Caregiving and Selfcare

Fallen_tree2Being a caregiver is, well, …giving!  There is a need.  We respond to the need.  We give.  There is taking from what we give.

When we talk about this, some of us hear the tap, tap of a bookkeeper balancing ins-and-outs.  Tap, tap, take, take.  We feel dangerously close to objectifying what is Magical.  Objectifying what we get from giving loses at this point in our thoughts the bigger circle of love that motivates us.  Let’s acknowledge and respect that.  The bigger reasons are so worth aspiring to and treasuring.  You who believe in what is more than the numbers of our motives and behaviors, please continue to nurture us with this wisdom.  Be patient as we wander in the corners and cracks and in the places we don’t understand so well.

The point of giving, others pursuing the caregiver’s story later respond, is what we receive.  The love, the satisfaction of observing what our efforts contributed to in another’s rescue.  Perhaps, knowing we participated in saving a life.

Am I a caregiver?  Are you?  Well, maybe we think we are excluded from this category because we don’t liaison between one suffering life-being with the world around.  But are!  We all are caregivers by the definition of what is means to be living.  Living is connection.  We, each of us, are connected to the Universe and the different points from there to here where we stand.  Connection is inherent to living.  To live is to be connected.  To disconnect is to die.

This is somewhere along the philosophical thought experiment of, “If a tree falls and no one hears it, does it exist?”  I am told by those who might be wiser that it does not.  I don’t get it and what does that say about me? 😉

Observation vs. reality.

Connection is like that.  It is not perceived sometimes, and sometimes it is perceived.  This is important to Me.  To the part of each of us that is more than our senses.  More than Time and the condition of our health.  More than brain illness.  This is important to caregiving because by increasing our self-awareness of our role in connection, and thereby caregiving, we have an opportunity to increase our ability to combine the Magic of it with the “accounting ins-and-outs.”  Thereafter, we are lead to increase our transparency to others, increase our connectivity and increase our experience in Life Quality.

Magic is compatible with that which is known.  More even, they are not divided, whether we know it or not.  Magic and that which is known, just are.  We are arrogant people any way we turn the talk, of course.  None of us without agenda.  None of us without projectile pride.  But despite this, we have Grace and whether we hear the tree or not, Magic and knowledge have made allowance for us.

Caregiving comes with connection.  We give, we receive, and we do it with agendas.  Increasing our self-awareness through the process, although it feels at times like ringing out a cash register, and feels soiled by the sound of that which taking brings, – self-awareness of our agendas brings more freedom.  We are more free to give by choice rather than martyrdom.  We give without perceiving ourselves the victim to those to whom we give.  We are more free to give to our other agendas.  We are more free to consider our own needs as needs-of-value from one who is also Loved and valued, Me.

Question:  Might increasing our consideration of our “Me” increase our giving well to others?

Do you consider yourself a caregiver?  How so?  Please tell us your story.

Self-Care Tip:  Give well to yourself to give well to others.  Keep on.

What to do!? On-Line Physician Bullying.

I’ve been to this great APA meeting, great that is, because of the people!  Wow!  The fellow attendees, the exhibitors, the speakers – just, WOW.

I’m going to try to share content with you but it will take me time.

bully

For today, “Are You a Sitting Duck Online?,” reminded me of our earlier discussions on the doctor-patient relationship and a previous post, on July 11, 2012, that went like this:

Hello Friends.

Please tell me how I’m doing on this.  Just out,

Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice

This is important to me as I treasure both my medical practice and our community, connection, exchanges on-line.   I don’t want to do anything that jeopardizes either, nor the implication that if I did, that means I would have mistreated a patient.

Thank you for this, what I call, a “good problem” to have – the joy of medical practice and participation in social media/networking.

So many of you resonated with this and engaged.  I am still super grateful.  I’d love to continue with you in further discussion and with your comments!

For me, one of the many reasons I was so excited about this recent talk at the APA is because of the mucho online stuff connected to my name that affects my patients and the dynamics in our patient-doctor relationship.

In my practice, these are just a few sites that have wrong information (demographics) on me:

  • healthgrades.com
  • vitals.com
  • betterdoctor.com
  • ucomparehealthcare.com
  • insiderpages.com

They didn’t ask to clarify my demographics.  They didn’t ask me if I wanted them to become an on-line reference on my behalf.  They use my practice information to drive “eye-balls” to their site so they can get advertizing money and more.  They impose incorrect information about my practice, knowing that in so doing, I will be pressed, (I call it bullied,) into contacting them with my correct information.

If I don’t do this expensive effort, (money, time, emotional expense – all in limited supply, to correct what they post incorrectly,) patients will continue to tell me that they couldn’t find my contact information.  When they Google me, instead of my website coming up, these other sham pages pop up.

Some patients call dead numbers or even drive to incorrect locations to find treatment.  Instead of whomever is behind these websites being held responsible, the medical providers are.

These are the notes I took from my colleagues, as I heard them say.

Unfortunately, I was late to the meeting so I missed two of the four speakers.  Even so, this is worth it.


Dinah Miller M.D., Author of “Shrink Rap” and writing regularly for Clinical Psychiatry News.

Dr. Miller told us about the difficulty of “patient” (or nonpatient, i.e., sham-patient) reviews online.

Who can review the physicians?

  • your patients
  • Friends and lovers
  • enemies
  • trolls – a negative internet stalker

Every practitioner has an idea that they are a pretty good doctor.  So it isn’t easy for any of us to hear otherwise ;).  After getting unsolicited feedback from a person who took the time to write a comment on a site that listed her, a site that listed her profile without asking her, Dr. Miller chose not to play the victim.  She decided to call “Health Grades,” and with her persistence, they took her information down.

On “Vitals” – she got an answering machine with a person’s voice mail and no name and number.  So she called CEO, Mitch, who stated she wasn’t able to take her profile down.  She didn’t ask to open herself up to trolls.

Dr. Miller asks, what shall we do, as physicians?

  • do nothing
  • write a response
  • try to call the company

There are many whose livelihoods depend on public opinion.  For example, waitresses/waiters – many lose their jobs if they get even one negative reviews.

The practitioners in the group responded with resonance with Dr. Miller’s ideas.  They also had thoughts that if left alone, the democratic process would win out over time, truth would come out and such.  (Maybe the nearby statue of Liberty played into our thoughts :).)


Paul S. Appelbaum, MD, Dollard Professor of Psychiatry, Medicine & Law, Columbia University

Principles that Might help physicians Identify Constructive Responses

  • Responses should be Effective
  • Practical
  • Compatible with medical ethics
  • Positive rather than negative consequences

Problematic Responses by Individual Physicians

  • Request removal by website – typically declined.  Saying you’re writing a public article on it might help.
  • Contact the patient who wrote a negative response to request removal – Patient not likely to remove response, many patients post anonymously, most websites won’t allow patients to remove them
  • Flood site with fake positive reviews – deceptive, embarrassing if discovered, ? inducing a person to rely on a statement that may be used to their detriment (fraud)
  • sue patient for libel – identify patient might be difficulty, people have a right to their opinions – would have to prove statements untruthful and not merely opinion, $$ in money/time/and emotion

Encourage Satisfied Patients to Post Reviews?  We could refer to a firm to do this.  $$

Some sites, similar to “Vitals” offer the option to the practitioner to respond to a posted review.

Negative Reviews:

If we do respond – how?  We don’t want to come across arrogant or insulting.  We fear violating patient-doctor confidentiality. In the end, we recognize we don’t have the last word.  We may respond with a soft word of concern.  “If you would call my office, I’d be happy to schedule at no fee to speak with you about this and see if I can help.”

Can Patient Reviews Be Controlled?  There once was a company that tried this.  “Medical Justice” developed a form that gives control over of copyright of all reviews to MD.  – Didn’t work.  See article, “Company tries to stifle online reviews with patient ‘gag orders’.”

Another idea is that medical practitioners help themselves by coming together to develop an internet ombudsman.  This would be a medical/mental health professional not involved in care of patient.

  • Independent (unrelated party) investigation of physician about the case.  A successful investigation may give a third party opinion.  There’d have to be a reason for the world to trust this opinion.

It is difficult for healthcare professionals to protect themselves from inaccurate complaints about their care.

Positive Reviews

Does it put undue pressure on the patients?

A sign in waiting room perhaps.  Make the information available w/o practitioner knowing if they have or have not commented.

There is a dissonance between the position of being a business person that says we must practice democratically and compete fiscally, yet stay in congruence with what tradition holds us to.


The issues addressed in the talk weren’t specifically about being bullied by sham-websites, but it included that idea, along with other difficulties physicians are experiencing in the rapid transition of 3000 years of tradition as a healthcare providers to spending the majority of their time serving patients first to now, the reckless $ burden of running a media vulnerable business.

In the practice of psychiatry, a traditionally extreme-private practice, this is dissonant to many.

Q:  How do we treat the extremely delicate practice of psychiatry as a business when we are held to currently minimally defended standards like this?  Please speak out and let it flow!  We need to hear from you!  …and, Keep on.

Self-Care Tip:  Deal with internet sham-sites and reviews in a method that is consistent with Me, and temperament, while doing the least damage to oneself. It will be better for oneself as well as others.

 

Everything starts and ends with Me ….Still talking about it

You make your own definitions of Me, self, and friendship. This is mine I share because it is friendly to Me. It is not meant to be a template.

I am the bride of Christ. When I speak of Me, I speak as one claimed by Love and in Love. When I speak of Me, I speak of this person I am in that complex union, dynamic and without lines. My self is the same as to say, Me with Christ and Christ with Me.

Using the term, Me, is a general term for that part that remains in each of us that is timeless, unchanged by trauma or indignity. The Me describes who you or I are still in any dimension or medical condition. The Me does not depend on a heart beat.

Being a friend to yourself means believing and treating yourself in ways that are consistent with your belief that although we are victimized in life, being the victim is a free choice. We are free to choose.

Out of this, our friendship grows to include the truth that we accountable to ourselves. We don’t look for nidus of control outside of our friend, Me.

Our friendship grows further to include presence with our personal journey, which in turn heightens our presence with what connections we share with others. These connections naturally require bank to generate and maintain and bank, as in any country, requires hard work. To serve others demands funds, even emotional and behavioral funds, physical funds and sociological.

Everything starts and ends with Me. (Refer to above.)

Question: What is your “Me, self, and friendship?” Please tell us. I’d love love to hear.

Personalizing Gossip; It Starts And Ends With Me

“Crying,” by Galway Kinnell

Crying
Crying only a little bit
is no use. You must cry
until your pillow is soaked!
Then you can get up and laugh.
Then you can jump in the shower
and splash-splash-splash!
Then you can throw open your window
and, “Ha ha! ha ha!”
And if people say, “Hey
what’s going on up there?”
“Ha ha!” sing back, “Happiness
was hiding in the last tear!
I wept it! Ha ha!”

I remembered this poem after visiting my friend Paul’s church when Paul told me that at least three of the people there asked him, in one way or another, if I had a disability. Poor Paul.

I’m pretty sure Paul was embarrassed but aside from that and my own begrudging unfortunate shame response, I have to say it made me laugh a lot. (I work with many labeled “disabled” and respect them. This community comment doesn’t come with the knowing of who is behind a simple word like “disabled.”)

Awesome!

I smiled at Paul’s daughter and she smiled back. What fun laughing with her. Apparently it was just that. My laugh.

Loud and disinhibited. (Laughing more.)

In high school a particular peer thought the same. In movie theaters when something hits that note, I have seen the looks. I have had sufficient opportunities to decide what to do with my laugh.

When weighing the risks and benefits of a “loud and disinhibited laugh,” the laugh has won out for Me. I get so much from it. Such pleasure of claiming that moment, that smile, that air passing through me and the intimacy.

Come join me! – “Ha ha!” sing back

One of the funniest kids I've met while travel...

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It doesn’t mean happiness. For me, it is part of presence. Happy or not happy, and that brings me pleasure.

My sweet friend Paul is a sensitive guy in ways that I am not wired to be. He is so beautiful. I know how he cares about the people around him. I know he respects them and considers their thoughts. It is not so much that he would ever be ashamed of me, abled or disabled. Rather he cares and said these things because in his consideration, perhaps if I was more aware then I would make a different choice about the risks and benefits of my laugh. He doesn’t know that I am informed. I have decided with knowledge.

There is no way he would know this about me. No one could. It was, as always, a statement those church folk made that was mostly about them and not me. That is universal. We all say things that are more about Me than anyone or anything else. It’s friendly to remember this, to Me and them.

“Happiness was hiding in the last tear! I wept it! Ha ha!”

Self-Care Tip: To not personalize what isn’t personal, start and end with Me.

Question: What helps you remember that what people say is about them more than about you? Even when those people think they are talking about you? How do you

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You Have the Power And You Are Not A Victim

Fire KnivesDo you every feel like a victim?

When someone is doing something to turn us into an emotional victim, sometimes it can look like a performance, don’t you think?  Someone is yelling, arms swinging about, face animated – and there you are, breathless and emotional.

However, being victimized and being a victim are different things.  Being a participant of an interpersonal exchange is different from being an audience to it.

Imagine a stage and you and have been selected from the audience.  You climb up and join the performer, let’s call him Ron.  Ron is a professional fire and knife dancer.  You are standing near Ron and flaming knives seem like they are everywhere.  He is quite a dramatic dancer and part of you wants to dance with him.  You know you would get hurt badly and yet you have the hardest time resisting the urge to participate.  Your wisdom prevails and you remain uninjured.  You applaud and walk away.

Later at home, you are still marveling that anyone could move that way and work that hard to evoke such strong emotion from their audience.  The emotions replay the dance in your mind almost as if you were still there with Ron.

Do you feel like a victim to Ron?  You don’t have to.

When you don’t like what someone is doing or saying to you, imagine that it is a performance of sorts and don’t take it personally.  You don’t have to be a victim.  You have the power.  Be a friend to yourself.

Now, if you can’t do this no matter what, if you feel powerless and unresponsive to your redirections, it may be medical.  You might be suffering from any number of illnesses that cause personalization, guilt, fear, reliving experiences and so forth.  You shouldn’t suffer like that.  You were created to feel pleasure.

Self-Care Tip – Applaud and walk away when someone is victimizing you.

Questions:  How do you manage to use your power when you are being victimized?  How are you accountable for your feelings and behaviors when people are hurtful?  Please tell us your story.

Revenge – Not so Friendly to Me

Original caption states "A photograph tak...

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If you have been around kids much you may marvel as I do, how fast they dish revenge.  I’m here to tell you, if you eat food off of my son’s plate, you should run.  Yet, seeing my or your four year-old hit someone is much less awkward than seeing an adult do it.  But they do.

Ingred told me that she had been humiliated at the make-up counter of Sephora.  A stranger had called her a bad name.  The stranger said it loud enough that other customers and staff heard it too, Ingred was sure.

“I just told her to go F— herself!”  

Unfortunately for Ingred, she was soon escorted out of the store by security who didn’t care about Ingred’s story and just wanted to keep the peace.  Also, unfortunately for Ingred, she essentially absolved the stranger of what little remorse she may have felt before Ingred retaliated.  Ingred essentially dissipated the natural introspection that comes to us after we misbehave, the natural drive to right our wrongs and the self-care that that stranger was due for.  Ingred had “paid the price” for both.  Ingred made herself the scape goat.

Ingred needed to buy into this concept but also that for her, everything starts and ends with Me.  Like us, Ingred takes care of her own feelings and behaviors to get friendly with herself. Taking revenge, getting even and responding by acting out we are trying to take care of their feelings and behaviors.  That’s not friendly to Me.

Inversely, if Ingred, or my four year-old son, had owned their feelings as their own, been accountable to their shames and angry selves and adapted to this stressor, they would have … Well you tell us.

Questions:  What has happened to you in these situations?  And how do you take care of your own emotions and behaviors, and account for them even when you perceive that you are provoked.  Please tell me your story.

Self-Care tip – Revenge isn’t friendly to Me, but being accountable to why we want revenge is, so try it out.

Write Your Letter To Get Self-Care Insight

Grafitti with social statement

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Self-Care Tip #206 – Write your letter to get what you’re looking for from self-care.  Be a friend to yourself.

So why am I so interested in self-care?

I’m not sure who said this first, but I heard it from speaker and author Peter Rollins, and it rings true.  People write letters not necessarily to communicate to others but because they needed to hear the words themselves.

For example, the smooth Paublo Neruda wrote in his poem XVII (I do not love you…) as translated by Stephen Tapscott,

…I love you without knowing how, or when, or from where.
I love you straightforwardly, without complexities or pride;
so I love you because I know no other way

than this: where I does not exist, nor you,
so close that your hand on my chest is my hand,
so close that your eyes close as I fall asleep.

You may also remember this verse from the movie Patch Adams.  I think Paublo Neruda must have really wanted connection.  And so with me, I’ve been writing my own letters of sorts – every day about self-care.  What do you think about that?

The truth is, it’s not hard to see why I’d need that.

This leads us to victims.  We’ve all seen them, and probably been them at one point or another.  Parents who blamed their kids behaviors for their feelings.  Spouses who blamed their Other for their feelings.  Physicians, nurses, accountants, judges who blamed their colleagues, who blamed their employers – “Every day there is just so much work put on me.  The system’s corrupt.”

What I realized is that I was also living like a victim.  I wasn’t taking care of myself.  No one can give what she doesn’t have.  And I didn’t think I was responsible for this.  I actually thought at some conscious and including subconscious levels that all these other things in life were reason enough to suffer like me.  Many of us think this way – stress leads to poor treatment of ourselves.  It may, or it may not.  But all we can have any control in, is our own selves.

Love Letter

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This was my ah-ha.  Self-care begins and ends with Me.  This became a passionate love-letter for me even though I’m still not above “victimhood.”

For us who were “ruined” by their circumstances, tired and loveless because someone cheated us, mad because of thoughtlessness – we were in need of Love.

 

No one is responsible for my emotions but “Me.”

Questions:  Why are you interested in self-care?  What letter have you been writing?  Please tell me your story.