Posts filed under PTSD

A letter to civilian providers

Dear Community Medical Providers,

How many Veterans do you have walking through your door who are either newly discharged from the military or have been going to the VA clinic for treatment? Probably not many. In all your multi-cultural training, did you consider Veterans as a having a culture all of their own? My hope is that the thought has crossed your mind. Even with an awareness of a difference, it is easy to fall out of practice of being culturally sensitive if you are not a Veteran yourself or not interacting with them on a regular basis. With the increase in the ability of Veterans to access non-VA doctors, it is reasonable to expect more Veterans to walk through your doors. Veterans, especially those who have spent significant periods of time serving or being seen in VA clinics, are likely to have become accustomed to a different manner of engaging in treatment than civilians. Adapting to the style of interaction and manner of this engagement is important to promoting the success of Veteran’s treatment. With this in mind, I offer areas to consider so we may best help serve those who served our country:

Please be direct. Be blunt. If you use any attempt to sugar coat or handle Veterans with kid gloves, you will lose them with the first grain of sugar. Understand that sugar coating is often interpreted as “This practitioner believes that I am not strong enough to handle what I am about to hear”.

Take time to explain. Standard procedure; got it. This “take time to explain” is more about the process than the diagnosis or type of test. It’s standard procedure to explore underlying causes through routine testing, such as basic blood work. Being thorough is a good thing. Many civilians understand that this is part of the process. More than once I have heard a Veteran express confusion regarding a civilian doctor checking things which seem unrelated to their complaint or ailment. There are times when Veterans have misinterpreted this as not being heard or believed about their perception of what was possibly the issue.

Ask “do you have any questions?”. That’s a question I get from my doctor every time. I ask them. Lots of other people ask them. In the military... you rarely ask them. Decisions are made by whoever is in charge of that area. Doctors are in charge of medical treatment. If the doctor has decided on a certain treatment, then the decision has been made. Yet, the civilian doctor will ask “do you have any questions?” because the patient is in charge of the patient’s body. Encourage them to ask questions and to question their agreement with the treatment plan so that the Veteran takes control of their health. Help them to collaborate with you rather than just do as they are told.

Give expressed permission for them to turn down treatment, testing, or a course of action. Veterans are seen all the time by the VA and are prescribed medication, fill them, stop taking them for a variety of reasons, and then don’t say anything to the doctor. The reasons they go about things in this manner varies, but the mindset isn’t always easy to shift when seeing someone outside the VA. Seems to me it would be better for you to know if they stop taking a certain medication rather than having them hide it. Permitting refusal allows for them to share this information. Additionally, a Veteran may just not return rather than refuse a treatment to their doctor. Reinforcing their voice in the decision making process can make all the difference. It’s the difference between choosing not to see the doctor because of their plan and choosing to make a different treatment plan with that doctor.  Along with “do you have any questions?”, it may good to also ask “what do you think about that plan (or treatment, etc)?”. If you get anything close to “you’re the Doc” or “if that’s what you think I need”,  stop and inquire more about what THEY think they need. There is a difference between consenting to treatment and agreeing with treatment. Don’t confuse consent with agreement.

Now, switch gears. Once you have a treatment plan, assign the task. Tell them directly they are to go make the next phone call or appointment needed to move forward with the plan. Put a timeline on it and be specific about what needs to happen next.

The world of a Veteran went from black and white to very very gray when they were discharged from the military. The culture they lived within is very different from our own. Some Veterans are able to switch over quite well. Others struggle. Just as we interact differently to accommodate those we work with who are from another country or religion, we should do so with our Veterans as well.

These are the very basic struggles with medical care which have come to my attention. Further understanding of their overall struggles may be beneficial to your success with these men and women. Familiarize yourself with Veteran reintegration issues and military culture. It could make all the difference in how effective we are in doing our jobs.

Posted on November 11, 2018 and filed under PTSD, awareness.

Helpful Hints for Veterans and Civilian Medicine

I am starting to see an increased number of VA connected Veterans utilizing civilian doctors through their private health insurance for a variety of reasons.Recently, I had the opportunity to be involved in one Veteran’s experience navigating the world of civilian medical doctors. Seeing a civilian doctor is something that is almost second hand nature to those who have not served. Most of us have been seen by a civilian doctor since a young age and learned how to work with a doctor as an independent living skill. Therefore, we have an awareness of when to call a doctor, either for a regular check up or when ill. This basic understanding runs deeper than just scheduling. Civilians have a natural grasp of the process, the doctors’ intentions, and the regular follow ups. Based on my observations of this individual and reports of other Veterans, I would like to offer the following tips to effectively navigate the world of civilian medicine:

TAKE CHARGE OF YOUR HEALTH

Regular check ups are not scheduled for you and sent by notice in the mail. You need an appointment; you call yourself. If you are supposed to follow up, you are responsible to set that appointment. If treating your ailment requires regular intervals of treatment, again, it is not standard practice to send notice in the mail. Yup, you have to make sure you stay on top of it.

TAKING CHARGE COMES WITH CHOICES

It is a lot easier when you’re given an order and it is expected that you follow. When you are in charge of your health (civilian medicine), you have choices. I work with many Veterans who are prescribed medication and afraid to refuse or make it known that they don’t want to take it. Many Veterans are told they need certain testing and they do so because they were told they “have to”. Civilian doctors’ recommendations are just that - recommendations. Refusal of medication or testing comes with no consequences outside of the impact it may have on your health. Requests for exploration of different medications are widely accepted. Second opinion? You get to have those too. Civilian doctors know that it’s just part of the profession. Patients may seek a second opinion and not compromise their relationship with their primary physician. Seeking a second opinion is often a smart idea when dealing with major illness because it GIVES YOU OPTIONS, which allows you to choose what’s right for you rather than just being told what is right for you. It’s always YOUR body in the world of the civilian physician.

DON’T CONFUSE  A THOROUGH  DOC AS NOT LISTENING

Civilian physicians have much more freedom in their approach to their patients. Go in for a pain in your back and they may draw to test basic blood work. They may discuss potential causes which, to the patient, may seem unrelated. Fairly routine. Underlying causes are also something to consider. Something they can consider. If you feel you are not being heard, you can ask them to take another look, answer your questions, and review your concerns. You are paying them for a service. Collaborate with them rather than follow them. They aren’t a superior giving orders.  If you feel you are still not being heard? There are lots of fish in the sea as they say. Go to another doctor. There are plenty and you get to choose who you see.

BE HONEST

“If I get treatment and it works, I lose my rating”

When using the VA as a mental health provider, Veterans have been warned that they may not  be candidates for certain treatment (i.e., EMDR) because of the fear that losing their VA rating may compromise their ability to progress in treatment. Yes, the general understanding is that your VA disability benefits can be reduced if you get healthier. My research has not yielded any statistics regarding the rate of benefit reduction. My position is: If a Veteran is seeing me (with the exception of being court ordered) then their level of discomfort has reached a point where they want to make progress. A civilian practitioner is usually not connected to the VA or your benefits; hence, the overriding position is to improve your health and quality of life. Feeling better may not be a bad thing.

SOMETHING DOESN’T SOUND RIGHT? DON’T DROP THE ISSUE

Doctors are human. The Veteran who prompted my desire to provide these tips was scheduled for a review of his medical testing with a doctor other than the doctor who initially examined them. This Veteran had been scheduled to see an alternate doctor to accommodate the Veteran’s limited schedule. But when the alternate doctor called to say the Veteran had to see his original doctor, the Veteran accepted this and scheduled an appointment a month out to see the original doctor. Didn’t make sense, but the Veteran did as they were told. Upon prompting, the Veteran called back and explained their confusion. The office acknowledged that the Veteran was correct! Who’d a thunk it. They rescheduled to an earlier appointment with another doctor and things moved forward. Question, question, question. It goes back to taking charge. Trust that  you know what you need for your own health

Posted on November 11, 2018 and filed under PTSD, awareness.

The beauty of EMDR

This weekend something so powerful occurred in my office and I have to share! 

I have a client who has completed several EMDR sessions.  (If you'd like more of an idea of what these sessions are like, I will soon be posting a video series!)  She has processed a significant amount of messages throughout her childhood that she is not loveable, that she must earn love, that she is not good enough.  We moved on to installing her positive belief system- I am loveable, I am enough.  She got a bit stuck in her childhood because she could still feel her parents presence and their negative messages.  I asked her what she needed to be able to help her get unstuck.  She said that she wanted to tell herself the positive messages.  So we started some bilateral stimulation....    

Organically and naturally, this session became about this client "re-parenting" her childhood self.  She went through the memories surfacing from infancy to adolescence and allowed her adult self to tell her childhood self, "You are not bad", "You are okay, we are okay".  As the sets continued, she began to see herself supporting her childhood self, such as attending one of her school performances.  She felt herself hold her childhood self's hand and hug her childhood self.  

It was remarkable. Powerful. Amazing.  She gave herself what she did not receive as a child. This is what EMDR does that traditional talk therapy cannot.  When allowed, the brain and body give a person exactly what they need to heal.   

Feel free to contact me for more information, resources, and/or a demonstration of EMDR.   

Follow up to this blog:  my client said she had an AMAZING week!  Any time she had a rough moment she used her visualization from last session to help her through.  Her self care also skyrocketed this week- exercise, healthy eating, and taking time for herself.  So thrilled for her!

Posted on March 29, 2015 and filed under EMDR, PTSD.