The Other Things I Wish I Could Tell My Patients

[lydy]

 16.  Please don't be embarrassed.  I have no interested in making judgments about your sleep habits, your weight, your appearance, or anything else.  I absolutely understand that life is complicated, people are weird, and you are unique.  When I ask for certain things, this isn't so I can make value judgments, it's so I can ensure a good study.  Please tell me the truth, I will not shame you, and there is no reason to lie.  

17. I'm a medical professional, and everybody has a bladder.  It's fine.  Really.  I do not mind in the least, and please don't make yourself uncomfortable.  I will cheerfully unhook you eighteen times tonight, if that's what you need.  I will never, ever shame you about this.  

Comments

[rachelmanija]

Is there a reason you can't actually tell them these things? There's some medically relevant things I normally lie about because I get shamed, scolded, dismissed, disbelieved, etc when I tell the truth. But if I was told upfront that I wouldn't be I'd tell the truth.

[lydy]

I do actually tell them point 17, they just don't believe me.

The other ... I don't quite know how to say it in a cheerful, conversational fashion that gets the point across. Thing is, if I say, "I don't make value judgments about people's weight" people hear, "You are fat." And most people have spent a lifetime being scolded about "early to bed and early to rise" and either embarrassed or belligerent about their sleep schedules.

Sleep apnea is associated with weight, which is not the same thing as saying I think your weight is a bad thing. And there's a difference between terrible habits that impede sleep and having an unusual sleep schedule. Also, terrible habits are sometimes the result of other stressors, and I understand that, but they still can be the cause of sleep issues. All of this is hard to tease all that out in thirty minutes of putting wires on people, explaining what the wires are for, and the basic structure of the study.

This may be my failure, and I'll have to think about it, more. But at this point, I am struggling with a history of being disbelieved, just as my patients are. Thank you for asking me to think about it again.

[rachelmanija]

You're welcome. I have some thoughts based on both my experience as a therapist (getting people to tell me stuff they normally wouldn't) and a patient (what doctors can say that would make me not lie to them) but I don't want to be advice-y, so... only if you want.

[lydy]

I would be happy to get advice, seriously.

I think my biggest challenge, and the place where I have much less patience than I need, is the area of sleep perception. People really don't know much about their sleep, and are often mistaken about it. I cannot tell you the number of times I have been told, "You can't know I have sleep apnea, I haven't slept at all" when I have two verifiable hours of sleep, and at least forty instances of obstructed breathing. People's symptoms are real, and people experience their lives how they experience them, and I find it hard to explain that objective data does not match their perceptions without it being condescending. I also don't know how to do that convincingly. I keep trying

This post and the last one were gripe posts. They aren't how I present myself in the lab. But one gets frustrated. As a therapist, I'm sure you have your own set of gripes. (I am very glad I do not know what gripes my therapist had about me. She was excellent and I am forever indebted to her.)

[rachelmanija]

I assumed they were gripe posts. ;) I just commented because I have similar issues. I think the thing I do that's most similar to what you do is the intake interview, where I ask a client I've never met before, who will most likely be given a therapist other than me, a ton of extremely personal questions about traumatic and/or extremely personal stuff, much of which they've been previously shamed for and some of which is illegal.

The illegal stuff may not apply to you, but maybe it does because drugs can interfere with people's sleep. In case it does, and because it also shows the general sort of approach I use for everything, here's what I say about that:

"Before I ask you the next set of questions, I just want to give you a heads-up that it's about drugs. I want you to know that as far as illegal drugs go, we are not the cops, and we really don't care if you're breaking any drug laws. [Confidentiality reminder]."

At this point, the clients who either don't use drugs or aren't going to tell me no matter what I say will break in to say that they don't do drugs. If so, I skip the next bit. If they don't, I go on,

"The reason we even ask about them is because we're trying to get a picture of your life in general, and that's a part of your life. Also, any drugs, legal or illegal - even stuff we usually don't think of as a drug, like caffeine - can have effects on people's moods. [At this point I sometimes tell an anecdote about someone who thought she was having panic attacks, but it turned out to be caffeine withdrawal - she'd gone on a health kick and went cold turkey on her multiple espresso habit.] Do you have any questions about this?"

At that point the majority of people who have anything to declare will say, "No, I have no problem telling you what I use," and tell me.

That's my approach in general to questions that people have reasons for normally lying about. I spotlight the main reason people normally lie, phrase it in a way that shows that I find it reasonable, explain why that doesn't apply, and tell them why I'm actually asking. It doesn't work on everyone but it works for a lot of people.

For sleep habits, I might start with something like, "I'm going to ask you some questions about your sleep schedule next. But before I start, has anyone ever told you that there's a right time to go to bed and get up?" (Or some such.) They will probably give you some example. "Yeah, there's a lot of ideas floating around about that. Most people have spent a lifetime being scolded about 'early to bed and early to rise.' But that's actually not true. There is no one right way to sleep - every person's 'best way to sleep' is the best way FOR THEM. Some people do best [insert weird but functional sleep schedule here.]"

I'd give them time to say, "No way, really?" Then I'd go to, "So, when I ask you the next set of questions, don't worry about your schedule sounding weird or anything. I promise you, NOTHING sounds weird to me. The reason I'm asking is [insert explanation." And then ask my questions.

Sleep perception is actually a more difficult area because you're asking them to trust your recordings vs. their subjective experience. I might try to tackle it via the same basic principle, which is to bring up the objection before they make it. Maybe something like, "Sleep is a funny thing. A lot of times it feels like you haven't slept at all, but what's actually going on is that you're sleeping a little bit, but not enough to feel rested or even feel like you've slept at all! But that's what the study is for..." etc.

Is any of that useful?

ETA: Re: weight: I usually use the word "body" rather than "size" or "weight" - all the words are loaded so just going with a slight-less-loaded one is sometimes helpful.

[lydy]

Yes, this is useful.

It occurs to me that it might really help if I explained why I want to know about sleep schedules. I am usually a little pressed for time at that point, but prefacing it by saying something like, "So, I want to get an idea of what to expect tonight, and also some information that will help me schedule my time." Something like that. Expand or contract as needed, but give them a framework for providing the information.