Attention-deficit hyperactivity disorder

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Our Patient-Doctor Relationship Improved by Self-Care and Back At You!

NICU Nursery

Image by EMS Shane in Portland via Flickr

I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:

Self-Care Tip #265 – Use your connections to help yourself and use your self-care to improve your connections (such as your patient-doctor relationship.)

Damaged and premature, my niece was born needing help to live. Now, one year later, I am playing ball with her on the floor. Her intelligent smile, thriving body, and especially the lovely nape of her neck with that baby-curl of hair lipping up makes remembering her near death-dive into life surreal. I don’t want to remember it anyway. But when I can’t help myself, what I like to think of is how my brother and sister-in-law were treated.

The clinicians at UCSD were unbelievable, my brother said. They included him in their decision-making and informed him of medical study results. If you don’t know, if you’ve never been sick or been in a medical setting otherwise, this doesn’t always happen. It isn’t traditional to share medical information directly with patients (such as x-rays, laboratory results, differential diagnoses, and to ask their opinion. Can you imagine?!  “…Um. Yes PLEASE! Can I be your patient!?” Sounds like fantasy.)

I’ve also struggled to collaborate. Hovering over charts and laboratory results, many of us practitioners behave as if our patients were at any moment going to throw us into court. It’s embarrassing, even though the truth is, too many of us clinicians are stalked by litigious intentions, whilst the truly awful practitioners seem to sail away on unsinkable malpractice without pursuit.

I have not enjoyed myself when I’ve done this. When I’ve acted suspicious of the very people I’m meant to team up with, work was not good for me. I don’t think my patients felt comfortable with the doctor-patient relationship either during those times. Hearing my brother talk about how he was treated has emboldened me to engage with more trust in the care I offer patients. Moreso, being friendly to myself has helped me be a better physician.  It’s tail chasing but with productive and enriching effects.

Making a choice to choose trust and transparency with patients and clinicians, even being present with the fear, is self-care although high pressure. With people’s lives on the line, clinicians and patients know mistakes will happen. The self-care will grow our ability to forgive each other.

My journey with self-care has brought me to see people differently. I look at them from the self-care angle. I look for those sticky bits where we can connect and collaborate. I expect things from them. I ally myself with their self-respect, with their intuitive desire to be friends with themselves. I am bored at work when I don’t do this. I am bored at work when my patients don’t do this too. Without self-care for myself and without my patient’s interest in self-care, medical practice becomes everything that the negative reputations advertise about the physician and the patient.

Yes. My quality of practice has definitely improved.

Who isn’t blessed when she sees the courage to face stigma, shame and bewildering illness? Who isn’t more informed every time someone chooses the freedom to do self-care, chooses to live, fights hard like my niece did and shows what that fight is worth?

Who doesn’t learn from that? When someone loses her identity to the defacing ravages of disease but still knows she is worth the fight, like PattyAnne, working beside her is one of the best places in the world to be. For Me. It starts and ends with Me.

Building trust in a patient or a clinician starts with us staying connected to others in our personal circle and along the ripples as the circle widens. We have to have a voice and hear their voice and we do this by maintaining a community of people.

Connection is part of self-care for both clinician and patient. In the case of PattyAnne, (yes, she’s still in our story,) she could take an action toward her self-care with the intention of gaining stronger connection to her community and to me. She could ask herself about her intentions. In fact, we both would do better self-care approaching each other this way.

Connection via the patient-doctor relationship is self-care and then back the other way too!

It starts and ends with Me.

Questions: Has your patient-doctor relationship been a friendly part of what you’ve given yourself?  What are some examples or in what ways have other connections you’ve chosen improved your self-care?  How has self-care inversely improved your patient-doctor relationship?  Please tell me your story.

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Trusting our Clinician, or Not

Free Fall Image

Image via Wikipedia

I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:

Introduction to self-care
self-knowledge 
presence 
moral neutrality
trust (Today’s topic)
patient-doctor relationship/connection

Question:  How do we trust ourselves when we choose to trust our clinicians?  What is your answer? Please tell me your thoughts.  These are some of mine.

…Enters experience, temperament, and personal self-care/readiness to practice of the clinician.

Self-care does.  Self-care is our tool.

The clinician living her own directives is university.  Going to work in a state of readiness is instructive.  At some level, her patient sees that self-care allows the clinician to go to work after personal needs have been attended to.  The clinician then is able to give over space in time, place and emotion and make room for her patient.  Who wants to go see someone for help but instead finds a clinician in role confusion?  The opposite can also be true.  The patient might mistake their own role and try to leave their real illnesses hidden, protected in the safety of their own expertise.

…Re-enters PattyAnne.  Remember her?

PattyAnne was pretty sure that getting an ADHD diagnosis would explain to the people she had hurt a better why for why she hurt them.  It would give PattyAnne a name for the chaos.  Having a diagnosis that comes from a figure of perceived authority, say a Doctor of Medicine, offers this.  It is like a judge who pronounces us innocent and another guilty.  This is not a bad or good motive.  It just is.  To want to get away from negatively perceived labels, is.

As a practitioner, it’s not simple to resist the lure of treatment, when it would be easy to make our patient happy.  It also takes a lot more time in patient education and building a trust relationship if we don’t agree with the patient’s self-diagnosis. Considering these pressures, many have wondered if the frequency of prescribing is affected by it.  For example, it is estimated that 73% of clinician visits for sore throats result in antibiotic prescriptions, but over 90% of sore throats don’t respond to antibiotics. (I know.  That’s robbery!  Those poor other patients who got nothing for their copays!  Not even a prescription!)

So in comes PattyAnne, diagnosis and treatment already in place. All she needs is my signature.

Being a patient is not always easy.  It improves some with insight or at least the ability to receive insight, a vulnerable pose, humility, courage, self-respect and so much more.  Maybe PattyAnne was thinking, “Oh boy.  Now I got this woman who doesn’t know that I’m ADHD!”

We have each other and begin the adventure of patient-doctor relationship, an alliance and a connection.

Self-Care Tip #264 – Trust to improve self-care, and take care of yourself to improve your trust.

It starts and ends with Me.

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Self-Knowledge as a Step Toward Self-Care

Yesterday, we introduced self-care and today we continue with self-knowledge.

Knowledge, mural by Robert Lewis Reid. Second ...

PattyAnne came in knowing what she wanted.  She was sure she was struggling with ADHD.  She could not focus, she had difficulty connecting with others, and she was impulsive.  This was limiting her intimacy with the people she wanted in her life.  PattyAnne had read about ADHD and was relieved thinking that taking a stimulant would improve her that much.

PattyAnne is rich inside, dark chocolate, not white, aromatic and effectively affecting.  Being with her means being touched.  When PattyAnne is good, her fresh aura in our shared space is healing.  Many baffled by this wonder why, when she passes through, they feel so much better.

Consistent with this intensity, when PattyAnne is not good, whatever comes from her is chemical warfare, and we are not safe.  You can leave, but you will always leave touched. Any time with PattyAnne feels like either too much time or too little.  We are wanting: wanting more or wanting less, somehow with PattyAnne, we will never feel satisfied.

This is part of why PattyAnne projected confidence while self-diagnosing.  Her temperament and coping skills predisposed her to do it.  Self-diagnosis in her and others also happen because of fear, lack of trust in their medical provider or defensiveness per their feelings of inequality.

There are good things that come with self-diagnosis to consider.

  1. Self-diagnosis is always informative.  Always.
  2. Clinicians may use it as a tool to build trust.  When not put off by self-diagnosis, clinicians might recognize these opportunities.

The self-knowledge each of us has on either side of the patient-doctor relationship is not inherently dangerous, and consider the inverse.  Clinicians come to the room with their own self-diagnoses as designed by biases and countertransference.  And which clinician is not also a patient?  There is good with bad and we have a choice, as always, within stories within stories….

Patients and clinicians perceive self-knowledge, at least in part, as self-care, and we are right.  Like Dad says, “Knowledge is never wasted.”  How many times have clinicians asked why patients do not try to educate themselves about their disease?  To begrudge them for it is to deny the value of that process and what clinicians also do under the guise of a license to practice.

Any of us can imagine that for both parties, these types of encounters cost emotional and physical energy.  For PattyAnne, we have mentioned already that she came defensive.

For me, I regret the times when I did not own responsibility for my feelings.  When a patient self-diagnosed, I too quickly assumed mal-intent, personalized behaviors and missed my opportunity to benefit from the connection inherent in the patient-doctor relationship.  This is what I wanted to avoid with PattyAnne.

I celebrate, however, these past many months our work on FriendtoYourself.com.  I experience much more pleasure in my profession.  I am even more clinically effective by taking care of myself first; by being present with myself.  My self-care professionally mirrors my personal self-care in that when I am first able to be present with my own self, such as through writing and interacting with you, my online community, I can then be present with my patients.

…I thank you for teaching me and hope we share this exchange for a long time.

When I can be present, I do not have to moralize my perceptions of patients’ behaviors and feelings.  Self-care is not a moral issue.

In the following posts we will discuss more about these terms: presence, moralizing self-care, trust, and the patient-doctor relationship.

Self-Care Tip – Grow your self-knowledge and find what it offers you, in turn, when observing it in others.

Questions:  What has your experience been when you have gone to your clinician with self-knowledge?  How has gaining self-knowledge been a friendly thing to yourself?  Please tell me your story.

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Blog-Jacking – by Rick C.

Hi Everyone… I thought I would kind of write a guest blog today (call it blog-jacking even) DQ did not specifically asked me to do this, however, I do not have any clear recollection of her specifically asking me not to do this either. With this in mind, I would like to let you know about my unique relationship with DQ (I am just going to write DQ because I have a very limited attention span and am likely to have two or three great ideas flow through my brain by the time I type Dr. Sana Johnson-Quijada and then I also start wondering if she has a middle name too and how she fits all those letters into those forms that have the little boxes on them). Anyway… I communicate with DQ on a regular basis and get interesting insight on a variety of topics. This makes me feel unique and special until I realize that most of the people reading this have the same opportunity. Then I kind of ask myself… “What kind of group have I joined?”

To begin, I would like to talk a bit about my psychiatric qualifications. I spent six years attending college. Technically, these were at a community college, but I did take at least one psych course while I was there. In addition, I am an alcoholic and drug addict in recovery who has previously attempted suicide. I take medications for both depression and ADHD. I had to go through a variety of medication to find the right combination because almost every medication I tried made me sweat profusely and/or break out in a rash. As part of my ongoing training, I am going through a nasty divorce which has caused me to be temporarily unable to see my son or live the life that I have become accustomed to. In addition, I have just lost my job of fifteen years due to cutbacks. All of this in the same month that I turned forty and should be free to seek out a quality midlife crisis.

The fact that I am laying in bed with my shoelaces in my possession in a nice room that I am free to come and go from as I please over two weeks after the divorce/job loss week most likely indicates that I am totally delusional and only think that I am happy or that I actually am. Either way, I am content in the place that I am at. This, to me, is pretty amazing.

I am grateful for that I have been through all the things that I have been through in my life because they have given me the strength and experience to go through what I am going through. Even though I did not do real well in school, I somehow did well enough with a big corporation that they are willing to give me a severance package that will basically pay me for the next four months as long as I do not get a job or accept one of the positions they have offered me. Basically, a bunch of paperwork and legal terms that say to me “Paid, vacation!”

Being an alcoholic and a drug addict have led me to become involved in a program that connects me with others who have previously tried to use alcohol and drugs as a solution for coping with life. These people are a great source of support and experience. As for the prescribed drugs, I am not even really sure that I need them all the time; however, I sure as heck am glad that I was on them when my “Perfect Storm” kicked off. Oh yeah, as part of my challenging week, I found myself with no place to live and immediate access to very little money. A little rational thought and I realized that I have an amazing amount of airline miles from years of travel. In fact, more than enough to take up residence in a nice beach front condo for the next month.

Why am I sharing all of this? For several reasons — First and foremost, I am newly almost single and think that this is a great way to meet ladies without having to ever think about the awkward point in a relationship where I will have to explain my past. In addition, the fact that everyone here is reading this most likely means that you have experience with challenges like mine and I can always use others that I can relate to. Lastly, I have found out that when I have felt that I have a very unique situation, I am usually wrong and that I am actually just not in a group of people who feel comfortable sharing their experiences. It would be kind of cool if everyone just wore a signs with their three biggest “issues” on them. I have a feeling that if everyone formed a group with only the people who had at least one issue in common with them… we’d all be in the same great big group called life.

Thanks for reading to this point. What do you think about this? Are you female and single or considering becoming that way? Could this really be a worse idea than matchharmoneyfinder.com or whatever it is called? Keep on and be a friend to yourself and stuff.

Oh yeah….DQ, please get better soon because this blogging stuff is cutting into my busy schedule!

 

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Branding and Branded. Stigma Goes Both Ways.

 

mentalhealth.wa.gov.au

 

Oh, the struggle to understand that behaviors may have something to do with the brain! I shake my fist at stigma! I shake my fist at prejudice!

Now, I can go on a little calmer and say, if you are struggling with this yourself, you are not alone. Even if you are the one propagating it. You stand on the shoulders of others.

In Jesus’ own words:

Father, forgive them for they know not what they do.

He was talking to me, I know, and you.   We have all been rude and ignorant in our own time and our own place.   We find ourselves holding 2 positions, accuser and accused. The context of our various roles changes with knowledge, coping skills, experience, maturity, pain, mental capacity and so on.   But that we hold both roles in some space of time and place will never change in this world.   Even in heaven when we “see face-to-face” we won’t be completely informed.  We know we will continue learning timelessly. What will change is the abuse, the prejudice, the judgement.  Once and for all, we will finally let that go and believe at a chromosomal level that God is and deserves to be the only Judge.

There must be a genetic component to our double lives in this world. This tendency towards stigmatizing. We know there is a lot that isn’t genetic and for that we fight to grow ourselves and grow others for our own sakes and for theirs. The benefits reciprocate as much as the pain does. And even though being branded feels personal, it is not.

For more relating to this, read the blog posts Forget About Divisions In Knowledge, and Forgive to Get Friendly With Yourself.

Self-Care Tip #109 – Don’t take it too personally when people sneer. Be a friend to yourself.

Question: How do you keep yourself objective when prejudice hits you or someone you love? Please tell me your story.

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Intent and Context Matter

 

A Beautiful Mind by Sylvia Nasar

Image via Wikipedia

 

Self-care is selfless, but doing things for yourself is not always self-care.

A reader commented, “I believe that if I’m NOT taking care of myself and feeling joy, then that IS self-centered….”  Too eloquent.  Love it.

Some of our confusion comes from the changing scenarios of self care.  The intent sometimes gets blurry.  The intent is hard to tease apart.  Sometimes what feels like taking care of ourselves is in fact, selfish.  For example, let’s say “hypothetically,” my husband, who is a palliative care specialist, chooses to work on twitter #hpm, play chess, or play guitar.  This is potentially positive and friendly to the self.  However, it depends on intent.  Sometimes we don’t know our own intent though.

There is also the context of what is happening.  Let’s say we were all fighting, and then my husband goes off to read Oscar Wilde.   Is this self-care or a way of abandoning and taking himself out of the present?  Self-care puts us into the present.  Whereas selfishness takes us out.

In another context, taking yourself out of the present is necessary to ultimately put yourself back in.  Doing this requires thought processes that can abstract and empathize (connect emotional content).

I rely a lot on intent! (Ahem!)

There is a mind disease called schizophrenia.  This disease is famous for hallucinations, hearing voices that other people don’t hear, seeing things that other people don’t see.  However the core symptom of schizophrenia is less famous.  It is the thought form, concrete and disconnected.

Concrete thinking is named well, unlike many other medical conditions.  (Think diabetes!  Who would know what that has anything to do with!?)  But concrete thinking is plain, hard, and flat like my sidewalk.  For example, if I asked what does the parable mean, “A bird in the hand is worth more than two in the bush?”

  1. Concrete thinkers might say, “Birds make a mess so we don’t want a lot of them.”
  2. Further, if their thoughts are also not connected, they might say, “Birds migrate in the winter and the bush is wet.”
  3. Contrast this to connected thought that abstracts, being able to answer, “If I have an opportunity to take something good, it’s better to take it than gamble for what I might not be able to keep in the end.”

Different emotional illnesses have trouble abstracting, but fewer have disconnected thoughts like schizophrenia.

If you are in a relationship with someone who has trouble abstracting (traumatic brain injury) and/or connecting emotional content (ADHD for example,) you might misinterpret his or her behaviors as selfish.  Being able to empathize after all is part of most Disney fairy-tail romances.  What more do any of us want?  Right?

Wrong.  The capacity to empathize doesn’t matter much if the intent is missing.

Wrong.  The ability to abstract doesn’t connect if the intent to connect us is not there.  The knowledge does not matter.  It is the context.

In the film, A Beautiful Mind, Russel Crowe plays a character that suffers from schizophrenia.  The woman who loves him, struggles to understand the way he loves her back.  His disease steals his attention.  His disease takes his time.  He seems selfish.  Their love survives when she discovers his intent in context.  He stays present in the relationship, despite all his limited capacity to relate.  Further, agreeing to the treatments of his generation, limited that they are, he is doing selfless self-care.

At the end of the day, I’m a grateful piece of dirt who means well.  Saying that up front immediately lets you get very familiar with me.  (I could have said “grateful piece of sh–,” but that would have been selfish.  The s-bomb is just playing with the word to have fun!)  Part of why I believe in God is because I know He goes for the losers.  He goes for the piece of craps out there.  That’s what the beatitudes are about.  He pours it on. (Intent and context, baby!)  At the end of the day, we are neither angel nor beast.  We are just human to Him.

Self-Care Tip #78 – Keep self-care selfless.  Be a friend to yourself. 😉

Question:  What do you think?  Please tell me your thoughts.  Please tell me your story.

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Claim Your Brain

My mind, like rusted gears, was not moving well.  It hadn’t been really since my 1st pregnancy 8 years ago.  There are few things that dumb us down as much as pregnancy and children!   Hormone changes, lack of sleep, fluctuating from 145-200-145 pounds three times, and then the subsequent growing beloveds around me to contribute to mental dissociation.  Simple sensory overload from talking, yelling, crying, petitioning, inquiring kids factors in.  You may read more about sensory issues here.

Daily writing, like a staunch governess, found my brain under cobwebs, bug carcasses, and musty stench.  (Hello old friend!  There you are!)  This helps to explain the joy gripping my hand, like girlfriends on the playground, when I sit down to write!  The world is active to me, including rather than excluding me. My in-between moments used to hang like an old woman’s breasts.   Now much more time full of nourishing thoughts bless me.  I am in awe.

My patient came in sighing deeply.  He wasn’t better.  No, he said.  He lacked motivation and interest and connection from the world.  He felt selected out to suffer.  A dumping ground for misfortune and misunderstood.  Efforts through medication, after medication changes were like looking for love in all the wrong places.

We talked about cognitive distortions, tapping into things that used to make him happy, road-blocks in poorly designed neurological grooves – volunteering at the library or animal shelter, journaling, sharing his life story with others, exploring his spirituality.  No.  No good.  Nor could he consider psychotherapy as he’d been through too much of it already to consider it again.  And he just couldn’t get interested in groups such as through NAMI.

His brain, assaulted by stressors, disease, and disuse was growing silent.

Being a friend means yelling, fighting to reclaim your journey, finding something to connect you to your process of life.  My patient was letting squatters take his property simply by being absent.

Self Care Tip #60 – Claim your right to health.  Be a friend to yourself.

Question:  What has helped you connect with your own journey in life?  What do you think?  Please tell me your story.