How often are we brining up this topic??!

In the most recent issue of O magazine, Dr. Mehmet Oz discussed the MD’s perspective on what is most important in patient-physician conversation. You may want to look up his whole article, but there are a few highlights I want to underscore.

Dr. Oz goes back to a study that indicates physicians spend only 23 seconds of listening before they interrupt their patients. That’s probably not news to you - except the part about the validated study! So what do you do with that information? Refuse to get sidetracked. Write down what you want to know and keep referring back to your concerns.  Ask the physician if there is another way to get your questions answered. Do they use email or a physician’s assistant or some other way to allow you to ask about symptoms, side effects or medication issues? Here’s where you remember that you need to be in charge – and that’s a challenge!

Part of being in charge is keeping track of all that’s said – and making sure you understand it.  Can you bring someone to help you? Is it possible to tape record the appointment so you get all the information and can listen to it on your own time? What’s the best way for you to take notes? Knowing that there is going to be a lot of information, and often new vocabulary, at a time when you may not be feeling well makes it even more important to find some ways to understand what your doctor is telling you.

Tell the truth. Hmmmm. How many times have you been tempted to make yourself sound better than you are because you don’t want your doctor to think you’re a whiner? When have you stretched the truth about how much medication you’re taking? Minimizing the number of painkillers or pretending you take all your medication when really you’re trying to cut back? Any way you dodge the truth can be harmful to you. Your doctor is not your mother – the physician needs accurate information in order to treat you appropriately. That includes those questions about how much alcohol you drink, or what kind of sex life you have and whether you’re smoking or taking recreational drugs. It all matters – and can make a difference in your treatment.

Those are the top issues – but I suspect you have more ideas about how to communicate well.  Most of these ideas in this column are things you can do, but another essential aspect of communication is how your docs talk to you. We’ve heard lots of horror stories, but I know there are lots of physicians who do an excellent job of getting their message across. I am collecting “best practices” that you have experienced, and in September I will be hosting a call in program where we can share these stories with each other.  Start thinking of how your doctor does it right.  I’ll be eager to hear and share!

Diane, a client of mine*, came in with a fist full of problems the other day. She began our session with a description of all the difficulties she was having with her mother. As she continued to describe the intrusiveness of her mother, and the escalating conflict, I gently interrupted her.
Diane, you are telling me a “problem saturated story.”  This is language I recently learned, and it sums up how we often tell our stories, or look at our lives.

The problems or negative events fill up the screen. We begin to hear and see what matches our problem, and we disregard what doesn’t fit. 

In Diane’s case, her mother is over- involved.  There is an issue. But she is seeing every aspect of her relationship with her mother through that lens. She doesn’t have a larger perspective.

Some theorists have called this being able to be an “observer” – stepping outside the situation and getting a view that is separate, not enmeshed. Others call it “being on the balcony” where you can imagine yourself looking down on your life as if it was a play that you can look at from a distance.

At first Diane resisted. She didn’t want to let go of her perspective – or her sense of being wronged. But we tried making the shift. She pictured an ornate balcony as if she was at the opera. In her mind’s eye she could see herself looking down at her mother and herself talking and arguing on the stage. She expected to see her mother’s controlling attitude and her resistance. But she was surprised to instead see her mother trying to reach out to her and she was backing away.

From another point of view her mother was not intruding but trying to get close as Diane retreated. 

Having another point of view helped her let go of the problem saturated perspective to a wider view. This also helped Diane think and feel a little differently about her relationship with her mother.

I tell you this story because we can do the same thing with our disease. We see our lives as “saturated’ with the problem of pain or of limitation. It is difficult to get up on the balcony, or step outside our usual point of view. 

But what if you tried it?

Imagine a comfortable seat that overlooks your life as you are living it. What might you notice? Perhaps there are more people on stage than you realized – friends, family, neighbors, CreakyJoints companions, your physician, your favorite nurse, the person at the gym who always smiles at you, there are many many people around.

What else do you see? Maybe your belief is that you are always struggling, but never getting enough done. From the balcony you witness yourself completing remarkable activities – your work, taking care of the daily business at home, managing children, pets, volunteer activities, getting exercise, doing multiple doctors’ appointments, and even having time for dinner with friends. How do I do it all you can wonder with amazement!

Broadening your perspective allows you to loosen your grip on the idea that your interpretation is the only truth. In reality, all of us just “interpret”. We notice what fits our perception, and discount whatever does not. From the balcony we can notice new information that doesn’t “fit” with our set perspective. We can be more flexible and open to different information and novel interpretations.

For any of us with joint problems, flexibility is a good thing, and a two way process. The more flexible you can be in your thinking, the more that helps your joints (and vice versa of course but that’s another column). It isn’t easy to let go of an idea or an interpretation that this is how it should be, or this is what must happen, but when we soften and give ourselves some room, wonderful things can happen.

*Not my client’s real name or problem. A composite identity and issue used to illustrate the article while keeping my clients anonymous.

While browsing through an article entitled "Perspective: Searching for Balance" in the Harvard Divinity School Bulletin, I came across an idea that intrigued me:  the importance of middle ground.

The author, Kathryn Dodgson, quotes a Nigerian writer, Chinua Achebe. Achebe writes that he is fascinated by the middle ground -- "It is neither the origin of things nor the last things; it is aware of a future to head into and a past to fall back on; it is the home of doubt and indecision, of suspension of disbelief, of make-believe, of playfulness, of the unpredictable, of irony."

My thinking was stimulated by the invitation to consider a  "middle ground" or middle way.  That idea is so out of favor in a culture of extremes.  Political and economic fortunes ride a roller coaster of extremes.  Religious convictions are either fanatical or absent.  We are encouraged to believe in absolutes in relationships, career choices and, of course, in regard to health.  We are considered either healthy or sick, strong or weak, flaring or in remission.

Yet isn't our reality more complicated than that?  None of us are in just one place.

Achebe, in his collection of essays, The Education of a British-Protected Child, writes that his people, the Igbo, prefer not singularity but duality.  Wherever Something Stands, Something Else Will Stand Beside It.  Isn't that a perfect description of life with illness?

We may see this most clearly in our fear -- on good days we are often only too aware that our joint disease Stands Close By.  It is difficult to believe in the singularity of health once chronic illness has struck.

But the reverse is also true -- and here is where we can miss something important.  You have a day where you only feel fatigue and aches.  It may seem that illness is the only reality.  But if you allow yourself to see your body in a larger context, you recognize that your health is also present -- it Stands Beside your fatigue and pain.

The middle ground, the middle way is a reminder that we are never really on one shore or the other -- we are all navigating back and forth, weaving several strands together in our lives.  One of the strands is the illness, one of the strands is our radiant health, one of the strands is pain, one of the strands is energy, and on and on it goes.

You may be wondering, how can this idea aid your daily living?

If you have the mental habit of "either/or" thinking, it can help to shade in a middle ground.  When you ask yourself "How am I feeling today?" -- go beyond "good" or "lousy."  Well, I have some pain in my knee, and the sun is shining on my head -- so there is some pain and some warmth and relaxation.

Look for the Middle Way, not just the extremes, and value it.  We can live in that place -- there is room to embrace more of life, and room for things to happen.  Mystery lives in the middle, as do miracles and possibilities.  This is where communication and community dwell -- where we join hands and hearts.

I look forward to meeting you there.

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