Primary Care, Mental Health and Healing

By Emmanuel Dizon, M.D, Internal Medicine Specialist, Henry Ford Health

As a primary care physician, I see patients all day—each of my patients have a story to tell. Sometimes it’s a straightforward story, a specific problem or complaint that needs a resolution. But most times there are multiple stories, layered and nuanced, oftentimes hidden beneath the surface but still begging to be told.

Patients present to us sometimes with a smile, sometimes a pained look or sometimes a searching in their eyes, an ever so slight turn of voice or tone, a folding of the arms or a looking away. We can easily miss these subtle cues—these subtle cues which are windows into mental health.

Physical health and mental health are not two separate entities. Our wellbeing depends not only on keeping your blood pressure down, but whether you have the tools and skills to manage stressful situations, and whether you feel that you are thriving in spite of challenges. You cannot have one without the other. Don’t discount the impact that your words, your displays of compassion have on your patients. Letting them share their story empowers them and heals them.

There was a young lady whom I shall name Q. I looked at her Intake sheet—high blood pressure. Oh, another non-compliant patient, I thought to myself. Her blood pressure was high in spite of being on multiple meds. I had made assumptions that perhaps she’s just stubborn and does not want to comply with my recommendations. Maybe she does not understand the risks of uncontrolled hypertension. Maybe she just resorts to fast foods and processed foods because she is unwilling to learn a healthier way of eating.

Sometimes in the busy day at the office with so many patients, it’s hard to slow down. It can be hard to listen. We make assumptions about our patients—without actually exploring. Perhaps what’s going on emotionally may be impacting their physical health.

I walked into the exam room—she appeared calm and collected with a pleasant demeanor. After exchanging niceties, I sat down. “How are you doing? How was your weekend?” I usually try to get them to share a little of their life before diving into medical concerns. Her weekend seemed uneventful. I went through her meds—she said she was taking her meds. She said that she would do better with her diet. I told her I noticed her blood pressure was high—she twitched slightly in her seat and looked away. I wanted to explore more about her lifestyle and her mental health.

“How are you sleeping? What kind of work do you do? How is your level of stress?” After asking a few questions she shared she was not sleeping well, she had just gone through a divorce and was taking care of three young children as a single mother. She was working a full-time job and trying to go to school. There was no time to prepare healthy food, get enough sleep or exercise. Her stress was very high as well worrying about her children. She did not know if there would or could be a change in her current life situation in the near future.

As a physician I might have glossed over it because I was already running behind. It’s easy to make assumptions when you don’t bother to ask. And it’s easier to just make a referral to behavioral health without really listening. But our active listening and empathy are just as important as prescribing medication or giving a referral. Instead, I asked her to share more of her life. I listened intently to her story and could feel the emotions in her words. “I can only imagine how difficult your life is right now.” I told her.

“I think your blood pressure might be high due to many factors. Let’s work on your lifestyle. Perhaps we can explore ways to help reduce stress.” Her GAD7 indicated some anxiety. I asked Q her thoughts about talking to a therapist. I asked how she felt about taking medication. She seemed receptive but not completely sure. In the end we came up with a plan. We worked on intentionality, referral to a behavioral therapist, and finding ways to improve compliance to her medications and healthy eating. She was grateful for the time that I spent with her. I also let her know that she could always come back for an appointment, even if it was just to chat. It took more time than usual but not an inordinate amount of time. In the end, Q and I both came away feeling like something healing had happened.

It’s these shared moments that make the practice of medicine worthwhile for me. It is these moments that we as human beings crave. It is these moments that are healing.

In a world where people are becoming increasingly isolated and disconnected, the need to take care of the mental health of our patients has never been greater. And now more than ever it is we in primary care who are at the frontlines.

The next time we see our patients, let’s pay attention to those unspoken gestures, facial expressions, pregnant silences. Acknowledging patients as more than a condition to be treated, creating a safe space for sharing, establishing therapeutic relationships with empathy and compassion —these are what is needed in this stressful day and age. Our health and the health of our patients depend on it.