Physicians are busy people. They're often constrained by practice rules outlined by insurance companies to keep appointments short and patients moving. So many times there isn't time to cover everything, and patients leave the exam room with unanswered questions or concerns. It's an unfortunate fact of life of today's medical world. But there are some things that I, as a health psychologist, wish physicians would say to their patients. Here are my top 5, from the home office in Oak Park Illinois:
- What do you do to de-stress?
Most MDs acknowledge that while stress doesn't cause most illnesses, it certainly isn't going to help once you have a chronic condition. It's probably safe to say everyone experiences stress, and not all stress is bad. It can be a great motivator. But there is a tipping point where stress begins to deplete our mental and physical resources, which in turn can cause spikes in symptoms. Now that we've covered that, the more important discussion point is what are you doing about your stress, and is it helping?
- How's your support from family and friends?
How are your loved-ones reacting to your illness or current symptoms? We know that people with good support systems do better overall. Good doesn't necessarily equal large, so the goal is quality first, quantity second. Are there people in your network who aren't helpful? We also know that chronic illnesses are often stigmatized, and stigma comes in many forms. From outright discrimination to more subtle, sometimes even well-meaning, comments like "what did you do this time to get sick?"
- What do you think of your current medications?
Recently we've shifted from using the term "compliance" when it comes to patients taking their medications to "adherence." It has less of a dictatorship ring to it. Unfortunately medication adherence is an ongoing issue, and as C. Everett Koop wisely stated "Medications don't work in patients who don't take them." The World Health Organization (WHO) estimates that up to 50% of patients are non-adherent at some point and this equates to over $290 billion a year in costs in the U.S. alone. There are many reasons why this happens, and we'll dedicate another blog entry to this topic. But one key discussion point to have with your MD is how much do you buy into the treatment? Do the benefits outweigh the costs (like side effects, actual costs, etc.)?
- How are you doing emotionally?
Seems like a no-brainer question, but it's one that MDs may shy away from because of concerns of opening the floodgates and then not having the time, or skills, to address it. Nevertheless, it's an important area to discuss if you're feeling overwhelmed. We know that people who have anxiety or depression on top of a chronic illness have poorer outcomes, and that treating anxiety or depression symptoms can reverse these negative impacts.
- I think seeing a therapist might help you - and no, I don't think you're "crazy."
There's a movement to integrate psychology into medicine that's slowly catching steam. A barrier to this is the stigma that mental illness carries in our society, and the notion that if my MD is referring me to a shrink, he/she must think I'm crazy. More often than not, this isn't the case at all. Rather your doctor understands the role that mental-health plays in physical health and appreciates what seeing a specially trained therapist can do.