Category Archives: communication

On Readiness

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NaBloPoMo 2016, Letters to Patients, Day 16

To Patients Contemplating Change:

You’ll do it when you’re ready.  And you’ll know.

My 24 hour Facebook fast is 90% complete, and I feel GREAT!!  Holy COW, I’ve been so productive, and for the most part I feel liberated and lightened.  The darkness of increasing online tension had spread over my consciousness rather insidiously, like a slime mold.  It’s not that I was totally unaware, or that I underestimated its toxic influences; I was just not ready to stop it.  The cost/benefit balance finally tipped and I was moved to act.  It’s that simple and that complicated.

Today I reviewed my notes from the physician health conference 2 months ago.  I came across an important exercise that illustrates my point.  The speaker had us make two lists: energy-depleting activities and energy-enhancing ones.  My second item on the former list was “Facebook+/-“.  It was the third item my latter list.  She then asked us: If we had 2 extra hours a day, what would we do more?  –Read, write, go outside, meditate, do stuff with kids (outside), plan road trips.  Then, if we had 2 fewer hours per day, what would we cut out?  –Facebook/news, TV/movies.

That was two months ago.  I knew I ‘should’ cut down on my Facebooking, but I was not ready.  Yesterday, finally, I crossed a threshold and the decision was easy.

I hear this all the time from patients.  “I know I should eat healthier.  I know I should exercise more.  I know I should quit smoking, cut back on the alcohol, go to bed earlier, address my relationship problems.”  And, “…I just don’t.”  Both patients and physicians can easily slide into judgment here, thinking, “If you know you should, why don’t you just do it?”  Defensiveness and self-loathing follow closely behind these words.

On the other hand, when patients return having cut out red meat, quit tobacco, and joined a basketball club, I ask them, “What happened?”  Most of the time I hear, “I don’t know.  Something just clicked and I decided it was time.  …And suddenly it was easy.”  Sometimes they identify an a-ha moment—when they first held their newborn baby, for example.  But more often there is no cloud-parting epiphany.  They simply cross the threshold of readiness to change, while walking the journey of life.

I confess I am guilty of impatience and judgment.  When I see your uncontrolled, lifestyle-related medical problems, and you resist behavior change, I feel frustrated.  I know you feel it, too.  But know that I don’t blame you.  If we all did everything we knew we ‘should,’ then—well—you fill in the blank.  The point is: we don’t make changes until we are ready.  Certainly we facilitate readiness—that’s a topic for another post.   Suffice it to say: I see you.  I know you want to live healthy.  You will know when you’re ready, and you’ll move.  Until then, I’m still here with you.

 

On Mutual Respect

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NaBloPoMo 2016, Letters to Patients, Day 5

To Patients Who Abuse Medical Staff:

Let me be clear: That is not okay.

Let’s define some terms first:  By staff, I mean clinic receptionists, medical assistants, nurses, phlebotomists, schedulers, hospital nurses, housekeepers, pharmacists, food service workers, billing and medical record staff, social workers, case managers, and anyone else who contributes to your care.

By abuse I mean insulting, yelling, name calling, intimidating, swearing, threatening, and otherwise conveying hostility and aggression toward others.

I have very specific behaviors in mind here.  I’m not talking about the inevitable frustrations that we all face in over-scheduled clinics and understaffed hospitals.  Exasperation, disappointment, and even anger are appropriate emotions we all share.  We understand that you may make surly faces and splutter a little when your expectations are not met.  Most medical staff are trained and expected to handle such interactions with patience, compassion, and calm.  They are frequently also given only narrow parameters within which to convey information, and almost no decision-making authority or autonomy.  Believe me, they feel terrible when they cannot help you, and often there really is nothing they can do in the moment.  But they can always ask for help, so I respectfully request that you give them the time and space to do so.

The medical community has a lot of work ahead to integrate our care teams.  We serve you best when all team members are empowered to exercise their best judgment, within their scope of practice, to move care forward toward your best health.  We are all here doing our best.  Physicians play a crucial role in both local and global medical culture.  But we are only recently stepping up as actively collaborative leaders, rather than authoritarians and paternalists.  You may see us physicians abusing our own staff, so let me be clear again: That is also definitely not okay.  Never mind that it undermines morale.  It can also endanger patients.  I hope in my lifetime to see an end to this contemptible behavior.

If I witness you abusing my staff, be sure that I will call you out.  I will do it respectfully, even lovingly, especially when I know you’re going through a hard time.  I understand how hard it is to control our emotions when we’re unwell and frightened.  It’s good for all of us, however, to know exactly where the boundaries of acceptable behavior and language lie.  Expect that if you cannot abide them, I will ask you to leave.

If you witness me or my colleagues abusing our staff, we need you to call us out, too.  Relationships are never one direction.  In medicine and health, the webs of connection are inextricable—one person’s mood and attitude can rapidly infect a group—and the stakes can be high.  I expect myself and my staff to conduct ourselves professionally.  We expect you to behave humanely.

Thank you for your cooperation!

On Walking the Talk

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NaBloPoMo 2016, Letters to Patients, Day 4

To My Patients Who Wonder, “How Healthy Is Your Diet, Doc?”

I cannot tell a lie, it kinda sucks sometimes!  I’m not a foodie, really.  In fact, I have maybe the least discriminating palate of anyone I know—everything tastes good!  I particularly love sugar, starch, salt, and oil—especially in combination.

So when I talk to you about the picnic plate method of eating—half stems/stalks/leaves/fruit, a quarter high quality lean protein, and a quarter whole grain—believe me, I understand the challenge!  In fact, every time I counsel you, I review my own food log in my head, and I resolve to visit the raw salad bar more often.  When I give advice or make suggestions, it’s not that I necessarily know better than you, or that I think I’m better than you.  We’re all here doing our best every day.  It’s my job to look out for your health, which research tells us is only 20% related to what I do in the clinic or hospital, and 30% related to your own habits (incidentally, it’s 40% related to your environment).  So if I can help you make even the smallest change for the better, then I feel useful.

When I ask you about exercise, sleep, stress management, and relationships, I am also taking stock of my own habits in those realms.  To me, these are the central domains of health.  And nobody has a perfect balance all the time.  Maybe you’re great at exercise, but your diet is the pits.  Maybe you eat really well, but you stay up too late at night.  Everybody’s patterns are different, and they shift over time.  Sometimes I might share my own fluctuating experiences with you, if it feels relevant and helpful.  But our time together is about you, not me.

I want you to feel free to ask me how I manage my own health.  It’s important to me that I Walk the Talk.  I will answer honestly, if sheepishly.  I will share my struggles with you.  I risk judgment by you when I do this, and I accept that.  One of you actually said, “Shame on you,” to me one time.  Maybe you feel judged by me, also?  I think that is inevitable.  We all judge ourselves, and then subconsciously project our judgments onto others.  I’m working on self-compassion—ask me about that, too!

It’s about strategy and execution, trial and error, and repetition.  No matter what the behavior change, the more times we try, the more likely we will finally succeed.  So the next time you come in and we talk about health habits, think of it as comparing notes, rather than reporting progress or regress.  If you found something that works, please share!  I might just steal the idea for myself.