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stringlengths 1
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stringlengths 1
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|---|---|---|---|
54_4
|
What's going on with that?
|
question
|
communication behavior
|
54_6
|
Well, I mean, I think you just need to maybe sit down and write down a list of reasons why you need to get back to the gym, and then on the other side of the list, put down, you know, um, ideas about what's going to help you get there.
|
therapist_input
|
communication behavior
|
54_8
|
What gym do you belong to?
|
question
|
communication behavior
|
54_10
|
Okay. And-and how far away is it from your house?
|
question
|
communication behavior
|
54_12
|
Just a couple of miles. Mm. So you-- you know, you could, like, ride your bike or walk there, and it would be [unintelligible 00:01:12] too.
|
therapist_input
|
communication behavior
|
54_14
|
Well, I don't know about that. Um. That-- you know, it's really important that you get your, um, not just your cardiovascular-- that's a good idea for the cardiovascular, but also, you know, your, um, weightlifting, the [inaudible 00:01:32] [crosstalk]
|
therapist_input
|
communication behavior
|
54_16
|
Yeah, yeah.
|
other
|
communication behavior
|
54_18
|
Yeah. So why-why do you want to-- what do you wanna do with that? You want to look different, or--?
|
question
|
communication behavior
|
54_20
|
Okay.
|
other
|
communication behavior
|
54_22
|
Okay. Yeah, because your-your health really, to me, it's more important than your-your looks. I mean, don't get me wrong, I understand what you're saying, but, you know, it'd be great to get back in those jeans, but—
|
therapist_input
|
communication behavior
|
54_24
|
Mm-hmm. Well, I think you know what to do. You've done it before.
|
reflection
|
communication behavior
|
54_26
|
Yeah. Just a matter-- You just gotta do it.
|
therapist_input
|
communication behavior
|
54_28
|
Yeah.
|
other
|
communication behavior
|
54_30
|
Yeah. And so that might mean, you know, like giving up an hour's sleep, getting up an hour earlier in the day, and going there and getting it done then. That's what I do.
|
therapist_input
|
communication behavior
|
54_32
|
Yeah.
|
other
|
communication behavior
|
54_34
|
So when I see you next time, you know, that's what I'd like you to do is to, uh, experiment with getting up an hour earlier and, um-- You know, 'cause, uh, getting healthier is more important than sleep, you know. I mean, I know sleep is important, but-- And then bring that list back that we talked about.
|
therapist_input
|
communication behavior
|
54_36
|
Okay?
|
other
|
communication behavior
|
54_38
|
All right, so I'll see you next week.
|
other
|
communication behavior
|
54_40
|
All right. All right. Bye.
|
other
|
communication behavior
|
55_0
|
Miguel, before we end the call, I did want to go over the answers you gave me on the questionnaire about drug use. Is it okay if we go over that right now?
|
question
|
communication behavior
|
55_2
|
Thanks. When I looked at your form, it looks like you use heroin weekly and you injected. What part of your body do you normally inject in?
|
question
|
communication behavior
|
55_4
|
Do you mind if I take a look at your arm, please?
|
question
|
communication behavior
|
55_6
|
Okay. Well, I don't see any redness. Um, can you go ahead and touch that Miguel, and tell me if it feels warm to you or if it hurts?
|
question
|
communication behavior
|
55_8
|
Thanks. Just so you know, when I talk to patients about drug use, my job is to be helpful. I'm not going to tell you what to do or what you should do. What I can do is share some information and be a resource. Does that make sense?
|
therapist_input
|
communication behavior
|
55_10
|
Right. What else can you tell me about your heroin use?
|
question
|
communication behavior
|
55_12
|
A couple of times a week. And where do you get your syringes?
|
question
|
communication behavior
|
55_14
|
Uh, what one do you remember?
|
question
|
communication behavior
|
55_16
|
Okay. How often do you use new deals when you inject?
|
question
|
communication behavior
|
55_18
|
Yeah, it sounds like your health is important to you.
|
reflection
|
communication behavior
|
55_20
|
And you showed up today to take care of your migraines.
|
reflection
|
communication behavior
|
55_22
|
So, uh, you wrote on here that you've experienced withdrawal symptoms when you've stopped using in the past, is that right?
|
question
|
communication behavior
|
55_24
|
What does that feel like?
|
question
|
communication behavior
|
55_26
|
That sounds awful. What do you do when that happens?
|
question
|
communication behavior
|
55_28
|
Okay. How else does injecting heroin impact your life?
|
question
|
communication behavior
|
55_30
|
Yeah. You want to stay healthy. I'm curious, what do you like about using heroin?
|
question
|
communication behavior
|
55_32
|
And what about your use do you not like?
|
question
|
communication behavior
|
55_34
|
Mm-hmm. So on one hand, using heroin feels like an escape from things you don't want to think about. On the other hand, it puts you at risk for an overdose in infections.
|
reflection
|
communication behavior
|
55_36
|
So weighing what you like and don't like about your use, where do you want to go from here? What do you want to do differently?
|
question
|
communication behavior
|
55_38
|
Well, some patients who inject heroin are interested in a medication called Suboxone. It reduces cravings, withdrawal symptoms without making you high. Some patients want information on how to inject drugs more safely or where to get new syringes. Other patients want to carry Naloxone which is a drug that can prevent one from overdosing.
|
therapist_input
|
communication behavior
|
55_40
|
Yes.
|
other
|
communication behavior
|
55_42
|
Where do you keep it?
|
question
|
communication behavior
|
55_44
|
In case you see someone overdosing?
|
question
|
communication behavior
|
55_46
|
Your housemate may be willing to give you Narcan if they see you overdosing.
|
reflection
|
communication behavior
|
55_48
|
Anything else you want to do about your use?
|
question
|
communication behavior
|
55_50
|
Okay. I can email you some information on how to inject in a way that reduces the chance of infection and we also have behavioral health specialists in our clinic who can go over how to reduce harm with you. I bet the syringe exchange has similar resources too.
|
therapist_input
|
communication behavior
|
55_52
|
So it sounds like you have two goals right now. You want to tell your housemate about where you keep the Narcan in case you overdose and you want some information on how to inject safely?
|
reflection
|
communication behavior
|
55_54
|
How confident are you to do these two things? On a scale of 1 to 10, 1 meaning not ready at all and 10 meaning very ready, what number would you pick?
|
question
|
communication behavior
|
55_56
|
Okay. You're very ready. Why do you think you picked a 10 instead of a lower number like 8?
|
question
|
communication behavior
|
55_58
|
What kind of plan could you put in place to make sure you meet these goals?
|
question
|
communication behavior
|
55_60
|
That's great. And how do you want to get the information on injecting?
|
question
|
communication behavior
|
55_62
|
Okay. I'd like to hear how your plan worked out for you if you're willing to come back for another appointment. I look forward to hearing about what worked for you and what was challenging say in four weeks.
|
other
|
communication behavior
|
55_64
|
Great. I'll see you then.
|
other
|
communication behavior
|
56_0
|
Hi, Mrs. Smith. I'm Denise. I'm the social worker here at the clinic work that's working with Dr. Fields and the rest of the team. And, um, I know you were here to see Dr. Fields today, and I-I just wanted to let you know, I usually work with people who are similar to- have situations similar to you, and that have gone back home from rehab. And, uh, so I'd like to find out a little bit if you would, if that's okay, about how it's been going since you got home.
|
question
|
communication behavior
|
56_2
|
Yeah?
|
other
|
communication behavior
|
56_4
|
Yeah. What are you really glad about?
|
question
|
communication behavior
|
56_6
|
Yeah.
|
other
|
communication behavior
|
56_8
|
I know, I-I understand that it was really-- That was your goal. That was a really important thing for you to be able to get home and it sounds like you've been able to really en- enjoy parts of it, and I know you've been going to the- both the physical therapy and the Tai Chi and how's-how's that going?
|
reflection
|
communication behavior
|
56_10
|
So, I'm wondering if something happened that that led you not to go. You look a little, um, down.
|
reflection
|
communication behavior
|
56_12
|
Mm. So you've been working really hard-
|
reflection
|
communication behavior
|
56_14
|
-through this whole thing, you worked really hard to get home.
|
reflection
|
communication behavior
|
56_16
|
And you- you've continued to work really hard with both the physical therapy and the Tai Chi and taking care of your house and doing all those things.
|
reflection
|
communication behavior
|
56_18
|
And you had this fall or semi-fall, and you're feeling like maybe- maybe you were pushing too hard?
|
reflection
|
communication behavior
|
56_20
|
Yeah.
|
other
|
communication behavior
|
56_22
|
Yeah, yeah. It's a lot of work.
|
reflection
|
communication behavior
|
56_24
|
What are you concerned about?
|
question
|
communication behavior
|
56_26
|
Mm-hmm.
|
other
|
communication behavior
|
56_28
|
Yeah, yeah, yeah. And- so you don't want to hurt yourself.
|
reflection
|
communication behavior
|
56_30
|
And what are- what are your concerns about-- It doesn't sound like you-you feel like you hurt yourself in this fall.
|
question
|
communication behavior
|
56_32
|
Mm-hmm.
|
other
|
communication behavior
|
56_34
|
Yeah. And, what are you concerned will happen if-if you get hurt or if something-
|
question
|
communication behavior
|
56_36
|
And it feels like the only way that you can really stay safe and not fall is to not do anything to kind of just hunker down.
|
reflection
|
communication behavior
|
56_38
|
Yeah, yeah.
|
other
|
communication behavior
|
56_40
|
Mm-hmm. Mm-hmm.
|
other
|
communication behavior
|
56_42
|
Yeah. So the physical therapy is can- you can kind of still see that it's helping you to build your strength, which-
|
reflection
|
communication behavior
|
56_44
|
-might have probably helped you break your fall this time.
|
reflection
|
communication behavior
|
56_46
|
Um, I'm wondering what you remember about what-what Dr. Fields said about the Tai Chi in relationship to falls. Did she talk with you about that?
|
question
|
communication behavior
|
56_48
|
Yeah.
|
other
|
communication behavior
|
56_50
|
Yeah. So you're feeling a little betrayed like it didn't-- "Look, and I did this, I was doing my Tai Chi, and all of a sudden, I- here, look at this, I fall."
|
reflection
|
communication behavior
|
56_52
|
Right.
|
other
|
communication behavior
|
56_54
|
So you're just starting to question a little bit about whether or not it might be what is useful and, you know, it-it does really come down to what works for you and what-wh-what you decide will help you stay safe. And I'd like to work with you as I know Dr. Fields would, to-to help build a plan that will help you feel as safe as you can in your home-
|
reflection
|
communication behavior
|
56_56
|
-and to keep you there and to keep you feeling safe.
|
reflection
|
communication behavior
|
56_58
|
Wh-what do you think about that?
|
question
|
communication behavior
|
56_60
|
Yeah.
|
other
|
communication behavior
|
56_62
|
Yeah, right.
|
other
|
communication behavior
|
56_64
|
Yeah, yeah.
|
other
|
communication behavior
|
56_66
|
So it really kinda strikes you that you're- that you're there alone and this could happen and--
|
reflection
|
communication behavior
|
56_68
|
What thoughts do you have about that? What have you heard that others have done, or what are- what are- what thoughts do you have?
|
question
|
communication behavior
|
56_70
|
Yeah, yeah.
|
other
|
communication behavior
|
56_72
|
Yeah, yeah. I know what's worked for a lot of the-the folks that I've worked with is there's like- it's called a lifeline and they can wear it around their neck and it's hooked up and- so that if you need help, you can push the button.
|
therapist_input
|
communication behavior
|
56_74
|
Mm-hmm.
|
other
|
communication behavior
|
56_76
|
It does really work.
|
therapist_input
|
communication behavior
|
56_78
|
Right. Right.
|
other
|
communication behavior
|
56_80
|
No, it is something that there's a couple of different of, uh, you know, a couple of different products out there, but it-it does- it can really help, uh, and-and it kind of gives- might give you this sense of security that you have at your fingertips.
|
therapist_input
|
communication behavior
|
56_82
|
Mm-hmm.
|
other
|
communication behavior
|
56_84
|
Yeah.
|
other
|
communication behavior
|
56_86
|
Mm-hmm.
|
other
|
communication behavior
|
56_88
|
We- we're gonna work with you to help you stay home as long as you possibly can and be safe.
|
therapist_input
|
communication behavior
|
56_90
|
So what do you think that will take, um, because you're the one that really knows how you're feeling about in the house and how you're feeling about your safety. What do you think? The lifeline is a possibility, that's something you can consider.
|
question
|
communication behavior
|
56_92
|
Mm.
|
other
|
communication behavior
|
56_94
|
Mm-hmm. What else do you think it would take for you to feel safe?
|
question
|
communication behavior
|
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