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Exclusion by diagnosis

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A factual description of your example (as free from judgement as possible):

This doesn’t at first seem positive- but it is…

I recently changed jobs, I have a shorter notice period than is usual due to the role being an internal transfer, I had a caseload of around 20 people, and I managed to work hard and complete treatment with all but 2. One patient just needed a reduction of visits s had recently had a baby and I was keen that after 2 years with the service she felt discharge was planned. My colleague was happy to take this patient on the basis that she had 4 visits to do.

  The other patient was not so simple, she has a diagnosis of DID (Dissociative Identity Disorder), this means that at times of stress she can change into a different part/ ego/ person. This lady is complex, in terms of passing on her care I first discussed it with my colleague, they felt unwilling/ unable to get involved, due to lack of experience/ feeling that this wasn’t their job, concern that this didn’t have capacity. We agreed that I would refer to CTT/ Psychotherapy/ Specialist service. Long story short for a variety of reasons I was unable to place her.

I had two options, to be angry, frustrated and upset on behalf of the patient, or welcome the predicament by choosing to change the focus of my studies (for my PhD) to a case study of a complex case/ the impact of labelling on patients in terms of their access to services and treatment outcomes.

 

Whose needs are met in the example that you outline:

  1. The patient and her alters, get to maintain treatment with the known and trusted clinician.
  2. The care worker, gets to maintain the learning she gets from working with this complex case.
  3. The team that the care worker is in benefit from this increased knowledge.
  4. The care worker, gets to link in with others with similar diagnoses, to really understand the experience of trying to navigate systems.
  5. Perhaps a PhD will be achieved.

 

What positive impact do you think this example had at the time?

  1. Initially, it did not feel positive at all, but I was able to see things from others perspective and how fear drives behaviour.

 

What factors do you think may have contributed to this example (e.g. leadership, pathway, values etc.)?

  1. Leadership, in terms of representing the clients care
  2. Pathway design and lack of access
  3. Gaps in services
  4. Fear and anxiety amongst teams

 

How do you feel when you bring this story to mind?

  1. I now feel positive that the outcome looks positive.

 

What motivated you to bring this example in particular:

It’s recent and at first sight it appears to not be positive, but ultimately the outcome is, I often think that in cases of trauma/ violation, outcomes can ultimately be life changing and positive.

Tags: compassionate transformational leadership

Published: 2021-07-28