Things patients don’t like to hear, but you have to tell them



By Dr. Javier Rivera | Jul. 10, 2021 | Generalities, Recommendations

If something can have negative consequences for the patient’s illness, we must let them know, even if this implies a certain conflict with the patient.

Some patients believe that when a doctor tells them about negative consequences it is because he/she lacks empathy, does not understand their situation or is a bad professional. But, far from this, we prefer to do our job well, even if it costs us a bad relationship with the patient.

I will mention here some of these negative things that patients don’t like to hear but that I often have to tell them:

Lose excess weight

Some patients consider that they do not eat anything and that their excess weight is because they retain liquids or because they get fat from drinking water, as they say. By using these arguments, the patient puts her/his problem beyond their reach and believe that nothing can be done to solve it.

These people are unaware that excess weight is a problem of energy balance and when more calories are taken in than they are spent, they accumulate in the body causing overweight.

It is important to know that the solution to the problem must be given by the patient himself, so he/she has no other choice but to accept this and from then on we will have to find the best way to solve it.

Physical Exercise

I don’t have time, I’m very tired or everything hurts, these are usually the excuses used by patients when asked about exercise. The patient must also be very clear that with a disease such as fibromyalgia it is impossible to feel well if they are not in good physical shape.

Physical exercise has proven to be the best therapeutic tool to improve pain, fatigue, sleep disturbances and mood in these patients. There are many ways to exercise, and this can be discussed in the consultation, but it is essential that the patient is clear that she/he should exercise and this should not be a reason for discussion.

Take less drugs

A fairly high number of fibromyalgia patients are polymedicated and it is known that this harms the situation instead of improving it, so we must try to reduce them.

Many patients believe that they would be worse off if they did not take drugs, but the truth is that several of the drugs are duplicated and are not necessary; others drugs have ceased to have an effect due to the long time patients have been using them; some others are clearly contraindicated in fibromyalgia, and many of them are totally useless and do not contribute anything to the improvement of the patient. Therefore, it is advisable to remove them.

The drugs that cost the most to withdraw are those that produce addiction, since they cause a withdrawal syndrome when they are suspended. Patients already know this because they have previously tried to eliminate them on some occasion and they know how unpleasant it is and how bad they feel. So, when they are informed that the drug must be withdrawn, consciously or unconsciously they begin to display all their arguments against withdrawal and defend them until they come into conflict with the doctor.

Major opioids, high-dose tramadol and all benzodiazepines are the ones that produce the worst withdrawal syndrome and with which it is easier to come into conflict with the patient when we want to withdraw.

Change of habits

Changing a habit is probably one of the hardest and most labor-intensive things. We are installed in our comfort zone and introducing something new in our lives requires an effort that many times we are not willing to make.

However, there are certain habits that must be changed for healthier ones if we want to improve our quality of life. Everyone is well aware of some of them, such as tobacco or alcohol, but there are other more subtle and lesser known that can be very harmful.

For example, I quite often see hyperactive women who tell me that before the disease they could handle everything that was thrown at them: work, home, husband, children, etc., and as a result of starting the disease they cannot do it.

We must recognize that in the society we live in it is very easy to fall into hyperactivity, but it is necessary to know that this harms and favors the appearance of fibromyalgia and that it is necessary to modify this habit.

Another habit of some patients with fibromyalgia is the belief that the solution to the problem of the disease depends on others and not on oneself. This is a misconception and, above all, detrimental to the patient because he expects the solution to come from outside to solve his problems without making any effort on his part. In fibromyalgia, this has been shown to be very negative for the course of the disease.

Carrying out daily exercises, as we have mentioned before, is, in short, creating a new healthy habit.

Don’t use a cane

With some frequency, I see patients in the consultation carrying the most diverse external devices such as cervical collar, wristbands, slings, knee braces, ankle braces, canes or crutches. Although most are harmless, it is worth stopping at the use of the cane due to its potential danger.

The most common justification for using them, according to the patient, is that they have poor balance and need it to avoid falling. However, it is precisely the opposite, because the loss of balance is usually caused by poor use of the muscles of the musculoskeletal system that are responsible for maintaining balance. With the use of canes, the atrophy of that specific musculature is further accentuated, favoring falls. The canes, on the other hand, overload the arm where they are supported, producing tendonitis in the shoulder or wrist, and also overloading the leg on the other side. In short, as we can see, using a cane is a ruinous business for the patient’s health.

The same thing happens with the use of a cervical collar for neck pain, it atrophies the cervical musculature and its weakness produces even more pain. Fortunately, the neck brace is seen less and less.

Thus, if there is no clear indication justifying the use of these devices, it is advisable to abandon them.

Surely you are thinking how easy it is to say this and how difficult it is to do it. Well yes, you are absolutely right, but in some diseases the easiest thing is to be wrong.

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