Wednesday, March 24, 2010

Going to the Doctor Part I of II - The Background Work (or Tips for Dealing with White Coat Anxiety)

Hello Friends:

I stumbled over a site today that was talking about the "little known or ignored sources of trauma" that can result in PTSD.  One of them was "hospitalization before the age of three."  I already knew my childhood medical history was a source of trauma, but had never seen it called out quite so specifically.  It is both validating and scary.  Doctors do suck, especially when you are a kid.

And Thursday, I have my first ob/gyn appointment in four years.  Yippie.

As you know I've posted occasionally about the fun you and I have dealing with health care.  It is hard enough these days getting decent insurance, finding a provider, scheduling appointments, and then actually showing up for them even if you are a 'normal' person.  The challenges are magnified when you have a history of abuse, never get enough sleep, are too afraid to leave the house, are terrified of needles, and on and on.  For me, visits to the doctor have always, always been terrifying.

One of the main reasons for that is, of course, that I was very sick as a kid.  I had a near fatal childhood illness that put me into the hospital at the age of two and a half.  A boy who was hospitalized for the same thing as I didn't make it through the week.  So I certainly caught the vibe, even then, that Something Was Very Wrong With Me.

In those days care for children was pretty barbaric; nobody was worried about traumatizing kids, just getting them out of the hospital in acceptable physical condition.  I was in the hospital for about a week or so the first time, and then had to go back again and again for the next nine years to have scar tissue removed and such.  From 2.5 to 11.5, I was on meds, dealing with visits to the urologist, hospitalizations, and the occasional bladder and kidney infections that were both painful and scary.  I was lied to by doctors, nurses, and lab techs about: how long procedures would last, if my parents would be in the room or not, if there would be needles, how much it would hurt, what I was or was not supposed to do, and more.  So I have some good reasons to hate going to the doctor, and good reasons why doctor's visits cause me some of the worst anxiety I have to deal with, along with great fodder for flashbacks.

Dealing with health care specific to female needs is the worst, at least for me.  In addition to the childhood illness, there was the abuse, and then I lived with an abusive boyfriend for five years just to make sure I had myself really, really messed up.  I'll also mention the painful endometriosis, polyps, and fibroids that went undiagnosed and untreated for more than a decade.  So I'm a bit touchy about my 'female areas' shall we say.  But for some reason, I got it into my head that it really was time to go back to the ob/gyn and get a check up.  And I actually managed to schedule it myself.  What was I thinking ...

So for the rest of this post, I'm going to write up some of the tips and strategies I've collected about how to be as comfortable as possible with your doctor, whatever the specialty in question.  I'll do the general stuff in this post, and then tomorrow I'll post about the specific stuff one can do on the actual day of the visit.

So first of all, "White Coat Anxiety" is apparently the general term for people who really do not like going to the doctor, any doctor, including the dentist.  It is pervasive, and as I noted in a previous post, I have no idea how it is doctors don't realize how badly people suffer just trying to take care of their health in a responsible fashion.  I'll mention that "White Coat Anxiety" is not the same as "White Coat Syndrome / White Coat Effect" which is the syndrome where some people's blood pressure skyrockets in the doctor's office, and they can't get a good reading.

These tips are not going to be useful for everyone, especially if you are in a deep depression right now or live in another country with different heath care rules.  But this is what I gots to give ya ...
  • Recast the idea of a doctor from someone who has control over you to someone who you are paying to provide a service for you.  You are the customer, and you can "fire" any doctor any time you want, and find another one.  Ah yes, power.
  • Find a provider of the gender you need.  I'm seeing a female ob/gyn, female dentist, female dermatologist, female optometrist and female general doctor.  My therapist is male.  All these were conscious decisions on my part.
  • Try to do some "interviewing" to find the doctor you like.  Find one who is in a clean, non-threatening facility.  One who has staff and nurses who are friendly, relaxed, and competent.  If you don't like the "interview" don't go back.  Get recommendations from people you know, and even from the doctors you visit; they will be happy to recommend their colleagues.
  • If it is right for you, tell your doctors about your mental illnesses up front.  When I called to schedule this particular visit, I made my history clear and requested a doctor who could deal with it.
  • Be kind to yourself and remember how hard all this is.  Pat yourself on the back any time you schedule an appointment.
  • If necessary, have a friend help you schedule and keep track of appointments.  And then perhaps that friend or another can help you actually get to and from those appointments.  If you have help set up ahead of time, the visits will be easier to handle.
  • Try to show up for every appointment you schedule, rather than canceling or postponing.  It will only cause more anxiety and hassle in the long run.
  • If possible, download forms ahead of time from their website, or get them faxed.  I hate filling out forms in a doctor's office with their disease-ridden pen, and with my anxiety-addled brain.  Filling the forms out at home relieves some of the stress.
  • Establish a relationship not just with the doctor, but with the staff.  If necessary, request to see just one staff person for having vitals taken, blood drawn, etc., and then only make appointments when that person is available.
  • Get all the help you can from your health advocates.  That's everybody: your spouse, family, friends, and especially your therapist.  Have your therapist call your doctor and make your needs clear.  Discuss possible accommodations with your therapist and make sure your doctor is on board with it.  I think advocacy is the strongest tool for making health care more manageable.  
Nuff for now.  More later when I'm contemplating how I'm going to make this next visit go as easily as possible.  Got any ideas for me, or for this list?

Your Hostess With Neuroses

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Andy said...

Some of those are great tips regardless of anxiety level. Going to the doctor is already no fun, as you note. Are there any doctors you find non-threatening? Getting an eye exam, for instance?

And perhaps this is a crazy question, but are there ever similarities for you between how you feel at a doctor's office and somewhere like a spa or hairdresser? They're totally different, of course, but on the other hand, in both places you can wait for "treatments"...

The Blue Morpho said...

Hey there Andy - Well, I think I generally find doctors threatening in proportion to how physically intrusive the exam might be. Gyn is the worst, given where they are intruding. GPs can poke you with needles and take blood. Eye exams bother me, but I will not allow any eye drops exactly because they freak me out. So no eye drops means the exam is pretty non-threatening overall.

And the hair dresser can be very stressful, but in some different ways. There I feel more like I can express my needs, and that I am seen as a valuable customer, so that changes the perspective. Still, I've had hair dressers and massage therapists both react strangely to my request that nothing touch my lips. No water or lotion or anything like that. Any time you give away a little control, you take a risk. It's a good thing, but still, it can be scary. And you can't count on people to be accommodating of your needs, even if they are trying to be, because they often just don't understand.

Amy said...

I have just as much anxiety at spa treatments as I do at the doc. I think it's a trust issue, and because my skin and body are so sensitive, even a basic massage can hurt. So the first thing I have to do, like you and your "nothing touches my lips" rule, is explain what can and can't be done in terms of pressure what kinds of oils are allowed, etc. It stresses me out just wondering if this person will be sympathetic or just confused, or if they will nod and then just do what they want. I can never, never, just relax.

Andy said...

I can totally see that. IIRC, acupuncture was surprisingly "easy" for you, though? Not trying to be contrary, just finding it interesting.

I had gum surgery, which was absolutely nerve-wracking for me. I was pretty bent out of shape beforehand, worried about worst case scenarios that were basically impossible. But knowing they were basically impossible didn't help much. :P

The Blue Morpho said...

Amy - Yeah, spas can be strangely stressful. You have to keep stating your needs to each new person, and then possibly repeating them. Sometimes the facilities can be confusing, too. Still, it helps me to remember that I am paying them lots of moola - it helps me speak my mind.

The Blue Morpho said...

Andy - Yeah, the acupuncture thing was very interesting. I was terrified of it for years. But after I started the somatic therapy, I got a better appreciation for what 'energy' therapies might be like. I had to get over the OCD fear of tetanus and infection. But having a better handle on that meant it could try it. Then it wasn't so bad and I did it again. Then again. Actually, the acupuncturist is probably the most calm, understanding, accommodating, and non-judgmental provider I have ever had. Her attitude makes almost anything possible.

expwoman said...

I still remember when my husband first told me about being hospitalized when he was 3 years old for a urinary tract infection and then years of urology visits, and no one would talk to him about it. It was painful to imagine him so alone and scared. When he first realized that this was a form of abuse, that truly he did nothing wrong, it was like reimagining the whole world.

The Blue Morpho said...

Hello expwoman - Whoa, that sounds much, much too familiar. I am so sorry he went through it - it is so terrible to feel like you are on your own at that age. But I'm glad he knows now it had nothing to do with him being 'bad'. Yikes. Tough stuff.

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