THE SECOND TIME AROUND....

As two separate teams we were tasked to lead respective horses around an arena; the last few revolutions without harnesses. Dream, my team's horse, was extremely food driven and distracted by the food pans outskirting the arena. It was difficult getting her started and initially we had to constantly guide and redirect her in the right direction otherwise we'd lose her attention and cooperation. The other team had a very independent-minded horse who required a lot of cajoling and resisted being lead. Naturally, analogies to the patient population were made. Our horse made me think of the overly dependent patient, the patient who wants an extreme form of guidance or the distracted patient, the patient who never keeps regular visits to treat a chronic problem because of lack of time or sidetracking life events. The other team's horse evoked what I personally feel is the most frustrating type of patient, the non-compliant patient. As a clinician, how hard do you push a resistant patient? At what point do we need to let go and still feel at peace with our own efficacy as doctors? For me, because my father was a non-compliant patient until the day he passed away, it was a question framed at a personal level and it asked, when do I GIVE UP? And viscerally it's hard to not frame it as "giving up"-- as a surrender or failure of sorts. But having learned how fighting the tide just exhausts one needlessly, I now consider the doctor-noncompliant patient interaction less as giving UP, and more as giving IN, and respecting our patients and their autonomy. It's a lesson I learned on a personal level and I think will serve me well professionally.

Oh, I saw "28 Days" this Friday after our preceptor mentioned it in class. Equine Therapy! In fact, one of the exercises we did in class on Monday was featured ("Hind Real-ease"). From coaching struggling alcoholics and addicts to future clinicians...is there no end to what these creatures do?