How to Trust Whom You Serve and Whom is Serving You

Michael E. DeBakey, world-famous cardiothoraci...

Much of what we do in medicine is elementary. I wouldn’t know how to quantify the amount of plainness involved with our goings-on. Behind the writing of controlled substances on pricey government controlled paper, behind our, “Hmm’s”, our flow of learning and teaching, and more (or less) than the laying on of professional hands, we are… we are common.

To say it simply, physicians are dealing with themselves. In medical practice, separating the self out, effectively breaking the emulsion of the physician from their personal journey leaves many of us suspiciously grouped into the numbers of old and lonely but practically excellent. Some medical specialties are infrequently bested by anything other than 80+ hour work-weeks, knowledge retention and steady hands. The imminent peril and the literal moment by moment of life-saving interventions helps the rest of us understand.

Even so, I’ve known some who have been “the best” and still managed to be connected to their personal. I imagine some other dimension is forced open by all the space that that kind of nearly fictional human occupies: Cardiothoracic surgeon, Anees J Razzouk, M.D., at Loma Linda University, for one; Gisella Sandy, M.D., critical care specialist, general surgeon and medical missionary in Peru, for another. We are all happy to say that the list is long here. We think of the ordinary physicians planted around our planet who are heroic enough to do the simple. After all, how much can a physician offer to her patient if she hasn’t taken care of herself first?

Those of us who seek medical care from a physician will be interested to know that the physician as well as the patient can only carry so much before things start to fall out of their arms. Before a sack tears on our way from the car to the kitchen, before there is spillage and things go unnoticed, we want to know that they thought about it. We want for them what they want for their patients in other words. Accountability to Me.

Wanting this for others, because we are afraid, is understandable. But it’s not at the aorta where life pumps and freedom flows. Each of us, regardless of fancy prescription pad or paper gown, to trust the other, we must have their own wanting. Wanting this for themselves. For Me. That is the pulse on trusting each other.

Questions: How has being a better friend to yourself improved your trust in those who are serving you? How has being a better friend to yourself improved your ability to trust those you hope to serve? Please tell us your story.

Self-Care Tip – Follow the thoughts that bring you back to Me where you will healthily grow your accountability, wanting and trust. Be a friend to yourself

An Introduction to Self-Care | Journal of Participatory Medicine

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I thank the talented editor and friend, Sarah McGaugh of birdinyourhandfor her untiring interest and excellence in helping me develop this journal entry.

An Introduction to Self-Care | Journal of Participatory Medicine.

Please join us in celebrating publication in this wonderful Journal.

“Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.”

Kathleen O’Malley, Managing Editor, turns out to be wonderful as well.

Keep on.

Seeing Your Brain As The Place Emotions and Behaviors Come from is Terrifying

Terror

Image by pablokdc via Flickr

Where do emotions and behaviors come from?

Now think about it and answer your true beliefs.

I was speaking with a wonderful physician the other day to whom I asked this question, (let’s call her Doctora.)

I respect Doctora for her character, personality, standard of medical practice and interpersonal beauty. She is a bulldog in the operating room. When patients need studies done that insurances won’t pay for, she tears barriers to treatment apart with vicious tools of rightness. And she cares.  She sits.  She asks.  And she cares.  She sees the person in the paper gown, each one for the person she knows them to be and the person yet unknown.

I admire Doctora greatly not only for these qualities but also because it gets personal.  I, who have my own special practice of medicine, cannot do her’s.

When just a green bumbler in medical school, there was a fateful day when I shadowed another great artist of medical care into a locker room.  I suited up in that blue sack they call scrubs.  I put little blue sacks over my tennis shoes too.

Do you know why there are blue sacks on the surgeon’s shoes?  So that when wet things come out of the human body and fall onto their feet, their toes won’t feel squishy. Yep. That’s what was going through my mind as I scrubbed my hands, each finger and each finger nail the ten minutes it takes to reach what is considered clean.

Surgery in progress, the color red mixed with a smell and monstrous sensual force that clobbered me to the ground.  I swooned, gagged and promptly ended my surgical career.

There is nothing more irritating to a surgeon than someone who doesn’t appreciate the “fun” of “cutting.” Yes. I irritated this mentor and others too I’m afraid.

This doesn’t keep me unfortunately from pleasuring in telling people, “I am licensed to do surgery.”  I am you know.  Any Jane with a medical license can pick a scalpel up and bring back the dark ages, or contemporary, depending on who holds the license.  I’m irritating to my mentors, remember.  It reminds me how anyone can go online and pay to become a marriage registrar, i.e. perform a marriage ceremony for couples.  My brother did that twenty years ago and has yet to perform the marriage ceremony for a willing couple.  For real judges and clergy, this might be irritating too and that makes me a little happy as well.

Anywho, Doctora and I were rolling with the injustices haranguing us in the practice of medicine, both from the angle of the physician and the patient. I was pumping her up for being the cutting-wonder who she was and she was dutifully marveling at my jabber-mouth work that she would, “never be able to do in a million years.”  Somehow this brought us round to how our culture avoids embracing the biological paradigm of anything inside our skull but is so willing to celebrate it for any other part of our human bodies.

Where do emotions and behaviors come from?

Doctora answered me with a frozen breath. Then after I soiled the air with a lot of jabbering and she was finally able to speak, she said,

I would just be horrified if my brain got sick!

I wondered if it was scary enough to clobber her to the ground, but I do agree.  Terrifying.  Don’t you think?

Question:  Is that why hardly anyone can speak about the brain being human and largely responsible for where our emotions and behaviors come from? How has this played into your experience of self-care?  Please tell me your story.

Self-Care Tip – Go to the fear that keeps you from embracing your biology to gain more freedom.

No One is Choosing For You – Know Your Choices For Health

Yesterday we asked some pithy questions re: Why Psychiatry?  Your responses were received with gratitude and humility.  It takes courage to understand our connection with psychiatry considering ongoing stigma.  Today we’re reviewing that some and taking it one bit further.

When referred to a psychiatrist for medical care, we can feel confused.

Why is my physician sending me away?  Does this mean I’m at my last resort?  Does this mean I’m that sick?, or,

Does he think I’m crazy?  I’m not insane!, or personalizing with,

Does my physician not want to work with me?  I’m that bad of a patient?  Cast off?

Our expectations when we first see our psychiatrist are often also similarly reactive.  Maybe,

I’ll give this one chance but if she doesn’t fix whatever it is that’s going on, I’m out of here. 

I am not going to be dependent on medications!

I do not want to be made into a zombie!

Are we looking for a cure?

Also, we might be confused by the amount of time that she spent with us the first appointment as compared to our follow-up appointments.

I need to talk about my problems!  I need time!

There’s a lot to take in.

Unfortunately, when we are referred to a specialist, often our referring physician hasn’t effectively communicated as to why we are being sent there.  This is for many possible reasons, including Me not hearing him.  Many other reasons are also understandable with insight but we aren’t always given the opportunity to hear the inside story of why our physician does what he does.  That doesn’t mean we have to accept it.  But if we do, we did and it’s our choice.

Choice

Image by Scarygami via Flickr

We have choices.  Before accepting the referral, we can ask, Why?  Keep asking why until we are satisfied with our level of understanding.  Schedule a follow-up appointment with the referring physician if necessary to gain more time if we think we need it.  Sometimes, despite our physicians best efforts, we won’t understand as well as we’d like and we have to make our choice with the information we have.  We can read up on our symptoms ourselves.  I read in Twitter from @NathanBransford,

The 11th Commandment: Thou shalt not ask someone a question thy could easily Google thyself.

That’s ridiculous although I cracked up.  The World Wide Web comprehensively and including Google or any other source within that World Wide Web are not designed to practice medicine.  When we read something, we need to ask for qualifications behind the author of the print, references and so forth.  The Internet is a tool worth our attention but you decide how far you are willing to take what you read before you consult with your own physician.  I think if Doctor Seuss were alive today, he’d write a book (or many) about health care; Oh The Tools We Can Use!  (Maybe Carl and Thysleroux will do a series or a post on this?  Should be fun.  – Asking, “Why?”  Becoming our own friend.  Connection.  Going towards shame, pain, anxiety.  Growing bank – and more.)

And so that brings us to today’s questions:  What choices do you perceive you have in referrals like these?  In your continuing medical care?  In your ability to collaborate with your physician?  In obtaining an understanding of your illness(es)?  Please tell me your story.

Self-Care Tip – Grow your understanding of your choices for your health and medical care.

Related Articles:

  1. Stay Connected For Your Sake and For Theirs
  2. Connecting To Others Is a Condition of Freedom
  3. Safety in Connections

Reworking Choices With Your Physician as Part of Your Team

What do you want? 

It is one of my challenges as a physician when someone comes to see me for reasons I’m not able to accommodate.  I can’t validate them.  I can’t tell them what they want to hear.

What can I do?  Help them “realize” that they came to see me for another reason.  Another way to say it is to help them “choose” another agenda.  A part of them realizes their need for help; they came.  A part of them believes I am a person that can help; they came.  A part of them.  A part that I and the patient are responsible to find and shift agendas deliberately or by any wiles possible.

Hands touching

Image via Wikipedia

We are an unusual team in this.  How often do you find another so awkwardly paired?  Yet these are some of my best patient-doctor relationships.

What do you want?

When there is a meeting up, a connection and everyone is working for the same “want,” both presence and movement are natural responses.  It’s like we’re standing still in the moment, senses taking it in, and moving all the while.  The process of moving itself brings pleasure and healing.  It is not always about arriving.  It is not always what we think we want.

Self-Care Tip – Enjoy your re-choices and what you will get from them.

Questions:  Have you every found yourself being “helped” to have a different agenda that improved your presence and movement in your personal journey?  Please tell us your story.

To Connect Because you Want To But Would Be Advised Otherwise, Set Your Rules

A Nuclear family, Image by FredCamina

Image via Wikipedia

When we want to take what is good and leave the rest, to keep the best and let the otherwise character pathology pass us by, to make good memories with someone who torches the ground and air they breath, splits families and catastrophizes the little and ignores the big personal flaws – when we actually turn around and say with a fully informed consent, “I want us in each others lives,” make rules.

1.  Take care of “Me” (bio-psycho-social)

2.  Have walk-away power

3.  Nothing violates what you say is impermeable; such as you and your spouse, your nuclear family, your home

4.  Consistency combined with as blind a vision as you can bare

5.  Take nothing personal

6.  Pick your fights carefully

7.  Let them save face

8.  Set them up for success in your relationship

Each one of these generally takes hard work.  Some of it will be natural and easy.  A lot of it will be hard.

Setting boundaries for the other person helps them control their chaos and they’ll feel safer with themselves.  The boundaries, when clear for a person with character pathology, helps them trust themselves more and subsequently us more.

Again, if these things seem exhausting and insurmountable efforts, it might mean that medically – emotionally and behaviorally …–>  Go back to #1.  Take care of “Me.”

Self-Care Tip – To connect because you want to even when you’d be advised otherwise, set your rules.

Other Fears of Medication For Brain Illness

Yesterday we talked about fears of addiction to medication therapy.  There are other fears that influence our choice to use or not use medication therapy for brain illness.

In clinic, we hear about people’s preference not to take medication, as if it were like ordering mushrooms or no mushrooms on pizza.

I am not someone who likes to take pills.

veggie pizza

Image by mccun934 via Flickr

Again, I think most of us agree entirely.  Who of us set out in life thinking, “I hope my life depends upon medication therapy?  I just want to have a reason to medicate.”

So tell me about this.  Questions:

  1. Are nonprescription substances safer for us?
    1. If so, why?
    2. If not, why?
  2. What are other risks you fear of taking medication for brain illness as compared the risk of brain illness remaining and likely progressing untreated?

Fears can provoke us to grow stigma and biases.  However they can also be used a tool for getting friendly with ourselves.  We can use our fears.  We can use them to gain clarity to know better why we are making our choices – stigma? Or friendship to Me?

Nothing is all right or all wrong.  But we should know our motives if we can because of it’s potential usefulness.  It is a friendly thing to do.

Self-Care Tip #285 – Know your fears so you know why you are making your choices.