Don’t Consult the Doctor

It seems like every time you turn around, someone is advising you to, “Ask your doctor.” Miss a day of work? Better go see a doctor to find out what’s wrong. Fever? Ask your doctor. Tired? Ask your doctor; it might be depression. Trouble managing your child’s behavior? Ask your doctor if your child may have ADHD or Oppositional Defiant Disorder. 

Many doctors are wise, resourceful, and helpful, but I don’t think we have enough doctors to answer all of these questions. Doctors’ schedules are overbooked and wait times are unreasonable. There are plenty of situations when you shouldn’t (at least not as the first option) consult a doctor.

Don’t go see your doctor when you have a simple, mild virus.
Unless you’re in frail health, you don’t really need to go to the doctor for a basic cold, or often even for the flu. Most people need to stay in bed, stay hydrated, and wait it out. If your symptoms are severe and you can’t keep fluids down, that’s when it’s time to call your doctor for an appointment.

Don’t make an appointment with your doctor for tiredness, low energy, or fatigue when you know the reason is your recent lifestyle.
If you’ve been burning the candle at both ends, up late, up early, chugging too much caffeine and overdoing the alcohol, you don’t need your doctor to tell you why you’re feeling run down. Take a self-care day and get some rest. Slow down. Cut out non-essential commitments, like socializing with co-workers, and take a nap midday. Turn in early. Sleep in late. Ask your spouse to get the kids ready so you can get some rest. Or cut out TV for a couple of weeks and get in bed earlier. Cut back on caffeine and alcohol. Eat healthy foods. If rest and self-care don’t make you feel better, then it’s time to assess things with the help of your doctor.

Don’t call your doctor when your family member (even when he or she has mental illness) gets angry with you for something reasonable.
When family members have depression or bipolar disorders, it can be scary to see them upset, but sometimes their behavior is normal for the situation. If you’ve had an argument with your family member, even if he or she has a mental illness, first ask yourself whether the argument was the kind of interaction that happens when most people get upset. Most of us get a little unreasonable when our feelings are hurt or when we feel misunderstood. We may yell, or say something hurtful, but arguments usually subside and apologies are made. The exception, or course, is when you have a safety concern. If you think your angry family member won’t be safe, call someone right away.

Don’t call a doctor for advice about disobedient children.
Most doctors are experts in the prescribing of medication. If you’re just beginning to tackle a child behavior problem, consider a counselor or a play therapist first. Your pediatrician has short appointments, and even if s/he has great advice to offer, there probably won’t be enough time to catch it all. Increasingly, pediatrics offices are employing counseling professionals in their clinics to address behavior. If your clinic has a counselor, ask to speak to that person first. If not, find a professional in your community who works with kids and parents to address behavior. A good counselor will tell you if your child needs a medical assessment.

Don’t ask a doctor to assess your relationship problem.
Like child behavior problems, adult relationship problems are best addressed first in counseling. Counseling appointments are longer and you'll be able to meet with your counselor more often. If one or the other partner needs a medical referral, a good counselor will let you know.

Why Don't My Parents Respect Me?

My parents don’t respect me!

Within the past week, an 18-year-old high school senior, a 20-year-old living at home, and a 35-year-old who has struggled to support himself all made the same statement; “My parents don’t respect me.”

Each one then spent the better part of an hour complaining about one or both parents. “They don’t give me enough money.” “My mom snoops in my room.” “My father won’t listen to me.” “My parents don’t take me seriously.”

Most people desire to be respected by their parents. But the individuals above had not realized that receiving respect from our parents is something we all have a hand in.

If you want the respect of your parents, try the following:

Start by showing some respect for yourself.
Respecting yourself is not just about confidence; it’s about taking care of yourself and your stuff. Do your laundry, shower, and dress. Clean up your living space and wash your vehicle. After doing so, you’ll feel a little more worthy of respect and maybe you’ll be ready to work on reshaping your relationships with your parents. 

Be a good communicator.
Tell your parent how you feel about the problems in your relationship, listen to his/her perspective, and try to gain common ground. Good communication is free of outbursts. Don’t react, just talk and listen. If you’re having trouble controlling your emotions in a difficult conversation, ask a family member, clergyman, or a counseling professional to mediate.

Stop complaining. 
It’s hard to respect someone who is complaining and laying blame on others. While it’s okay to discuss problem relationships and attempt to sort out your feelings, if you’re blaming and complaining, you’re probably wasting your valuable time. Instead, try to work toward solutions. If you cannot think of ways to move forward, ask someone wise for ideas, but remain focused on resolving problems rather than running through a list of ways you’ve been wronged.

Be kind.
Kindness earns respect. Little gestures, like making coffee in the morning, or stopping to say “thanks” for they ways your parents support you, go a long way toward a more respectful relationship. Treat them the way you hope to be treated in return.

Earn your own money.
Earning a little bit of money, even a small amount from a few hours of childcare or lawn work on the weekends, can help. Taking care of your own needs gives you more freedom and control, and it’s easier for parents to respect you when you function independently as an adult.  

Be accountable for your choices.
Everyone appreciates someone who takes responsibility for his or her actions. If you make a mistake, apologize sincerely and solve any problems caused by your mistake.

And finally, if you have done everything in your power to gain your parent’s respect and nothing is improving, maybe it’s time to get some distance. If you’re a young adult living at home, it might be time to look for another place to stay. Sometimes a little geographic distance helps create better relationships in a family.

Seeking the Opinion of a Psychiatrist?

A local therapist contacted me this week and asked what my philosophy was about when he should get a psychiatrist involved in the care of his patients. 

It’s an interesting question. When should a psychiatrist, a mental health physician, get involved in the care of a mental health patient? When an assessment is needed for a medical diagnosis? To help develop a treatment plan? When medications are indicated? When the patient is complicated? All of these?

One could argue that an assessment with a psychiatrist is a staple of any thorough mental health assessment, but there would be several problems with sending everyone with a mental health issue straight to a psychiatrist. First, there is a serious shortage of psychiatrists. The Hogg Foundation www.hogg.utexas.edu notes that in 2009, 171 Texas counties did not have a single psychiatrist. Due to the shortage, securing an appointment with a psychiatrist is difficult. Wait times in my county can exceed 6 months, especially for appointments with child and adolescent psychiatrists. Even for those capable of securing an assessment with a psychiatrist, there remains the problem of professional bias. The fact is, doctors prescribe medical treatments. It’s what we are trained to do. Only rarely do physicians provide reassurance and recommend that patients not take treatment for an illness. Involving a physician often means beginning down the road of prescription drugs, and in some cases medications are unnecessary (or even harmful).

So in answer to my therapist colleague, I said, “When a patient needs medication. Or when the situation is complicated and you need help from another professional.”

But this answer is disheartening. We are taught in medical schools that psychiatrists should be the leaders of mental health assessment teams, that we should be the experts who develop diagnoses and then work with teams of professionals to provide appropriate care. In the real world, we are impossible to connect with. When our patients see therapists, we rarely coordinate with them. When we treat patients in the hospital, we too often fail to talk with the outpatient providers to coordinate care.

If you’re a patient or family member experiencing behavioral or emotional problems, my advice is that you first seek guidance from a counseling professional. Counselors are readily accessible and if your problem is beyond a counselor’s expertise, he or she will make a referral to an appropriate professional. 

For counselors, I say find the psychiatrists (and other mental health providers) in your community who collaborate well, and develop team relationships so you can make referrals when necessary.

Dear Introverts, We're Sorry. -Extroverts

The introverts are speaking up and educating the rest of us about how our perceptions of normal are skewed toward an “extrovert ideal.” Now acknowledging you’re an extrovert can feel like confessing that you’ve been an insensitive jerk for eons. To all the introverts, we’re sorry.

After reading a recent HuffPost article by Kali Rogers titled An Open Letter From Introverts to Everyone Else, I decided to come out publicly in this blog post as an extrovert. Now, for those who know me well, this is probably not a surprise. Meanwhile my professional friends in medicine and mental health and almost everyone I know in the writing world are all introverts. As are my spouse, all my closest friends, and almost everyone I love most in the world. I think it’s wonderful that the growing discussion about introversion and extroversion helps expand our understanding of one another. And I will try to do better. We all will.

Here’s my open letter in response to Kali Rogers:

1.    We appreciate the reminder that weekdays are “me” days for our introverted friends.

Thank you for reminding us. After a long day of work, you need some alone time to re-charge. We extroverts don’t mean to sap all your energies when you’re trying to recharge. We really don’t. We are honestly just full of social vigor. We enjoy talking to you, and seeing you. Doing so helps us replenish our energies at the end of a long, tiring workday. But we can get those needs met on workdays by hanging out with the other extroverts who need the same thing. So feel free to decline our aggressive invitations. Just tell us you’re in need of a bit of quiet time, and we’ll respect your decision to head home for some rest.

2.    We will try to “have a reason” when we call you one the phone, instead of just dialing you up to talk about nothing.

Whoa, boy! We’ll do our best, but honestly, we might forget. We pick up our phones and just dial people we like. If we call you up for no reason, most of us extroverts can take any feedback you want to give us. We can be thick skinned, and in this case it’s a good thing. You can ask us to get to the point, or remind us you don’t enjoy chitchat, and we’ll apologize (for the ump-teenth time) and let you get off the phone. It’s okay to screen your calls when you don’t feel like talking. Just text us later and check in so we know you still love us.

3.    We will attempt to remember how important it is for you that social events happen with people you know, not just a room full of strangers. 

Right. Hanging out with strangers is stressful for you, not loads of fun like it is for us. Again, we’re really sorry. It can be kind of hard to imagine how an activity we get so much pleasure from can be such a nightmare for you. Don’t let us be insensitive about this. Confront us if we’re oblivious, and remind us that we are different from each other, and that’s fine!

4.    We understand you have just a few friends, not a “bajillion” like us.

We know this about you, introverts, and honestly, it’s one of the biggest reasons we enjoy your friendships so much. Our extroverted friends are fun to hang out with, but sometimes they aren’t very invested in us on a personal level. You introverts are often our most loyal friends, and we love you for it.

5.    We have seen how intense and passionate you get about the topics you find important.

We know introverts. We know. Politics, religion, money, complicated relationships; these are the topics you want to discuss. You would rather have substance in your conversations than fluff. Us extroverts, on the other hand, we like fluff. Our conversations are sport. We volley the discussion back and forth just to see if another person can keep up, and that’s entertaining. Forgive us if we feel uncomfortable with the deep content. It slows down the fun and makes us think. But we want you to contribute to the discussion, so chime in! We can adjust.

6.    We won’t make you reach out. We will do it for you..

It’s okay, introverts. We extroverts reach out constantly. We are often in perpetual contact with someone, and if you don’t call us, we’ll probably call you anyway. As long as we know you still love us.

7.    We appreciate the reassurance that you like us.

We like you, too! You introverts are our most trusted friends. You know how to keep a secret. You’re there for us when it counts. You’re real and genuine. We love everything about you. Just remind us to be sensitive to your needs. We aren’t trying to steamroll over you. But sometimes you’ll have to give us a gentle reminder that you and we are different, and that’s a beautiful thing!