January 13th, 2011
Note: This is the first in a series of case studies about how to figure out if you’ve got the right healthcare provider for your needs. This case study talks about how to work with those unsettling feelings that may be your first indication that things aren’t working for you.
Jane (a fictitious name) went to see her primary care doctor to talk about her anxiety and felt unsettled afterwards. When I asked her what felt unsettling, she said she was sure it was “all in her head” and that “it didn’t make any difference because this is the only provider she can see right now due to her insurance.”
“Maybe I was just too tired to explain things clearly”, she said. “I showed her the Appointment Prep form because I felt too overwhelmed to talk much. But I still feel uncomfortable with what happened.”
I asked her whether she could identify any bodily sensations when she thought about her relationship with her doctor. She said: “Yes, when I think about what happened, I clench my teeth, my shoulders ache, and I feel my stomach churning.”
I said to Jane, “When you think about your interaction with your doctor and you feel into those sensations, what’s the first thing that comes up.”
Jane hesitated and then replied: ” I don’t know. I don’t want to think about it though.”
There was a long pause before Jane said, “Well, it may have something to do with the fact that I have been on this medication for a long time to manage my anxiety and they’ve adjusted the dose a couple times. However, when the nurse verified my medications, their electronic records had the dose wrong. That made me uneasy as the dose was way higher than what I usually take. And the last time I was there, before they switched to electronic records, they couldn’t find my chart and when they finally found it, it was the wrong chart and we didn’t figure it out for a while. Or, maybe, the time before that when the nurse came in and said the doctor only had 10 minutes to see me even though I’d waited over an hour for her for a regularly scheduled appointment and I felt like my issues needed more attention than that. And come to think of it. . . . ”
As you can see, there’s plenty of reasons Jane felt unsettled about her relationship with her healthcare provider. Here’s a little synopsis of what wasn’t working for her:
-an error in the electronic medical records about her medication
-administrative issues regarding locating and then showing up with the correct chart
-inadequate attention to her medical issues
-excessive wait time for a scheduled appointment
Here’s the point: When you have that “unsettled feeling” with your healthcare provider, it’s worth exploring. Why? Because, over time, you’ll be able to evaluate if this is truly the healthcare provider for you or whether you need to look at alternatives.
Though you may think there’s no alternatives available due to your insurance, the needs of your other family members, or other reasons – you can trust the old expression that where there’s a will there’s a way. And the first step is to look at what’s bugging you about your situation.
Regardless of what type of healthcare provider you’re working with – a therapist, psychiatrist, physical therapist or other provider – if you’re feeling uncomfortable, there’s a reason for it. It’s useful to know what that reason is as a starting place to figuring out how to get your healthcare needs addressed. Notice that I said this is a starting place to ask yourself first what’s going on. I encourage you to think through this thoughtfully and carefully so that you can make the choices that are right for you.
Here’s the first step if you’re feeling unsettled about your relationship with your healthcare provider: Ask yourself if you’re willing to explore what’s bugging you about this? Don’t force yourself to think this through – instead, extend a friendly invitation to yourself like this. “Hey, if you wanna talk about what happened, I’m here . If you had to guess, what’s the first thing that comes to mind?” You may want to journal on this, talk it over with a friend or leave a comment here to get it out of your head.
September 27th, 2010
I’ve heard it said that you should never go to a surgeon’s office by yourself; you need a second set of ears to make sure you get the story straight.
Though I believe that’s true, what is also true is that I didn’t have someone with me today while I was at the surgeon’s office.
And you know what? Even though I was in pain and scared and overwhelmed by the whole situation, I felt grounded and focused.
Why? Because I had prepared for my appointment ahead of time by using my Appointment Preparation Worksheet. It took two minutes to fill it out. I also kept track of my medications, symptoms and medical history using Patient Power so I had all the information I needed right at my fingertips.
At a time when I felt so vulnerable, I had the tools I needed to stay on track and remember what hurts, what makes it better, and what aggravates my symptoms.
And you can have these simple tools too, and walk into your healthcare provider’s office feeling clearheaded and secure.
Here’s what happened to me:
I arrived early, filled out the necessary paperwork and was greeted promptly by a very helpful nurse who performed some initial tests. So far so good. However, I was thrown off track because, after explaining my symptoms and how the computer aggravated them, the surgeon said: “You have bilateral carpel tunnel and it’s a myth that working on the computer causes carpel tunnel.”
I felt angry when he said that and I said to him, “What I’m saying to you is that my symptoms are worse when I’m on the computer, and I know that for a fact.”
He simply retorted: “And what I’m telling you is that the computer is not causing your symptoms. The computer has nothing to do with your symptoms.” He then went on to quote a prominent study to support his statement.
To tell you the truth, I wasn’t interested in science. I wanted help understanding why my hands hurt, what my diagnosis is and what my treatment options are.
Telling me that my symptoms, which are most intense when I’m on the computer, are not caused by the computer felt invalidating and unsupportive.
Though he may be correct and I’m sure he’s up on the latest scientific studies, this kind of information did not give me the feeling that he understood how much I use my hands for work and how this adversely affects my daily life.
This is just the kind of thing that happens to me (and lots of other people) all the time.
When I’m uptight and uncomfortable and a healthcare provider appears to be challenging me on the legitimacy of my symptoms, it’s easy to forget why I’m asking for his expertise.
(In fairness to this surgeon, I’m sure what he was trying to do was to dispel a myth about carpel tunnel and give me some data in support of his statement. It just wasn’t a match for my needs for empathy and understanding. And it caused me to momentarily lose my focus about what I really wanted information on.)
Here’s what’s important for you to remember:
If you tend to get overwhelmed when you’re dealing with your healthcare provider, by writing things down you can stay on top of your game. Just the act of writing things down helps you remember them even if you forget to look at them as you’re talking.
Why? Because writing things down gives your brain a break from remembering things. And everyone’s brain deserves a break in this very hurried world we live in.
If you are forgetful – as I am - writing things down helps as well.
And, if you know you’re forgetful, you can train yourself to look at what you’ve written down OR go back to the office (as I did) when you forget to ask something important.
Next, when a healthcare provider is talking so quickly that you can’t take it all in, you can verify your understanding by using my materials. It’s easy to make sure you’ve understood what they’ve said correctly and a good provider will want you to understand their recommendations clearly.
Give your good brain the rest it deserves especially when you’re not feeling well.
Prepare ahead of time for your appointments, make sure you got the story straight, and then you’ll have what you need to use the healthcare system in a way that works for you.
Sometimes, there are so many changes – in an hour, an afternoon, or over a couple days – that it can be really difficult to stop what you’re doing and catch up with yourself.
A client of mine with back issues was doing much better for a while. Physical therapy was effective, exercise was working, and things were looking up.
At the same time, those little things that bug her were adding up, there was a death in the family, she felt isolated and frustrated with various personal relationships, she’d lost a couple major accounts due to the economy and life felt unpredictable and out of her control.
On top of all this, she’d just broken her arm, two ribs and her right foot in an accident.
With her tendencies toward depression, all of this stuff felt like being in the eye of a hurricane – too much, too fast, and no way to digest it.
Her usual mode of self care and dealing with mood issues - exercise, getting out with friends, shopping, being strategic and organized (which she discovered required not just her brain but her arms and legs) weren’t working.
I asked her what she thought the message was. She sat with the question for a moment and then, in an exasperated tone, said: “How can I answer that? All the things that used to work I can’t do anymore – either for financial reasons, because money is a problem, my body isn’t cooperating or because I don’t have people in my life who get it.”
I sat quietly with her as she continued for what felt like a long time – sensing it was my time to let her listen to herself rather than offer suggestions.
“Self care doesn’t look like anything familiar to me. I’m used to writing, I can’t write. It’s even hard to hold a book. Language helps me feel better, talking helps me feel better. I want to get out of the house. I can’t drive. I feel challenged on every level,” she said.
Having lived this myself, I totally get where she’s coming from. What she’s describing is the need to “retool” when we’ve been hit with more than one thing at a time that affects our attitude, behavior and well-being.
I listened and nodded, and quietly said: “Yes, you’ve not been through anything like this before.”
“Oh Thank God, you get that. And you’re not telling me what to do. I don’t need one more person telling me what to do here,” she said.
I repeated the question again: “So, if you knew what you needed to do to help yourself feel more comfortable, which you do*, what would you do right now?
(* I believe on an intuitive level we ll know inside ourselves what we need to do to help us feel more comfortable no matter what the situation. It can feel hard frustrating, irritating, and annoying listening on this level – to say the least – especially when you’re in pain, physically and psychologically. And if you’re willing to deeply listen and practice that process, the answers are inside you.)
“I don’t know – that’s the problem.”
We paused together. She took a deep breath. We sat quietly on the phone.
I said: ”I have an idea. How about if you talk for the next couple minutes and just respond to this question. Even if you say I don’t know, I don’t know, I don’t know. . . . after a few seconds of saying that, you mind, just by you giving it permission to not know, will start to remember what you do know that would be helpful. Wanna try it and see what happens?”
Through her tears, she said: ”Sure, but I don’t know I don’t know I don’t know I don’t know and this sounds like a bunch of hippie garbage that I don’t know what to do! I don’t know how to help myself – if I did, I’d do it.”
I said: ”Yes, I hear that. Feeling better may be out of the question right now as you’ve got a broken hand, foot, ribs plus all this other stuff. But, here’s the sentence for you to complete. If I knew what I needed to do right now to feel more comfortable, which I do, I would. . . . Now, it’s your turn to talk.”
Here’s the short version of what she said: ”If I knew what would help me feel more comfortable right now, which I already know, I would not do one thing but sit here and cry. I’d cry til I couldn’t cry anymore. That’s what I’d do. And I wish someone was here to hold me while I cry and there’s no one here do that, and that’s really scary because I can’t do this alone. I may never stop crying. I may never get out of this situation and things may never change which is why I am afraid to start crying.”
I asked if it would help her if she cried while I was on the phone with her.
She said, “No – but it would really help me if I could call or email you when I’m done. Or if I get stuck. Or if I haven’t stopped crying in two weeks.”
“No problem”, I said. “And I promise you that you won’t cry without a break for two weeks! I’m pretty sure of that.”
Twenty minutes later she emailed me and said she felt so much better.
I then asked her this question, “Now that you’ve let yourself do what you needed to do to feel better, what have you learned about yourself?”
She laughed and said: ”Well, I won’t cry forever and nothing stays the same. And now I’m ready to listen to Geneen Roth’s new book, Women Food and God, while I go through some filing and pull some financial stuff together.”
“Great”, I said, “and when you notice that something has shifted for you and this starts getting hard for some reason, ask yourself question number one again.”
So, here’s the recap.
When situations come at us all at once, whether they a personal, professional or both, and you notice you’re feeling overwhelmed, despondent, angry, sad or hopeless here’s a couple simple steps to remember:
1. Stop what you’re doing. Something isn’t working. Your mood is giving you a message that something isn’t right in your world.
2. Ask yourself this question: ”If I knew what would help me feel more comfortable, and I do, what would I do right now?
3. Give yourself 2-3 minutes to talk it through with a friend, write about it, talk out loud (a voice recorder can be handy for this)or some other way to get it out of your head so you can hear yourself think. A timer can be handy to keep you focused. Don’t worry about finding the perfect journal, right words to express yourself or having the perfect space to do this in. You are of course welcome to contact me and I’ll lead you through this as well.
4. Let yourself do it. If you can’t do it right now (i.e. you’d love to take a nap and you’re at work doing this in the bathroom as it’s the only place you can get some peace and quiet), make a date for yourself to do it soon.
5. When you’re done, notice what you’ve learned and ask yourself: Now that I’ve let myself do what I thought would help, what have I learned? Stay open and curious – maybe it didn’t help at all and you need to try something different, maybe you feel much more energized, maybe you’re feeling like you wasted your time.
7. Repeat this process as often as you like.
A few caveats here:
- Slow down your learning curve on this. You won’t do it “perfectly” because there is no such thing.
- Oftentimes, when we ask ourselves what will make us feel better our brain gives us so many things to do at once that it’s impossible to figure anything out. That’s where writing can really help you think it through because it slows the thinking process down. Getting it out of your head is really useful to hear yourself think.
- This is a practice – you’ll learn more about yourself every time you do it.
No matter what you’re facing in your life – whether life is on the upswing or things are coming at you in massive ways – asking yourself these questions is my all purpose solution to helping you feel more comfortable. I hope you’ll share what you’ve learned so we can learn from you too.
I was talking with a friend and colleague who has chronic pain as a result of fibromyalgia. She is taking several different medications, her symptoms change frequently and she had many concerns and questions.
She’d thought about filling out the Appointment Preparation Worksheet before her doctor’s appointment but didn’t get around to it. She said she “kicked herself” afterwards as she froze up when the doctor came in, unable to articulate her questions and concerns.
She recently was vomiting and having incredible pain.
She was able to pull herself together enough, before leaving for the ER, to tell her husband to take notes on the Appointment Preparation Worksheet about what was going on (in between bouts of horrendous pain and other horrible-ness).
Here’s what she said: ”When I went to the ER, I got to be the patient and didn’t have to advocate for myself. What a relief!”
That’s such a huge thing especially when you’re too sick to talk about it.
Her husband signed her in and gave the Appointment Preparation Worksheet to the receptionist who made a copy for her chart. The doctor’s read it as they were examining her and several staff members mentioned how appreciative they were that she had everything in one place.
As it turned out, she had a gall bladder attack and needed to have her gall bladder out. She also explained how much my work helped her while she was in the hospital. She found herself much more willing to ask for what she needed (rather than pretend everything was alright).
“Even the name, Patient Power, helped me realize that I don’t have to be a victim anymore. I can ask for what I need rather than feel guilty because I need help.”
She said in the past she’s felt so much guilt for having an “invisible illness” that clearly compromises her daily life and can’t be seen by others. ”It’s not like having a broken leg where there’s a cast and everyone knows that something is wrong.”
“Invisible illnesses” are my pet peeve because finding ways to explain what’s going on with you internally is so difficult.
That’s why I was so proud of her that she ASKED her husband to fill out The Appointment Preparation Worksheet as she was describing what was happening. “Ask and you shall receive!”
It is my mission to help people who don’t feel well find the words to express themselves clearly. That’s why I developed the Appointment Preparation Worksheet that is available right now for you for free. I also created Patient Power to insure that you and your provider are on the same page.
Use my materials with your healthcare provider and let me know how they work for you.
I noticed from the moment I picked up the phone that my client was unusually quiet. She’d been dealing with mental health issues as well as some back pain. She had been with a competent therapist and psychiatrist for a while to manage her mental health.
She found my material particularly helpful because she could now talk with both her therapist and her psychiatrist more specifically about what was going on with her. The key was when she began using the Appointment Preparation Worksheet ahead of time. She felt more focused on her issues of the moment instead of thinking through things hurriedly and forgetting important stuff because, as we all know, appointments end all too soon sometimes.
The results for her were profound: it was easier for her psychiatrist to tweak her medications, her therapist was able to target her needs and suggest specific helpful strategies more clearly, and she was able to observe what her situation was as it was happening because she was tuned into the philosophy of Patient Power.
When I heard the lifeless tone of her voice, I listened as she described how responsible she felt for the well being of others and how frustrated she was by her inability to just “be okay already.” She was she was giving up, that there was no help for her and she was unwilling to keep trying so hard to “get it right.”
Please remember that I am not a medical provider. I am passionate about helping people who don’t feel well speak the same language as their providers so that they can get their healthcare needs met.
Having said that, the first step in speaking the same language as someone else is to meet YOURSELF where you are in the moment. No one does this perfectly – that’s not the goal. What I want you to remember is that it’s important to do the best you can to notice your thoughts and feelings and I strongly suggest getting it out of your head and writing it down so you can see it more clearly.
It was her husband who showed her a potential blind spot when he said that he had been reading about bipolar and questioned whether she may have it.
When he said that to her, she said she wanted to throw up – just the idea felt both true and impossible at the same time. She couldn’t face that this too could possibly be adding to her already complex situation. That’s the dilemma she called me with.
I listened more carefully to her story and felt her pain. I felt her husband’s concern for her as well. I understood her fear, her disappointment, and her love for her family.
“What do you think”, she asked me.
I shared how I heard her husband’s concern for her, understood her fear, her overwhelm, her pain and her love for her family. We took some time with this part here as I felt it was important she feel truly acknowledged and appreciated for sharing something so difficult and personally devastating.
After she clearly acknowledged that she didn’t feel unsafe, I made the following suggestion:
“Give your husband a 7 day dosage log and you can both prepare one separately to note the effects of your meds, your mood and also that you’re taking them as scheduled. Both of you can also keep track using an Appointment Preparation Worksheet of your current symptoms, questions, and how things are changing. That’s the first step.
You can also make an appointment with your therapist and your psychiatrist after you observe this together for a week to ten days. Then you can go in with clear information if you decide that it’s time to be evaluated.”
She agreed that this sounded like a good plan and would get back to me to let me know how it goes.
Here’s the important learning’s from this case study:
- Vague information won’t get the job done: Going to your provider in situations like this with unclear vague information is NOT the way to get the healthcare you deserve.
- Specific information helps: Sharing short phrases about your state of mind, physical condition, etc gives your provider clear information so they can custom tailor their recommendations according to your unique needs.
- Listen Up: Other people’s perspective on your behavior can be very useful (not necessarily definitive though) and we’re all here to help each other.
As always, if you are in dire straits and feel so much pain that you can no longer keep yourself safe, it is IMPERATIVE that you err on the side of caution and seek help immediately. Only you can be the judge of that.
In Part 2 of this, I’ll share the results of this case study with you and we’ll find out together what this client learned. My prayer is that she can continue to deal with life’s daily changes in a way that works for her.
I deeply admire her willingness to explore her issues as well as her husband’s courage to share this with her.
What are you willing to notice about yourself today? Is it possible you have a blind spot like this client did and need an outside perspective? Or, maybe you’re the person who’s noticing something about someone you love and want to consider talking with them about this? I welcome your thoughts, comments and insights.
May 17th, 2010
A potential client contacted me last week with questions about Patient Power. I could hear how difficult it was for her to talk and guessed that she really needed someone to hear her story. I simply asked her how I might be able to be of service. With that, she began to cry.
She spoke of some long standing feelings of not wanting to live anymore, that she felt squeezed in every direction by relationships that were demanding and no longer fulfilling, financial constraints, a budding business that seemed like a great idea and also bore no financial fruits, and how for years and years she had tried to re-kindle her zest for life amidst chronic pain that had no diagnosis.
My armchair diagnosis, remembering I am not a doctor, was that she was both depressed and anxious. I kept those labels of depression and anxiety to myself. Instead, I continued to let her expound on her story because I could see it had been a long time since she felt truly listened to. It was an honor that she chose to call me. She said she’d read my blogs and felt like I may be someone who could understand what it was like to be her.
Digressing a moment for my personal views on depression. . . ..
Depression, and its cousin anxiety are illnesses that no one likes to acknowledge. They don’t have a clear start and end date: it’s not like a broken leg when your leg gets out of the cast and then, though you may hobble, you can walk more normally. They often sneak in through the back door – we don’t know what or why or who tipped the scales.
Yet, for those of us who are prone to it, we somehow find ourselves in the company of these smug companions who slowly stealthily steal the life out of us. It’s often not a one time event but like an Achilles heel it is something we are susceptible to over and over again.
It’s usually not a dramatic downward shift. It’s the little things that often feel like they take more effort to accomplish. It’s that existential question of “how did my life end up like this” or “why can’t I get over this already”? Its questions that have no answers, and answer that don’t make sense to us anymore.
What motivated us at one time no longer does – the relationships we once held dear are all up for grabs though we may in fact still feel very responsible to uphold our end of the bargain. We may find ourselves more tired, going from one thing to another feeling rather unfocused, or in general feeling like our get up and go got up and went.
When a physical illness occurs, there is often a grace period given by society, friends and family where you get a chance to adjust to it.
Depression and anxiety don’t have a grace period when it comes to other people – they have a finite shelf life. The rule is get over it, do the things that help, exercise, find a routine for yourself that works, and keep yourself busy so you can’t think too much. Don’t forget to get your hair done, pick up the kids, keep up with the laundry, and hold it together at work.
And for God’s sake, help yourself because other’s need you to be available for them. Society has a lot of rules for pretending that something isn’t happening.
Back to my potential client now: Her true gift was in her willingness to acknowledge what was happening to her. What we acknowledge, we can begin to take the first steps to deal with.
I didn’t have a simple solution for this potential client either.
What I did share with her is that communicating clearly helps. I assured her that by buying Patient Power (which she chose to do) she would not have a magic answer to how to pick her life up off the floor and create a life that felt meaningful and fulfilling again. She wouldn’t find solutions to her issues in Patient Power.
The beauty of the Patient Power is it is a resource guide to help you ask the questions of yourself and your dedicated healthcare provider to find the answers that are most appropriate for your needs.
Used over time, it is likely to help you make the informed healthcare choices that are so integral to your psychological well being.
I look at Patient Power as a book of mindful questions to help you gently and consciously look at what’s happening in your life, express it clearly and hopefully find an experienced healthcare provider who realizes they are privileged to have an opportunity to help you when it’s so hard to help yourself.
If my work helps one person bridge that gap between talking about their needs and hearing what their provider’s recommendations clearly – that would exceed my wildest dreams of success. The next step, of course, is seeing whether what that provider is suggesting is truly a match for you.
We are a society of individuals. At one time or another, each of us will find ourselves grappling with issues that feel insurmountable. We’ll feel helpless and alone – even when we don’t want to admit it. We won’t know where to turn despite how we may pretend otherwise.
Patient Power is designed to help you take your power back with the help of someone who knows more than you do in the area that you’re struggling.
My prayer is that life blesses all my readers with good health – both mentally and physically.
And, in those human moments that we all face when life seems hard to handle, my hope is that you consider Patient Power as a first step to getting reliable help from someone trustworthy to enjoy your life in ways that feel truly meaningful and hopeful.
May 13th, 2010
It is so hard to take care of ourselves, notice what’s going on inside our bodies and make mindful choices. Even when those choices involve taking care of ourselves, there often is a sense of losing control when we say no to certain activities we’re used to doing, choosing to take care of ourselves instead.
When I describe it that way, check in with yourself and ask how you feel about that. Consider those things you honestly feel you “should” do because they are good for you that seem inconvenient and take time, even though often we feel better afterwards.
Let’s look at physical exercise. The exercises that feel so good as we’re doing them often hurt when it’s over – or maybe even while we’re doing them.
A client of mine has fibromyalgia. While she’s working on improving her posture because that’s supposed to help with some aches and pains she is having, it’s painful to do the exercises. It h-u-r-t-s!
Some may call that whining. I call it being honest and in touch with your body. And sometimes the truth of what we’re feeling isn’t pretty – it can be powerfully immobilizing.
Imagine a boxer showing up at a boxing ring with a tutu on. Ridiculous huh?
Well, many times what’s asked of those of us struggling with pain is to show up in life with our most beautiful “tutus” on and do pirouette’s around the room.
Our “pirouette’s” may show up as hosting parties, being there for other people who have “bigger problems than we do”, attending weddings in our finest attire, or decluttering the house for guests that are coming in from out of town. That’s just as ridiculous as a boxer showing up in the rink wearing a tutu. Why? Because it’s not appropriate behavior for how we’re feeling.
My client was hip to this idea. We’d been talking about the importance of being mindful of her symptoms and flare-ups. She was not about to host a party, had drawn firm boundaries with others who were zapping her energy, had declined numerous parties and had lowered her standards about decluttering her home for others.
The changes in her life were aligned with how she was feeling – low energy, unpredictable pain randomly circulating throughout her body, and mood changes were all part of her life right now.
It surprised her when she said to me the other day: “I don’t get it. It is so tiring trying to be present with these symptoms and accommodate them. I’m so sick of being mindful of what my body needs. And it seems like once I make one adjustment, something new pops up. I do my exercises and take Motrin afterwards. My depression goes away but my body hurts. I rest and feel better afterwards and feel ready to talk to a friend. I do it and feel zapped. Will my life ever be normal again?”
I heard her pain on so many levels. I understood why she feels as she does. And I don’t have a solution or a crystal ball as to when things will shift.
The fact is that dealing with fibromyalgia is tiring and unpredictable. Little things can help like modifying your schedule and commitments. Those same little things can be energizing when you do them and your heart is into them. Like the old saying goes, “it’s not what you do, it’s how you do it.”
I wish I could wrap this message up with a bow on it. I can’t say that fibromyalgia is a gift. It isn’t. Some days are harder than others.
What I do know for sure is with fibromyalgia, as with life in general, small simple steps work. When you’re tired, notice what you’re thinking. What helps? What doesn’t help? Try something and see how you feel later.
I’m a big fan of Havi Brooks (no relation by the way) whose work is nothing short of brilliant. Among other things, she talks about creating the Book of You.
This doesn’t have to be a physical book. It can be a word document or it can be in your head – though I’m a strong proponent of writing things down to remember them (even if you never look at them again!).
In the Book of You, you keep track of 5-6 key feelings you have and what helps when you feel that way.
With this client, she’s noticed that when she feels tired exercise helps. She uses Dance of Shiva, low impact aerobics by Leslie Sansone, and yin yoga by Paul Grilley as ways to increase her energy and lift her mood. She chooses any one of these and inevitably feels better – even though it may hurt while or after she’s doing it. They always work.
I invite you to create your own Book of You and feel free to share any questions or insights you have about this.
Here’s the scene:
You’re at your primary care provider’s office to get your routine cholesterol check. And you’ve got this bum knee that locks up when you’re exercising. It’s nothing terrible – you can make it through the day. But, man, it hurts sometime. You’re really too busy to be at the doctor’s in the first place but it happens that you’re there for this routine check so you thought you’d just throw it into the mix of things to discuss in your appointment.
Your cholesterol results look good – sounds like your exercise and eating are helping shift things in the right direction. And you’re looking for that lucky break in the conversation to discuss your knee.
As she’s walking out the door she asks how your exercise is going and you say, “Great – it’s just afterwards my knee seems to lock up a couple hours later, it wakes me up when I’m sleeping and getting out of bed in the morning is kinda tricky though I hate to admit it.”
She babbles off a bunch of options very quickly – take this test, try this drug, have you considered stretching, maybe you need physical therapy, a few more things and before you know it she’s out the door. No one’s fault – everyone’s busy. Scurrying off she tells you that the nurse will be back with your paperwork and she’s outta there.
Oops – what just happened here? That was quick! And there you are feeling confused, overwhelmed and kinda sorry you asked the question in the first place – because it’s not THAT bad. Except, it’s really painful sometimes.
What you’d really like is to have your knee feel better but you have no clue how to make that happen.
Why did your mind go blank?
Well, with all due respect – why is the WRONG question for things like this.
But, since we’re looking at this question of why anyway – here’s a couple possibilities. (We’ll get to the “right question” in just a moment or you can skip down to the end of the article if you’re in a hurry)
Here are a couple possibilities why our minds go blank (and my mind goes blank many times too just for the record – ask my kids!!):
- TMI: It’s too much to digest when you’re given many options all at once in a short time period. No one can take them all in and get them straight.
- Brain Freeze: Do you know that feeling when you’re eating ice cream and you feel it right between the eyes? That’s the same thing that happens when you’re in the middle of this sort of thing – you can’t take it all in and it’s kinda surprising as you notice something just went right over your head.
- Preoccupied: Maybe the doctor’s running late, you’ve got kids waiting for you to pick up or you were supposed to be at work a half hour ago. Maybe the doctor’s running late and SHE needs to be out of there 10 minutes ago so she’s talking quickly. Maybe someone knocked on the door interrupting the conversation mid stream. For many many reasons we get pre-occupied – totally human, no one’s fault and a very good reason that our minds go blank.
It’s very understandable that you’d want to know why you lost track of the conversation AND the real question is WHAT can you do to make sure you understand what your healthcare provider is suggesting for you.
Now, here’s what to do to make sure you get the information straight. There are two parts to it:
- Write it down: Have a clipboard in front of you with your filled out Appointment Preparation Worksheet available along with a pen. Take notes as she’s talking
- Verify what she’s said: Repeat what she’s said to you asking questions about things that are unclear. This part may be hard to do if she’s already out the door by the time you’ve gotten the information written down.
Well, this is precisely what helped me fill that crucial gap between giving clear information and getting the professional advice you receive straight and complete.
One of my favorite expressions is from my husband who used to say, “Wear a belt and suspenders too”. This totally fits my philosophy of getting the healthcare you deserve. Here’s the next step to making sure you have truly understand their recommendations:
- Fill out the Appointment Summary Form which is part of Patient Power: Get the HealthCare You Deserve. Follow the directions and forward it to your provider for their approval.
You are entitled to get the healthcare that works for you. Get the story straight by using the Patient Power Process as your way to get the story straight from the get go so you can make good decisions.
After all, how can you possibly make good decisions when you can’t even remember what the options were in the first place? Knowledge is power and your good health matters.
April 12th, 2010
A client of mine has had chronic back pain for a while and things are finally starting to resolve. It’s been going on for a while, she’s been through countless physical therapists, exercises, etc. – everything has helped to a degree, but she’s now able to put it all together and feeling more alive. She can now go out to dinner with friends, mow the lawn and do other things that were previously off limits because she was in so much pain.
Yeah for her – her success has been a very hard won struggle!!!
I give her so much credit for working sooooo hard to get out of pain. Seriously, it’s so much easier to live with things sometimes than to actually deal with them – especially when you try so hard and it’s so frustrating.
Moving on with our story here. . . . .
She spends a ton of time on the computer doing her best to create a sustainable business that creates a livelihood for her and her family. She’s a dedicated Mom with kids that are her heart plus a huge animal lover. She’s got some phenomenal ideas and is finally figuring out a way to put it all together.
Ooops – too much time on the computer apparently has caused her hands incredible pain.
She’s purchased my eBook Patient Power and we were talking the other day. She said to me: “I can’t POSSIBLY see my doctor about this – I can’t handle one more thing related to my health. I’m at my wit’s end.”
I listened deeply as she continued on, in tears, trying so hard to “get it right already” and so sick of trying hard and as she put it “getting nowhere.”
Knowing it was the wrong time to remind her of her progress as she was in such a funk, I simply asked her: “Well, what do you already know that works for you when you’re depleted and in pain like this?”
“Ahh”, she said, “Great question.”
“What I know is I have your book and am taking Advil for this in varying dosages. I could record those on your 7 day dosage log and get more information about what’s working and what’s not. I could use an Appointment Preparation Worksheet to note what my symptoms are, what helps and what doesn’t, when they are more pronounced.”
I was ECSTATIC that she could see the tools she had already in place that she could use to gather information.
In the meantime, she’d ask for suggestions from others who she felt might know something about this, researched on the internet, and come up with her own suspicion about what this is.
Note: I never advocate self diagnosing! But, I am a strong supporter of getting good clear information about what’s going on with you before seeing your provider in non-emergent situations so that they can truly be of service to you.
Anyway, here are a couple things to learn from this amazing client:
- Get Your Facts Straight: When you’re in pain and don’t know what to do, gather your facts together. Figure out what helps, what hurts, and keep track of it.
- Write It Down: Use Patient Power to stay on top of your symptoms, your medications to give clear information to your provider.
- Be Kind To Yourself: It’s okay to wait in a non emergent situation when you’re “at capacity” dealing with health issues provided you’re not jeopardizing your ultimate well being.
- Work with What’s Happening To You Right Now: Remember life is always changing. Ask for support from friends, family, online communities that you are a part of. You never know what you may find.
Question for the day: What’s going on with you where it would help to have more information but you are “at capacity” dealing with whatever is on your plate? How can you work with what’s true right now?
I’m in your corner, it’s hard when you feel like $%$% and you can work with it just as this client did using Patient Power as your pathfinder!!!!
The other half of the story is making sure that when you tell the provider what’s going on with you and what you need help with, that you clearly understand what they are suggesting to you.
I developed an Appointment Summary Worksheet to help you do just that: get the facts straight first so that then you can figure out if what they are suggesting is a match for your needs.
Let me give you a real life example from a courageous client of mine. He struggles with serious depression and has been in remission for many years. Unfortunately, he had a serious setback which really “took over” his life in a debilitating way.
Those of you who have struggled with depression may know that its symptoms are often confusing and pervasive. This client was having a lot of trouble describing what was going on with him and he called me because he couldn’t fill out his Appointment Preparation Worksheet in a way that made sense to him. He felt paralyzed, confused and overwhelmed YET also on top of his game enough to know he needed help. He had the insight to know he needed to see his therapist and scheduled an appointment.
I am honored that he chose me by scheduling an appointment so I could help him fill out his Worksheet ahead of time. I have a gift for helping others find language for things that can be very difficult to describe and it is my privilege to share that with others. He could have also chosen to call a close friend or family member.
The point: When you need help and don’t know how to describe what you’re experiencing, ask someone you trust for help.
The Appointment Preparation Worksheet states: “Describe Your Current Symptoms”. I asked him some follow up questions and here were his answers to me. As he told me his story, I typed his answers onto the form.
v “Anxious when I wake up in the morning, have difficulty moving and getting to the bathroom, then feel overwhelmed with details.
v Force myself to exercise which helps until I get to the cool down. Hard cardio is especially helpful. When I cool down, all the anxiety comes flooding back in as I think of everything I have to do during the day.
v I remember my precious cat who was recently killed, and think of all the other losses in my life, I can’t stop crying, I can’t meditate, I lose my appetite.
v I take my anti-anxiety medication and feel better for about 3 hours and then it starts all over again.”
The second question on the Appointment Preparation Worksheet is: “Additional Symptoms/Changes/Questions you have”
v He told me what medication he was currently on and that he was staying away from toxic people, taking his vitamins, drinking water, and taking simple action.
v He said he wanted help with getting off the anti anxiety medication and figuring out what had him so triggered that he felt so depressed. He said he wanted to focus on his work again and wondered who he needed to talk to or see to get some help with this? Was he in the right place to get through this?”
The therapist was so impressed with the form that she asked whether he’d mind if she kept her copy for his records. He was thrilled to have given her useful information that she could refer back after his visit and they scheduled a return appointment.
He then explained to his therapist that he wanted to send her a summary of what she had heard her say to makes sure he had gotten it straight. She requested that he send this to her by pdf.
He was kind enough to copy me in on his Appointment Summary Worksheet to show me how it worked for him, wanting to make sure he had the story straight.
Here’s what he said:
The Appointment Summary Worksheet asks: “What did the provider say:” Here is his response.
v Look at the losses that led up to the situation before you found yourself feeling so depressed before your pet was killed?
v Go back through your history since you’ve seen me last, using a calendar if it is helpful to see whatever changes, losses, insults, difficult things that took place leading up to this event?
v Think about how your children were affected by your behavior: what they saw were symptoms of your illness, not the real you and you can follow up with them in an appropriate way to repair those hurt feelings they felt from seeing you in so much pain.
The next question on the Appointment Summary Sheet reads: What are the next steps for you? Here is his answer:
v Contact psychiatrist’s office on Thursday and give the nurse an update on my condition. Maintain anti anxiety medication and ask her advice about continuing it, clarifying dosage and ask about what to do about insomnia. Ask if I need an appointment.
v If suicidal thoughts are present, ask for an appointment as soon as possible. Let them know I’m continuing with social worker and have an appointment next Monday.
v Look at the individual disappointments, losses, insults, and hurts using a calendar that led up to my current feelings.
He emailed the Appointment Summary Worksheet to his therapist who will either email him back that he got it straight or correct it and he’ll send a revised copy. If he ends up seeing his psychiatrist again, he’ll bring this approved Appointment Summary Worksheet with him.
Notice how this works:
v Preparation Helps: He went to his appointment with this therapist fully prepared with a list of his symptoms, concerns and questions. When he got there, he handed it to her as he was too upset to talk and felt it would save time.
v Listening Carefully: She gave him some things to think about which he is now verifying by using the Appointment Summary Sheet
v Verifying The Information: He will submit the Appointment Summary Worksheet via email to his therapist first to make sure he got it straight.
v Following Up: He will wait for her feedback or contact her in 3 days and be sure she received it.
v Think It Through: He will do his assignments, prepare his answers for his next Appointment Preparation Worksheet with his therapist and share his Appointment Summary Worksheet with his psychiatrist if he chooses to see him.
Sounds like a lot of work huh? Well, that’s one way to look at it. The other way to look at it is taking this in small steps de-constructs a previously life threatening condition and makes it manageable and has the potential to create a more satisfying life. I’d say that’s well worth some attention that actually takes very little time to do once you get in the habit.
Notice the effects:
v The System Works: The patient and all providers are all up to date on what’s going on with his mental health Everyone is well informed about the medications and psychological issues that have led to his condition
v Patient Power: The patient is doing his homework by looking at what individual issues may be contributing to his depression.
Notice the longer range effects. This is the biggest bonus – the patient is now getting the healthcare he deserves from competent providers who are willing to use their professional expertise and direct it specifically towards what he needs. Hopefully, the patient’s symptoms will continue to improve as he continues to participate in partnering with his providers. It’s a win-win for everyone.
Think about your own well being. Maybe your issue is more physical in nature like diabetes, obesity, migraines, fibromyalgia, or heart disease. Perhaps you have a combination of things going on such as depression as a result of dealing with chronic pain or celiac disease.
Maybe you don’t even know what the problem is but you know something is bugging you though you can’t put your finger on it. It may be a knee injury that keeps acting up or maybe it’s a result of some surgery that isn’t healing quite right.
My point: Whatever it is, you can deal with it with competent healthcare by giving clear information and making sure you understand the recommendations that have been given to you. I have given you one of the tools with the Free Appointment Preparation Worksheet.
That is only half of the equation though because you must be sure you understand what is being recommended. You do that by using the Appointment Summary Worksheet which is part of the instantly download-able eBook Patient Power: Get the HealthCare You Deserve. Along with the other simple to use Worksheets that take very little time and energy, you have an opportunity to take charge of your health and get your needs met.