There is a dialog between patient and provider that is often overlooked. A topic not normally discussed, and the source of frustration caused by boundaries that have already been set and later ignored.
Well-meaning people seeking to protect themselves and others have found that in order to identify a problem, one needs to perceive it in another. Once what we've determined to be a problem has been found to exist in another, we seek to remedy that problem by correcting its manifestations. Often the perception of the problem is based more upon identification with it; that is, the problem is magnified by the person who perceives it. It is much less florid in the world (and the people who own it), than it is in the mind of the person who tries to correct it.
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. If a patient is expected to consent to treatment for a hopeless condition, then the provider has set up a fraudulent transaction, and a patient has a right to write his or her own plan for the doctors consideration and consent. [i]
Changing a plan can't be accomplished during treatment without disrupting the continuity of care and prior expectations. Once a service is established, a practitioner is involved in the delivery of standard practice. The treatment has been accepted by society at-large as a remedy that 'works', and there is no need for further discussion by the client other than to receive the treatment consented to in exchange for a fee. Even witchcraft can be accepted as a standard practice if there is faith in the community that supports it.
It is the standard of the community that builds confidence in a patient, and a person who has been 'treated', is accepted back into the community because the community standards have been met. But if someone is being treated for a hopeless condition, the grounds for treatment are meaningless, and whatever treatment might be used as an experimental practice, or research and development which is in and of itself considered to be unethical with human beings.
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 standards of 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 power within the Courts that corrects fraudulent practices and claims!
If a condition resulting from the repeated practice of a physician is supported by a cultural norm, and innocent minds choose make an abusive claim, the practitioner cannot deny that the problem originates with the procedure accepted by his or her profession, and the practice cannot continue unquestioned. 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. It is our belief in the practice of the physician that renders to Scissor that which is Scissors, and dubious powers to the physician.
The only rational motivation the continuation of a practice like this is the exploitation of the patient, or opportunities that result. And, a practitioner without a proven strategy for the correction of resulting deficiencies ought not make or recommend a decision to use the procedure on anyone who has not, or cannot consent to it. Though there may be other motivations for using a procedure like circumcision or abortion, such as social control - they, like other forms of manipulation, including castration, might also be best managed by use of the Courts and Law Enforcement, rather than the Health Care industry.
Treating the trauma of these life events, even beating the breath into an infant cut from his or her mother might need kindness and understanding to recover from, but sympathetic relationships ought not be established to ensure the welfare of a client. Treatment ought not become an intermingling of feelings, and dependency (or enmeshment) ought not be a basis for treatment or financial transaction.
There need be no discussion about the source or value of a payment, or the adequacy of the treatment if it has been accomplished - just a fee for the service that has been provided. Then, both the provider and the patient can avail themselves of the treatment environment without the interference of unwarranted expectations.
When a complaint is made and there is a need for advocacy, assessment, or arbitration, we may need to take it to a superior, mentor, teacher, or regulatory agency to work out retribution, or new treatment strategies. However, as we've described in Transpositions and elsewhere, what we've realized about evaluation (Please see Transpositions second column: The Evaluating Mind), is that our expectations are at risk - that no matter how carefully we evaluate an outcome, our own expectations may not be met because the expectations of others have not been considered. [iii]
In my opinion, it is best to let go of the analysis of the provider, and focus our attention on developing treatment plans that will be useful to the client, and those the client needs to secure to be healthy. By fielding input from the client him or herself directly about those he cares to include with his or her own expectations, we can determine what will work for all concerned and preserve faith in the practice, the practitioner, and good relations with the client. If it truly is 'a hopeless condition' let's keep working out our options and plans to see what we can accomplish!
Some patients may become dependent upon treatments, or even evaluations, so ending either one might not be the best option for a patient, and it is of consequence to providers too to loose a client. We return to boundaries and treatment plans based upon expectations, or review strategies that have been proven to work to determine if a satisfactory [iv] alternative can be accomplished without violating expectations, or the law.
Then, consent for treatment is on the provider’s conscience, not the patient’s (whose competency is frequently already in question). If the provider cannot consent to the new plan, then the provider has the right to refuse the role as provider and refer a patient as a last resort. The authority of a teacher, superior, or trade union workers/labor union workers ought to be available to enforce the decision and remove a patient from becoming a threat to the specific 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. IMID Ltd, Bodywork 2014: Treating a condition at the source of the injury rather than discussing beliefs about it.
2. IMID Ltd, Medical Model 2014: The Medical Model (Describing the hopelessness of treating addictions of any kind)
3. IMID Ltd, Transpositions 2015: Establishing limits on evaluations and dependency.
4. IMID Ltd, Patients Bill of Rights 2014: A patient has the right to seek an alternative provider, a second opinion, or legal advocacy, etc.