Treatment in the face of uncertainty following traumatic anhydrous ammonia exposure
The patient lost consciousness and his vision. He then experienced incomplete sight recovery, anxiety, and recurring nightmares. How would you proceed with his care?
This approach had the added benefit of helping the patient feel empowered. When JD a and family physician, he was frustrated that no explanation had been found for his problem. As a result, he feared that nothing could be done. When told that a rehabilitation and gradual exposure approach would likely help him, even if we were uncertain of the absolute cause, he became an eager participant in his treatment. He also embraced the idea that it wasn’t up to the doctors alone to improve his condition, but that he could be an active participant. In our view, his enthusiastic efforts contributed to the ultimate treatment outcome.
Often family physicians think they should refer these “complicated” patients to other specialists. However, for patients with combined psychological and physiological pathologies, we believe there are no better experts than family physicians. Properly trained family physicians could have treated this patient without the aid of a psychologist. Other patients who can benefit from this type of integrated biopsychosocial rehabilitation include those with chronic fatigue syndrome, chronic low back pain, and debilitating epilepsy.26-28
