I recently spent an hour with a confused patient whose physician had quickly scheduled a procedure without much explanation. Increasingly squeezed for time, even those physicians who tend toward explanation may leave this part out of the patient encounter. Still, I was filled with irritation and thought, “That physician should have explained this!” Fortunately, this thought was followed by some wiser words that a friend recently saw on a bumper sticker (of all places!):
THE OPPOSITE IS ALSO TRUE
The work of Byron Katie (www. thework.com) can help whenever we are caught in the rigid thinking that rejects the reality of what is happening. I’m sure everyone can remember a time (or a thousand) when our insistence that something should be different caused us anxiety, grief, ruined relationships or missed opportunities.
Katie suggests that whenever we have a thought that something should not be the way it actually is, we ask four questions and then turn it around. For example, I would take my statement, “The physician should have explained this to the patient,” and ask:
1. Is this true?
Well, I certainly believe it’s true!
2. Can you absolutely know that it’s true?
I guess not. Nothing terrible happened to the patient, and this is how the physician’s successful practice operates. I guess it’s just my opinion!
3. How do you react when you think that thought?
I get angry and resentful, and that certainly doesn’t feel good. These feelings distract me from focusing on what I’m doing.
4. Who would you be without the thought? I would be happier and more peaceful – I would treat the patient as I thought appropriate and not waste time or energy on ill feelings toward the other physician. (At this point, I’m really starting to want to drop this thought.)
Then, come up with ways of turning the statement around, and see if any of them are at least as true, if not more so:
The physician should NOT explain this to the patient.
There might have been a real reason why explaining on that day was not the best choice. Perhaps he had an emergency, or maybe he prefers to do most of his explanations at a preprocedure visit – after the patient has read the brochure he gives out.
The PATIENT should explain this to the PHYSICIAN.
The patient should definitely explain that he was unhappy to the physician – this might be an opportunity for the physician to see that his patients would appreciate more explanation. It might serve the patient in other areas of his life if he could become more assertive about what he needs.
I should explain this to the patient.
Well, that is definitely true – probably the truest of all the statements! One of the things I love most about being a doctor is the chance to help people understand their bodies, medical conditions, and how to stay healthy.
At this point, I’ve stopped feeling angry with the physician and am simply enjoying what I love to do – taking care of my patient in the best way I know how.
Eastern traditions teach us that it isn’t what happens that makes us unhappy – it’s our thoughts about what happens that create our distress. By questioning these thoughts – either through “the work” or by asking, “How might the opposite be true?” – we can make some space to accept the realities in our lives. Then we can consciously decide what we want to do with that reality. By using this simple technique, you might be surprised at what you learn and how much less stressful life becomes.
by Helane Fronek, MD, FACP, FACPh