Treating Self-Injury (SI)

[Richard B the EMT]

I'll admit I just glanced and didn't read fully the original post, but any injury is treated as an injury, period. I might ask how it happened, and document it on the call report, including, if I have them, doubts of veracity, and why I have the doubts.

Of course, if the patient just ups and says "I did this to myself", you know I document that, and bring it to the attention of the ER staff, so, after they treat the presenting injury or injuries (always the priority), then, the ER staff can make whatever determinations might be needed, up to, and including a 72 hour "psych hold".

[AnthonyM83]

I think the validating feelings part is acknowledging their feelings are real and justified (yes, you got dumped...it's normal to feel really sad)...they need someone who understands them...but then follow up with explanation that it's still not justified behavior. Then, you just lose the connection with them.

Some of these people are going through things I've never had to experience...who am I to tell them, their feelings are unjustified. That does not mean I'm saying their actions or method of addressing their feelings are justified.

[Michael]

I think the validating feelings part is acknowledging their feelings are real and justified (yes, you got dumped...it's normal to feel really sad)...they need someone who understands them...but then follow up with explanation that it's still not justified behavior. Then, you just lose the connection with them.

Some of these people are going through things I've never had to experience...who am I to tell them, their feelings are unjustified. That does not mean I'm saying their actions or method of addressing their feelings are justified.

Sorry, I'm confused. If you'd say this in other words, I'd like to try again to understand.

[crotchitymedic1986]

someone called it right - Psychology BS. Oh they were talking about the degree, my bad.

[Michael]

What are you dismissing, crotchitymedic?

[Eydawn]

Michael- I believe Anthony is saying that one can validate the feelings that a patient is having without condoning SI as a valid, beneficial or otherwise GOOD mechanism for coping with those feelings. Unfortunately, expressing that SI is not a valid mechanism or a good mechanism may alienate your rappor with your patient and not do anyone any good... but at the same time, you can't say "good, sure, cut your wrists instead of taking that overdose" because it's positively reinforcing a behavior that is less negative than the alternative but surely still a negative.

You don't say "you're overreacting, you shouldn't be depressed"... you ask "how are you doing now? Is there anything I can do for you right now?" But you still have to indicate that SI is bad in some way...

It's tricky.

Wendy

CO EMT-B

[crotchitymedic1986]

The whole liberal pablum-puking suggestion that these patients (or any patients) need "rights" written on paper. You should treat all patients with dignity and respect -- doesnt matter what ailment or injury that they have.

[crotchitymedic1986]

Lets write some rights for those who are domestic abusers:

1. You have the right to beat your wife/child without being labeled dangerous.

2. You have the right to use violence as communication.

3. You have the right to feel good about the tension that you released through violence.

Same "Hippie-Feel-Good-Group Hug-Its not your fault bullshit".

[Michael]

Wendy, I followed you down to where

But you still have to indicate that SI is bad in some way

Why do you "have to" do that? Did someone ask you [not you Wendy, rather you as the provider]?

Surely, if asked, I would give my opinion, but can we not suspect that someone suffering a medical emergency already knows that what caused the emergency was not ideal? Or, if we really think we're introducing a novelty into the person's thinking, do we think we will be the first or last person to introduce that notion to the patient? Or one who, in the brief duration of our contact, will influence the outcome positively rather than negatively?

People who feel desperate enough about their lives that they physically attack themselves don't, I think, need strangers' unsolicited disapproval about what they just did that is already hurting them. However well meant expressing such disapproval may be, it sounds like the best way to discourage calling for help next time.

It's tricky.

Talking a jumper down from a ledge is tricky. I don't see that keeping one's opinion to oneself need be any trickier in this situation than filtering out criticism of a smoker's, drinker's, foodie's, slacker's, or abused spouse's slower-working techniques for self-injury.

[crotchitymedic1986]

I do appreciate your bleeding heart mike, but I think we need some clarification on what kind of patients we are talking about:

Are we discussing those patients who are truly suicidal, or just those who are crying for help (shot herself, but didnt die -- or scratched her wrist with a butter knife) ?

I do not judge either, but I have often shown my disapproval through an educational tone, with teen girls who take an OD of tylenol, with the thought that it is a safe way to get attention, not realizing that dialysis could be in their future.