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Tuesday, June 11, 2013

Dealing with those people

MDs and DOs learn a “medical problem solving process” to address medical problems. It ensures a disciplined, rational and repeatable approach.  Over-simplified, the process is:

  • Define the problem (chief complaint)
  • List the ailments that could cause that problem (differential diagnoses)
  • Rule out (or prove wrong) every item on the listwhat cannot be ruled out is the working diagnosis.

A workup narrows the list

Physical exam, imaging, and laboratory tests help test the differential diagnoses, which are called “the differential.”  

Helps deal with probable neurotic disorders 

We can start a list, or differential, by observing a behavior. We can’t make a diagnosis without further studies. However, we can sometimes use the “suspected diagnosis” to deal with that particular person

Statesmen use highly-trained teams to plan negotiations with a foreign leader based upon the most likely causes for his behavior – his differential diagnosis.

We can do that too. If someone’s comments seem to meet the diagnostic criteria for a certain personality disorder we may be able to plan our approach to that person. That is, if the diagnosis of a type of psychosis called “Schizophrenic. . .” fits, then we plan to allay her suspicions, and reorient her to reality, early and often when talking with her.

This one is easy to find locally 

Let’s try Paranoid personality disorder. The disorder is characterized by at least three of the characteristics listed below. Several frequent commenters and/or local bloggers exhibit some of these characteristics.

1.     excessive sensitivity to setbacks and rebuffs;

2.     tendency to bear grudges persistently, i.e. refusal to forgive insults and injuries or slights; (Hate-filled commentary and blogs over a period of years qualifies.)

3.     suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;

4.     a combative and tenacious sense of personal rights out of keeping with the actual situation; (An example might be insisting on non-existent “rights” such as “my constitutionally-protected reproduction rights” or demands by speakers at City Council meetings for “rights” when they mean  privilege – privilege is a granted exception to rules, not a right.)

5.     recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;

6.     tendency to experience excessive self-importance, manifest in a persistent self-referential attitude; (We might consider a pronouncement like, “I’m not convinced [about the Mayor’s sincerity]” since it implies that he considers himself an authority on the Mayor’s thoughts, feelings, and beliefs.) and

7.      preoccupation with unsubstantiated “conspiratorial” explanations of events both immediate to the patient and in the world at large. (The accusations of underlying and unsavory motivations in the Mayor and Mayor Pro tem fit here.)

Can't diagnose but can use the info

Even if the person has three or more of these behaviors we can’t diagnose Paranoid Personality Disorder without testing and interviewing them. But we can remember to take her pompous pronouncements as probable reflections of her personality disorder

We, like the intelligence services, can benefit from using a differential to understand “where he’s coming from.” We’ll use this technique in the future to help understand other behaviors we observe in Costa Mesa, both the healthy behaviors and those not so healthy.

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