The Complication of Doctor-Patient Communication

Do you ever think about what it means to visit the doctor? Most people do not attach much meaning to such visits but rather consider them as just any component of one’s yearly routine. Experienced quite differently, visiting the doctor when living with a chronic physical illness is accompanied by a host of complicated emotions. There are many layers to consider. For example, there is the literal communication style of the doctor one is treated by. Is s/he authoritarian, collaborative, or passive? Another layer is comprised of all the associations and emotions that journeying to a doctor’s office brings up. Similarly, such visits may elicit anxiety or fear about one’s condition. These are some of the thickest layers, although if one takes the time to reflect many more may emerge.

How have you interacted with authority figures throughout your lifetime? Do you feel comfortable with others telling you what you should do or do you react negatively to such direct suggestion? Perhaps you grew up in an environment where you were directed on how to make personal decisions and feel anxious in situations when you are not told specifically how to proceed. Maybe you feel like you have had enough of others telling you what to do and seek a relationship where you feel like you are an equal collaborative partner. Regardless of your personal history and style, it is important to identify what interpersonal communication style works for you when seeking out a doctor. If you prefer a doctor with a more collaborative approach and yet you visit a doctor with an authoritarian approach who insists on doing things his/her way, then you are probably going to leave the appointment feeling a bit more uneasy than if you sought out a doctor with a communication style that works for you. Of course there is probably going to be moments when your doctor recommends something that you do not want to hear but which is the best option for you, but this is different from a consistent communication style. Reflect on yourself and on your needs. If you see a doctor with whom you do not feel comfortable communicating with, you are probably going to be less likely to adhere to treatment recommendations, even if they are the most appropriate recommendations for you.

Sometimes less tangible than communication styles, are the associations and emotions that come up when visiting the doctor. These vary depending on the person, the time in the person’s life, among other factors. Feelings regarding self-image may emerge. The appointment may serve as a reminder of the changes that have occurred in one’s life, including visible changes in one’s body, mental state, and relationships. Associations to trust and betrayal may be present. What happened the last time you shared with someone the results of your doctor’s appointment? Can you trust this doctor when you had a bad experience with the last? Frustration is also quite common. Imagine having 2-3 medical appointments a week, which is not that uncommon with people who live with chronic conditions. It can feel like not only is the illness taking time away from your life but that the visits to the doctor are also eating away at your time. In its more intense form the frustration can also be anger.

Perhaps the most obvious layer and at times the most uncomfortable is the anxiety and fear that looms a few days, and at times weeks, before a specific appointment. One's initial diagnosis can very often be a traumatic experience which can shatters one's sense of security in the reality s/he believed to be. The what if factor may arise. What if the results of the tests are not good? What if there is an additional diagnosis? What if I am told I need more treatment? What if the treatment recommendations come with side-effects? The list goes on. This fear and anxiety can be maddening. 

This brief essay has not even scratched the surface of what is involved for a person with chronic illness when communicating with doctors. Much of these fears and associations may feel uncontrollable and at times usually very helpful coping mechanisms may feel powerless. Sometimes it is just a matter of finding a way to tolerate whatever comes up and knowing that it will pass. However, one thing that is more in one's control is finding a doctor one feels comfortable with, can trust, be honest with, and who takes you seriously. Additionally in one's control is the power to educate. Educate your loved ones, family, friends, coworkers, and ignorant strangers on what it is like to interact with medical professionals when living with a chronic illness. It will be worth it, even if you can stop just one person from saying, "your going to the doctor, what's the big deal?" That is one more person who now understands. 

The Mind-Body Connection: The Influence on Perception

"Am I beautiful? I used to look so much better before I got sick. I hate how I look."

Many chronic physical illnesses come with changes in the body and in appearance. Sometimes the changes are due to the illness itself, such as rashes on the body and face that may occur when living with lupus. Other times it is the treatment that causes the changes, such as hair loss in patients undergoing chemotherapy or weight gain due to certain medications. Sometimes it is the mind-body connection, where there is no actual physical change but the person living with the physical illness perceives one to exist. What is happening in such cases?

People who live with chronic physical illness may at times feel poorly about their appearance, specifically in comparison to how they looked before receiving a diagnosis. Friends and family may look at the person with the illness and wonder what the person is talking about, s/he looks exactly the same as always. However, s/he does not feel the same as always! This person may hurt when trying to engage in any physical activity, including such basic movement as walking. This person may feel stomach pains when eating certain foods or may just constantly experience nausea and dizziness. In these cases, the body hurts but the person looks the same. Yes in some cases increased pain decreases physical activity which may follow with weight gain, but this is not what is now being described and rather people whose appearance has actually not changed is being discussed.

It is hard to imagine how connected the mind and body are, to the point that what you feel in your body can be what you perceive mentally or in your mind, even if that is not what is objectively there. For example, "I feel so disgusting today (meaning I feel physically sick) but when I feel this sick I look disgusting too." The days of understanding the human body as a seperate entity from our mind, including our emotions, perceptions, and thoughts, are over. Being chronically ill not only affects one's health but it can shake up one's entire perception of oneself.

It can be a frightening thought to think that what my body does/feels can affect how I perceive myself, my body image, my appearance, and my self-esteem. It can leave one feeling as if s/he has little control. However, it is important not to forget that the connection is not unidirectional. To the extent that how you physically feel can influence your perceptions, your perceptions can also affect how you physically feel. There are multiple techniques for changing how you see yourself and the world that can distract you from your physical symptoms and even lessen them. Some might even suggests cure...but that is something to be discussed with your individual doctor.

So it can go a couple of ways: 1. I hate how I feel right now (physically), I look disgusting and don't really want to go anywhere. 2. I feel gross (physically) but I am going to do something nice for myself anyway because I might as well show myself some kindness since my illness is not. Oh... and I just realized that this illness does not have complete control over me! 3. Ok so maybe today I feel too sick to take a shower and get dressed and I just need to stay in my pjs in bed, but that does not mean tomorrow has to be the same.

People must take care of both mind and body, especially when one is particularly weak, the other can help balance and pick up the slack so to speak. Everything within you is connected. You are not just a body or just a bunch of thoughts, but rather a whole person, whose entire being must be cared for and nurtured. Take some time to think about why you may feel so badly about your appearance when you objectively look the same. Maybe it is because your body hurts and is sufferring. Does your mind have to suffer too or can it be the healthy part of you, helping to maintain balance in your being? This is not an easy task and you might need some help from a support group or a psychologist; however it is not an impossible task. It is a real possibility!