been very polite with Mrs. Rogers in answering her questions about her husband’s medical condition. She was also very patient with Mrs. Rogers and listens carefully to what the other woman is speaking of. Dr. Davies did not interrupt Mrs. Rogers even if the conversation drifted from the Captain Roger’s medical condition to something about her personal relationship with the patient. In fact, Dr. Davies encouraged her to talk about her personal life and freely offered her professional opinion about her psychological condition and giving her sound psychological advice. Dr. Davies draws information from Captain Rogers by giving him accurate information about his condition using evidences from various medical cases she have encountered and are familiar with. She must have been aware of Captain Rogers’ indifferent manner that she withheld some information from him which prompts him to ask her questions to confirm what he is thinking. This is an inventive way to communicate and interview patients since the interviewer gives her medical opinion towards the matter without asking a single question yet verifies the interviewee’s thoughts by the remarks he make during the whole conversation (Hasefield 1990). As a result, Captain Rogers did not feel violated and although his enthusiasm did not change during and after the conversation, Dr. Davies was able to confirm that he felt the crawling sensation which is a sign of his brain’s initial reaction to trauma. (Q2) Ineffective communication in healthcare setting reduces the accuracy of the diagnosis (Mock 2001). Lack of empathy and failure to engage the patient in an effective communication process are two of the ineffective verbal strategies that can be noted in the case study. What Captain Rogers has gone through is never easy considering that he has lost his job, his comrade, his appetite, and his enthusiasm to live in addition to the paranoia he felt towards the sensations he get from his traumatic experience. As such, the healthcare practitioners of the hospital, acting in good faith as professionals, should have been more considerate to how he feels instead of making Captain Rogers feel unwanted, like what Nurse Larkham did. Nurse Larkham did not observe the appropriate proprieties required in building rapport with the patient and his relative. Building rapport is necessary in building good clinician-patient relationships (Macleod 1984) because it influences positive behavior from patients which would help clinician efficiently gather the required information to make diagnosis. Dr. Gregan did not exhibit any interest on what Captain Rogers has to say, has shown mockery and inattentiveness during the whole conversation, and is dismissive of Captain Rogers’ ideas, emotions, and his medical condition which violates the goal of healthcare institutions which is to make the patients feel better – emotionally or otherwise (Kasar & Clark 200; 125). Gregan’s attitude towards Rogers inhibits effective communication process as walls are created between clinician and patient because of the sarcasm and uninterest in the doctor’s attitude towards the patient. Medical professionals should understand that the way they interact with their patients predict the patient’s adherence to a treatment plan (Mock 2001). (Q3) According to McCall & Tankersley (2007), at least 80% of the communication process that takes place in the healthcare setting is nonverbal. Verbal and nonverbal communication helps clinicians as well as the patients convey what they want to communicate towards each other. More importantly, nonverbal communication conveys information in the healthcare setting words alone could not (QAP, 1999). From this, it can be argued that appropriate use of nonverbal communication during the interviews in the case study affirmed medical guesses and builds an environment of trust between Captain Rogers and the medical health practitioners. Three of the medical health practitioners included in the case study has exhibited positive nonverbal attitude towards the patient and his immediate relative. These people are Nurse Larkham, Nurse Blake, and Dr. Davies. Nurse Larkham has shown that she sympathized with Mrs. Roger’s concern verbally (by being courteous and polite) and nonverbally (through sympathetic listening). Nurse Blake has also exhibited positive nonverbal communication by being polite and by showing kindness to the indifferent Captain Rogers. Dr. Davies did so by showing her respect to the patient and letting the patient grieve over his loss without judging his actions leading to his confinements. She has also initiated small talks with Mrs. Rogers and casual talks which according to Macleod (1984) is a good way to build rapport and initiate effective communication process. The combination of verbal and nonverbal strategies in the patient interview has allowed these medical practitioners to communicate with the patient and gather the information they need about his medical condition. This goes to show that emphasis on non-verbal communication should be done in future patient interviews in order for medical and health practitioners to establish mutual respect with the patients (particularly the difficult ones like Captain Rogers) and at the same time obtain the medical information they need to draw conclusive diagnosis. That means to say that observation of nonverbal cues will be included in the typical patient interview process. (Q4) From the responses obtained during the interview, it can easily be inferred that Captain Rogers sees his mind separate from his body. This belief is referred to as duality (or dualism). Because of the traumatic experience he has had which gave him the unexplained pains his mind became more detached to his body in order to get hold of himself. Dualism works pretty much the same thing. Dualism believes in the notion that mind is separate from the body and whatever experience is gained by the physical body, the mind can escape it, or vice versa. From the responses, Captain Rogers is experiencing an ontological type of dualism where a person chooses the things he has to be dualistic about (Robinson 2007) where he choose to separate his pains from his consciousness as much as he can manage. Dr. Davies’ diagnosis indicates that he is experiencing a variant of phantom limb (or phantom pains). Phantom limbs are sensation commonly felt by amputees that include tingling, twisting, cramping, stabbing pains, and pressures (Durham 2004). It is possible that Captain Rogers detached his consciousness from his physical pain to easily manage the pain as what ontology describes. The intense pain that Captain Rogers is experiencing is hard to manage and resist as phantom limbs usually are. It is very possible that his physical pains are eating him from the inside which practically takes him off balance. By detaching himself from his sensations, he was able to bear the pain. However, the act causes him to alienate himself from his family and friends as well. This explains why Captain Rogers acts that way. References Durham, Janelle. 2004. Phantom Pain and Alternative Medicine. Accessed on April 1, 2009 from http://transitiontoparenthood.com/janelle/energy/PhantomPain.htm Haselfeld, D. (1990). Patient assessment. AORN, 52(3), 551-557. Kasar, J. & Nelson Clark. 2001. Developing Professional Behaviors. Slack Incorporated McCall, R. & Cathee Tankersley. 2007. Phlebotomy Essentials. Lippincott Williams and Wilkins. 4th Edition Macleod Clark, J. (1984). Verbal communication in nursing. In A. Faulkner (Ed.), Recent advances in nursing Communication (Vol. 7). Edinburgh: Churchill Livingstone Mock, Kathleen. February 2001. Effective Clinician-Patient Communication. Physician’s News Digest. Accessed on April 1, 2009 from http://www.physiciansnews.com/law/201.html National Institute of Mental Health. 2008. Post-Traumatic Stress Disorder. Accessed from http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml    Office of Disease Prevention and Health Promotion. November 2001. Health Communication. Healthy People 2010. Accessed on April 1, 2009 from http://www.healthypeople.gov/document/HTML/Volume1/11HealthCom.htm Pessin, Al. (May, 2008). U.S. Army Suicide Rates continue to Rise. Accessed on April 1, 2009 from http://www.voanews.com/english/archive/2008-05/2008-05-29-voa64.cfm?CFID=70325093&CFTOKEN=14770328   Quality Assurance Project. 1999. Improving Interpersonal Communication between Healthcare Providers and Clients. Center for Human Services. Accessed on April 1, 2009 from http://www.qaproject.org/training/ipc/ref.pdf Robinson, Howard. 2007. Dualism. Stanford Encyclopedia of Philosophy. Accessed on April 1, 2009 from http://plato.stanford.edu/entries/dualism/#PreDua Read More