Stigma and Me: Me-on-Me Crime

who me?

Me-on-Me Crime!

I was doing my speed walking thing on the Balboa Beach cottage lined shore. Gorgeous, it was. Fluffy thoughts were everywhere. I was purposely passing under the low hanging docks to upscale some lower body muscles. Some string bean teens with their fishing poles moved into the water’s leisurely lipping edge ahead of me. Who wouldn’t be distracted by such poetry?

Can you guess what I did? I looked up. I lost my squatting waddle.

When someone driving on the freeway slows down to look at an accident on the shoulder, we call them “rubber-necks.” What do we call someone who walks taller, someone who loses her shorter self under a low dock when “speed walking” at approximately four-miles-an-hour?

Me.

This was more painful than my three cesarean-sections. Of course, there was no anesthesia when I sped into the solid, immovable wood. I loosely figured, with physics being what it is, that I received in return the equivalent to someone slamming me with a baseball bat. I was never great at physics but I remember that Force = mass * acceleration. I am not telling you how much “maaaass” was involved, so, for the disgruntled forensic’s enthusiasts out there, we just won’t know how hard I was hit back.

As the blood was pouring down my throat, out of my mouth, down my face, and as I gargled the words, summarily “help,” to 911, I thought, “That wood was not there before, because, why would I do this to myself?!”

How are we our own enemy? I’m learning a lot about stigma these days, in preparation for a couple CME talks coming up. Stigma is a molded and remolded term, but for our purposes, we’ll say that it can be broken down into, prejudice and discrimination.

Prejudice refers to our attitudes, beliefs, and emotions.

Discrimination refers to action, what we do about it, and behaviors.

I really like this. It helps to see where “Me” plays into our own stigma behaviors toward our own selves. For example, skipping our medications on and off.  That would be, discrimination, when it is done in response to a conscious or unconscious prejudice about taking medication. Maybe taking medication induces feelings of shame or blame. Then we behave with missing pills.

Another example of stigma, is seen in our aging “baby boomer” population. Turns out, psychiatric patients are living longer too. Social workers and other professionals are admitting more and more psychiatric patients into senior facilities, e.g., assisted living, nursing homes, home health services at home, hospice, etc., and the staff at these agencies do not know how to work with psychiatric patients.  So, the senior facilities try to send these patients to psychiatric hospitals or hospital emergency rooms, and the nursing home or senior facility won’t accept them back into their program afterwards, stating “We don’t have the staff or programming to work with psych patients.”

Senior nursing home/assisted living facilities are realizing that they need to hire/train their staff to work with psychiatric patients in their senior years and that this is part of their growth as an organization and their commitment to providing quality care to seniors.

The prejudice comes from feelings, such as inadequacy, on the part of those serving psychiatric patients. The discrimination is when the patients are turned away. Everyone loses.

It’s an exciting time for senior facilities. It’s an opportunity for their staff to learn new skills and understand that with even some basic training on communication skills, therapeutic interactions, some do’s and don’ts, they CAN admit and care for psychiatric patients in these senior facilities. Everyone wins.

The most important message in learning about stigma, is we hurt ourselves any way it turns. And why would we do that to Me?

I still have a headache, three days later. My teeth hurt. And I’m not as pretty.

Self-Care Tip: Break it down – What are you feeling? How are you behaving to yourself?

Question: How have you been prejudiced and acting out toward yourself? How have you eliminated stigma toward yourself? Please tell us your story!

Keep on!

What to do!? On-Line Physician Bullying.

I’ve been to this great APA meeting, great that is, because of the people!  Wow!  The fellow attendees, the exhibitors, the speakers – just, WOW.

I’m going to try to share content with you but it will take me time.

bully

For today, “Are You a Sitting Duck Online?,” reminded me of our earlier discussions on the doctor-patient relationship and a previous post, on July 11, 2012, that went like this:

Hello Friends.

Please tell me how I’m doing on this.  Just out,

Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice

This is important to me as I treasure both my medical practice and our community, connection, exchanges on-line.   I don’t want to do anything that jeopardizes either, nor the implication that if I did, that means I would have mistreated a patient.

Thank you for this, what I call, a “good problem” to have – the joy of medical practice and participation in social media/networking.

So many of you resonated with this and engaged.  I am still super grateful.  I’d love to continue with you in further discussion and with your comments!

For me, one of the many reasons I was so excited about this recent talk at the APA is because of the mucho online stuff connected to my name that affects my patients and the dynamics in our patient-doctor relationship.

In my practice, these are just a few sites that have wrong information (demographics) on me:

  • healthgrades.com
  • vitals.com
  • betterdoctor.com
  • ucomparehealthcare.com
  • insiderpages.com

They didn’t ask to clarify my demographics.  They didn’t ask me if I wanted them to become an on-line reference on my behalf.  They use my practice information to drive “eye-balls” to their site so they can get advertizing money and more.  They impose incorrect information about my practice, knowing that in so doing, I will be pressed, (I call it bullied,) into contacting them with my correct information.

If I don’t do this expensive effort, (money, time, emotional expense – all in limited supply, to correct what they post incorrectly,) patients will continue to tell me that they couldn’t find my contact information.  When they Google me, instead of my website coming up, these other sham pages pop up.

Some patients call dead numbers or even drive to incorrect locations to find treatment.  Instead of whomever is behind these websites being held responsible, the medical providers are.

These are the notes I took from my colleagues, as I heard them say.

Unfortunately, I was late to the meeting so I missed two of the four speakers.  Even so, this is worth it.


Dinah Miller M.D., Author of “Shrink Rap” and writing regularly for Clinical Psychiatry News.

Dr. Miller told us about the difficulty of “patient” (or nonpatient, i.e., sham-patient) reviews online.

Who can review the physicians?

  • your patients
  • Friends and lovers
  • enemies
  • trolls – a negative internet stalker

Every practitioner has an idea that they are a pretty good doctor.  So it isn’t easy for any of us to hear otherwise ;).  After getting unsolicited feedback from a person who took the time to write a comment on a site that listed her, a site that listed her profile without asking her, Dr. Miller chose not to play the victim.  She decided to call “Health Grades,” and with her persistence, they took her information down.

On “Vitals” – she got an answering machine with a person’s voice mail and no name and number.  So she called CEO, Mitch, who stated she wasn’t able to take her profile down.  She didn’t ask to open herself up to trolls.

Dr. Miller asks, what shall we do, as physicians?

  • do nothing
  • write a response
  • try to call the company

There are many whose livelihoods depend on public opinion.  For example, waitresses/waiters – many lose their jobs if they get even one negative reviews.

The practitioners in the group responded with resonance with Dr. Miller’s ideas.  They also had thoughts that if left alone, the democratic process would win out over time, truth would come out and such.  (Maybe the nearby statue of Liberty played into our thoughts :).)


Paul S. Appelbaum, MD, Dollard Professor of Psychiatry, Medicine & Law, Columbia University

Principles that Might help physicians Identify Constructive Responses

  • Responses should be Effective
  • Practical
  • Compatible with medical ethics
  • Positive rather than negative consequences

Problematic Responses by Individual Physicians

  • Request removal by website – typically declined.  Saying you’re writing a public article on it might help.
  • Contact the patient who wrote a negative response to request removal – Patient not likely to remove response, many patients post anonymously, most websites won’t allow patients to remove them
  • Flood site with fake positive reviews – deceptive, embarrassing if discovered, ? inducing a person to rely on a statement that may be used to their detriment (fraud)
  • sue patient for libel – identify patient might be difficulty, people have a right to their opinions – would have to prove statements untruthful and not merely opinion, $$ in money/time/and emotion

Encourage Satisfied Patients to Post Reviews?  We could refer to a firm to do this.  $$

Some sites, similar to “Vitals” offer the option to the practitioner to respond to a posted review.

Negative Reviews:

If we do respond – how?  We don’t want to come across arrogant or insulting.  We fear violating patient-doctor confidentiality. In the end, we recognize we don’t have the last word.  We may respond with a soft word of concern.  “If you would call my office, I’d be happy to schedule at no fee to speak with you about this and see if I can help.”

Can Patient Reviews Be Controlled?  There once was a company that tried this.  “Medical Justice” developed a form that gives control over of copyright of all reviews to MD.  – Didn’t work.  See article, “Company tries to stifle online reviews with patient ‘gag orders’.”

Another idea is that medical practitioners help themselves by coming together to develop an internet ombudsman.  This would be a medical/mental health professional not involved in care of patient.

  • Independent (unrelated party) investigation of physician about the case.  A successful investigation may give a third party opinion.  There’d have to be a reason for the world to trust this opinion.

It is difficult for healthcare professionals to protect themselves from inaccurate complaints about their care.

Positive Reviews

Does it put undue pressure on the patients?

A sign in waiting room perhaps.  Make the information available w/o practitioner knowing if they have or have not commented.

There is a dissonance between the position of being a business person that says we must practice democratically and compete fiscally, yet stay in congruence with what tradition holds us to.


The issues addressed in the talk weren’t specifically about being bullied by sham-websites, but it included that idea, along with other difficulties physicians are experiencing in the rapid transition of 3000 years of tradition as a healthcare providers to spending the majority of their time serving patients first to now, the reckless $ burden of running a media vulnerable business.

In the practice of psychiatry, a traditionally extreme-private practice, this is dissonant to many.

Q:  How do we treat the extremely delicate practice of psychiatry as a business when we are held to currently minimally defended standards like this?  Please speak out and let it flow!  We need to hear from you!  …and, Keep on.

Self-Care Tip:  Deal with internet sham-sites and reviews in a method that is consistent with Me, and temperament, while doing the least damage to oneself. It will be better for oneself as well as others.

 

You Have the Power And You Are Not A Victim

Fire KnivesDo you every feel like a victim?

When someone is doing something to turn us into an emotional victim, sometimes it can look like a performance, don’t you think?  Someone is yelling, arms swinging about, face animated – and there you are, breathless and emotional.

However, being victimized and being a victim are different things.  Being a participant of an interpersonal exchange is different from being an audience to it.

Imagine a stage and you and have been selected from the audience.  You climb up and join the performer, let’s call him Ron.  Ron is a professional fire and knife dancer.  You are standing near Ron and flaming knives seem like they are everywhere.  He is quite a dramatic dancer and part of you wants to dance with him.  You know you would get hurt badly and yet you have the hardest time resisting the urge to participate.  Your wisdom prevails and you remain uninjured.  You applaud and walk away.

Later at home, you are still marveling that anyone could move that way and work that hard to evoke such strong emotion from their audience.  The emotions replay the dance in your mind almost as if you were still there with Ron.

Do you feel like a victim to Ron?  You don’t have to.

When you don’t like what someone is doing or saying to you, imagine that it is a performance of sorts and don’t take it personally.  You don’t have to be a victim.  You have the power.  Be a friend to yourself.

Now, if you can’t do this no matter what, if you feel powerless and unresponsive to your redirections, it may be medical.  You might be suffering from any number of illnesses that cause personalization, guilt, fear, reliving experiences and so forth.  You shouldn’t suffer like that.  You were created to feel pleasure.

Self-Care Tip – Applaud and walk away when someone is victimizing you.

Questions:  How do you manage to use your power when you are being victimized?  How are you accountable for your feelings and behaviors when people are hurtful?  Please tell us your story.

Give Because You Want To, Not Because You Are a Victim To Their Taking

Giving

Self-Care Tip – Give to others because you want to and have so much to give.

People who live in chaos, generally do because they want it. They are the ones who think you are the best one day and are screaming you down in the next. They pit team-members against each other. Without the team-members knowing what happened they are now distrustful of people they used to trust, feeling suspicious and defensive. The people who live in chaos have their own gravitational force for extremes. Extreme behavior finds them. They are suffering. No doubt, but at the same time, they thrive on this in some way. They choose it. Even so, they don’t know their choices and are ever the victim in any crime scene.

I have seen a few amazing life-stories unfold where these habits were reorganized into friendly behavior. It took years but every time I see these people, knowing where they came from, my mouth is open, my soul lays in splayed humility and I have new hope in the Love that heals us.

Clara was one such as this. I’m not going to tell you all of her story but let you know that now she has woven a net of support around her, people she spends time with, peer groups she attends. She takes her medications and doesn’t change the doses without discussing them first with me. She feels pleasure without having to be at an extreme.

Clara still has some people in her life who haven’t done this for themselves. Who haven’t worked on themselves and become their own friend and she has been tempted to “save” them at times. Clara just told me the other day,

I am not responsible for the fact that she doesn’t have any one else but me.

Clara has been tempted to stop investing in herself to invest more time caring for those who don’t care for themselves. But she didn’t. She maintains her health and investing in herself and she is still living. She gives to others because she has so much to give. Not because she is a victim to their taking. Clara continues to fight for herself and I respect her. I am learning still about doing this for myself and hope you are too. Out.

Questions: Have you ever seen these kinds of miracles in people’s lives around or in you? What was it like? Please tell me your story.

The Pleasure That Should Be Ours In Emotional Health

Cup of coffee with whipped cream

Image via Wikipedia

Some time, I’d like to come back to our bullying series as there is still some help to be had for us.  However, today, my cherubs are asleep and it’s only seven PM.  My feet are up.  I’m sitting by lots of beauty colored in varied hues of sunset, shadow and dusk.  Tonight will be short.  I will let today end and indulge the coming together of these things.  (I am even drinking reheated coffee with lots of whipped cream!)

What I have thought of to share with you my friends, as I’ve enjoyed its friendly work on me today, is the pleasure that should be ours in emotional health.

Bad things will come.  We will have anger, lower communication and such.  We will wish we hadn’t pushed the call button on the phone by accident when yelling.  BUT.  But (“Mommy you said a potty word!”).  But it will pass.  It will not define our day or our perception of self.  We won’t catastrophize and we will trust ourselves to show love and mercy to Me in our weakness.  This is a pleasure to experience.  This is what comes when we have brain health.

If this is what has always been your reality, well great.  BUT.  But (“Mommy!  Why did you say that?).  But, many of us know what it is to crave for days when we can say that the blow-ups, outs and ins don’t blot out the sun.  They shouldn’t.  The pleasure comes with health.  Go for it!  You are worth it.  You were made to feel pleasure.

Questions:  When was it that you realized that your emotions and behaviors didn’t rule you or someone you love any more?  What did/does that mean to you?  Please tell me your story.

(Ah!  There goes the last of the sun and the trees are now silhouettes.)

Self-Care Tip #257 – Go for the pleasure of trusting yourself to respond with healthy emotions and behaviors.

Bullying That Includes Life-Threatening Behavior

Bullying:  Series Continued.

  • #144 Leave Space In Your Beliefs To Grow
  • #163 “He’s Never Hit Me.” Abuse.
  • #251 Just Ordinary Bullying – The Bully and The Bullied
  • #253 How to Be A Friend To Yourself When Thinking About Your Bully
  • #254 Free To Do Self-Care, Despite Our Bully

Bullying is a broad term.  We could call it “dirty,” meaning non-specific.  Here we’ve spent several days discussing it and stil trip on the dirt.  What we want to do is tease life-threatening events included in the broad category of bullying apart from the…, I don’t know, can we call them lesser degrees of bullying?  Anything that isn’t perceived as life-threatening can lay in that heap, let’s say.

Teddy bear - Rory

Image via Wikipedia

Each of us must figure out where we are in these two categories.  What type of bully did I or do I have?  (I have to smile when I say “My bully.”  Sounds like a teddy bear or blankie.  And it sooo is not!)  I think when we can do this, we can know even more about our self-care options.

There is a main category named, “Bullied.”

Event perceived as life-threatening -> you folks on the right.

Event perceived as non-life-threatening -> you folks on the left.

On the right, we have some who have Post-Traumatic Stress Disorder (PTSD) and some who don’t.  I’ve seen mothers get it after a traumatic birth and post-partum period when their baby might have died.  I’ve seen people get it from watching terribly violent movies.  Of course we’ve all seen or been survivors of abuse, war, or other near death experiences who become angry, irritable, nervous and suspicious of others.  We’ve watched our once cuddly personality disappear.  Everyone in this system is hurt and hurting – bully and bullied and those connected to either.

Not all survivors go on to develop PTSD after life-threatening events and we can’t clearly say why.  These people on the right straddle the line with those on the left.

We also have current events and past events.  We can number there order of passing in our lives.  For example,  1.  saw our mother beat up for years by our father, 2. watched Silence of The Lambs, 3.  excluded and conspired against in high school by mean click, 4.  neighbor strong-arms you into getting rid of your dog and paying him money for perceived damages.

PTSD can set in at any point on that time line because of the conditioning/changes the life-threatening event did to the brain.

Those on the left didn’t get much attention today.  I’m sorry about that.  You guys are just as important but my agenda today was to clarify.

Questions:  How does this clarification help you, if at all?  How would you try to define bullying?

Self-Care Tip #255 – Know what type of bully you had or have to know how to approach yourself in friendship.

What Do You Say About Bullying?

Rally

Image via Wikipedia

Bullying:  Series Continued. 

  • #144 Leave Space In Your Beliefs To Grow
  • #163 ”He’s Never Hit Me.” Abuse.
  • #251 Just Ordinary Bullying – The Bully and The Bullied
  • #253 How to Be A Friend To Yourself When Thinking About Your Bully
  • #254 Free To Do Self-Care, Despite Our Bully

Being a friend to ourselves in the context of bullying has been one of the most difficult things to get positive about, to talk about with hope, to feel empowered and to claim our freedom to self-care.

Why is that?

How do we claim our freedom to self-care?

We talked a lot about kids, many of us hopeless to a degree about their vulnerability to bullies.  But what about adults?  What are some examples of empowered adults in the context of being bullied?

Our own Sarah McGaugh of birdinyourhand blog-site asked yesterday,

What should we do to keep from getting angry when we are forced to interact/negotiate with a bully? Say, in the line of work, when we have to sit in a meeting with them or something. Some people come into those situations with only fight in them. Usually in my previous position I was fairly good at diffusing them…but I would still feel the anger over it. How do we not let a bully get into our inner world, and still deal with them?

How can we respond?

I would love to hear from you.