Why Navigating Medical Situations Can be Extra Challenging When You’re Anxious and What to Do About It
For many people with anxiety, navigating medical situations can be confusing and overwhelming. Anxiety clouds our ability to think clearly, making it difficult to evaluate various treatment options a doctor is presenting and arrive at the best path forward.
Furthermore, the specific focus of many people’s anxiety is often something medically related (e.g., fear of getting cancer, COVID, an STD, etc.), muddying your ability to ascertain what is really happening vs. what your anxious brain is telling you could happen. Even if your anxiety is not medical in nature, sometimes medical doctors lack a gentle bedside manner because they are rushed or have not been trained in how to work with patients with anxiety or trauma. Naturally, this can exacerbate anxiety, making it even more challenging to hear what the doctor is saying, critically think about it, and ask questions to determine a plan you feel good about. People with anxiety sometimes struggle with confidence and self-advocacy, making it difficult for them to ask questions if they are confused or tell a doctor that something being recommended does not feel like the best option.
In addition to these common scenarios, anxiety can make it difficult to understand which symptoms are a result of a physical process, such as an irregular heartbeat, and which are “psychosomatic,” (i.e., the way our emotions are affecting the various systems in the body). Often the physical and emotional are inextricably intertwined.
For example, take a child whose parent was an alcoholic and would become physically abusive when he drank. This child was the protector for his younger siblings. However, a bad fall during a basketball game one day left him with a broken arm. Without both of his hands, he was not as equipped to fend off physical attacks from his father. Fast forward to adulthood: this man tweaks his back while lifting, resulting in a herniated disk. He finds himself on edge about this injury, despite the concrete treatment plan he, his doctor, and his physical therapist have developed. While this is a physical injury, the trauma from his past, in which he was not able to defend himself when injured, has put his body into a heightened state of fight or flight following this injury. This heightened cortisol response may contribute to worsened pain. His symptoms are neither strictly physical, nor strictly emotional. The physical and emotional are intertwined and impossible to pull apart. For this man, simply incurring a physical injury is emotionally triggering. It also may be confusing for him to understand the way his physical and emotional pain are playing off of one another, since they are so interconnected.
Without attending to the emotional pieces being activated, physical recovery can be delayed or all together arrested. If a medical doctor does not know the patient’s history or have an understanding of the way emotional trauma operates in the body, all symptoms the patient reports may wrongfully be attributed to the physical injury (e.g., the bulged disk) and all treatment interventions are focused on healing the disk. Because some of this man’s symptoms are a result of his emotional trauma, they will not fully remit until that trauma begins to be treated.
This is where therapy comes in as an essential companion to medical intervention. In addition to working on your specific triggers in therapy, what else can you do to better manage medical situations in the meantime, when anxiety is running high? Here are some tips…
Write out a detailed timeline of your medical history, print it out and bring it to appointments: Since anxiety disrupts our ability to think clearly, it can be hard to accurately remember and report your medical history in a succinct way to your doctor. It can also increase anxiety when you aren’t sure of something from your history and are trying to go based on memory. Having a detailed, written medical history that includes past diagnoses, surgeries, symptoms, and conditions that run in your family can help eliminate this issue. Make sure to write it out using simple and clear language–in bullet points, rather than paragraphs. Once you have it documented, it’s easy to add to it as you continue to learn more information about your condition/diagnosis. Print it out and bring a copy for yourself and for your doctor to appointments. Reference this timeline when your doctor asks you questions so you can report accurate information and don’t add stress to an already stressful situation by trying to do everything from memory.
Keep a written log of your symptoms using clear, data-driven language: Anxiety can also make it difficult to accurately identify, remember, and report the progression of your symptoms. For example, if you’re very anxious one day, it may feel as though your symptoms are worse and have been consistently bad, when in fact two weeks ago they were better. In other words, heightened anxiety can color how we see the world and ourselves, including our perception of symptoms. Keeping a log each day can help make sure you are reporting facts, rather than that day’s emotional perceptions. As with the timeline, try to use clear, succinct language. Consider giving your pain/symptoms a rating (1-10). You can then aggregate this data into a summary if you need to give a report to your provider.
Research what you’re experiencing using high level sources: Googling a medical condition can often spike anxiety. It can also be misleading, as unrelated information, sometimes from poor quality sources, pops up. Instead, ask your provider for sites that have high level, research-based information about your condition. Go directly to those sites, rather than passing through google. When you’re gathering information, take bullet-point notes to help you absorb and remember what you’re learning.
Identify the top 1-3 things you want to get out of your appointment with your provider: Unlike psychotherapy, where we prioritize consistent sessions with enough time/space to process the various thoughts/feelings/memories arising for you, medical visits can be short and feel rushed. When anxiety makes it difficult to think, it’s a stressful combination. Don’t wait until your appointment to determine what you want to accomplish by the end of the visit, as that is a lot of pressure and can lead you to be disappointed. Ask ahead of time how long the provider is scheduled to spend with you. Based on how much time you have, identify ahead what you want to get out of the appointment. Write it down, again, in clear, concise language (e.g., I want to know what my diagnosis is and I want to walk away with your top three treatment recommendations for this issue). During the appointment, check back on what you wrote down to confirm your priority questions have been answered.
Write down a list of additional questions: In addition to the top one-three things you want to get out of the appointment, create a list of other questions you have ahead of time. Check them off as you talk with your provider. If you did not have time to get all of your questions answered, ask your doctor if there is anyone else in the office you can follow up with (a nurse or aid) or how you can schedule an additional appointment. Be firm and trust that your questions are important–this is your health and you deserve to have all of your questions answered so you can make the best decisions possible. If there was not enough time during this appointment, another appointment can and should be scheduled.
Practice self-advocating with a partner or friend: Oftentimes people with anxiety fear saying no or asking for a different approach, as they’re nervous they’ll upset their provider or be labeled as “difficult.” This is something that can be worked on in therapy, however in the meantime, consider practicing with a friend or family member. Have the other person pretend to be the doctor and suggest something you know you would not be comfortable with. Practice saying “I don’t know if I’m comfortable with that plan” or “I need to think about it and get back to you,” or “I don’t want to take that approach. Are there other options you can recommend?” Starting to say these statements out loud can help create a new neural pathway in the brain that makes self-advocacy more comfortable.
The bottom line? You are in charge of the outcome of your healthcare. The above strategies are ways to help you organize your process and in doing so, minimize anxiety from getting in the way of your medical care.
At SageWell Health we have a lot of experience working with individuals who are experiencing a medical condition or who have medical anxiety/OCD. Contact us to learn more about how psychotherapy could be a beneficial adjunctive treatment.