I am a 47 year old woman with two children, a healthcare related business, a husband with diabetes, and a chronic medical condition myself. I’ve sat in more than my share of medical offices. About women, I consider myself an expert. About health issues, I’m learning every day. As I sit to write this article, I am looking at a pamphlet mailed to health professionals around the state promoting a seminar called “Understanding the Gut Brain: Stress, Appetite, Digestion and Mood.” As a mental health professional, I am intrigued. Google the term gut brain and you get 30 million results. What? Am I the only person on the planet not yet aware that my gut has its own operating system and that medical science is bouncing off the idea of this second brain? Thinking with our stomach? Intestinal neurons distressed due to emotional stress? Has figuring out what is going on in the female brain just got twice as complicated? Perhaps, it has. I then found an article from nearly two years ago in Popular Science which stated, “Bacteria in Gut Influence Brains of Mice, Soothed by Probiotic Broth”. The article states that the mice given probiotics had lower levels of stress hormones. As a woman and healthcare professional, this type of news related to how mental health is linked to physical health is very important to me.
A recent article in Women’s Health magazine outlines how to survive your doctor. It wasn’t really tongue in cheek, but instead outlined how to avoid medical mistakes when you help your doctor help you. Empowering women to take charge of their medical care isn’t a new idea, but it has become more important than ever. Many women, and frankly men too, still have an outdated relationship with our healthcare providers. Our interactions with doctors are often from a parent-child perspective rather than an adult-adult relationship. We hesitate to ask embarrassing questions, we don’t provide enough information and in the past we haven’t viewed ourselves as experts of our own mind and bodies. Times are definitely changing, though the communication gap remains very wide.
We are all aware of the major shifts in healthcare right now and many of the changes relate to the proliferation of electronic information and our access to it. When the television was invented it took about twenty-six years to reach mass penetration, the Internet has achieved the same level in just seven years. Healthcare consumers are coming in every day armed with data. Per Wikipedia, the popular online free encyclopedia, cyberchondria is a term now used to describe the unfounded escalation of concerns about common symptomology based on review of search results and literature online. It goes on to say that some medical practitioners are open to a patient’s personal research, as this can open lines of communication between doctors and patients, and prove valuable in eliciting more complete or pertinent information from the patient about their present condition. I think we have to find a happy medium between hypochondria-induced cyber sleuthing and how to communicate our relevant medical search queries. And as professionals we have to find ways to make technology work to our benefit instead of the other way around.
The remainder of this article, I’m focusing on three basic actions any doctor can take to improve their care of women, and the population at large. These ideas might represent a slight shift in thinking for some, but mostly they are just a reminder of topics to stay mindful of throughout our daily interactions.
–Recognize the red flags that can link a mental health issue to an emerging physical health issue. The link to mental health and physical health is inextricably linked and scientific studies every day are proving ways in which they converge. Although there is a lot we still don’t understand about the mind-body connection, there are some obvious red flags we can bring to the attention of our patients. There is new research on stress-induced depression, sleep duration and the link to ghrelin, a hormone produced in the stomach. So, lack of sleep and the link to weight loss has become a hot topic. Are we questioning our patients about sleep? We know that poor omega-3 fatty acid status increases the risk of depression. In fact, deficiencies of folate, vitamin B12, iron, zinc, and selenium tend to be more common among depressed than non-depressed persons. A study published in the March, 2010 issue of the Journal of Clinical Endocrinology and Metabolism found that a jaw-dropping 59 percent of the population is vitamin D deficient. Are we encouraging our patients to take their vitamins? Patients with vitamin or nutrient deficiencies, who are not sleeping well or who find themselves stressed beyond what is comfortable for them are vulnerable to both mental health and physical health issues. Are doctors doing enough to inform?
Childbearing-aged women are particularly vulnerable to the adverse effects of poor nutrition on mood because pregnancy and lactation are major nutritional stressors to the body. The depletion of nutrient reserves throughout pregnancy and a lack of recovery postpartum may increase a woman’s risk of depression and other health risks. Women are at risk during this time and need to be told so. Menopause is another time in which hormones and body changes all converge to a potential tipping point.
In fact, any person in the midst of highly stressful life events – divorce, marriage, new job or lack of one– are vulnerable to the tipping point for both mental health and physical health issues. Once, I cried my eyes out in the doctor’s office when asked about my plans to have children and I was working 60 hours a week headed for divorce. The doctor was very kind but never suggested follow-up with a mental health counselor. Looking back, I needed it. Since that time I have had many health issues, all related to inflammation. A 2012 article in Science Daily proves the link, “How Stress Influences Disease: Study Reveals Inflammation as the Culprit.” Patients need to be warned and encouraged to maintain self care during times of great stress and perilous periods in the lifespan. (No pun intended.) The complexity of the issue is unmistakable. However, if an important element of illness prevention is to be particularly mindful of self-care during critical times, why not be the expert who tells us so?
– Be cognizant of your therapeutic communication skills. One of the tools in the therapy trade is motivational interviewing which requires four core competencies. These include: the ability to ask open ended questions, the ability to provide affirmations, the capacity for reflective listening, and the ability to periodically provide summary statements to the client. In other words, how to talk so your patients will listen and listen so your patients will talk.
The bottom line is that the way you talk with your patients about health care can substantially influence their motivation for behavior change. Motivational Interviewing can elicit from the patient their own good motivations for making behavior changes. It involves guiding more than directing and listening at least as much as telling. Many MD’s find they do not have the time to listen as they would like. I think there is room for creative improvement. It may require a change in mindset. Imagine what it would be like if doctors encouraged their patients to email their office monthly regarding goals related to well care. What a shift for a patient who is being directed to take responsibility for self care to the point of reporting in to the physician. Perhaps your office could charge a separate fee for this type of service arrangement? Doctors can participate or keep abreast of discussion in online patient communities where patients share stories, learn from others, spread knowledge and instill hope. Another idea is to simply ask a patient what changes they would like to see regarding their health and how they plan to go about doing it. How would a patient respond to a doctor who had written a few notes about their plan and followed-up on their ideas to encourage their progress? I would certainly give my doctor the highest Internet rating if they had a process for such follow-up.
This leads me to my final point.
– Don’t be afraid to try something creative as it relates to health promotion. One of the biggest disconnects in our healthcare system is that for far too long we have focused on managing illness, not promoting health. Well, perhaps another disconnect is the thought that physicians can’t creatively promote health. If we want to change the way we approach the issue of wellness, then we need to change what we are thinking about. We are trying to solve the problem of people not making healthy choices. How can we do this in a creative, palatable way? The topic is far more complex than pounds and inches. Self-care involves lifestyle, mindset, personal responsibility and gentle guidance, not firm rebukes. This requires a mind shift for physicians from “I will fix it” to “Let’s work on this together.” Thoughts such as, “I am not just here to treat symptoms. I am responsible for encouraging patients to be ever mindful of health.” Perhaps sponsor a health forum for a local large company? Or team with another service provider who targets your same market to initiate a wellness challenge. A small change could be to update your website to include links to popular wellness sites.
The U.S. Center for Disease Control and Prevention reports that more than 75 percent of an employer’s health care costs and productivity losses are related to employee lifestyle choices. Those who rise to the challenge of promoting health have a lot to gain. Why not be the one to take the lead? I believe physicians who become progressive on this front, will find their practices flourish. You came to the healthcare profession with the desire to make a significant difference in the lives of individuals and to make some money with your expertise. In today’s times we all have to move beyond day-to-day operations and spend more time forward-thinking in creative ways.
Many in the mental health field are familiar with an analogy related to gardening to describe their work with their patients. They view their responsibility in terms of planting seeds. Sometimes we never see the bloom but we know we prepared the soil and cultivated the right atmosphere for growth. Difficult patients change slowly, they need loads of support and they test us in interesting ways. We learn a lot from them. How can we use our experience and knowledge in creative ways to promote growth and change in the direction of wellness for both women and men in our community?
By Soni McCarty, LMHC