Medicine

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What do you think they need to hear?

Hello, Friend to Yourself Community!

Please let me know what you think these fine folk need to hear from us?  It is our chance to talk to college pre-med students!

English: red apple

This is the caption of our invite-letter:

Dear Dr. Quijada,

Thank you for participating in MDCN 204: Introduction to Medicine at —-University. It is my pleasure to have you join our lecture series this year. 

Students are very excited about the prospect of meeting a physician and learning more about medicine. For many of them this is a firm choice and they would like to add to their knowledge base, while others are simply exploring medicine as a possible health career. Many students in the class are freshman, but several are sophomores, and juniors; a few of them are seniors.

I am really looking forward to hearing your thoughts, questions, if you were them, and recommendations.

Thank you friends.  Keep on.

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Getting Yourself Healthy Protects The Freedoms of Others

hey if you are too stinky we will ask you to l...

hey if you are too stinky we will ask you to leave not really sorry (Photo credit: stevendepolo)

Some of our most difficult cases are when we, the medical care-givers, think we know better how to take care of someone than we do take care of ourselves.

When a person maintains decision making capacity, but whose brain health disables them, if we care, we care.

Monty was one of these.  He was ill!  He was ill on so many tectonic plates, no one near him could keep their footing.  His quality of life wasn’t what he wanted.  He was disconnected from meaningful relationships.  He was suffering.  However, he couldn’t decide to engage in therapy.

Monty wanted to go “natural” but couldn’t name any natural therapies he’d be willing to try.  He didn’t want to continue suffering, but couldn’t accept medications “just yet.”  We went into one option after another, invested time together learning about brain illness and coming to terms with the biological involvement in where emotions and behaviors come from, and we did it many times.  Monty had a full informed consent.

Deciding not to treat or to treat is not easy for any of us.  Watching Monty step away into the foggy chaos of sex abuse and obsessive compulsive rituals was really hard.

We fight for our freedoms when we fight brain illness.  I suppose we fight for the freedoms of others as well, simply by taking care of our own selves.  Letting Monty choose even when his choices are affected by his illness is still his right and I defend him.  We all who take care of ourselves have more to offer Monty than if we didn’t, including a defense against the losses that brain disease brings – like processing information.

I’m not sure yet how to explain how taking care of ourselves influences the freedoms of those around us who are less inherently free by brain illness.  I suppose like anything good, freedom is contagious, a little bit of light in any room, Love being stronger than death and the Gettysburg address – this is along those lines.  It makes a difference to the Monty’s out there that we all take care of ourselves.

Self-Care Tip:  When frustrated that you can’t help others, get yourself healthy.  It’s contagious.

Question:  Have you been in the place where you thought you knew what was better for someone else then that person’s own choices?  How did you deal with that?  Please tell us your story.

Recommended Reading:

Why not skip medication And Go Natural?

Mistaken Expressions of Freedom and Medication Compliance

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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

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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.

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What Makes A Doctor-Patient Relationship

Power

Image by JAS_photo via Flickr

In our last post, The Struggle in A Doctor-Patient Relationship To Not Get Personal, your comments were critical to bringing it all together.  So much so, that I think it’s worth our time to review the main points about the doctor-patient relationship.

1.  People wonder about how to relate or conduct themselves.  It’s not clear and there are no directions.  In fact, for something so objective, why isn’t it?

  • a subject I have often wondered about – Cindy Taylor
  • when I see the new Doc, I just tell my story and describe symptoms????  – Sekan Blogger
  • hope that those professionals would be much more upfront with their patients – Nancy

2.  The professional distance itself between doctor and patient lends to the healing process

  • The doctor patient relationship is one thing that makes healing possible – Pattyann
  • if friends could help me I wouldn’t need to see a professional… – Patricia
  • distance …is such a strength – Kate Shrewsday
  • something far more greater than what a friend could provide and if I knew the intimate details of her life, that would have changed – S Sanquist

3.  The exchange of money for service is generally part of its constitution and brings motives into question.  Is there a price for the value of a patient’s health or even life?

  • You better keep me alive or there will be less money for you to make – Carl D’Agostino

4.  Power Imbalance

  • health professionals and I are not on the same social level when I am the patient and they are my health provider – Val
  • It (is) a loss to move from friend to patient. That is just how it has to go in the self-care process. Then there is the anxiety of the Dr. discovering who you really are and perhaps being disappointed. – M
  • same fine line in the teaching profession – Sarah McGaugh
  • most of my relationships have some sort of power imbalance – Shout Abyss

In truth, all relationships have an imbalance of power.  In healthy personal relationships, there is a flux in power, back and forth.  It’s a problem if they don’t pulse and is possibly one of the signs of an abusive relationship.

However, this doesn’t hold true in doctor-patient combos.  They are imbalanced by design and stay that way.  It feels counterintuitive at times to those involved.  But a good physician is like a good book – he/she/it is there for Me.  It is a unidirectional relationship.  There aren’t many good unidirectional relationships otherwise, …except for all those others.  You’ve heard of police, cashier’s, housekeepers, entertainers or, for example as Sarah reminded us, teachers.  But these are professional relationships and none of these are personal either, are they?  Unless you’re human, and then they are.  Oh bother!

Self-Care Tip – Find out what pleases you and what bothers you about your doctor-patient relationships.

Question:  What does please you and what does bother you about your doctor-patient relationships?  How do you imagine it would be if it were even better for your needs?  Please tell us your story.

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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
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Why Psychiatry?

An American Lady butterfly against a cloud-fil...

Image via Wikipedia

If we have ever seen a psychiatrist, then there has been some point in our lives when someone told us to go or we told ourselves.  I have some questions for you.

How did you hear about psychiatry?

What are your thoughts?

What did/do you understand?

Please tell me your story!

Self-Care Tip – Explore your connection with psychiatry.

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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.

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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.

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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.

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Guest Post by Richard

Chronic pain

Image via Wikipedia

Guest Post by Richard, who was kind enough to send me his recap on last night’s Self-Care Workshop:

Salient points:

  1.        We are not special by our pain, we are special by who we are.
  2.        I use what I have (am).
  3.        The natural laws stay constant. There are small differences between each person. The divisions are flat.
  4.        Benefit of medical evaluation first to rule out physical causes, then look at outside of medical.
  5.        We inflict the pain not the biology.
  6.        We are in the present, trying to reach goals that will never be completely reached.
  7.        The agenda within, (such as your job.)
  8.        Unwrap and fight for your freedom, illustrated by our national history.
  9.        Stigma is biological.
  10.       Guilt is not always a choice.
  11.       Relinquish opinions of others. Cannot  change how others consider or view us as related to those who knew who we were at a different point in “our story.”  …I guess stigma is in the eye of the beholder?
  12.       The initiation of self-care is a difficult first step.

Question: how do you get loved ones to take the first step or do you?

-Richard

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Taking Care of Our Own Emotional Junk Empowers us Not to Take Care of Theirs

Women Only - Choose your Favourite-Bangalore-n...

Image by najeebkhan2009 via Flickr

Yesterday we started a narrative series on understanding where emotions and behaviors come from:

  1. Emotions Are Contagious
  2. Our own Emotional Junk (today’s post)

Yesenia and Rob chorussed,

Yes! I am worse when Yesenia is not doing well. Who can cope around that!?

Yes! Rob is making me sicker!

Saying emotions are contagious is not the same as explaining causality or fault. It’s talking about an influence. I didn’t want Rob to misunderstand me. Saying emotions are contagious is information to use to empower us; not to make us feel like victims. It is to help disclose our own vulnerabilities, our own needs and our own quest towards healing and presence.

But how to be present with “falling knives,” as Cindy described this in yesterday’s comments?

It starts and ends with Me. So getting back to Me simplifies things and short-cuts our confusion.

It’s easier for us to be around so much charged air when we have already gone toward our own flaws, pain, emotions and anxieties. It is easier for us to not make something personal that isn’t if we have already stayed in our own nasty space for a time, did that process over and over, and each time stayed long enough to see what is there/what will happen until we realize – not much. (That was what I like to call a “super-sentence!) Taking care of our own junk helps us be available for other people when they are spilling theirs. We are less controlled by shame and fear.

This may not happen when complicated by our brain disease. Personalizing things may be inevitable if we do not get medication therapy. Being present with our own journey might not happen without medical help.

Sometimes when we are ill, we feel like we are spectators of our own life story, standing off to the side, just watching the show. With healing, we join with that living active self and can be present and whole. With healing, we don’t have to personalize someone else’s emotion-spills. With healing, we can improve our quality of life. When they don’t fight for brain health, such as taking needed medications, or whatever it is that would have been friendly for them to do – we don’t have to make it about us.

And! And if we choose to, we can be with them. We can be with the people we love! Isn’t that great?! Even when they don’t do their own self-care. Even then. Or not. But we are choosing now rather than reacting defensively.

Kaily said it yesterday like this,

Now, when I notice that my mood is starting to mimic the negative mood or negative atmosphere around me, I stop myself and realize that just because those around me are negative, stressed, uptight, etc., I have the choice and the power to stay positive and at peace within myself. Just because everyone else is jumping off the cliff doesn’t mean that I have to follow.

Self-Care Tip #268 – Taking care of our your own emotional junk helps you not try to take care of theirs.

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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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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.

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Choose The Learning and The Teaching You do, and That is Done To You: Patient-Doctor relationship

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Self-Care Tip – Choose the learning and the teaching you do, and not be passive to it, when in your patient-doctor relationship.

Hearing a physician tell us when we can and cannot take medications is somewhat private.  In our culture in our “advanced” and liberated age it isn’t so easy to feel handled like that.  But feeling handled verses helped is our choice.  It is all the more reason to dig in our fears and see what scares us.  If what we find there is that our fear is playing into keeping us from receiving this information, and decide actively if that is really in our best interest.  Emotion has it’s own activity, different from a muscle in our arm.  When we respond to the emotion, and especially if we respond before we do this kind of digging into the fear, we might not actually be doing protective behavior, like our fear would have us believe.

We have talked a bit in previous blog-posts about the patient-doctor relationship being a team effort.  It quickly became apparent that some of us don’t perceive that we have the luxury of working with a physician who see’s their patient as a person to learn from and influence their treatment decisions.  But it is still important to know that this exchange is critical for us and then to let that knowledge progress to a wanting in us to have this dynamic relationship with our physician.  The knowledge and the wanting will have their way in us and in our communities subsequently.  We do not know how long that will take but it will happen.

The marvelous scientist, Deb Roy, from MIT talked about his research on language development.  It was of course extremely endearing as it began with his work with his own infant baby and hooked us both by the intimacy of it and the marvelous discoveries.  Then after we were oohing and ah’ing (most appropriately because this is AWESOME stuff!) he moved us into our cities and media and showed us with his data and eloquence that in order for learning to happen, the professor and the student, the sales rep and the client, the physician and the patient, the parent and the child, both learn and teach simultaneously.  Whether it is subconscious or conscious.  The baby teaches the parent to teach him better and the parent learns this from the baby.   The physician teaches the patient and the patient teaches the physician to teach him better.

Both roles of instructor and student you see requires humility to learn and teach.  They both push into private spaces of the other.  Without consent, either conscious consent or subconscious consent must be there, it will not happen.  So this is consensual, even when we do not realize it.

Now what do you think the friendly thing is for us to do for ourselves, considering this growth in our knowledge?

Of course.  We will be more effective if we embrace this knowingly, willingly, humbly.  Move this learning process from the subconscious to the conscious level.  Make it as deliberate as possible.  For both physician and patient, this is good self-care.  Accept that when we engage in a patient-doctor relationship, we are giving that other person admittance, by our will and choice, admittance to that private space inside of us and not feel the victim when they enter.

Questions:  How has feeling like a victim sabotaged your patient-doctor relationship?  How have you worked past it in a positive way for both of you?  Please tell me your story.

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Choose Back! …As Long As Life Chooses You.

A Girl On A Footbridge

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Self-Care Tip #241 – As long as life chooses you, it is your right to choose back – so do.

Although I am not a geriatric psychiatrist, I have still been given the pleasure of serving a “golden” few.  What has impressed me has been their willingness to start over.

Starting over takes courage and humility whether it is deliberate or not.  Sometimes fear dances between the lines of all the emotions and intentions. But still, wouldn’t you agree that it takes courage and humility to negotiate fear?

(Enters Hans.)  Hans was seventy-three years old.  He had struggled with brain illness on and off he thinks since he was at least twelve.  There were big spaces of time when his disease exacerbated, and he largely suffered.  But he chose, at this age, to try again for improved brain health.

Is there a time when we start thinking, don’t keep trying to start over?  Maybe in the dying process.  In case you don’t know, the dying process is a specific term.  It means the time when a person is facing impending death.

This area of medicine is not my specialty but I imagine at some point we want to stop with that starting over process, give up, but not in a hopeless way.  In a way that says,

I can stop trying for new anything and sit in the space of what I already have in me…

…Which hopefully includes all the ingredients and interrelations of life.

But how far before that point in life do we consider starting over reasonable?  I’ve heard of kids being told they’re too young to ride a bike, or cut with a knife, or understand the dinner conversation.  No one bobs their head at that.  But find a seventy-three year old who believes that after a lifetime of perceived failure by onlookers or themselves, who still says,

Now let’s give this another go,

…and if it hasn’t been said, it’s been thought,

give it over already!  You’ve hit your seventy-times-seven chances!

It’s like they’re shopping in the teen-ware.  We blink our eyes and angle our heads.  Even the thought of starting over as a real option feels indiscreet.

(Enters Hans.)  Hans is seventy-three.  He is starting over.  Humbly and with courage, he pursues brain health in the face of stigma.

I think I had celebrated my six birthday when my dad asked me if I felt any different from how I felt when I was five.

Yes!  I feel older!

 Then he asked me how old I thought he was.  When I answered some enormous number like, “twenty-two!” he asked,

Does forty-four seem old to you?  

Of course it did!  But I had an intuition that if he was old, than he’d die, so I said a definitive,

NO!  Daddy you’re still young!  You aren’t old!

Now, almost that same age myself, I am in awe of him and the others in their golden or not so golden years (Enters Hans) who believe that as long as life chooses them, they will choose back.  It is their freedom.

Questions:  When all your senses don’t sense pleasure in life, or you feel old and useless, or you feel that you’ve failed too many times, how do you choose to start over?  Who has inspired you and what did they do?  Please tell me your story.

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Patient on Patient Crime – Our Response to Our Own Illness

a "low profile" sole provides a grea...

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Self-Care Tip #238 – Think about your response to your own behaviors and emotions.

Bianca agreed with her husband.  She was too depressed.  She never wanted to go out and cried a lot. Perhaps she even deserved to be cheated on and abandoned because she was so unbearably dull.

Pause button.

We have discussed where behaviors and emotions come from – the brain.  We have identified the brain as human material, matter, biological and as susceptible as anywhere else on the body to illness.  In short, We could say at this point that Bianca is in a Major Depressive Disorder – a medical disease.   There are many medical diseases secondary to design, behaviors or lack of behaviors.  Or for other reasons.  However, I don’t know many medically ill that when the spouse walks out on her, we say,

Well of course!  She had cancer!

Or,

He lost his leg in a car accident, get someone else!

But throw in some aberrant emotions and behaviors for unacceptable time, and the escaping spouse is given running shoes as a gift from their concerned community.

How could he stand her!  Of course he left.  She wasn’t taking care of his needs.

You see the disparity and when written this way, it looks really ugly and I apologize.  I’m not trying to thumb people for biases and prejudice.  Both parties are hurt.  I’m also not trying to say that this happens only in marriage.  It happens in almost any setting.  Emotions and behaviors are just not considered to be symptoms of disease.

Have you ever heard the term, “Women on women crime?”  Well this is something like that.  I’m thinking much of this will improve when we treat ourselves with more insight and understanding consistent with our biopsychosocial model.  If we don’t do this first, who will.  We aren’t responsible for how others treat us, but we are responsible at least for ourselves.

This is one more wonderful way of claiming our right to say, self-care starts and ends with Me!

Questions:  How can we wrap our beliefs around this seemingly enigmous concept that when someone is crotchety, negative, irritable, inattentive or boring – it might not have been because they chose to be that way?  How do you own if in yourself?  Please tell me your story.

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Self-Care As it Affects Your Professional Self

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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.

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

Not sure where to look

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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.

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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

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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

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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.

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