University of Southern California Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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"The Blame Game"

Bart Simpson has become one of television's most entertaining and funny characters in part because of his bratty personality, in part because of his many sayings. And what does Bart reply when Homer or Marge ask him if he was responsible for the latest prank? "I didn't do it." Nobody likes to take the blame, or the responsibility that goes with admitting that you had a role in something that didn't turn out for the best. There are lots of times when there's really no one to blame, when circumstances beyond anyone's control are the most likely cause of something, such as when our study participant Chris had a heterotopic ossification (an internal growth of bone in soft tissue, such as joints like the shoulder, elbow, hip or knee) that caused him to develop a pressure ulcer (which means the same thing as "pressure sore" or "bedsore"). But on occasions when the patient's health isn't coming out as planned, there's a temptation to become frustrated and wonder, "Hey, I followed all the rules, why is this happening?" Welcome to "The Blame Game."

As our study participants told us, and as you have probably discovered in your own life, pressure ulcers can be prevented. But sometimes they happen anyway, and with so many possible causes, it's possible to try to pass the buck to someone else - that's "The Blame Game." At its worst, "The Blame Game" could create negative thoughts like these:

"This is the fault of my medical team; my caregivers are careless and the hospital didn't warn me how to take care of myself. The advice they gave me was all wrong. They don't know what they're doing."

"This is the patient's fault. We told them and told them what they need to do, but they didn't bother to try. They're noncompliant. They don't even care about their own health."

The truth is, neither one of these extreme statements tells the whole truth. These are both descriptions of stereotypes people can make about the person on the other "team" in "The Blame Game." It's probably much closer to reality to say that caregivers try to do their best, hospital staff try to give education to people with spinal cord injuries about prevention techniques to do at home, they try to use their knowledge to give the right advice to patients, and people with spinal cord injuries do their best to avoid risks and are very concerned about their health.

However, it's also part of the reality to admit that sometimes care attendants make mistakes, or some might not be as good at their jobs as they should be, as when Rachel's care attendant put paper towels into her soiled diapers instead of changing them, or when Ken had an attendant who took drugs, stole from him and walked out with no notice. There are probably also times when health care practitioners make a poor suggestion or try a treatment that is not effective, as when Alley was told by a home health nurse to leave on a DuoDERM® patch without changing it, and then was seen by a wound care specialist whose "doctoring" did not clear up the pressure ulcer she had. There are also times when people with spinal cord injuries enjoy taking risks for excitement, like when Billy raced his wheelchair to get over railroad tracks before the barrier came down (he beat the train, but not the barrier; the injury from hitting the barrier resulted in his losing a toe), or when Charlie competed in a wheelchair marathon (usually a good thing, because of the benefits of exercise, including the sense of pride you can get from it) but injured himself when he fell. And, there are times when people with spinal cord injuries put a priority on working hard instead of on pressure ulcer prevention practices, like when Judy continued to spend hours up in her wheelchair to get a project at work done despite having a pressure ulcer that was growing on her bottom, when Dave stayed up in his wheelchair from 4:00 AM till late at night because the company he worked for was experiencing financial setbacks, and when Ken continued working with students and doing other tasks related to his job as a counselor even though he had a pressure ulcer.

So what is the real story behind "The Blame Game"? The truth is, no one "wins" trying to play that game. Figuring out whose "fault" it is and blaming that person doesn't make a pressure ulcer go away, and wastes valuable time on being angry at someone else. Of course you have a right to the best medical care, but unless your health care provider has been truly negligent (that is, made a mistake because they were careless or because they did not have enough training), then even if you are mad at them, there may not really be something to "blame" them for. It might be better to accept that "stuff happens" (that is, there are sometimes events in life or other circumstances that can't be controlled). Each of us is unique and so is each medical problem which takes place in our bodies; because of this, there are times when good advice may not lead to the predicted outcome in a particular situation, especially a changing situation like the state of a person's health. What's more important is getting on with the business of healing the pressure ulcer.

One of the most important reasons for thinking about the cause of a pressure ulcer is to discover what actions or habits might be avoided in the future, so that a person does not get another pressure ulcer for the same reason as the current pressure ulcer. It's also a good idea to figure out what it was that helped, so that the useful techniques of prevention and healing can be used again. A trusted doctor or other health care practitioner, or a friend or family member who is very familiar with your health, might be able to help you think about the things that led to creating, and to healing, the pressure ulcer. Think of this as being "The Reality Game;" that is a game worth winning!

Max J. Starkloff, whose spinal cord was injured at the third, fourth and fifth cervical vertebrae in a car accident in 1959, was an advocate in the independent living movement, empowered himself and became independent as a way of getting beyond frustration and placing blame. You And Your Doctor: Rights and Responsibilities, on the website of Craig Hospital in Denver, Colorado, is another resource that might help you think about this subject in a new way. This page points out that you have rights as a patient, but you also have responsibilities to your doctor, like telling them your medical history truthfully, for example. Craig Hospital also has a page called Interacting With Your Doctor, which has ideas on working with your doctor to improve your health care, such as questions to ask about treatment options, or, if that fails, tips on Changing or Choosing Your Doctor.