Dear Dr. Vicki,
I always enjoy your newsletters, and today it came just as I was grappling with a situation with my doctor that made me very upset. When I dropped my urine sample at the doctor's office, the nurse told me that I'd only receive a phone call if the doctor wanted me to follow up in any way. I called the office because I was curious about the results, only to find that the sample never got to the lab. The nurse at the doctor's office asked me to come back and give another sample, and initially I said yes. Then I reconsidered when I realized how angry I was. What do I say and do to assure the best outcome for me?
Pissed Off
Dear Pissed Off,
Thank you for demonstrating how and why the "no news is good news" follow up program for medical tests is unacceptable for the smart, proactive patient. I commend you for making the call, and trust you will continue to get all of your test results, whether or not your doctor offers them. You can bring a stamped, self addressed envelope to each doctor appointment just for that purpose.
I also commend you for your focus on your outcome.
The first order of business is addressing your medical needs. Time has passed since the doctor ordered the urine test, and some tests are only helpful if they're performed at a time of active symptoms. I would check with a doctor before going to the trouble of bringing in a second specimen.
The next step of understanding the message your anger delivers is equally important. Anger calls attention to an unmet need. I could make some guesses about why you're angry. Another trip to the doctor could be a huge imposition. You might wonder if other things have been missed at this office. You might want the apology that was not offered. One client told me, "My lost lab specimen feels like a symbol for the lost caring of my doctor. I knew it was time to find another doctor."
Here are things you could say to the staff at the doctor's office in a note, email or phone call: "I'm annoyed because I'm paying a big price for your error; I have to take time out of my crazy schedule to bring in another sample. I would like an apology. I'm angry that you do not have a system to catch human errors like this, and I'd like to know what you will do to prevent another patient from slipping through the cracks." Or you could just decide to quietly find another doctor. As you think about your options, the right course of action will emerge.
Thanks for sharing your story that will help other people who have walked in your shoes.
To health!
Dr. Vicki
Dear Dr. Vicki,
Ever since I began a new medication, I've had bloating. I look like I'm four months pregnant, and my tailored clothes don't fit. When I told my doctor about it, he said, "You should be happy that you don't have serious problems like many of my patients. A little bloating is no big deal." I didn't say anything at the time, but this is a big deal to me. What should I do?
Tight Pants
Dear Tight Pants,
Let's assume that you have a well-intentioned doctor attempting to reframe your concerns. It backfired, as it so often does when the helper tells you how you should think and feel instead of listening to your thoughts and feelings. It's like a parent who responds to a child's request for a snack by saying, "You can't be hungry. You just ate an hour ago." Just as only the child knows if she is hungry, only you know how illness and medical treatment impact your life.
You deserve a doctor who cares what it's like to walk in your shoes.
You can say to the doctor in person or by phone or in a note, "I have been thinking about our conversation. While I'm grateful that I'm better off than many of your patients, the bloating is a big problem for me. I can't fit into my clothes. Do you agree that the bloating is a side effect of the medication, or are there other causes we should consider? If it's the medication, are there others I can try instead?"
There are always options. You may be able to switch medicine. You can always ask your doctor, "What would happen if I went off the medication altogether?" Then you can decide whether the benefits of the medication outweigh the risks, including the need to buy new clothes.
Please have a conversation with your doctor before stopping medication. It's a courteous way to treat your doctor and a responsible way to manage your health.
I'm glad you wrote. I hope a little alarm goes off every time a doctor tells you how you should think or should feel. Only you know what your experience is.
To health!
Dr. Vicki
Dear Dr. Vicki,
Caring for Mom falls squarely on my shoulders. My brother and sisters assume that I'm handling it. They never offer their help, even as Mom's care demands more of my time and energy. I want some help. I need some help! How do I get my siblings to pitch in?
Burning Out
Dear Burning,
The best way to get the help you want and need is to ask for it and then receive it.
Easier said than done.
If my house fire showed me anything, it's that giving comes naturally for me and receiving is hard work. A wise friend said, "Don't worry. Receiving is just another skill, like riding a bike. You might fall a few times and bruise yourself, but you'll get it."
My tricycle-level lesson occurred when bags of clothes and toys and food just appeared. Thoughtful neighbors, friends and families at my son's school anticipated my needs, collected things and delivered them. It was easy to graciously receive this help.
Just as advancement from a tricycle to a bike requires an inner sense of balance, I had to be more centered to advance to the next stages of receiving. It meant being more proactive in describing what I wanted, then asking for it. The difficulty increased as offers of help progressed from "Can I get you some milk at the store" to "Can I get you anything at the store?" to "Call me if you need me to do some shopping."
Advanced receiving skills were required when giving people asked me, "What can I do to help?" I challenged myself to have a list of three ideas at all times.
Call a family meeting. Let your siblings know what's involved in caring for your mother and suggest that you manage this as a family team. Ask them how they would like to contribute. Have a list of ways they can help, like cooking meals or taking her to the doctor or playing cards with her on Sunday afternoon.
Many caregivers are reluctant to ask for help because they fear they won't get it. If that happens, what have you lost by asking?
You're welcome to borrow my tricycle if you would like.
To health!
Dr. Vicki
Dear Dr. Vicki,
I'm caring for my sick parents. I keep thinking there's a right way to do this caregiver job. If only I could find the instruction manual that will tell me the right things to do and the perfect things to say, I would find some peace. I go to bed at night thinking, "I'm blowing this." What do I do?
Looking for a passing grade
Dear Looking,
Your note reminds me of a conversation I had with my son when he was nervous about taking his first standardized test. What if he didn't understand the instructions? What if he didn't know the right answers? What if he got a bad score? Does anyone get 100% right?
I wonder how many patients and caregivers have asked just those questions. Caring for someone who is sick, whether it's a loved one or yourself, can feel like taking a standardized test.
I shared some thoughts with my son. I assured him that the teacher would explain the directions before he began, and he could ask for clarification. I told him that the tests are designed so no one gets 100%. He can certainly shoot for the lofty goal, because you never know, but not be heart-broken if it doesn't happen. I suggested that if he knew the answer, mark it down carefully. The right answer put in the wrong box is recorded as wrong. If he didn't know the answer for sure, but had a hunch, go with the hunch and don't second-guess yourself. If you have no clue, guess b.
The most important thought I sent him to school with was this: I will love him just because he is who he is, not because of his performance on a standardized test. I asked that he give it his best efforts, and that's all either of us could ask.
Being a patient or a caregiver can be a real test. All that anyone can ask is that you do your very best. I know some things for certain. When it comes to health-related choices, there are no right answers, despite the longing that it were so. Even with the best efforts, no one enjoys a perfect outcome. Following hunches is a good idea. And when you don't really know, go with c. Caring and connection and maybe a healthy dose of chocolate.
My best,
Dr. Vicki
Dear Dr. Vicki,
My dad loves fast food. If it were up to him, we would have stopped at the drive-through window for French fries on our way home from the hospital. We were not there visiting a sick friend; Dad was the patient hospitalized for his heart attack. How do I make him give up French fries?
Caring Daughter
Dear Caring,
You can’t. Remember the psychiatrist and the light bulb. There’s only one person you can control and that is you.
However, you can influence your father’s choices, and your love for him is your most effective change agent tool.
In the spirit of the CAB approach, you might begin with, “Dad, you really love your French fries, and I can only imagine how hard it would be hard to give them up. I hope you’ll find a way. I heard the doctor say those French fries could lead to another heart attack. I love you and I want you to be around for a long time!”
Some people say that French fries melt away worries. They’re right. What you eat influences how you feel, at least for a little while. The gut is lined with the same nerve cells that are found in the brain. If your dad is using food as medicine to treat an unpleasant mood, you can explore other ways to manage these feelings that promote health rather than disease. You’re not necessarily looking for another food to replace the French fries, but another way to manage an unwanted feeling.
You may not be the best choice for an accountability buddy because your feelings for him may get in the way. Keep reminding him of your love for him and cheer him on as he drives to the senior center instead of through the ersatz kitchen.
To health!
Dr. Vicki
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