Things I Wish I Could Tell My Patients
May. 27th, 2018 04:05 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
lydy1) Please sleep between the sheets. They are changed after every use; the blanket and comforters...not so much.
2) When you go to bed and when you get up are not state secrets. It would also be really helpful if you would answer the questions I ask, rather than the ones you want to answer. "When do you normally go to bed?" is not the same question as "When do you want to go to bed tonight?" If they are different, I do want to know the answer to both of them, but to repeatedly answer the second when I ask the first frustrates both of us.
3) Likewise and also, "What is the latest I can get you up tomorrow without screwing up your day?" is not usefully answered by "I always wake up at five-thirty." If you have sleep apnea, and if I put CPAP on you, two things we do not currently know, there is absolutely no guarantee you will wake at your normal time.
4) "It varies," is not an answer. Values for "varies" ... vary, a lot. When pressed, people have explained that they mean "between ten and ten-fifteen" or "between nine in the evening and two in and the morning." Likewise, "late" and "early" are not useful descriptors, late meaning anything from ten in the evening to three in the morning, and early anything from three in the morning to seven in the morning. I am not being rude when I press you for details, I am trying to get really basic information.
5) Almost everyone has a sleep schedule. People who truly sleep at entirely random times a) do not hold down jobs and b) are really, really rare. Please don't tell me "I don't have a schedule." Tell me your normal range.
6) I will listen politely to your theories about your sleep. However, I won't take them very seriously. The person who knows the least about your sleep is you, because you are unconscious at the time. I will do my best to sort out actual information from theory, but you make it hard when you mix verifiable facts in with complex theories with no data to back it up.
7) You are a competent adult, and that means that you have the right to refuse any and all medical interventions, up to and including CPR. I must, therefore, assume you are in the lab voluntarily. If you really don't want to be here, why the hell did you show up?
8) I am very sorry your doctor doesn't listen to you. They don't listen to me either. Telling me won't help you communicate them. If you really hate your doctor, maybe you should get a different one? Just spit-balling here.
9) Barring basic social lies, I will tell you the truth. There are questions I cannot answer, either because I don't know or because I am not allowed to tell you. But everything I tell you about the test, your health, and sleep is, to the best of my understanding, true. I also won't tell you partial truths to mislead you.
10) I do exert control over your environment. I do this to get a good-quality sleep study. I understand that this isn't how you sleep at home. I am not trying to measure that. I am trying to measure biological, intrinsic sleep, and I want to eliminate environmental factors that might confound the results. I will try to work with you on psychological issues that may affect your ability to initiate sleep, but I am not just being an authoritarian prick when I tell you you may not have the television on all night.
11) I am not running a scam, and I am insulted by the implication that I am. However, even if I were, why would I ever admit that to you? Therefore, accusing me of running a scam is pointless as well as irritating.
12) Please do not attempt to discuss politics or religion with me. There is a chance that you will be comforted by the fact that the person guarding your sleep is an atheistic anarchist with bisexual leanings, but most of you will not, in fact, find that to be relaxing. Let's just not talk about it, m'kay?
13) Do not talk to me about your sex life. At all.
14) The wires are not negotiable. And, yes, if this is a repeat study, they did all of this to you the last time, too. Just because you don't remember a specific item doesn't mean that it wasn't used last time. In point of fact, it was. There are standards, and every accredited lab follows them.
15) If I do my job right, you will be unable to tell if I actually like you, or if I have classed you as a video game, where the win condition is to make you think that I like you. I actually do like most patients. It still doesn't matter. Let's get a good sleep study, and move on with our lives, m'kay?
2) When you go to bed and when you get up are not state secrets. It would also be really helpful if you would answer the questions I ask, rather than the ones you want to answer. "When do you normally go to bed?" is not the same question as "When do you want to go to bed tonight?" If they are different, I do want to know the answer to both of them, but to repeatedly answer the second when I ask the first frustrates both of us.
3) Likewise and also, "What is the latest I can get you up tomorrow without screwing up your day?" is not usefully answered by "I always wake up at five-thirty." If you have sleep apnea, and if I put CPAP on you, two things we do not currently know, there is absolutely no guarantee you will wake at your normal time.
4) "It varies," is not an answer. Values for "varies" ... vary, a lot. When pressed, people have explained that they mean "between ten and ten-fifteen" or "between nine in the evening and two in and the morning." Likewise, "late" and "early" are not useful descriptors, late meaning anything from ten in the evening to three in the morning, and early anything from three in the morning to seven in the morning. I am not being rude when I press you for details, I am trying to get really basic information.
5) Almost everyone has a sleep schedule. People who truly sleep at entirely random times a) do not hold down jobs and b) are really, really rare. Please don't tell me "I don't have a schedule." Tell me your normal range.
6) I will listen politely to your theories about your sleep. However, I won't take them very seriously. The person who knows the least about your sleep is you, because you are unconscious at the time. I will do my best to sort out actual information from theory, but you make it hard when you mix verifiable facts in with complex theories with no data to back it up.
7) You are a competent adult, and that means that you have the right to refuse any and all medical interventions, up to and including CPR. I must, therefore, assume you are in the lab voluntarily. If you really don't want to be here, why the hell did you show up?
8) I am very sorry your doctor doesn't listen to you. They don't listen to me either. Telling me won't help you communicate them. If you really hate your doctor, maybe you should get a different one? Just spit-balling here.
9) Barring basic social lies, I will tell you the truth. There are questions I cannot answer, either because I don't know or because I am not allowed to tell you. But everything I tell you about the test, your health, and sleep is, to the best of my understanding, true. I also won't tell you partial truths to mislead you.
10) I do exert control over your environment. I do this to get a good-quality sleep study. I understand that this isn't how you sleep at home. I am not trying to measure that. I am trying to measure biological, intrinsic sleep, and I want to eliminate environmental factors that might confound the results. I will try to work with you on psychological issues that may affect your ability to initiate sleep, but I am not just being an authoritarian prick when I tell you you may not have the television on all night.
11) I am not running a scam, and I am insulted by the implication that I am. However, even if I were, why would I ever admit that to you? Therefore, accusing me of running a scam is pointless as well as irritating.
12) Please do not attempt to discuss politics or religion with me. There is a chance that you will be comforted by the fact that the person guarding your sleep is an atheistic anarchist with bisexual leanings, but most of you will not, in fact, find that to be relaxing. Let's just not talk about it, m'kay?
13) Do not talk to me about your sex life. At all.
14) The wires are not negotiable. And, yes, if this is a repeat study, they did all of this to you the last time, too. Just because you don't remember a specific item doesn't mean that it wasn't used last time. In point of fact, it was. There are standards, and every accredited lab follows them.
15) If I do my job right, you will be unable to tell if I actually like you, or if I have classed you as a video game, where the win condition is to make you think that I like you. I actually do like most patients. It still doesn't matter. Let's get a good sleep study, and move on with our lives, m'kay?
no subject
Date: 2018-05-28 09:21 am (UTC)Labs and techs vary, but a lot of people need the television to fall asleep. I, personally, discourage this, but will allow it with a sleep timer, if it seems necessary. One of the things doctors want to measure is "sleep latency," which is how long it takes you to fall asleep. Actively reading, watching television, playing on your phone, etc., confound that measurement. So, whenever possible, I like a clean start to the study: lights out, eyes closed, electronics off. But I will negotiate with you if you feel you really need something in order to fall asleep. You might be surprised at the number of people who tell me they cannot fall asleep without the television on who, when asked to do so, fall asleep almost instantly without it. That, by itself, can be a clue that at least some of the patient's sleepiness is do to bad habits rather than an intrinsic disorder.
Assuming that your tech knew what they were doing, they may well have had all the data the needed by six. The point isn't for you to get a good night's sleep, the point is to get enough data to make a diagnosis. Technically, the only thing required for a "complete" sleep study is six hours of recording, regardless of the amount that you actually slept. It's also really desirable to get at least two sleep cycles, where possible. Again, I try not to kick people out too early, hence the questions about when people normally get up and when they absolutely have to get up, but by six in the morning, I am very likely to know everything I need to know about your sleep. Which is not the same as you having had a good night's sleep. As a rule of thumb, we're not looking for your "normal" sleep, but rather representative sleep. In addition to two sleep cycles, the tech would really like to see both sleep on your side and sleep on your back in case you have positional sleep apnea.
I think that sleep studies are more accurate if the tech tries to match, as close as possible, normal bed and rise times, but that may not be possible, depending on the way the lab works. For instance, I don't have day staff some days of the week, so I absolutely have to have patients up and out of the lab by my quitting time. If I have day staff coming in, I can potentially let them sleep in. But even there, I would only do that if I thought there was some useful diagnostic reason. If it is just because you don't want to get out of bed... I actually hate waking people up, but as you point out, you can always go home and get some more sleep.
sleep is interesting
Date: 2018-05-28 08:03 pm (UTC)I've had one sleep study done, maybe ten years ago. The only thing I wish that had been clearer beforehand what would trigger their waking me up. Then again, I like to know stuff, lots of stuff.
8) Doctors should not only listen to their patients, they should ask leading questions to elicit more, not less, info from the patient. And it should be more like a conversation. If more doctors worked in customers service than in dictatorships, the world would be a healthier place.
Re: sleep is interesting
Date: 2018-05-28 09:24 pm (UTC)The other really tricky part of my job is providing the correct amount of information. Some people want to know a lot, some people don't want to know anything, and not overwhelming the latter can be important to their comfort. Sometimes people know what they want and will tell you. Sometimes, they won't.
I completely agree with you about doctors, but part of the doctor's problem is that insurance companies dramatically limit the amount of time they can spend with patients. And the problem with listening to patients is that they are often full of irrelevant detail and useless theories. If what you've got are fifteen minutes, you need to drill down quickly, which means cutting off their weird-assed theories at the knees. But this eliminates huge amounts of useful information that you could get, if only you had time. And, unfortunately, a tech is not a good substitution for a doctor. I have more time, but do not have the training to notice when the long, painful story about how the patient can't sleep because of a particular trauma has a telling detail. I can listen to the story, but won't be able to see the telling detail.