Credit: The internet, anonymous facebook post

 

And other things you don’t have to care about.

I present myself in this blog as both patient and provider.  A rarely seen side, very few providers have neither the time nor the desire to share much with their patients. The reason is that some patients view the provider-patient relationship as being closer than it is. Don’t get me wrong I think my patients are good people (some in screwy circumstances). I also do not want to take a “warm shower in the wee hours of the morning with them,” to quote Clint Eastwood.

So why talk about me?  Back to the subject, since I wander so well, it is to show you not only that I can be a provider, but I am also a patient with complex conditions that requires me to be on the receiving end of patient care. I have hypertension which has been a bitch to control, I am overweight and out of shape (also a bitch to control). I take medications or have for PTSD. I have empathy for many things my patients go through, and I enjoy that aspect as it makes me say things like, “when you are drinking bowel prep for a colonoscopy, experiment with what tastes the best with the prep, I tried broth this time, hugely salty, but covered the taste.”

Granted, most providers are empathy-driven and many can tell you things from personal experience.  Still, it is sometimes helpful to know we are human and have all the struggles that everyone else has.

When I worked CCU many years ago, we had a cardiologist that was overweight.  In his words, “I didn’t care.” Then he had a heart attack, and his tune changed. He did all things he demanded of his patients for years; lose weight, eat a healthy diet, exercise, rehab, the whole 9 yards.  He dropped about 50 pounds in his convalescence and kept it off. We didn’t even recognize him when he came back to work. His exact words were, “I didn’t realize how tough it was.” “However, I also realize the importance far more than I ever did and I have a better idea on how to manage patients and approach their rehab.” All of this stuck with me and was a valuable lesson for both my nursing practice.

Now don’t get me wrong; I am way different here than when I am working.  I do not overshare all the deets (as the kids say) of my life.  I do use them, indirectly, to make teaching points. It is essential to acknowledge the lifestyle changes that have to occur with a patient who has a chronic disease. You can’t just write the script and say, “go for it,” you have to say, first and foremost, here are the lifestyle modifications.”

Lifestyle modifications, there is one treatment modality that our instructors and preceptors hammered into us as NP students. Well, ya have to help them.  You can’t say stop using salt.  People use salt and don’t know it.  You have to ask how they prepare their meals.  Do they routinely salt in the prep?  Do they salt when they sit down or taste it first? Breaking it down so that you (and more importantly them) catch those instances of adding salt they do not realize.  Many providers tell them to stop salting food without addressing the subconscious use.

We have a pill culture, we want a pill that allows our poor choices in an area, and then ironically refuse to take it. Don’t believe me? While they will tell you at their provider appointment when asked that they are compliant, home health or caregivers will tell a vastly different story. Hell, I have to use a med minder to get it right. I shrug when asked why it took me so long to use one myself.  Unless the illness is dangerous, I like to go through a diary of diet and exercise and habits and see the patient for a close follow up 1-3 weeks (yeah I have that ability in my practice) and have them maintain a diary for a week of food or sleep or what have you.  Then we can talk about what’s right and wrong.  You are also able to show them what they are doing that doesn’t work. You can teach to their life, not just pull pat answers up.

If you are trying to do it on your own, make a daily food diary or sleep diary that documents both the items as well as behaviors.  Then let it sit a day or two and look at what you do.  You can very quickly make modifications. Ask your provider; you now know we have similar struggles.

Be the kind of person your dog and your mom think you are.