MD’s With Empathy…..The Real Key To Patient Compliance

start empathy

Medscape just published an article titled “For Noncompliant Patients, a Fix That Works”. I often read posts on this website, to stay informed of the latest medical breakthroughs, treatments, and health issues and feel they are one of the most credible and informative sources out there on the web today.  I have several chronic health challenges, not the least of which is being an ashamed educated smoker…..which surely complicates all the other health problems I have as well as being a problem on its own. Addiction is a tricky thing. I have tried without success yet several times to quit smoking, so in this respect I suppose I am a noncompliant patient……which made the article piqué my curiosity.

Many doctors over the years have approached the topic of quitting smoking with me. The talk usually goes like this: “Well,are you still smoking?”. Yes I say. “You are slowing your body’s healing process and constricting your blood vessels by continuing this. You need to quit.” I know I say to myself silently, as my eyes lower their gaze towards the floor. “Here, take this pamphlet. There is a quitline phone number on the back of it to give you options on how to quit. So, how is your pain today?” And the discussion ends just like that. Now don’t get me wrong…..it is certainly not the doctors fault that I haven’t been successful at quitting yet, only mine.  It is noteworthy though that this is typical of most doctor patient conversations of this type.

This article recognizes that many patient noncompliance discussions are just not done in the ideal way. Whether it is an issue like mine, or taking lifesaving medicine as directed, or changing other lifestyle habits that directly impact health and mortality there is an overall sense of frustration. Enter a new approach that doctors can take with their patients…..it’s called motivational interviewing. I quote from the article: “A growing number of doctors have been using a special technique that gets superior compliance from patients….. It’s a way of talking with patients that’s designed to elicit their barriers to compliance and assist them in overcoming those barriers. Studies show that doctors using this method of interaction can often work wonders. ” So what is motivational interviewing, you ask?

At first glance, I thought perhaps this was some new conversational technique that had just been discovered and unleashed upon the medical community with astonishing results. Then I read the entire article. Well, it turns out that motivational interviewing is exactly what the specialty doctors I trust the most, and feel are truly integral in my support, have done all along. In a nutshell, its demonstrating genuine empathy for the patient. The “technique” as described involves partnering with the patient, asking positive open-ended questions to stimulate a dialog, using scales to encourage patient interaction, and planting the seeds of change. Funny that I would assume most of these would be commonplace, yet my experience has shown the opposite. I have a handful of phenomenal doctors that I consider key members of my “team”, and I went through dozens more before I landed in the office of these gems. Looking back now I see the one thing that makes these doctors different…..keepers if you will….from the others that I chose not to continue treating with. They all have empathy. Each one of them makes me feel like they take a genuine interest in ME. With these docs, I don’t feel a number or a chart or worse yet…..a paycheck. Yep, what sets them apart and makes them stellar in my eyes is their authenticity when they say they really care about me…..it shows. And the proof that this technique actually works? I am after all still struggling with smoking…..a fact that these specialists don’t typically address with me. Well to me the proof is that after a decade of despair, uncontrolled pain, and a general tumbling down into the rabbit hole I found this team and have made remarkable progress in recovery and general everyday functioning in the world. Although I still have scary issues that arise, I am doing so much better in the last couple years than anyone could have imagined. That is my definition of success. As the article states, doctors can get the ball rolling in less than five minutes during a visit because most change happens incrementally over time. And that is the key in my mind…..a general chipping away of old patterns to be replaced with new through caring conversations and gentle reminders, always reinforcing the goal. So it’s not really the message that doctors are delivering that makes the difference. It is, in fact, HOW the message is delivered that works these wonders. Imagine that.

doctors with heart

 

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Make Your Voice Heard

Make Your Voice Heard: Guidelines for Effective Advocacyadvocacy

One crucial part of my mental health recovery journey is  reaching out to help others in need. I do this in a variety of ways. One area that is truly a life saver for me is the volunteer work I do assisting people seeking Protection From Abuse orders, or PFA’s for short. Another area I concentrate on is acting as an advocate for people who are struggling because of their involvement in a system. I offer free help to those encountering issues with the legal system, medical system, tax system, benefits system, and school system the most often, although there are other systems I have tried to help untangle as well. I am learning through these experiences with individuals about the type of advocacy work that is done on a larger scale for whole groups.

Advocates for individual groups often meet unfair policies and practices that hinder rather than help their clients. Changes to such policies in the form of rules, regulations and laws, often require the support and commitment of legislators, political leaders and other policy makers. The following are some guidelines on how to be an effective advocate and communicate your message. Remember that efficiency requires education, both your own and your audiences, as well as reliability, accessibility and persistency.

Identify Your Goal

  • What do you want to accomplish? For example, decide if you want to introduce legislation to change a discriminatory employment practice like lifting a particular occupational bar or licensing restriction for people with criminal records.

Develop Your Strategy for Accomplishing Your Goal

  • Who has the power to effect your desired change? What is the process for the policy or regulatory change that you want to make and who has the power to make it. It could be legislators on the local, state or federal level, or perhaps, appointed commissioners on the state level who are responsible for promulgating the particular rule or regulation.
  • Who are your partners? Identify organizations and individuals that may share your goal and who can help you communicate your message. These may be local or statewide residents, coalitions of individuals and/or groups, as well as community-based organizations, faith-based organizations, and other advocacy groups.
  • What is the timeline for your goal? Be aware of legislative timelines, such as when the legislature is in session. Be patient, understand that achieving your goal could take a considerable amount of time.

Create Documents that Will Help You Communicate Your Message

  • Are your documents clear and concise? Politicians, policy makers and other officials, and their staff, are busy and often do not have time to read a lot of information. However, supplying them with written information that includes data and research on your issue may support your position. Therefore, make sure that the written materials that you provide them with are specific to the issue and the area that they represent.

Helpful Tips for Conducting a Meeting

  • When introducing yourself make sure that you identify yourself as a constituent or as someone who represents constituents.
  • State the point of the meeting at the beginning.
  • Be brief and to the point.
  • Listen as well as talk during the meeting, as well as take notes on questions or concerns that come up during the meeting.
  • Be honest. Acknowledge the positive and negative aspects of the issue.
  • Share written materials during the meeting, if it is appropriate, and leave them behind for the leader of the staff that you are meeting with to read.

Cultivate a Champion

  • Who can represent and advocate for your issue publicly and champion your goal? It can be incredibly beneficial to have a public figure, such as a famous person or politically powerful person, to help you with your advocacy and to deliver the message you need to achieve your goal. Regardless of who it is they need to be persistent, charismatic and effective.

Most importantly, don’t burn any bridges, whether you achieve your goal or not. You never know who you may need to work with again. Be a gracious winner or loser.

Hey Universe, I Hear You This Time!

Juanita-Lewis Universe is callingThis post is about a tremendous AHA moment I experienced on Friday. It is so powerful that I needed to share it with all my fellow seekers out there. You see, like many others I am aware of way too many moments in my daily life where stress, anxiety, depression, and a sense of despair threaten to undermine if not destroy my happiness. With all the daily practices I have in place to increase my conscious awareness, I still am a work in progress and prone to ruminating about the tragedies in my past and fretting over my future.

I begin each morning with a silent gratitude session, before my feet even touch the floor. This small ritual is a fabulous way to set the tone for the day. After I drink my deliciously flavored coffee, finish with my personal hygiene, and dress – I then have my morning meditation session. There are days when I am not as religiously adherent to this schedule as I would like myself , but on the whole it is a steady routine of mine. Later on, typically about 6 PM, I have an evening meditation session and finally about thirty minutes before I go to sleep…..or attempt to go to sleep at least…..I put on one of my self-help relaxation CD’s and drift off. Sounds good, right? So what is the problem…..you might ask? Well, even though these steps have positively impacted my physical, mental,emotional, and spiritual health…..I still find myself in states of extreme anxiety throughout the day with a feeling that there is a giant boot poised right above my neck about to stomp down and crush the life out of me.

So, I muddle through day by day, seeking solutions and tools that will help me increase my life satisfaction. I am a firm believer in the concept of Go Give. I find that by giving back and helping others…..even in small ways such as offering a smile to a stranger…..I gain just as much satisfaction as the person I am helping if not more. One activity I do in that vein is volunteering as a legal advocate in the local courthouse for people who want to file for PFA’s…..or protection from abuse orders. This is where, on Friday this week, I met her.

She was a well dressed middle-aged woman with piercing green eyes wearing what looked like elasticized bandaged sleeves on both her arms. She was glad she had made it here….. in the tiny coat closet sized room given to the woman’s advocacy center I volunteer for in the basement of the courthouse.  As is my custom, I offered her a seat and a box of tissues and asked her how could I help her and what brought her to here this day. As she began to tell me her story, I found myself so captivated that time just seemed to stop. Over the next hour, she shared with me story and why she was seeking a protection order that day. But it was not so much her story that hit me like a bolt of lightning hurdled from the sky…..it was her attitude, the peace and love that radiated from her, and the sense of unflappability that she displayed. The universe was speaking to me, through the form of this brave woman…..and I was listening this time.

She is a survivor of childhood incest and adolescent rape. By 24 she had given birth to four children and escaped from a tortured and abusive marriage. At 37, a devastating car accident landed her in a coma for 17 days and more metal in her body holding her together than I can imagine. Then at 45 she started the journey of dealing with the  big C…..stage 2b metastatic breast cancer. This lead to lymphedema which is why she was wearing support sleeves on her arms. She had psychiatric hospitalizations for earlier suicide attempts and takes medication daily for bipolar depression. During that time of mental health crisis, she found herself in the wrong place with the wrong people and is now facing two separate legal battles that could potentially send her to prison for decades. Oh, and they found tumors in her uterus so she is undergoing a hysterectomy at the end of this month. She found herself on this occasion filing for a PFA for her 3-year-old grandson against his biological mother’s new boyfriend. Wow…..and that is the short story.

As I was struggling to comprehend the enormity and pain of her journey through life and offer her support and compassion, I realized that I was more shook by her account than she was. Is it my imagination or is she just exuding this amazing steadiness and calm? And it wasn’t an act…..she truly gave off a vibe of peace and serenity that I have only witnessed before in yogis and advanced meditators. I politely asked if she would be willing to tell me her secret for seeming so happy and at peace while facing what seemed like overwhelming circumstances. She paused for a moment, taking a deep breath, and said she would be happy to share it with me.

“It didn’t happen overnight, and it hasn’t been easy,” she replied “but I have finally learned to deeply love the person I am. You see, I have been at rock bottom for most of my life and it got to the point that I only had two options left….end my life or turn things around and go up. Naturally, I tried the former approach first and when that didn’t work I began to research and look for ways to radically transform my life. I spent my whole life trying to give…..it was my job to keep everyone else as happy as possible. I didn’t mind giving to my children. I wanted them to have a happy life. But I didn’t give to myself and I didn’t know how to receive anyone else trying to give me help. ”

Boy, did that hit a nerve with me. How many of us are programmed to give but don’t have a clue about how to receive? I was just mesmerized by her and wanted to hear more. “I learned that if I am constantly putting energy out and not allowing any back in, the message I am sending out into the universe is there is no space for abundance in my life. I also needed to learn to love myself and appreciate the moments, people, and things I did have. I spent so much time and energy worrying about what HAD happened to me and what MIGHT happen to me that I never got to appreciate what really WAS happening. When I finally learned how to be present in the moment…..to live in the now as they say…..I feel like my whole life changed and I became almost reborn.”

I have read about this concept before. I do try to practice being present and enjoying the moment that is. Yet, I heard this from her as though it was a brand new revelation. For whatever reason, this time and in this space with this woman, I got it. If she can take the practice of living in the now and implement it in her life in a true deep way to make it automatic, then I can too. This woman came into my life looking for my assistance and help, but instead gave to me a gift that is truly so precious. Live each moment as if it is the only moment, because it is truly the only moment that ever matters. And practice loving yourself as deeply, truly, and profoundly as you give love to others. Pay attention, bring conscious awareness to your thoughts and emotions. Allow yourself to feel and to think as you may, but stop and witness these thoughts and feelings and consider that you do not have to act on any of them…..only acknowledge them and watch them. Live in the now…..what a concept! Hey universe, I heard you this time.

sign from universe