Posts Tagged ‘Anxiety’
Having spoken to dozens of patients on the phone this week, and having spent more than a few sleepless nights myself, I am all too aware of the impact that this strange, strange time is having on all of us.
It can be particularly difficult for those with rheumatological conditions. Many of my more experienced patients will be all too aware of the impact that sleep disturbance and stress can have on their symptoms and their ability to cope.
Although I don’t have any easy solutions for this crisis here are few (non medical) things that you might find helpful;
Coping with Corona Virus: How to stay Calm and Protect your mental Health – A Psychological Toolkit by Professor Brendan Kelly.
“How worried should I be? What information can I trust? What should I tell the children? Can I survive the panic, let alone the virus?”. All these questions and more answered by Irish Psychiatrist, writer and master communicator, Brendan Kelly in this Kindle edition. It costs $1.14 (US store only at the moment). If you’re lying awake at night worrying and feeling bit overwhelmed this might be a good place to start.
Ten Percent Happier have a meditation app which I use from time to time. They have a free resource called Corona Virus Sanity which is worth a look. It includes a number of talks and meditations for relaxation for Corona virus induced anxiety. My favourite (!) is ‘How to Wash Your Hands and Meditate at the same time’. They have generously made their meditation app available to health care professionals for the duration of the pandemic. They also have a great podcast.
This is a wonderful new poetry podcast by Irish poet Pádraig O’Tuama which has become hugely popular since its timely launch in January. In each of his series of 8 minute podcasts, Pádraig reads a poem that has given him comfort, solace or meaning in his life. It includes poems about friendship, home, memory and love – from poets you may know, and from many you may not have heard of.
Here’s the link to the website but you’ll, be able to find it on all of the usual podcast platforms.
What resources would you recommend?
If you are a doctor who (despite your best efforts) often runs behind, and consequently has to deal with a waiting room full of unhappy, anxious or angry patients, you will be glad to hear that help is at hand. Some familiarity with the science of waiting may help you take practical steps to improve the waiting experience of your patients — even in situations where a medical wait may be inevitable.
The reassuring finding from the literature is that overall patient satisfaction correlates poorly with the amount of time spent waiting.
A study from patients waiting in a busy Chicago emergency department showed that patient satisfaction was better predicted by other (modifiable) factors, such as satisfaction with information delivery (regarding tests, procedures and reasons for delays) and the courtesy, friendliness, and professional attitude of the doctors and nurses.
Additionally (and although it may seem obvious), patient satisfaction was also higher where the actual waiting time was less than expected. Unfortunately, this rarely occurs in practice — unless scheduling is engineered to give that appearance. Deliberately misleading patients is not recommended — but at the very least, offering them a realistic expectation of what to expect in terms of waiting times can do a lot to placate an anxious patient.
Some other potential contributors to consumer dissatisfaction that may also be relevant include…
Occupied time feels shorter
Boredom, it seems, results from being attentive to the passage of time itself, so anything that can be done to distract those waiting may help — reading material unrelated to the medical agenda, for example.
Unfortunately, out-of-date copies of Hello magazine or Horse and Hound can give the reader the impression that he or she has moved back in time rather than forward, but suppliers can provide waiting rooms with an up-to-date selection of magazines on subscription (and at a significantly reduced cost).
Some restaurants will provide a library of books for customer perusal in the waiting area — an increasing number of doctors’ surgeries are creating similar libraries of books for use by their patients. A UK charity ‘Poets in Waiting Rooms’ provides packs of cards of poetry of suitable length and content for this environment.
There is also emerging science to support the anxiolytic effects of music and radio played in waiting rooms. In a study which explored the preference of patients awaiting radiotherapy, ‘easy listening’ seemed the most popular, with jazz being the least popular. Staff potentially subjected to repeatedly listening to Engelbert Humperdinck and Roger Whittaker may need to be consulted.
Get them started
People like to get started, or at least feel that they have started the process of their medical consultation. This is one of the reasons that customers are handed menus while waiting to be seated in restaurants.
Although there may not be a menu equivalent to this in most medical practices, handing the patient a questionnaire to complete or somewhere to write down questions that they would like to ask the doctor may help pass a few minutes. It implies ‘service has started. We know that you are here’.
Whereas waiting even a short while for something of perceived little value can feel unbearable, the converse is also true — the better they perceive their doctor to be, the more patient the patient will be.
Whereas we can’t always control how patients perceive us, providing good-quality care (even if that means spending extra time with patients that results in delays to others) may help keep patients calm in the waiting room.
While all those sitting in a waiting room need to feel they have been noticed and not forgotten by office staff, this needs to be balanced with their need for privacy. One way of keeping patients abreast of progress in hospital environments is a paging system, which will allow a patient to go for a stroll or a coffee while waiting. A company who provides this service to Irish hospitals is SS Communications.
Barcelona-based design company Fuelfor (www.Fuelfor.net) specialises in the systemic redesign of the medical waiting room experience, including: special patient-friendly signage; customisable modular furniture; integrated play areas for children; acoustic separators for privacy; mobile phone apps (which update patients on appointment delays); and printed notepads for patients to prepare questions for their appointment.
This approach has been shown to improve the perception and effectiveness of healthcare service delivery.
With increasing pressure on doctors’ time, it seems likely that medical waits are going to continue, if not worsen. Although there are certain types of delays that no amount of information, reassurance or distraction can prevent, quality medical treatment or heart-felt apologies will make it bearable. There is something we can do to ease the wait.
This article was originally published in The Medical independent
What is Mindfulness based meditation?
Mindfulness based meditation has been around for thousands of years. Whereas modern mindfulness practice has some origins in the Buddhist tradition, one does not need to subscribe to any particular faith to practice it. Mindulfness is defined as “the intentional, accepting and non-judgemental focus of one’s attention on the emotions, thoughts and sensations occurring in the present moment”. Don’t let the language used to describe it put you off….
On first look, the idea of paying MORE attention to ones pain may not initially make sense to someone suffering from it. But by paying attention to pain, Professor Mark Williams (writing in his introduction to the book, ‘Mindfulness for Health’) we become aware of the“very subtle processes which switch on automatically to turn up the volume of the very pain you want to get rid of. It is because these aggravating factors switch on automatically, without your awareness, that the spotlight of attention is needed. If it all happens ‘in the dark’ you remain lost and alone with your pain. But if you can shine a light of attention upon your suffering, then it begins to dissolve.”
There’s evidence of its effectiveness in the treatment of the symptoms of arthritis, fibromyalgia and low back pain, and also in depression and anxiety.
Most studies of the use of this type of Mindfulness are based on the work of Jon Kabat-Zinn a Massachusetts based scientist. His work demonstrated the effectiveness of mindfulness in reducing pain and the emotional reaction to pain in the setting of an 8 week course. Meditation Courses like this (i.e. specifically designed for chronic pain sufferers) are not widely available but thankfully there are now a number of web-based / distance learning programmes available (see resources below).
There’s also variety of helpful guided meditation apps, CD’s and books. Although most of the available evidence that confirms the effectiveness of Mindfulness is based on those attending formal classes with a teacher (we don’t yet know how effective other means of learning mindfulness are yet), these resources are an excellent place to start.
Firstly, Here’s some videos I recorded about Mindfulness and pain management.
Please support your local bookseller by purchasing these locally. Dubray books don’t charge for postage if you pick up in-store.
This book is based on an 8 week course designed specifically with sufferers of chronic pain in mind. Written by two people who have used mindfulness to help ease their pain and help them cope with it, this an excellent book and primer for those interested in learning more. Included with the book is a CD with guided meditation to get you started.
Jon Kabat Zin is the Massachusetts based scientist and researcher who is largely credited with introducing mindfulness to Western Medicine.
Headspace (Paid app after 10 days free). This is a really user friendly app (iPhone and Android) with great video animations which help explain mindfulness. Not specifically for chronic pain but excellent modules on stress and anxiety. I use this one myself daily.
Insight timer Free app for iPhone and Android with a variety of different meditation teachers and styles of meditation and a handy meditation timer. In-app purchases available
There is a great article written by Galway (NUI Galway) psychologist Michael Hogan describing the research on the use of mindfulness in pain management. Michael and his team have done some research on the effectiveness of a Web based pain management programme using mindfulness. Links to the audio files used as part of the course are also online.
This is the organisation who run the courses on which the Mindfulness for Health book are based. Great resource (mainly UK)