A Reference of Blog Posts:
I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:Introduction to self-care self-knowledge presence moral neutrality trust (Today’s topic) patient-doctor relationship/connection
Question: How do we trust ourselves when we choose to trust our clinicians? What is your answer? Please tell me your thoughts. These are some of mine.
…Enters experience, temperament, and personal self-care/readiness to practice of the clinician.
Self-care does. Self-care is our tool.
The clinician living her own directives is university. Going to work in a state of readiness is instructive. At some level, her patient sees that self-care allows the clinician to go to work after personal needs have been attended to. The clinician then is able to give over space in time, place and emotion and make room for her patient. Who wants to go see someone for help but instead finds a clinician in role confusion? The opposite can also be true. The patient might mistake their own role and try to leave their real illnesses hidden, protected in the safety of their own expertise.
…Re-enters PattyAnne. Remember her?
PattyAnne was pretty sure that getting an ADHD diagnosis would explain to the people she had hurt a better why for why she hurt them. It would give PattyAnne a name for the chaos. Having a diagnosis that comes from a figure of perceived authority, say a Doctor of Medicine, offers this. It is like a judge who pronounces us innocent and another guilty. This is not a bad or good motive. It just is. To want to get away from negatively perceived labels, is.
As a practitioner, it’s not simple to resist the lure of treatment, when it would be easy to make our patient happy. It also takes a lot more time in patient education and building a trust relationship if we don’t agree with the patient’s self-diagnosis. Considering these pressures, many have wondered if the frequency of prescribing is affected by it. For example, it is estimated that 73% of clinician visits for sore throats result in antibiotic prescriptions, but over 90% of sore throats don’t respond to antibiotics. (I know. That’s robbery! Those poor other patients who got nothing for their copays! Not even a prescription!)
So in comes PattyAnne, diagnosis and treatment already in place. All she needs is my signature.
Being a patient is not always easy. It improves some with insight or at least the ability to receive insight, a vulnerable pose, humility, courage, self-respect and so much more. Maybe PattyAnne was thinking, “Oh boy. Now I got this woman who doesn’t know that I’m ADHD!”
We have each other and begin the adventure of patient-doctor relationship, an alliance and a connection.
Self-Care Tip #264 – Trust to improve self-care, and take care of yourself to improve your trust.
It starts and ends with Me.
- An abortion ruling that puts the privacy of women at risk | Kate Smurthwaite (guardian.co.uk)
- The many faces of a clinician (medrants.com)
- Choose The Learning and The Teaching You do, and That is Done To You: Patient-Doctor relationship (friendtoyourself.com)
Yesterday, we introduced self-care and today we continue with self-knowledge.
PattyAnne came in knowing what she wanted. She was sure she was struggling with ADHD. She could not focus, she had difficulty connecting with others, and she was impulsive. This was limiting her intimacy with the people she wanted in her life. PattyAnne had read about ADHD and was relieved thinking that taking a stimulant would improve her that much.
PattyAnne is rich inside, dark chocolate, not white, aromatic and effectively affecting. Being with her means being touched. When PattyAnne is good, her fresh aura in our shared space is healing. Many baffled by this wonder why, when she passes through, they feel so much better.
Consistent with this intensity, when PattyAnne is not good, whatever comes from her is chemical warfare, and we are not safe. You can leave, but you will always leave touched. Any time with PattyAnne feels like either too much time or too little. We are wanting: wanting more or wanting less, somehow with PattyAnne, we will never feel satisfied.
This is part of why PattyAnne projected confidence while self-diagnosing. Her temperament and coping skills predisposed her to do it. Self-diagnosis in her and others also happen because of fear, lack of trust in their medical provider or defensiveness per their feelings of inequality.
There are good things that come with self-diagnosis to consider.
- Self-diagnosis is always informative. Always.
- Clinicians may use it as a tool to build trust. When not put off by self-diagnosis, clinicians might recognize these opportunities.
The self-knowledge each of us has on either side of the patient-doctor relationship is not inherently dangerous, and consider the inverse. Clinicians come to the room with their own self-diagnoses as designed by biases and countertransference. And which clinician is not also a patient? There is good with bad and we have a choice, as always, within stories within stories….
Patients and clinicians perceive self-knowledge, at least in part, as self-care, and we are right. Like Dad says, “Knowledge is never wasted.” How many times have clinicians asked why patients do not try to educate themselves about their disease? To begrudge them for it is to deny the value of that process and what clinicians also do under the guise of a license to practice.
Any of us can imagine that for both parties, these types of encounters cost emotional and physical energy. For PattyAnne, we have mentioned already that she came defensive.
For me, I regret the times when I did not own responsibility for my feelings. When a patient self-diagnosed, I too quickly assumed mal-intent, personalized behaviors and missed my opportunity to benefit from the connection inherent in the patient-doctor relationship. This is what I wanted to avoid with PattyAnne.
I celebrate, however, these past many months our work on FriendtoYourself.com. I experience much more pleasure in my profession. I am even more clinically effective by taking care of myself first; by being present with myself. My self-care professionally mirrors my personal self-care in that when I am first able to be present with my own self, such as through writing and interacting with you, my online community, I can then be present with my patients.
…I thank you for teaching me and hope we share this exchange for a long time.
When I can be present, I do not have to moralize my perceptions of patients’ behaviors and feelings. Self-care is not a moral issue.
In the following posts we will discuss more about these terms: presence, moralizing self-care, trust, and the patient-doctor relationship.
Self-Care Tip – Grow your self-knowledge and find what it offers you, in turn, when observing it in others.
Questions: What has your experience been when you have gone to your clinician with self-knowledge? How has gaining self-knowledge been a friendly thing to yourself? Please tell me your story.
- Doctor vs. Patient: We Need Better Communication, Not Faith (blisstree.com)
- Interview of Dr. Dan Siegel about THE MINDFUL THERAPIST (westallen.typepad.com)
- Re-Humanisation: The Doctor-Patient Relationship (2020health.wordpress.com)
- New Warm Line Helps Clinicians Tackle Patients’ Substance Abuse (nlm.nih.gov)
- Paul Krugman on How to Keep the Doctor-Patient Relationship Sacred: Less Commercialism, More Bureaucratic Oversight (reason.com)
- A fathers story : Speech given at the AGNC conference (undiagnosed.org.uk)
- Four Reasons Doctors Worry About Social Media – #GetOverIt (forbes.com)
- The Patient-Centered Approach to healthcare (exuberantdentist.org)
- Doctors need to be the leaders of health care change (kevinmd.com)
- Be Alert, Be Healthy! (savetime.com)