WORKING WITH THE PERSON WHO RESISTS MEDICAL TREATMENT
Alison Boyer and Kathy Wilkie Kossey
Some people are so fearful of doctors, nurses, and other medical technicians that they refuse medical attention. Medical desensitization is an interdisciplinary approach to help the client become more comfortable with a variety of medical procedures. The objective of desensitization is to improve health care. The clinician (nurse practitioner, physician, or nurse) works with a psychologist and other appropriate staff or family members in sessions that are held at regular intervals. Several approaches are used to facilitate these practice sessions, including positive reinforcement, relaxation, distraction, and role playing.
For the past five years we have worked with several women who are mentally retarded to help them tolerate gynecological and physical examinations. First we try to help the client feel comfortable in the examination room. Then we introduce the components of the physical examination step-by-step, beginning with the least intrusive procedures, such as listening to the heart and lung, or examining the eyes or throat. We proceed gradually to the more intrusive portions of the examinations: ear, abdomen, breast, and finally, the pelvic and rectal areas.
The client has the option to terminate any portion of the examination, but the session is always ended with a procedure that the person responds to positively, such as a heart and lung exam. The reinforcers that we use are praise, stickers, food, and other preferred items or interactions, depending upon client preferences.
One woman rarely had gynecological examinations prior to our working with her, and those were only able to be performed under general anesthesia. After a year of weekly sessions, she allowed a full