Patient-Doctor Relationship

shoes

Tonight I pulled together all the posts we have on the patient-doctor relationship into one page.  Please let me know your reactions.  This is a journey I am really grateful to travel with you.  Keep on.

 

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.

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.

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.

Self-Care Is Not A Moral Issue

Facial emotions.

Image via Wikipedia

I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:

Self-Care Tip #263 – Experience, use, observe and interpret emotions, but don’t moralize them.

We sometimes forget about the involved journey to a healthy Me.  Because of this, we become fearful that it means alone-care, apart-from-God-care, selfish-care, excluding experienced-and-professional-input-care and so on.  It’s not.  Self-care is collaborative, yet that doesn’t negate the fact that it must start and end with Me.

When we take care of “Me,” we can connect more with others, including God, have more inside of us to give to others, and have more interest in the world around.  The opposite disables our abilities to do those things.  No one can give what she doesn’t have.

We have this person, “Me,” to take care of.  This “Me” is valuable, of high priority, to be celebrated and cheered on.

Please, shake it off.  Self-care is not a moral issue.  It just is.  It is a choice, a freedom and an opportunity.  It is not about salvation and has no influence on our worth.  It just is.

We are more willing to buy into the, “It just is,” self-care tool when we understand where emotions and behaviors come from – the brain. This biological stance is the evidence for deescalating our drive to moralize emotions and behaviors.  They are not from an aura, a gear we can shift, or any nidus of control outside of our human bodies.  Emotions are how we interpret the world around us.  They are not linked to morality.  Please don’t take them to the pulpit.  If you do, I will still be polite, although breathing through a mask.

Emotions are our interpretive lens for our physical self.

Questions:  How’s the clarity of your lens holding out after considering this part of self-care?  What influence does what you “see” with your emotions have on your ability to befriend yourself?  Please tell me your story.

Presence Encourages Self-Care

The Forgetful Professor

Image via Wikipedia

I am writing a series of blog-posts outlining self-care in which we examine the tenets of self-care:

Self-Care Tip – Sit back and listen to the emotion to be present in your own life.

There are two terms we’ve used in psychotherapy since before Freud and Jung were around:

  • Transference – putting our feelings on the clinician.  For example, my clinician looks like my father.  I will transfer onto him my feelings about my father and subconsciously think he is like my father.
  • Countertransference is the opposite.  The clinician thrusts her own memories and associations on her patient.

These can be positive or negative.  Of course they do not stay in the clinic.  Transference and countertransference happen between all of us all the time.  Often it is healthy.  It helps us grow, model others, fantasize and move towards fantasies long enough to make them true.

Remember PattyAnne from yesterday?  …In PattyAnne’s and my case, PattyAnne could be said to have transferred her fear of being treated as a lesser person.  But what was my reaction and what is yours in similar situations?  What is our countertransference?

I have often been guilty of negative countertransference in situations like this.  I remember feeling dirtied by people’s prejudices and fears.  Almost like I needed to bathe afterwards.  The truth is, though, we don’t have to feel this way.

When people are afraid of us, we do not have to be afraid of them.  We do not have to anger, agitate, or feel “soiled.”   We can just be with them.  Let it be about them and not run away.  Be present.

Clinicians can be open to hearing this song.  When any patient starts in again, this time, sit back and listen to her fear rather than worry about what words carried it.  Patients will be better for it.  Maybe clinicians will be, too.  And that is key.  The gift we give first is to ourselves.  By just being with someone in her fear, we can just be with ourselves too, and vice versa.  Quite friendly to us both.

Presence encourages self-care.  It helps guard us against the temptation to see ourselves as victims.  When we do not realize that our emotions and behaviors come from us, were not imposed upon us from external sources or realize more specifically the transference or countertransference that we are responsible for – we can feel like victims.

Any time we do not own our emotions and behaviors, this is a quick path to losing our connection to our personal journey and become “absent” rather than present with ourselves.

Still, many wonder: at what point does “too much self-care” become part of the symptomatology?  This concern will resolve when we see how emotions are not moral implications.  “See” you tomorrow!

Questions:  How has feeling like a victim disconnected you from others and yourself?  How have you collected your absent self and come together again?  Please tell me your story.

 

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.