I have stood here before inside the pouring rainMy anxiety that is frequently triggered by doctors has all sorts of connections to my thoughts. Specifically errors in my thoughts that lead me to a clustering illusion or, perhaps, just plain old confirmation bias. Let me walk through a recent situation and a therapy technique that can help me police my thoughts.
With the world turning circles running 'round my brain
I guess I'm always hoping that you'll end this reign
But it's my destiny to be the king of pain
-- The Police
Weeks ago my wife developed joint pain so I took her to a small family doctor's office, with whom we had been established patients for over a year. After the pain was not controlled by the initial suggestions, I took her back to see Dr. A on Friday. Dr. A was late -- my wife was his first appointment of the day. After an exam, Dr. A suggested physical therapy and also a prescription painkiller. Dr. A agreed to write a prescription so my wife could go to a particular physical therapist that I knew was good. Although he could have handed us a paper prescription, he suggested that we use the office's electronic "patient portal" to provide the physical therapist's particulars (name, fax, etc) then he would have a fax sent to the physical therapist's office. At home later that Friday, we used the patient portal to send the info to Dr. A so he could have the fax sent. My wife's next day off was in 6 days so I expected on Monday to make a Thursday PT appointment.
On Monday the physical therapist's office had not received the prescription and, per their understandable policy, would not let me schedule an appointment until they had the prescription. That afternoon I called Dr. A's office to check why. The receptionist did not know why and Dr. A was out for the day. I explained that I had expected Dr. A to have the prescription faxed on Friday and we had followed his instructions. There was nothing the receptionist could do and no one but Dr. A could use the patient portal to respond to what was basically in his inbox. I asked if Dr. A could access the patient portal when he was out of the office. The receptionist told me Dr. A would not be able to do anything until tomorrow but he had patient appointments lined up so did not know when he would address it. I asked since Dr. A had failed to take care of it several days ago, would it be possible to flag this in the patient portal to move it to the front of the line so it could be addressed first thing Tuesday. At that point I got the impression the receptionist thought I was lying even though she confirmed she saw through her read-only access exactly what we sent via the patient portal and its time stamp. She thought Dr. A would address it Tuesday so I stopped pushing my luck, thanked her for her time, and hung up.
On Tuesday, after Dr. A had been in the office a few hours, I called to check the status of the prescription. The receptionist indicated Dr. A had not gotten to it yet so I thought another day, that might have allowed my wife to secure a Thursday appointment, wasted. The receptionist took my number and said she would call once Dr. A did his job so I thanked her and hung up. Not the least bit confident that it would happen that day or that I would be called, that same afternoon I drove to the office and explained to the receptionist face-to-face what I needed. Dr. A overheard me, told me he had patients waiting on him and lined up the rest of the day, and that he would take care of it that night (so he can access the patient portal when out of the office, shocker, but I thought what about Friday night, Saturday night, Sunday night, and Monday night). I reminded him that we followed his instructions Friday so he could get the fax done Friday then asked if there was any way he could do it that afternoon because the longer he took, the less likely I would be able to secure a Thursday appointment. Then he acted exasperated by the patient portal system because he explained that even if he did his part, the system would send the info to a medical records company which would take some amount of time before the fax was sent on his behalf. Finally he asked me to wait so he could write the old-fashioned, time-tested paper prescription with the help of the receptionist. He disappeared, the receptionist handed me the prescription, I thanked her, and I left. I then sped across town to get the the physical therapy office before it closed. One of their office's three receptionists had not yet left for the day so I handed her the prescription so we could check for Thursday appointments. She told me the prescription was not dated, an oversight on Dr. A's part, and when she saw the look on my face, she gently asked me if there was another doctor my wife could see to get a proper prescription. I told her it had just been written today and that I would get her a dated prescription as soon as I could. She allowed me to make an appointment for my wife and, as I had feared, Thursday's schedule had filled up. I made an appointment for the next week and left. I immediately called the Dr. A's office and explained that he had not dated the prescription so I still needed him to produce a dated one and requested that our Friday patient portal message be flagged as still needing to be addressed. The receptionist said she would message Dr. A about it then call me tomorrow when it was done.
On Wednesday there was a possibility that the physical therapist would have a cancellation allowing my wife to have her first PT session on Thursday so I called them twice but to no avail. The odds of a Thursday appointment all but gone, I still called Dr. A's office that morning to check the status of a dated prescription. It was not done but the receptionist offered me a choice: I could come in and get a paper prescription or wait for Dr. A to do the patient portal method after which I would be called by the receptionist. I asked when was the absolute latest time that Dr. A would do the latter and was told I could not be given a time. So I gave up trying to explain that all I wanted to know is a time after which I could call and remind them that I needed it and just thanked her for doing whatever she could then hung up. After lunch I went to the office intent on sitting in their waiting room until it was done. The receptionist recognized me walking in, insisted she had not forgotten about me (damn right, I know the squeaky wheel gets the grease -- I just feel like a jerk for having to bug them so much but I feel at this point it the mistakes were about 0% my fault and 100% Dr. A's fault, although the weary receptionists may never know this), who finally decided to take care of it once and for all. Ten minutes later she told me that two dated prescriptions were done, one going electronic which would eventually get faxed and a paper one she handed me. I thanked her profusely and left.
A lot of people might agree that I had experienced crappy service and, if you are of a certain age, wonder what happened to customer service. But this is where I need to start policing the rest of my thoughts that had been percolating through Friday, Saturday, Sunday, Monday, Tuesday, and Wednesday. On Friday Dr. A was late and, although he apologized, I do not feel he did much to make it up to my family but I did my best to move on, accepting that sometimes crap happens. But crap happened again on Monday. Then on Tuesday and, although the doctor apologized, I thought why me (also stop with the apologizing -- actions speak louder than words, doc)? Then he did his job wrong and I have to keep going way outside my comfort zone to make sure the system cares about me and, most importantly, about my wife's increasing pain. Each piece of this reinforces what are typically fleeting thoughts like I am unimportant, I am not heard, I am not believed, no one cares whether I am inconvenienced, no one cares whether my wife's pain is getting worse, my wife is going to get stuck with a mediocre physical therapist, I am failing as a husband, and what the hell is it about me that signals that I ought to be treated like a doormat -- I must be broken and unfixable. Yes, that is where my mind goes.
But for fleeting thoughts I have techniques that allow me to shift my focus onto more positive and, ideally, more realistic thoughts as they speed through the highways of my mind. It takes significant effort to stay positive when I see the negative in the world around me faster than I can cope.
I mentioned a therapy technique -- it has the unremarkable name Challenging Beliefs. After describing the event, step 2 is rating the belief I have in each thought, 0% meaning I do not believe at all and 100% meaning I completely believe:
- I am unimportant 75%
- I am not heard 50%
- I am not believed 90%
- no one cares whether I am inconvenienced 95%
- no one cares whether my wife's pain is getting worse 90%
- my wife is going to get stuck with a mediocre physical therapist 25%
- I am failing as a husband 10%
- I ought to be treated like a doormat 10%
- I must be broken 75%
- I must be unfixable 75%
- frustrated 90%
- angry 75%
- anxious 75%
- sad 25%
- Is there evidence for and against? There is not evidence from a single incident that supports a single thought -- it is more a general sense I get from a cluster of frustrations. What I wonder is when there are clusters like these, are they worse or more frequent compared with what a typical person in my situation experiences? If yes then I am unlucky frequently (which I fear is evidence for my pet theory about serial victims giving off a signal that invites others to treat them like doormats). If no then I am falling victim to the clustering illusion but it does not change my impression that my thoughts and feelings are more extreme than what a typical person experiences. Either way the result is about the same -- the trick is figuring out the root cause to address.
- Habit or fact? Probably a habit since most of the thoughts I have had plenty of other times in past situations.
Step 6 is coming up with alternative thoughts to what I listed in step 2:
- I was a victim of a series of unfortunate events which, on their own, I might have been able to brush off but was overwhelmed by the cluster 90%
- Dr. A's bedside manner has gotten worse over time 25%
- Dr. A actually had issues/patients that took more attention than my wife's pain, several days in a row 25%
- Dr. A might make it up to my family if he ever realizes the impact on us 25%
- I did a lot as a husband which ultimately got proper prescriptions, just not as swiftly as I would have liked (meaning so my wife could secure a Thursday appointment) 75%
- I am not broken just bent 10%
Step 8 is to state and rate how I feel now:
- frustrated 75%
- angry 25%
- anxious 10%
- sad 10%
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