It is indeed very difficult to retain a freshness of approach to our patients if they have been coming to us for a long time. Often we are only too pleased to welcome patients we think are doing well, because we feel they are unlikely to challenge us by presenting us with new problems. These are patients whose treatment we assume to know in advance. Here we can be at risk of falling into rather too well-worn a rut if we are not careful, thinking that our patients will be as they were before. Perhaps unconsciously we ignore the possibility that they may have changed in some way, since changes require us to make more effort. It is much easier, we may think, to continue doing what we have done so apparently satisfactorily before.
And then we may not see, or choose not to see, something in our patient which should be pointing us in a new direction. A long- term patient of mine, whose treatment I regarded as being simple to plan ahead for, turned up for one appointment not as I expected her to be. If I had not been alert, I could easily have overlooked the slight change I perceived in her. She herself volunteered nothing until I probed a little more and discovered that quite a disturbing event had happened to her, which totally changed the direction of the treatment I was intending to give. Looking back on this afterwards I realized that I had been in danger of assuming in advance that I would find her as I had done before, and might perhaps have ignored the pointer alerting me to a need to re-evaluate the treatment I was intending to give her, which was now no longer appropriate. We must never assume that we know our patient’s needs of today, since yesterday may have changed them.