View Workout (Joe Uhan)
AM weights? - bad work morning
January 30, 2020 (Morning)
Exercise Type: Weights
Comments:
I can't remember if I lifted weights, but I think I did.
The rest of the morning: BAD.
I have a single "problem-patient": one single person who:
* has, since day one, shown red flags for problematic chronic pain behavior. This includes
1. having foot/ankle pain for, like, 10 years
2. multiple surgeries
3. the guy (around BGD's age) drives FROM PORTLAND every time
4. constantly thinking catastrophically ("there must be something really wrong!")
5. the guy is a clinical psychologist/counselor. The worst: he thinks he knows a lot and (like most of us), you pick the profession with which you have the worst relationship (= many psych professionals "have issues")
* after improving his primary symptom (rearfoot/heel pain) early on, flared his forefoot (decompensation)...and has plateaud since like AUGUST...yet keeps coming back, despite the fact that I referred him to IPA Physio and super-star Foster King in September!
* is SUPER-fucking negative. In general, he has "Eeyore" affect: NEVER energetic, never positive. But the last couple visits, he's been even worse, with even more catastrophizing and bitterness. And he, in effect, is taking it out on me.
Like with Michelle, I knew I needed to "break up" with this guy, primarily because I'm not getting him better and he's not happy! That should be logical - and with 99.9% of all other clients, they would've moved on from me months ago. But not this guy. And I have no idea why, other than the same dysfunctional notion with Michelle: some unhealthy dependency where he (and she) are unhappy and even resentful of the (perceived) shortcomings of my service, yet refuse (are too scared?) to go elsewhere. It's terrible. It's toxic.
But for me, it's more about Tim Ferriss' 80/20 rule. 20% (or in this case 1%) of people tend to give you 80% of the trouble (and in this case 90-95% of the trouble). These people are NEVER worth it.
Lastly, once you lose "Unconditional Positive Regard", you HAVE to be done. I'm long past that with Michelle (and her constant guilt-trips and insults layered with "gratitude"), and - after today - fully there with this guy.
For the most part, the visit was fruitful. For several weeks (if not months), he's been describing a sensation of, when walking, being unable to smoothly roll from rearfoot to forefoot, and he thinks this is playing a role in his forefoot pain. In general, his foot and ankle motion is good, but today - after my PT visit - I considered that there's some mid-foot stabiilty going on, so I taped him and that got markedly better.
This didn't faze his negativity at all.
One of his catastrophizations is this belief that the tendons on his lateral shin are "loose"/"dislocated"/"torn". When I again reassurred him that weren't, he legitimately got pissed at me.
I nearly lost it. It was, by far, more pissed than I've ever gotten in a PT appointment. But at that moment, I was able to bite my tongue. At least 'til we got to the end.
With ten minutes left, I brought up two points:
1. "Why are you still coming here?" I truly wanted to know. His driving 4hr round trip for no improvement baffles me. Him driving that far, when a (superior?) clinic I referred him to is maybe 15min from his house, baffles me.
His point: sunk cost, and not "wanting to start over with a new doctor", makes some sense...but this is the same shitty logic people use that keeps them in shitty jobs and shitty relationships!
2. I brought up his negativity. The physiological evidence is clear: negative thoughts and beliefs impede healing.
We went over-time. But I:
* comped his visit
* told him I wound not see him again unless he reads "Explain Pain" (an evidence-based book on pain physiology).
That was the most riled-up I've ever been. The confrontation was nerve-wracking, and it impacted most of the rest of my day. Thankfully, the rest of my patients were pretty good.
That said, mid-morning, ANOTHER client e-mailed saying I flared her and she was going to cancel. Fuck. So I emailed her back later, apologizing and offering her next visit free (I hate, more than anything, to flare someone. My treatments never flared "this guy").
Got done working at 1:45 (after a couple challenging new evals), then went home. CA had packed the van for another ski trip! I was pretty damn tired and cranky, but we gave it a go....