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Nothing like fear to focus the mind.

July 15, 2013

In medicine we doctors see people all the time who are anxious.  Virtually every pre-operative patient has some degree of nerves.  It is something some doctors deal with better than others, and how a doctor deals with it has as much to do with how a particular doctor deals with his/her own anxiety as it does in how he/she helps the patient deal with his.  The New York Times published a beautiful essay by Daniel Smith about anxiety which I reference here:

http://opinionator.blogs.nytimes.com/2013/07/13/nothing-to-do-but-embrace-the-dread/?hp

Anxiety is normal, it is evolutionarily useful, and within reason it is healthy.  From an Anesthesiologists perspective, healthy anxiety is situational and can be alleviated by good information, thorough communication, a little humor, and a small dose of Valium.  Any anesthesia practitioner can tell unhealthy anxiety from 100 feet.  These are the people who have high blood pressure and high heart rates.  They are information-seeking or information-avoiding, depending on personality.  They have exaggerated reactions to mild pain like that involving intravenous placement.  A small dose of Valium doesn’t touch such a person.  Humor only takes the poor anesthesiologist so far.  From a physiologic, medical, scientific perspective healthy anxiety and unhealthy anxiety are just different degrees of stress hormone release.

But, as Daniel Smith points out, anxiety is not just stress hormones.  It’s a felt, experienced emotion involving brains and thoughts.  The doctor’s brains and thoughts play against, or with, the patient’s.  In my experience, anxiety causes a person to run in one of three speeds:  fast-forward, slow-forward, or stop.  For some people, the discomfort associated with a thing being incomplete, a project un-finished, a wall half-painted is so strong that they will accept poor quality work or suboptimal results just to have the thing done.  This is the person who buys the first couch they see on-line just because the idea of having the couch un-bought is intolerable.  This is the patient who doesn’t want to hear anything anyone has to say, or even in some cases do what needs to be done, they just want it over with.  For other people, something un-finished is comforting.  For these folks, the idea of something being “done”, interpreted as “unalterable”, is just as intolerable.  These people never get anything done.  This is the patient who asks a thousand questions and still can’t decide between a general anesthetic and a spinal.  The slow-forward patient is the one we doctors want.  This is the person who knows he has to buy a new couch, hates buying furniture and has put it off because it’s uncomfortable, still looks at a reasonable number of on-line choices, considers his/her budget, makes a decision, and lets it go.Healthy anxiety causes these patients to ask appropriate questions, make decisions based on the information, and trust the rest to the professionals.

Baseline anxiety level is probably inborn, or at least a pretty stable personality trait.  Surgery is an anxiety-producing event even for the slow-forward types.  Some things you can do no matter your speed:

1. Determine how much information you are comfortable with.  Some people want to know everything, some want to know nothing.

2. Bring someone with you who can help you.  Ideally someone who is slower on the anxiety scale than you, or someone who has done what you’re doing before.

3. Make sure you’ve discussed the procedure TO YOUR SATISFACTION before you book the surgery.  The unknown is the most anxiety-producing part.

4. If you know you are an anxious type, ask your surgeon or pre-op nurse if you can be prescribed a sedative to take prior to your arrival at the hospital or surgical center.

5. Try not to read the horror stories on the web.

6. If your doctor and nurse are discussing their latest vacation or the escapades of their teenagers understand that they are not taking your case lightly.  They’re in their normal environment.  You are not.

7. Trust the professionals.  Seriously.  We’ve done this a hundred times.  We’re not worried.  You’ll be fine.

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