Health care

by

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

Related articles
by

An Introduction to Self-Care | Journal of Participatory Medicine

logo

I thank the talented editor and friend, Sarah McGaugh of birdinyourhand, for 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.

Related articles
by

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.

Related articles
by

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
by

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.

Related articles
by

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.

Related articles
by

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.

Related articles
by

To Catch What People Throw At You, Give a Little or You’ll Drop It

Football: Jets-v-Eagles, Sep 2009 - 16

Image by Ed Yourdon via Flickr

Sometimes it doesn’t serve us well to follow our instincts.

When I was little, I don’t know, maybe nine, I remember one of the many times Dad tried to teach me how to throw and catch a football on our front lawn, under the huge tree that seemed to always block me. Dad had played college-ball on scholarship at Duke University where he promptly blew out his knee; one of the many orthopedic problems he’s known. However, he still had his arm and his gentle way of making me feel like he really enjoyed lopping the ball over short distances with me and my awkward hands.

Catch the ball right here, into your arm like you’d cradle a baby.

Nobody needs to try that many times before learning that footballs are hard and pointy and hurt a lot when we catch them wrong. Purposefully putting my body in front of that spinning high-speed object didn’t feel safe.

Get in there and watch it the whole way make contact with you as you catch it.

My eyes were still shut when he said that. I was trying not to cry but I was pretty sure my fingers were going to look differently when I opened them.

Here came more less obvious instruction,

Let your arms and hands give a little, while you catch, closing down on the ball as you let it push you.

People throw all sorts of things at us in the space between “me and thee.” It can hurt to catch and even physically damaging. But counterintuitively, we need to catch like we are cradling a baby, get in there, and give way a little.

This isn’t always advisable but it refers to opportunities to practice presence. Not every interpersonal moment is such an opportunity. Nor will each true opportunity be received naturally or effectively. Those will improve with practice, or perhaps coaching or medical intervention.

The other day, Frida told me with some self-satisfaction about the long hoped for day when she stayed with her daughter during her daughter’s anger, rather than escaping. She gave space for her daughter to throw her pain around. Frida cradled her in her personal space long enough to receive and throw back. For Frida, what she threw back was the next effort of growth. That day we celebrated the presence she was able to offer her daughter and herself.

Now get in there Frida, let it come into you. Give way to some of the momentum or you’ll drop it, and cradle what you catch.

For Frida to do this, she owned her choice to find the presence and to do the work to gain the skill. As I am a medical physician of the brain, you might guess we worked on her illnesses. Frida stayed, received her presence in the company of her daughter – and we celebrated.

Self-Care Tip #284 – Give way to some of the momentum and cradle what you want to be present with.

Related Articles:

Sucking Up to the Boss May Move You Up and Keep You Healthy

by

Grief Can Be Treasured At The Same Time That We Celebrate Life

Self-Care Tip #283 – Find the treasure in your grief while celebrating life.

Today is my daughter’s sixth birthday.  If ever there was a person who doubled the love she received, it is this chid.  She is all passion.  Yes, both ways, but that isn’t to judge.  Just, there is so little I can offer in words to describe her power of self.

They're asleep!

Image via Wikipedia

Tonight, we pushed two twin beds together so she and I could sleep beside each other.  Her sister slept nearby on another twin bed.  Her brother set his bed up in the closet.  (I know.)

If I wasn’t so tired, old and broke, I might be made vulnerable by times like this to having more kids.  Since that’s not going to change, these chubs are what we will stick with.  Happily.

My mind is turned toward God by this girl.  I somehow arrive in the moment praying when with her, perhaps for strength and patience or for humility and gratitude.  I learn from her.

Mommy, when I’m scared I talk to Jesus.

Often in times like this, I think of my niece, dead now six years, and how her parents and we wanted what was, what was stripped.  Still grieving and still living the life with us and in us, our braided thoughts and emotions easily lose their flow.

But today I have this clarity.  My niece is gone now six years and ten days.  Today my daughter is six years old.  Today I am sleeping with my three children.  Today I know that this is precious but this is not all we want.  We want what comes after our living years.  We want to let loose to Love the grief and the life; to untangle.  Not more.  Not less.  But we want.  We want what we have, now, although still in the unknown dimension of our forever.

In psychiatry, we are alert to grief that warps the ability to engage in life.  Grief that mars the connections of survivors.  Grief that becomes pathology, brain disease and a medical condition.  This grief disables and, for example, in the case of my daughter’s birthday today, would dissolve my ability to feel pleasure.

It is difficult to gain access to treatment as many of these survivors have ill opinions about medical care.  Such as; fearing medications will mute their connection with the deceased; mute their grief, or in other words, tribute/offering to the deceased; take away the personal punishment for surviving…

Questions:

  • What do you say to these weeping lives?  How can we de-stigmatize medical care for them?
  • How have you been able to treasure your grief and the life with you and in you?
Related articles
by

Stop! Don’t Stop! – Affecting Our Practice Of Medicine and Other Agendas

Self-Care Tip #281 – Be aware of how your “Stop!  Don’t stop!” behavior is interfacing with your agenda.

One of the challenges in practicing medicine is the inevitable “Stop!  Don’t stop!” petitions.

stop & go

Image by Joseph Robertson via Flickr

It’s similar in a few ways to being a shoe cobbler who receives clients that don’t want her to use leather.  Ms. Cobbler spends 40-60% of her time with clients persuading them of her capacity to use leather, the objective and subjective evidence behind the use of leather and empowering her clients to wear their leather shoes despite public opinion.

This sounds silly and is not meant to be disrespectful to patients, including myself as a patient of physicians and my own difficulties being a patient.  It is only to describe the forces we are all working with when we work together in medical care – physician and patient.

Quenn came in reminding me of this.  Quenn was a 32 year-old married mother of three, who complained of trouble swallowing, sleeping and ability to feel pleasure over the past two months.  She had struggled with this after her mother died nine years ago, but the problems went away over the following year.  However nine years-ago, Quenn was not a mother.  Nine years-ago, Quenn could shake, stay in the house with the shades down, silent or crying loudly, not eating lying in bed for days and if she wanted, nine years-ago no one would know.  This time however, Quenn told me she was desperate.

I have to get better!  This time, I’ll do anything!  But please start with something natural.  I don’t want to get addicted!  I’m someone who never does meds.”

Quenn, why are you seeing me?  

This is challenging for everyone.  Together, the physician and the patient work with this influence on their agendas.

My brothers and I used to play a game on each other when we were kids.  Maybe you did this too.

Stop!  No don’t!  Stop!  No don’t! Stop!  Don’t!  Stop! Don’t! Stop! Don’t stop! Stop! Don’t!  Don’t Stop!  Don’t Stop!

And for some reason that was hilarious to us.  I like to remember this when I’m in the office and smile despite being played by the “Stop!  Don’t stop!” behaviors and emotions.

Questions:  How about you?  How are the “Stop!  Don’t stop!” behaviors and emotions playing on your agendas?  Please tell me your story.

Related articles
by

The Growing Process Shifts From Shame and Fear to Friendship

Hello Friends.  Tonight ends our pilot run of the self-care workshop series.  Whoop!  Thank you for your support.  Very much.  The growing process, when in the company that we have here, shifts the experience form one of fear and shame to one of …well this:  friendship, with you and with our own selves.

One of our participants was kind enough to send me his recap,

Some of the points that were most important to me were:

  1. Going toward our temperament/the languages we use,
  2. Invest in your bank,
  3. Going against your intuition,
  4. The energy balance as illustrated by the triangle diagram,
  5. It doesn’t always feel good to perform self-care.
  6. categories in the bio…model and how they interrelate, i.e. biopsychosocial model.  (Smile.)

Pretty good! Huh?

This was written after our second week.  After tonight, we can add,

  1. Accountability for our flawed self doesn’t mean blame or fault.
  2. Our flaws become part of our opportunity for growth and personal presence.
  3. Self-awareness is a tool for,
  1. Understanding our agendas,
  2. Bettering our sense of presence,
  3. Freedom that is ours independent of our effort, morals, or any human quality
  4. A freedom that we want to fight for with everything we’ve got to preserve.  I.e., a freedom we can lose.
  • Using the biospychosocial model as a tool for,
    1. Understanding where our emotions and behaviors are coming from
    2. Understanding where emotions and behaviors of others are coming from – such as STIGMA

    I wish I had another summary from one of our participants rather than my own.  I can make this so much more complicated than it is!  I am learning.  I am flawed.  I am accountable.  I am not blamed.  I am in the company of friends, including myself!  Whoop!

    If I get another summary though from “someone,” I’ll pass it on for your perusal and comments.

    Again, thank you and until tomorrow…!  Keep on.

    Related articles
    by

    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.

    Related articles
    by

    Introduction to Self-Care

    Questions:  How do we collaborate with our patients, or with our clinicians, to take action on behalf of health?  What can we as clinicians or patients do to teach, learn and practice the tenets of the field of self-care?

    Self-care is living consistently with the belief that the success of our health (emotional, physical, spiritual) begins and ends, not with “me,” but with “Me.” To teach and practice self-care comes when we understand that the essential self, the Me, is always worth fighting for, always worth the journey, always of value even in the throes of mental illness.  Here at FriendtoYourself.com, we work to define and teach self-care daily, we attack guilt, we stand up to shame, we live as we choose despite stigma and we work harder than we ever have on perhaps the hardest job of our lives.  Self-care is not weak but rather courageous.  It brings us to humble accountability for our lives, not seeking to erase our history but still reminding us that we are free to start over any time.

    I will be writing a series of blog-posts outlining self-care in which we will examine the tenets of self-care: self-knowledge, presence, moral neutrality, and connection. We will look at self-care as an essential practice for both clinician and patient, examining the ways in which a self-caring clinician may, in turn, provide better care to her patients, and patients take better care of themselves.

    Self-Care Tip #260 – Clarify what it means to be your own friend.

    By the way, check out a still unknown glorious writer at ASkirtAWeek.com.

    Related articles

     

    by

    Self-Care As it Affects Your Professional Self

    Of the patients waiting at the Out-Patient Dep...

    Image via Wikipedia

    Self-Care Tip #236 – Think about what self-care is doing for your professional self.

    When speaking with managing editor of the Journal of Participatory Medicine (JoPM,) Kathleen O’Malley yesterday, I struggled to explain the presumed simple description of what effect self-care has had over the past many months on my professional self.  I realized that I hadn’t spoken much about that yet.  The words spilled out, messy and ungraceful.  I’d like to say it better so I’m going to try again, and then many more times.  Self-care has helped me be a better physician.

    I 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 a friend 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.  Yes.  My quality of practice has definitely improved.

    Who isn’t blessed when they see 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 when disease is damaging them, fights hard like my niece did and shows what that fight is worth?  Who doesn’t learn from that?  Who doesn’t want more?  When someone loses their identity to the defacing ravages of disease but still knows who they are, is for me, one of the best places in the world to be.

    Working harder on myself personally is working harder to improve myself professionally.  One healthy is another healthy Me.  Self-care has helped me find more pleasure at work because I know I am responsible about how I feel when I’m there.  I take care of myself when I’m there and then I’m able to give more to my patients because of it, including just being present.

    Being present is really a lot to get and a lot to give.  I sense this in my kids who want me to see them.  They call out for observation of activities; riding without training wheels, jumping super high, running in fast shoes, building awesomeness.  But those are code.  They want me to see them.  I just can’t do that when I’m self-neglected.  It carries over in all spheres of my life, including the office.  Who wants to consult a physician who is half asleep in the chair?  (Now if I need a nap, I just go all the way and sleep! j/k.)

    I know my self-care is participating in the practice of this kind of medicine with you.  I’m hoping to get better saying it.

    Questions:  What has self-care done for you in your professional world?  How has it helped you work better as a team-member?  How has it helped you receive better from others who have something to give – such as teach you or give directions?  Please tell me your story.

    Related Articles
    by

    Participate – Work as Part of A Team With Your Medical Providers

    Katrina-14841

    Image via Wikipedia

    Self-Care Tip – Work as part of a team with your medical providers.

    Today I had the pleasure of speaking with managing editor of the Journal of Participatory Medicine (JoPM,) Kathleen O’Malley.  Ms. O’Malley spoke to me about the effort they are making in this online journal to collaborate the work between patients and physicians.  Ultimately, their goal is to eliminate the barriers that keep us each from seeking to learn from the other’s perspective and knowledge.  She tells me that,

    We are a team.

    When my brother Vance’s baby was born, she was damaged and premature, so tiny and needed 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 really want to remember it anyway.  But when I cannot help myself, what I like to think of is how my brother and sister-in-law were treated.

    The physicians at UCSD were unbelievable.  Vance told me, with somewhat pressured speech from his amazement, how they, without hesitation, included him in their daily decision-making and informed him of any medical study results.  In case you don’t know, in case you have never been sick or been in a medical setting otherwise, this does not always happen.

    I know I am guilty of this too.  Hovering over charts, hiding laboratory results, many of us practitioners behave as if our patients were at any moment going to throw us into court.  It is embarrassing, even though the truth is, too many of us physicians are stalked by litigious intentions, whilst the hoards of truly awful practitioners seem to sail away on unsinkable malpractice without pursuit.

    Ms. O’Malley and the JoPM are working with all of us to put the bows, arrows, guns and weaponry down and take two steps back.  It is Thanksgiving-day every day there (I call Pocahontas!  I look good with brades.) and at the safe-place that this journal offers, we can learn from each other.  We can collaborate.  We can be vulnerable and not be preyed upon.   We can be sick, we can teach, we can simply observe and hope that like my niece, in time, we will find ourselves growing up in health and love more so because of it.

    Please take a gander over to JoPM.  Say hi to Ms. O’Malley.  Read some of the stories from patients and physicians.  Comment if you will and participate for self-care.  It is your right.  You are free to choose.

    Questions:  When you have had, or been proxy to (as I was with my niece), a spectacular patient-doctor exchange – what made it so great?  How did you “participate?”  How did participating make a difference for you v. “being mere passengers?”  Please tell me your story.

    Related Articles

    by

    Where to Find Your Council On Self-Care Outside of Yourself

    Not sure where to look

    Image by quinn.anya via Flickr

    Self-Care Tip #226 – Find your council for self-care outside of yourself with psychiatry.

    Many may wonder why a psychiatrist would talk about being a friend to yourself.  People who know psychiatry involves medicine, who think psychiatry excludes psychotherapy, who think self-care is holistic (i.e. holistic they interpret as non-medical) or who don’t bridge the gap that voluntary choices and choices regarding what is involuntary is still self-care – these people may wonder…  It’s no fault or judgment, it just is, as we like to say.

    After all, psychiatry has changed a lot in the last thirty-plus years.  This category of people I speak of includes even physicians.  It is not easy to keep up on each other’s specialties.

    I make my case for “microphone-time” (taking liberties to speak on this) based on the Biopsychosocial Model.  I boldly say that because Psychiatry flattens the planes between biology, psychology, sociology, then Psychiatry should speak up on self-care.  It is a broad perspective and often with some affecting differences from religion, clergy, laymen, psychology or other therapies by reputation (I’m not speaking about individuals.)

    The beautiful bridge linking voluntary behaviors and emotions with the involuntary, and how that relates to our choices, our self-care, our freedom, saying all health begins and ends with Me is an enormous step in friendship with oneself.

    Questions:  Where do you find your own opinion on this spectrum of thought?  And why?  What has your experience been with this?  Please tell me your story.

    Related Articles
    by

    The Patient-Doctor Relationship And Self-Care

    Viral pharyngitis. The oropharynx is swollen a...

    Image via Wikipedia

    Self-Care Tip – Explore self-care in ways where you do have choice, including healthy alliances with your connections.

    PattyAnne came in knowing what she wanted.  She was sure she was struggling with ADHD because she could not focus, she had difficulty connecting with others and she was impulsive.  This was limiting her intimacy and ability to love and be loved by 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.

    Getting ADHD as a diagnosis would explain to the people she would hurt why she hurt them.  It would give PattyAnne a name for the chaos that followed her or preceded her – she could not tell which.  Having a diagnosis that comes from a figure of perceived authority, say a Doctor of Medicine, offers this.  It is much like a judge who pronounces us innocent and another guilty.  This is not a bad or good motive.  It just is.  It is natural, as far as I can tell, to want to get away from implied or direct negatively perceived labels.

    As a practitioner, it is not that easy to resist the lure of treatment when it would be so 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.  These pressures are real for any practitioner and many have wondered if the frequency of prescribing is affected by it.  For example, it is estimated that 73% of doctor visits for sore throats result in antibiotic prescriptions, but over 90% of sore throats do not respond to antibiotics.   (I know.  That is 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 thinks she needs is my signature.  It is not easy to be a patient.  Being a patient is a hard job in fact.  It requires at least some insight or 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 does not know that I’m ADHD!”

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

    Questions:   What does a doctor-patient relationship mean to you?  How do you see your involvement in choice and control inside of it?  Please tell me your story.

    Related Articles

     

    by

    Self-Care Woven and Unravelled Simultaneously for Best Results

    Change is good--Kente Cloth Loom

    Self-Care Tip #222 – See the different parts of your self-care as independent yet dependent on each other.

    One of my truest pleasures would be to teach well.  My temperament is, per Myers-Briggs, designed to be a teacher and I agree that I feel inner congruence when I’m doing just that.

    …If you’re feeling your hands closing into a bracing grip, it is probably because you, like many, really don’t want to be schooled – which has happened in my less refined moments, so caution is understood.  This is not what I hope to do here.

    After yesterday’s blog-post and comments received, it shows that I have not taught as well as I implied to myself.  Implied intimacy is a danger of any familiar relationship, including with ourselves.  The beauty of you guys, is you help me say things “out loud” decreasing misunderstandings.  You guys are teaching me and I thank you.  So whatever this is we are doing, learning, schooling, teaching or whatever it is that Mr. Rick C. does – what we are doing here together is mucho-much fun.

    As we unravel the rug together, we see these threads,

    • emotions and behaviors appropriate to context – yesterday we spoke about guilt
    • emotions and behaviors inappropriate to context – yesterday we spoke about guilt as a symptom of medical illness
    • the magical miraculous beyond our current understanding – before we “see face-to-face” – yesterday Carol Ann mentioned the changing power of God
    • freedom to do self-care and related choices
    • what choice yet remains when other choices are lost either by action or disease
    • (this last one I’m just putting in here to finish the pretty rainbow) – helps me get in the barn where I’m comfortable

    The reason I think it’s important to see these together yet apart, as well as we can (through a glass dimly), is that too much of one or another of these, diminishes the results of our self-care intentions.  Don’t mistake this for preaching that one can get too much of God in their lives.  It just isn’t true and not in our best interest to get waylaid.

    Questions:  How do you see yourself more effective in your self-care efforts and what has influenced those improvements?  In what way have certain bits of your self-care gotten “too much” attention?  Please tell me your story.

    Related Articles
    by

    Living Where We Feel Safe is Part of Self-Care

    Self-Care Tip #213 – Live in safety.  Be a friend to yourself.

    In My Fridge

    Image by Nikita Kashner via Flickr

    I love psychiatry because for me it is a safe place.  A place where I am comfortable pushing aside distractions.  The blinking lights disappear and I don’t have to waste myself on B.S.  Some time ago, I told you about how Mom has been when Dad’s been hospitalized in the past.  When she pushed his tubing aside and just got in bed with him to hold him.  All that mattered then was Love.  They didn’t see the clutter any more.  That’s what psychiatry offers.  If we want, we  can come together and be real.  In twenty to forty minutes, we can hune and warp time and find a gravity where we breathe differently.

    Chewbacca

    Image by Andres Rueda via Flickr

    Unfortunately, I have found that the longer I do this psychiatry thing, the worse I am with life otherwise.  Whether I’m with the grocer, dog-trainer, my child’s teacher or person in front of me in the coffee-line – I just don’t graze well.  (See blog-post, “Do You Feel Pleasure.”)  I’m always yelling, “Hit it Chewbacca!” and we’re off at warp speed into asteroids of personal information; perhaps inappropriate to the setting.  (See blog-post, “Using The Force.”)  I hate to think what I’ll become when I’m more thoroughly demented and disinhibited.  These things just get more pronounced with age and soon I’ll just be that crazy Auntie with her bra snapped on top of her bathing-suit in winter yelling at the young kids to turn the music down so we can talk.

    The truth is, I’ve never been so wonderful in tinsel-town.  I found home and found that home needs to be a place where we are safe.  In fact, this is true materially in the home we live in.  It starts there and diffuses out.  If at home we are able to speak uncensored knowing we respect others and are respected because we are human, not because we have to earn it, if we can enter our kitchen and not fear temptation from chocolate chip cookies, open the fridge and know as an alcoholic the wife or husband didn’t buy beer, argue and trust that we are loved enough to be a priority, we know the issue won’t be lazily passed up, we know we are safe – then there is a ripple and a ring of safety and another ripple and another ring of safety and soon safety follows us because we just aren’t interested in anything else.  (That was a super-sentence.)  We have found home.

    Questions:  How do you define safety?  What feels safe for you?  How do you grow your circle of safety?  Please tell me your story.

    Related Articles
    by

    Get Your Butter Knife Out and Spread Your Biopsychosocial Self Together

    Grape Jelly is Spread Over Peanut Butter

    Image by Old Shoe Woman via Flickr

    Probably when you have thought about psychiatry in the past, before this blog, you weren’t thinking about self-care.

    What do you think of psychiatry?  Would any of you shout out a word, can I have a word, give me a word, any word that shoots to the front of your thoughts?

    Psychiatry has changed.

    There is a progression of how we view mental health now vs. even thirty years ago.

    Back in the day, things went along the lines of poisonous medicines, close the window because sunshine is unhealthy for you, surgery without anesthesia, maggots… drilling holes in people’s heads to let evil spirits out and offering cigarettes to calm the nerves – or cigars as I wonder if any of u would argue.

    Truth be told, I’m still learning about psychiatry.  I imagine I will be forever, because I think it is a science that flattens the universe and is unhinged from Time.  I don’t know how big or involved that is, but I’m thinking more than my sum of years can master.

    For now, we understand that there is interplay between biological, psychological, and social issues that make us who we are.  We call this the Biopsychosocial Model.  Pretty cool word – biopsychosocial.  It hit me last night when I was working over these thoughts that self-care can also be organized, framed, conceptualized and all that to help it make more sense to us.

    What is self-care?  Self-care is a philosophy that everything starts and ends with Me.  And that Me is all of me.  My biological, psychological and social self.

    Self-Care is teaming up with our biology.  So where do behaviors and emotions come from?  This to me is one of the most challenging questions to answer from a cultural and moral level.  Can you tall me your gestalt?  Where do our emotions and behaviors come from?  What do they mean about who we are?

    Self-Care is Empowerment and not victimization.  This is part of our “psychological” selves.  No one is responsible for our emotions but “Me.”

    Self-Care is knowing our Essence. This is part of our “social” selves.  Our Essence is what we find after we get sick, after we change in every way but one, it is our identity, who or what we are.

    To understand our essence, knowing our connections helps:

    Connection:

    1. God/Love
    2. People
    3. knowledge

    When we get sick, our identity, who or what we are – our essence might feel threatened.  Some people call this our “soul” instead of essence.  I found it interesting to think of the soul or essence as part of our “social” selves but it is and it helps me bring it all together better.  My soul is created for connections.  With you in fact.  And my soul has been more connected to the rest of me since you came.

    Self-Care is Freedom.  This is another part of our “social” selves.  You may remember that phrase, “To love someone, you have to let them go.”  Freedom brings connection.  Lovely, no?

    Now get out our butter knife and let’s smear all this together in a sandwich.  That is who we are.  Without dividers.  That is important if we plan on getting friendly with ourselves.

    Self-Care Tip #211 – Whatever is tripping you up when you go, blend it in with the rest of you and things will get more friendly (smoother.)

    Related Articles