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

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.

 

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Hey Universe, I Hear You This Time!

This 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.

Little Known, All Natural Secret Treatment For Depression

I Got Major Depressive Disorder (Photo credit: Jean Big Cat)

I have battled the beast otherwise known as major depressive disorder for a decade or so now. During my battles I did extensive research on treatments for this debilitating condition and consulted with many professionals. I met with dietitians and nutritionists. I met with spiritual counselors, I joined a support group…..which turned out to be a triggering  and numbing experience for me personally. I had, and still have, many sessions with psychologists. I was treated by psychiatrists. I considered whether I should have ECT therapy….. otherwise known as electric shock…… after several courses of several different anti-depressive medications seemed not to work. At one point, one of my treating doctors had me on a regimen of medications that included an SSRI, a tricyclic antidepressant, an antipsychotic, an anti-anxiolytic, and gabapentin. Within six or seven weeks of this regimen, I developed a pretty severe reaction called serotonin syndrome that put me in the ER.

Finding a treating psychologist that is a good fit for you is a tricky thing in my experience. It has a lot in common with finding a mate. It takes a bit of time to figure out if you are a good fit.  Just like dating, some things look pretty and shiny and wonderful on the surface, but as the layers peel back over time, you find some behaviors or thought processes that are deal breakers……you just aren’t the right fit. For some people they find the right fit on the first or second try. With me, it took five. It seemed like it took forever and I was ready to give up hope on the whole thing. But number five was THE ONE. And his advice and guidance has been more precious to me than any diamond ring. While helping me address and process the trauma and issues that are my life in a way that will lead to my maximum return to health, he has passed on to me some real gems. So many of these things in hindsight seem so obvious……the kind of “duh, why didn’t I think of that” obvious. And I am about to share one of them with you.

As a firm advocate of holistic healing, he understood my strong dislike of taking psychotropic medication.  But he also knew that I was  struggling with strong suicidal ideation and very scared of my own mind. During the course of one of our sessions, he told me that a wise old guru once shared with him that when a person feels down, what they need to do most is go give back. The worse one feels, the more depressed one is, the more urgently they need to go volunteer. They need to help someone else who is struggling. His prescription to me that day…..immediately go do something nice for someone who was suffering and expect nothing else in return. And you know what?…..This RX is one that really works.

During the eight years before getting this prescription, I had not heard or read of this idea once before. But it seems so natural. What a concept! If you are feeling down…..force yourself to get out from under your covers and go give back. Not only will you receive the blessed feeling of doing something good, it will naturally lead you to contemplating gratitude. Practicing gratitude flips a metaphorical switch in your brains thought processes for the positive. You will be amazed the power that a smile to a random person holds. I know I was, and continue to feel this way .  I find that something Tony Robbins says quite a bit holds true in my life…..if you look at the ceiling and smile and laugh…..even if you are forcing it…..it is practically impossible to feel bad in that moment. While it is virtually impossible to look up and smile every minute of every day…..doing something to help someone else on a daily basis is much more attainable and gives you the same results.

So please go share this “secret”treatment…..dare I even say for some a cure……for depression. Give it a try and tell everyone you know. Let’s make this the worst kept secret ever. Keep on going!

Breaking News! This Just In…..

To all of us who are concerned with the state of mental health recovery in this world, what follows is important and amazing news. I just found this as reported at http://www.mindhacks.com. I am shocked and saddened that this is not international news being reported by every media station worldwide.  I want more people to know about this, so I am reporting it and hope that others will follow.

National Institute of Mental Health abandoning the DSM

In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5diagnostic manual that it will be “re-orienting its research away from DSM categories”.

In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.

This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.

As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:

Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.

As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences.

For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.

Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.

It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.

It is also true to say that RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.

The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.

The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.
Link to NIMH announcement ‘Transforming Diagnosis’.