There is an understanding between patient and provider that is often overlooked, normally not normally discussed, and can become a source of frustration for both parties.
Well-meaning people seeking to protect themselves have tried to do so by identifying the problem in others. If there's agreement about this perception, we then seek to remedy the problem by correcting what we perceive to be wrong. What I've begun to realize about this habit is that the perception of a problem is more often based upon identification with it than it is in the world. That is, the problem itself is much more in the mind of the person who perceives it, than it is in the world.
Whether by written plan, dialog, discussion, or non-verbal communication a patient/provider relationship ought to be a dialectic, not a dictation - especially if a condition determined to be 'hopeless', or untreatable, such as a common addiction is being treated. In order to determine what the problem really is, and what exactly would be helpful, the patient needs to be trusted with the information he or she brings to the provider, including what he, or she knows to be true about the behavior and opinion of others.
By relying upon what the patient has to say about him or herself, what might be considered a hopeless condition may actually be found to be a manifestation of hate, or enmity based upon the use of a label, or combination of labels providers have used to establish treatment for another form of addiction, or hopeless condition. If a patient is expected to consent to treatment for an endless string of hopeless conditions, then the provider has established a relationship that ought to involves his consent rather than the patients. A patient ought to plan for the treatment of conditions the doctor deems hopeless on his or her own, and allow the doctor to either agree to the treatment the patient has in mind, or drop the idea of treating a hopeless condition entirely. [i]
For example, if a patient has been advised to seek treatment for alcoholism when complaining of offensive behavior or sexual disfunction in the home, and does so, only to return to complain of sexual disfunction sober, then nothing has really been accomplished. And, if s/he is then advised to seek mental health treatment, the patient might have a right to object. And, if after receiving mental health treatment the patient continues to report ongoing sexual offenses and retaliation, the patient ought to have a right to charge the health care system with a failure to address the problem that was brought up to begin with.
To continue to distract a patient from the treatment of a condition he or she complained about by treating other conditions may be a form of fraud, or an indication of greed, and once the labels have been applied, it becomes very difficult to fight. It is the use of a standard practice that the community relies upon to approve and reintegrate a person who has been 'treated'. And persons who do not comply with the prescribed forms of treatment are not accepted back into the community because the standard practice has not been fulfilled. So when the physician finally does comply with the original request, it's not in the interest of the patient anymore, but out of a duty to meet with the expectations of the community. And it's no longer the will of the patient to work with the health care system to achieve his or her goal because the perception of the problem became an evil distraction that cost him most of his life.
With boundaries established by consent (Please see: Medical Model), there is no discussion about the adequacy or inadequacy of evaluation or treatment. [ii] Everything has either already been determined, or you've agreed to what's being done based upon the standard practice approved of by the community licensure. The judgement of an injured party, or a provider is irrelevant, and one of very few options for treatment (even the treatment of 'hopeless conditions'), is to appeal to a provider's instructor, superior, or others who can legally advocate for the patient if the experimental treatment or clinical trial is not considered to be useful. Licensed Practitioners, and Judges are equally qualified to determine a person’s capacity, or competency to consent to radical treatment, and Character reference or demonstrations of previous capacity to serve support both determinations, but ultimately it is our faith in the practitioner that heals, and the power of the Court to make judgements.
If a condition resulting from the standard practice of physicians is supported by the community based upon faith or traditions, its difficult to silence innocent minds who perceive the practice as a mutilation, but society seems to want, or need some kind of control over the public beyond the power of religion and the courts, and therefor relies upon the power of the physician to establish a kind of rule of his or her own. The determination of hopelessness may in fact be the result of the procedure, practiced for thousands of years, but nonetheless condemned by the outrage of the uninitiated; a practice that may have outlived its usefulness for the surgically compromised, but exported to lands where the practice seems inhuman, and is used to justify the practice of even worse perversions, and its unlikely to prevent those who are aware of the long-term consequences of the procedure from becoming harmful as a result.
The only rational motivation the continuation of a practice like this to establish control, and gain the opportunity to continue to treat ongoing complaints that result. Practitioners without recourse for the correction of resulting deficiencies have no choice but to proceed by way of distraction to try to make the patients life more comfortable, or meaningful by other means, though they may not know why. There are more honest motivations for using a procedures like circumcision, castration, or abortion, but they would best be managed by use of the Courts and Law Enforcement, rather than the Health Care Industry which is motivated by profits.
Create a list of do-able steps. A great example of baby-steps was created by The Founders of the 12-Step Program. (Please see: Step Primer.)
The Program Founders were a part of a Christian Fellowship known as the Oxford Group, and their radical 6-Step Program must have seemed daunting to early sobriety, so rather than doing Restitution in one step, they broke it down into two:
Even each of those steps can become more well developed by listing for example, a break down of Step 8 into:
Preparations for making amends are here:
The point is, to write a plan in steps we know we can accomplish.
See also: Problem Solving Training
Treating the trauma of injuries such as these, and others, such as beating the breath of life into an infant cut from his or her mother's placenta cannot logically come from the same provider. To seek treatment for the trauma and injuries that result from standard practice defies the community standards, and results in banishment. When the health care provider is challenged, they point to the traditions of our faith, and our faith refers to even worse scenarios, such as God's effort to remove the Breath of Live from the face of the earth (Genesis 6). However, we can try to work with each other to achieve healing and transformation by other means, such as Alternative, or Complementary Medicine, or what I call Adaptive Medicine, and we also need to be able to keep boundaries.
There need be no discussion about the source, or value of a payment, or the adequacy of a treatment if it has been agreed upon and is accomplished - just the fee for the service that has been provided. Then, both the provider and the patient can avail themselves of a treatment environment without the interference of unwarranted expectations, but when a complaint is made and there is a need for arbitration, we may take the concern to a court to work out a settlement, referral, or new treatment strategies, but we realize that evaluations (Please see Transpositions second column: The Evaluating Mind) in general are not likely to be accomplished well alone, and that disputes can only be settled by the parties involved. If a boundary has been crossed the community ought to be able to be available to correct an ongoing issue, but so far, this one's unaddressed. [iii]
In my opinion, it is best to let go of the analysis of a provider, and focus our attention on the opportunity to develop treatment plans that will be useful to ourselves, and potential clients. By fielding input from clients and their partners we can determine what's working best and preserve faith in the practice, and practitioner, to keep good relations with a client. And if it truly is 'a hopeless condition' then let's keep working out our options and plans to see what we can accomplish on our own.
Some patients may become dependent upon treatments, and even evaluations, so ending either one might not be the best option for a patient. We return to boundaries and treatment plans based upon our own expectations, and review strategies that we've proven to ourselves to work to determine if the community will accept our [iv] alternatives without violating the expectations of others, or the law.
Then, consent for treatment is our own responsibility, not the patient’s (who may not even know what he or she needs treated or why). If a provider does not consent to a new plan, then the patients will likely get referred as a last resort. The authority of a teacher, superior, or trade union worker/labor union representative ought to be available to enforce a decision and remove a patient from becoming a threat to a practice by referring him or her to another provider even if they are dependent upon the practice in question.
Please see: Patients Bill of Rights
1. The Trusteeship IMID, Bodywork 2014 - 2019: Treating a condition at the source of the injury rather than discussing beliefs about it.
2. The Trusteeship IMID, Medical Model 2014 - 2019: The Medical Model (Describing the hopelessness of treating addictions of any kind)
3. The Trusteeship IMID, Transpositions 2015 - 2019: Establishing limits on evaluations and dependency.
4. The Trusteeship IMID, Patients Bill of Rights 2014 - 2019: A patient has the right to seek an alternative provider, a second opinion, or legal advocacy, etc.