Why Can't Physicians Have Intelligent Adult Conversations with their Patients?

I am a medically savvy woman. My vocational background has required that I have extensive medical knowledge gleaned from a diverse number of number of health-related fields. However, I am not a clinician which makes me unique. Being medically proficient allows me to understand and make better decisions about my health. In spite of this, I have had experiences with some physicians listening to my concerns about their recommendations. This led to me wondering why is it so hard to discuss my health issues with my physicians.

Recently I was referred to see a physiatrist (a physical medicine and rehabilitation doctor, not a psychiatrist) for crippling muscle spasms resulting in radiculopathy (shooting pains) down my left arm. She was a competent physician with a bedside manner of a prison matron. Don't get me wrong, I appreciated her no nonsense approach. The reason I maneuvered to see her was because she had successfully treated a hip/muscle injury I had. After taking a series of cervical spine x-rays, she informed me I have some "slippage in my spine". Surprised by this being told to me so glibly, my response was to ask if I had spondylolisthesis. Shocked, she inquired if I was one of those patients who read the internet. "No", I said, "I am one of those patients who works for the School of Medicine and reads medical journals." For those of you who don't understand medical terminology, she just told me I had degeneration in my spine with a slippage which ultimately will result in the development of a Dowager's hump. Soon I'll be starting physical therapy. But more importantly, yoga has been shown to prevent and/or reduce kyphosis (the slippage to which she was referring) if caught soon enough and the person is dedicated to its practice. Given my physician's mood, I decided not to tell her how UCLA funded a study showing the benefits of yoga to people with "slippage". One cannot fill a full cup.

The conversation with my physiatrist struck me as an indication of how much physicians fail at having adult conversations with informed patients. God only knows how the medically uninformed fare. When she went over her recommendations, I objected to one of the medications she wanted to prescribe because of the serious side effects. Visually, I could see she was frustrated with me, even though I raised legitimate concerns. Finally, she agreed to compromise and halfed the meds I objected to, leading me to agree to take it. In the end, she was right; what she gave me worked, giving me needed relief from my pain. In my last conversation with her I conceded she was right to negotiate with me. My hope is that we both learned a lesson here.

I think about people who don't have my level of medical knowledge and how they cope in a world where in 15 minutes one has to share symptoms, listen to the doctor's recommendations, and attempt to understand the implications of the medical lingo. And doctor's wonder why we are on the internet.

THERE'S A BLOOD MOON ON THE RISE, APRIL 4TH

"Full Pink Moon – April This name came from the herb moss pink, or wild ground phlox, which is one of the earliest widespread flowers of the spring. Other names for this month’s celestial body include the Full Sprouting Grass Moon, the Egg Moon, and among coastal tribes the Full Fish Moon, because this was the time that the shad swam upstream to spawn." -The Farmer's Almanac

At 5:05am (PDT) on April 4th, we have the domino effect with the third of four total eclipses in a row. This blood moon in Libra promises to be surprising, unexpected, and shocking. The balancing act of the Libra scales will be tested by being in the immolating sign of Aries, followed Jupiter's trine in Leo. Translation: keep calm, take a deep breath, don't judge by appearances, go for neutrality, and have faith something wonderful will come from this. Not just wonderful, but seemingly miraculous. 

Coming on the heels of Good Friday and Passover, this Holy Saturday lunation inspires resurrection from the tortuous death of anything that has been holding us back. In Tarot, this would be represented by the cards Judgment and Death. The Judgment card speaks to awakening from punishing, self-defeating speech and behavior to seeing limitless potential and opportunity for regeneration. The Death card allows us to get past the funeral, the burial, and the period of bereavement to see life always follows death. Spring always follows winter. We are ready for our despair to give way to the joy and happiness we have been denied. There is nothing more to do, to say, and to wrestle with-we are free to go. The lessons learned gives us gratitude for whatever wakes us up, moves us forward, and inspires us to courageously embrace our highest good.

Some affirmations for this Eclipsed Blood Moon:

• I am in the right place, at the right time, successfully engaged in the right activity.
• I can handle this situation with poise, dignity, and strength.
• I am ready to experience my good in whatever form it takes.
• My heart and spirit attracts the best.
• I take a leap of faith to manifest that which benefits myself and others.
• I am peaceful and resourceful.

April Showers: The Rough Psychological Ride into Spring

The last thing I wanted to do is make the first day of April into a downer, but knowing the importance of the information contained below in this blog could save someone's life.

Having spent most of my working life in human services, I have always dreaded spring. In particular, the month of April is hands down the most unpredictable. They don't call April the cruelest month for nothing. April is well known in psychiatry as the peak of the depression and suicide season. This runs contrary to what one think would be logical as the most vulnerable time. Most mistakenly think the holidays spur the highest suicides. Over the years I have observed the emotional roller coaster ride which affects all of us because of the lengthening of light, but especially for those vulnerable because of underlying psychological issues.

After months of winter depression, one would assume that warmer temps, seeing flowers burst forth, and the lengthening of light would diminish the blues. Indeed, it does lift the hearts of many to say good-bye to winter. However, the sad fact is that for those who experience depression, it is usually at it's highest peak in spring. This is not always the fact  for all depressives, but the tendency for depression to worsen in spring is well documented by numerous studies. The lengthening of the spring light and other factors can give some depressed people, who have been psychologically depleted for months, the energy to carry out a plan as they begin to feel better. That is why those at risk for suicide are most apt to act out during the spring months. Suicidal attempts are frequently made when going into or emerging out of depression. It is ironic that the season of sprouting life also emboldens those on the precipice to jump.

But depressed people aren't the only ones affected by spring's rocky transition. Those diagnosed with bi-polar disorders also feel it's weight. Spring's longer days can make those with mania become more manic and those depressed, more paralyzed. Manic behavior may not look suicidal, but because those with bi-polar disorders lack judgment and impulsive control, they are vulnerable to situations in which their flawed decision-making encourages risky and sometimes dangerous behavior. Excesses abound when mania is present, making delusional thinking and revved up psycho-motor behavior a formula for disaster. If the depressive element is present, the person can dive deeper into the depths of despair. Psycho-motor slowness, immobility when it comes to taking action, flat affect, overwhelming unrelenting tortuous thinking, and sometimes catatonic behavior, plague the depressive swing from mania.

But one does not have to be diagnosed with these disorders to also be affected by spring's influence on cataclysmic behavior. Just look at events in history: the Waco inferno, the Randy Weaver/ATM debacle, the Boston Marathon killings, the Oklahoma City bombing, the West Virginia Tech shootings, the Columbine massacre, it goes on and on-they all happened in April. Specifically, I have observed the week of April 20th, which coincides with Hitler's birthday, to be the height of acting out behavior.

This illustrates another point about suicidality: if one is suicidal, it can also spur one to be homicidal. When I worked in a commitment unit in psych, all suicidal patients were brought in restraints and loaded on anti-psychotic medications. The supposition is that if they don't care about their own life, they will not care if they have to take anyone with them. How many stories have we heard where a depressed father or mother killed their whole family (and the family pets) before killing themselves.

Make no mistake, whatever it is that makes April touchy affects all of us as well. Springing forward can produce restlessness, irritability, and an impatient desire for the new. A new you, a new them, a new job, a new life... Winter's discontent dissipates slowly. Yet spring if also a time of renewal. There would be no joy without grief. Life resurrects after months of hibernation. April is also a month for transformation. We shed the cloak of winter to anticipate the season of growth.

More than ever, April is a month for treating ourselves and others more lovingly. The dark underside of April belies its hope of renewal, hope, and feeling connected again. Questions to ask are: Can I be more understanding, more thoughtful, and more compassionate with both myself and those struggling with April's rough ride? How much will a kind gesture, good word, and supportive deed go to nurture the sting of this tender transition? What can I do to be good to myself and others during the times when wrestling with feelings of disconnection, fear, exasperation, anger, etc? Who is struggling around me that could use my support? Even if they are little ones, what are some positive steps I can take now?

This is an important month to put out as much positive energy as one can to everyone, including ourselves. Happy Spring.