I was chatting with a colleague today about a complicated & interesting case of hers, severe hypothyroidism coupled with overt hypercortisolemia (salivary cortisol up to 230!). This is a distance patient & she’s sharing care with a couple of other health professionals with conflicting ideas…tricky!!
So when my friend received an email last week to the tune of… “things are bad, everything is terrible if not worse”, then naturally she starts worrying: What has she missed? What’s gone wrong? What more could/should she have done? Is this some sort of aggravation to the treatment she’s recommended?
This is the place our minds naturally go when faced with these scenarios however one of the things I have really learned over years in clinic is that patients, like me, like everyone else I know, are labile, in the moment kind of creatures & we’re all vulnerable to having BPDs.
I’ve received plenty of BPDs emails. It’s the gut client whose stools have radically improved over months but a couple of days of old bowel habits send them racing for the ‘OMG nothing has changed, I’m back where I was!’ kind of email. It’s the severe hypothyroid patient who’s been responding beautifully to treatment, slowly getting her energy and life back over 3 months who then decides to suddenly sleep less & work harder and falls in a crumpled heap emailing, “HELP, I think I really need thyroid replacement”.
In the past my head would have gone to the same place of worry and self-doubt that my colleague’s did. Now when I receive these kind of emails, of course I still have concerns, consider the possibilities but the biggest thing that I have learned to do is ….STOP…BREATHE…LEAVE A LITTLE SPACE and allow for the possibility that this is in fact one of those BPDs.
Of course, if I think there is imminent risk I will react promptly, but in most situations there’s not, so rather than responding right away, I allow a day or so to pass and then gently reply with something like, “sorry to hear you were having a tough time, how are things now?” If another email comes in of a similar vein, I usually offer a bit of perspective about where they started compared with where they are now and what I consider realistic expectations in terms of recovery time-frames. So often, the BPDs pass, perspective is restored, hope and confidence reinstated & all without me needing to turn myself inside out with worry.
So the punchline to my colleague’s story is that yesterday she had another consultation with her patient and, what would you know, it was one of those BPDs! In fact, the patient’s abnormal pathology has improved so radically the GP is calling my colleague a genius and the patient actually recognises the significant gains she’s made in just a short space of time. So next time you get an ALARM! email from a client, just remember it could be a case of BPDs and don’t turn yourself inside out…when safe…wait to see if it passes