How to meet a doctor. View Full Version Some questions to ask yourself

If a doctor uses too many scientific terms and you don't understand him, there is no shame in asking him to speak in a language you understand. Explaining what is wrong with you and how the treatment will take place is part of the job.

2. Wrap up the meeting

In order not to deal with appointments and recommendations at home, check on the spot whether you understood everything correctly. Then say aloud the order of your actions after visiting the doctor, for example: “At the pharmacy I buy potion X and drink it every day, a tablespoon in the morning and evening for two weeks, after that I come back to see you, right?”

3. Ask for written opinions, pictures or videos

For example, if you had an endoscopic examination, the course of which was recorded on video, be sure to ask for a recording, and not just a conclusion. The same goes for x-rays and other pictures. If you were served under the MHI policy, you may not be given these files, but if you visit a doctor for a fee, they should remain with you.

4. Ask for your best and worst outcomes

And also about the likelihood that each of them will come.

5. Find out the contacts of someone who has already been treated

If you have major treatment or surgery coming up, ask your doctor if you can talk to someone who has already been through it. Perhaps this will help you not only get useful advice, but also positively tune in.

6. Ask about alternative treatment options

As well as the advantages and disadvantages of each. Ask if the treatment prescribed for you is classic or if the doctor uses some unusual treatment regimen. If your option is the latter, visit another doctor to confirm the diagnosis and clarify the treatment plan.

For several years now, the topic of the doctor-patient relationship has been gaining more and more attention. The most common complaints are that these relationships are no longer what they used to be, that doctors have lost the ability to sympathize, that in this area, obviously, they do not receive special education.

But is this really the problem? Is it only about education or is it about practical skills and the opportunity to exchange views with colleagues regarding their relationship with patients in certain specific situations? From the experience of conducting educational courses for doctors, we know how interesting it can be to find out what a colleague is doing in a given situation. Participation in the exchange of experience is always preferable to the acquisition of theoretical knowledge: it is more interesting to hear judgments about oneself than just to get acquainted with a certain “know-how”.

We started from specific, frequently occurring situations proposed by a group of medical practitioners and relevant to daily practice.

This is not about ready-made recipes that can be mechanically used in a given situation, but about sentences and judgments that can become, so to speak, the key to a cipher. Everyone can judge the appropriateness of the proposed situations, taking into account their own practical experience.

And the last thing: since we are practicing doctors ourselves, we know how we do not have enough time to read even interesting books! For this reason, we have tried to be as concise as possible. Each chapter of this book can be read in a few minutes, regardless of whether the others have been read. Because, once again, we did not aim to provide exhaustive information and delve into the subject in detail: we only wanted to provide an incentive to think about your practice.

Situations related to patient behavior
“Doctor, things are really bad, terribly bad, terribly!”

Of course, in the hope of getting help in solving their problems, all patients go to the doctor with complaints. But among them there are those who come to the reception with the sole purpose of expressing their complaints. The fact that a person sits in front of them, whose duty is to listen and alleviate the suffering of another, is an irresistible temptation for them.

What are patients complaining about?

It is clear that the causes for complaints are innumerable, but they can be divided into three broad categories:

complaints about "internal" factors associated with illness or social conditions (suffering, difficulties, loneliness);
complaints about "external" factors related to the environment (society, family, young people, neighbors, ..);
complaints of an "interactive" nature related to medical procedures (side effects during treatment, doctor's behavior ...).

Of course, these problems may be real, but there are undoubtedly patients who, when faced with the same difficulties, are much more likely to complain than others.

What is the function of complaints?

In general, each complaint should be considered as a message. The problem is to correctly decipher its meaning.

Does the patient want advice, or does he just need to be listened to and expressed sympathy?
Is he complaining in order to reproach the doctor for something?
Isn't the complaint a "helping hand" to the doctor, to help him ask questions about a problem that he himself did not dare to ask directly?

Even if there are "Chronic Complainers", every complaint should be treated with respect, at least initially: it should be shown that the patient is given the right to complain, that the doctor makes an effort to understand him and wants to help him.

Some strategies for dealing with complaints

1. Empathy (empathy)

Empathy is a general attitude, both psychologically and behaviorally, expressed in respect for the point of view of another person, even if this point of view is not shared. This position, for example, can be expressed in such a response to a patient complaining about treatment: “I see that the side effects have brought you embarrassment, I understand that you are a little disappointed. But at the same time, I think it's the best treatment available, and here's why. In the first sentence, the doctor shows that he does not question the complaint itself and that he understands the patient's emotional reaction (disappointment). By acting in this way, he increases the chances that the patient will listen to him when he makes his arguments.

2. General approach

Paradoxically, it is sometimes a good tactic to inquire about the presence of other complaints before discussing the one already expressed, because this avoids a game of verbal ping-pong like: “Okay, doctor, but there is also this, this and this.”

After listening to the complaint, the doctor may begin to ask questions: “I agree, I see. Are there other problems?

After “managing” complaints, the doctor can proceed to a “global restructuring”. For example, regarding complaints about side effects: “Okay, we have already talked about the problems that you had to face because of the treatment, and what you can think about it. But we have not yet talked about the benefits that the treatment has brought. Did it benefit you?" By acting in this way, the doctor increases the likelihood that the patient will positively evaluate the main result of the treatment, which could not be expected before the dialogue about his complaints.

ERRORS TO AVOID IN RESPONSE TO COMPLAINTS

Patient complaint:

“Doctor, this is terrible, after you changed my treatment, I feel worse and worse.”

Possible (but undesirable!) answers:

Ignoring a Complaint:"Um...yeah, but what about SLEEP?"
"Legitimization" of the complaint:“That's how! We need to reconsider all this, the treatment will be changed again. We'll see...."
Correction of the content of the complaint:“I understand, but you always exaggerate a little. You look really good…”
Aggressiveness:“You are always dissatisfied. Whatever it was, but in your case there is only this type of treatment ... "

3. Advice after listening to complaints

After any dialogue in connection with the complaint, it is better for the doctor to avoid giving advice or expressing his point of view. The patient cannot immediately approve the doctor's position and advice: the negative emotional charge of the complaint, as a rule, does not allow one to immediately agree with a different point of view. That is why advice and arguments for "correcting" the patient's opinion should sound like assumptions: "This is how things seem to me, taking into account my experience. I suggest you think about it, and we'll talk about it later."
Is it always necessary to listen and express support for a complaint?

It has been thought for a long time (and this point of view has been supported by various schools of psychiatry) that the patient's desire to express his complaints should be systematically encouraged. Many of the types of psychotherapy, however, amounted to years (!) of the patient complaining about his past or present in the face of a doctor who was silent.

Today it is believed that complaints, of course, should be listened to and treated with respect, but they should not be unduly encouraged. The more a person complains, the more he gets used to responding to his problems in this way, at the expense of more effective psychological or behavioral attitudes.

In the case of chronic complaints that are not directed against the doctor, it is sometimes worth entering into a dialogue by asking the patient the question: “Does it bring you relief in the depths of your soul that you are telling me your complaints?”.
"Come in when you want to take a glass of aperitif, doctor!"

People of all professions make friends at work. Why should this be forbidden to a doctor? Why can't we make friends with our patients? If a real friendship can be born as a result of a consultation in a doctor's office, then, as we will see, the issue becomes delicate and requires an approach taking into account some nuances. Here we will talk about rather intimate friendships that have arisen at the initiative of a doctor or patient, for example, with an invitation to visit one's home, participation in family life. In contrast, situations arising from attending the same sports club or attending the same events are unavoidable, especially in smaller towns, but they do not in themselves constitute an attempt to make friends if the contacts remain purely cordial. .

Why do patients want to penetrate the doctor's private life?

Here are a few reasons why a patient might want to make friends with a doctor.

Confidant

Sometimes the doctor appears as one of the few persons with whom the patient can speak freely. The experience of intimacy with friends may cause our patient to consider you as a new friend, and he will offer him what friends offer: an invitation to dinner, an offer to participate in entertainment, gifts.

Selfish Relationships

The doctor may appear to the patient as a prestigious acquaintance, so the patient will seek to bring some of this prestige into his social life.

Manipulation

Some people seek to make friends with a doctor out of a more or less conscious desire to secure future privileges (easier appointments, pay benefits, friendship-based referrals).

Gratitude

Some patients may feel grateful to their doctor, with the feeling that they have a "duty" to the doctor. They will offer the doctor what they consider most valuable: their friendship, their reception in their family, their participation in leisure activities.

natural affections

For example, a doctor and a patient would become friends even if they had met under different circumstances, in different occupations. Of course, this happens, and we will look at how to avoid trouble in such situations.

What are the risks of friendship with a patient?

You risk getting involved in relationships that will become difficult to maintain over time.

What happens after the feeling of pleasure from the first meetings outside the doctor's office has passed, and you find that your patient and his family members are not as funny as they seemed before? Don't forget: it's usually harder (and more painful for the patient) to cool down an existing relationship than not to start it from the start.

The patient gets the opportunity to manipulate you

If you've had the misfortune of becoming friends with a manipulative patient, you run the risk of him asking you more and more often. For example, calling you on a Sunday morning for medical advice or a real consultation at the end of breakfast, will ask you to issue him a certificate or certificate that you are not authorized to issue, and finally will ask you to urgently arrange for the placement of his demented grandmother in any institution.

Unbalanced relationship

Too much difference in social position between the doctor and the patient, different emotional needs are some of the risk factors that will be difficult to manage when establishing a friendly relationship with your patient.

Difficult situations

If you make friends with your patient, you will get to know his family, wife, children. How will you feel when you see your hypercholesterolemia patient eating too much butter at the family table? And if you keep his diagnosis - lung cancer - a secret - how will you put on a good face at dinner when your wife, who knows nothing about the diagnosis, begins to tell you about the family's plans for future years? And what about alcoholic or seropositive patients? There are pathologies that are difficult for a doctor to deal with even in his office. Does he overestimate his strength when he thinks that it will be easier to cope with this in social life?

Money problems

Money is often a source of embarrassment when friendship and caring get mixed up. Won't your patient friend think he can use your services for free? What to do if at the end of the consultation he warmly thanks you and leaves without paying?

Deterioration in the quality of services

This is the last of the risks, and it is the most important one for us physicians to consider. Friendships that are not good enough or poorly balanced create difficulties that are likely to affect the objectivity of our diagnoses, the quality of therapeutic services, and the doctor-patient relationship that we must maintain.

Finally, even with a successful friendship, there is a risk of getting an unsatisfactory result. A friend should not be asked certain questions or given instructions, he should not be examined as an ordinary patient. Moreover, in this case, it will be more difficult for both to survive errors in diagnosis and treatment. However, this problem can also arise from the other side, since some of our friends want us to accept them as patients ...

How to refuse friendship without causing offense?

If you come to the conclusion that it is better not to respond to your patient's offer of friendship, then how to refuse friendship without causing offense? Suppose a patient has invited a doctor to dinner... Here are some strategies for deferring with respect:

Show that you are touched by the patient's attention: "I am touched that you invited me, and I see this as evidence that you trust me."

Refuse and explain why: “Unfortunately, I cannot accept your invitation, because I want to remain a good doctor for you, I must play my part and not mix it with others.”

End on a positive note: “I'm sure you'll understand what I'm trying to say. It is not easy for me to refuse you, but I want to remain your best doctor as far as possible.

It may happen that, despite your efforts, your interlocutor will be somewhat offended by your refusal. It's unfortunate, but it's still better for both of you than getting into a relationship that becomes difficult and unstable.

What if friendship seems possible?

However, you may come to the conclusion that it is possible to enter into friendly relations with some of your patients. In this case, do not forget that there may come a time when it would be wise to advise your friend to consult with your colleague in the future. And explain the reason: even if successful, friendship can make it difficult for the doctor to make a diagnosis and choose therapeutic agents, which is to the detriment of the patient who has become our friend.

SOME QUESTIONS TO ASK YOURSELF...

What are the possible reasons that push this patient to offer me his friendship?
What reasons do I want to accept this friendship?
What happens if I get disappointed in a relationship?
If we had met under different circumstances, would we have become friends or not?

Answering “yes” to the last question may be the only reasonable reason to develop a friendship with a patient, provided that you guarantee the quality of services that he will receive continuously.
Situations related to medical practice
"Do I really need to take this medicine?"

"The doctor should be aware that patients often lie when they say they have taken medication." This quote from the writings of Hippocrates reminds us that physicians have always faced the problem of patients not following their prescriptions. A recent survey conducted by SCREZ showed that

58.6% of patients distort doctors' prescriptions
of these, 21.5% do not follow dosages or instructions regarding the number of medications to be taken
37% - do not take treatment for the recommended time (as a rule, they reduce this time).

Well, what about other numbers? It is estimated that after one month, 10% to 15% of patients suffering from hypertension do not follow the doctor's instructions exactly.

Another study showed that a proportion of patients with depression receive treatment for only 3 weeks, although they should receive it for many months.

Regarding the treatment of the upper respiratory tract with antibiotics, the survey showed that 36% of patients do not follow the instructions for their treatment properly.

Reasons for non-compliance with doctor's orders

There are four main categories of reasons for non-compliance with doctor's orders.

Causes related to the drug: side effects (it is usually better to warn patients about these effects from the very beginning); prescribing treatment for a long time (in this case, the best results are when the medicines are taken once a day).
Causes related to the patient's personality: negative / objecting personalities or people who listen to the "good advice" of others.
Illness-Related Causes: Chronic illnesses can lead to fatigue and forgetfulness, sometimes even unconscious rejection of illness.
Causes related to the relationship between the doctor and the patient, and a good relationship contributes to the implementation of the doctor's prescriptions.

self control

To understand the reasons for following or not following doctor's orders, you need to understand the concept that psychologists call self-control. “Self-control” refers to the ability of a particular individual to perform some action with the aim of obtaining a benefit in the long term without necessarily obtaining a benefit in the short term (for example, when a student makes an effort since September to pass an exam in June, or a young woman immediately denies himself confectionery to lose weight by summer). Not everyone is endowed with the ability of self-control to the same extent, and this ability is closely related to psychological and educational factors.

On the other hand, certain circumstances, by their nature, suppress this ability, because they lead to discouragement. Such circumstances are chronic and asymptomatic diseases. In this case, it is difficult to see the result of regular treatment (taking medications and following some kind of diet), regimen or hygiene rules, because:

the benefits will be in the distant future (but today you need to make efforts to achieve results in a few months or even years);
the benefit may be abstract (not getting sick for several years);
the benefit may be hypothetical (reduce risk without absolute certainty of a protective effect).

That is why the doctor should make life easier for the patient, including in relation to self-control. This does not mean that he should lecture the patient ("Be reasonable, it's for your good") or teach him how to live ("I know what's good for you, and you should obey me"). Such statements may in some cases be effective in the short term, but these strategies have not proven to be effective in the long term.

The evolution of the doctor-patient relationship

Gone are the days when medical prescriptions were an unconditional order for the patient. Today, doctor's prescriptions are more like diplomatic agreements than imperative recommendations...

It can be stated that the doctor-patient relationship falls into one of three categories:

"With a pedagogical bias":"I will explain to you what you must do, it will be enough if you follow my advice."

"Relations of the type of cooperation":“Here are my tips for your case: do you think they are feasible?”.

None of these types of relationships can claim absolute superiority: the authoritative attitude is accepted in emergency situations and in short-term treatment, while relationships with a pedagogical bent are well suited for initial consultations. Each of these attitudes has its limits: for example, it is known that the most informed patients are not necessarily the best ones to follow the doctor's orders. But, undoubtedly, a collaborative mindset offers the best prospects for long-term compliance with the doctor's prescriptions.

Strategy for Better Compliance

The role of the doctor cannot be reduced to making a diagnosis and prescribing treatment, the doctor must also ensure that the patient complies with his prescriptions. To paraphrase Clemenceau (“War is too serious a thing to be left to the military”), compliance with prescriptions is too serious a problem to be left to the patient.

Time must be taken to ascertain whether the prescriptions are being followed. Ideally, you should follow the three-thirds rule whenever possible. A third of the time should be devoted to clinical examination, a third to conversation, and a third to writing prescriptions and related activities (“accompaniment”). You need to reserve time to explain how to follow the prescription, to reveal what the patient is silent. In this case, the likelihood that the patient will follow the doctor's prescriptions exactly is greater than in the case when the prescription is written out at the very end.

Managing the process of formulating medical recommendations

The management of this process is based on simple pedagogical principles: inform the patient about his problem and treatment, remind him of the need for regular treatment, reveal what the patient is hiding, and discuss it with him seriously and without criticism. In addition to the prescription, life hygiene rules, etc., should be discussed. Sometimes it may be useful to increase the patient's involvement in treatment, for example, by asking him to choose a form of the drug among many forms ("Which syrup do you prefer: strawberry or orange?").

Every doctor should proceed from the fact that it may not seem obvious to the patient the need to comply with medical prescriptions for many years.

Therefore, it is useful to ask him questions on this topic regularly, while expressing empathy: “I know that it is not easy to receive treatment in a regular way. Do you sometimes get bored and stop treatment for a while?

In this way, you will get more truthful answers than if you simply ask: "Do you take medication every day?". What can the patient answer, except: "Yes, of course, doctor."

WHAT NOT TO DO WHEN GIVING INSTRUCTIONS OR RECOMMENDATIONS:

Write a prescription in the style of "leave quickly", assuming that the patient agrees with this: "Okay, here, take all this and let me know."
Present the act of issuing prescriptions as an act of asserting one's authority: "Do you trust me or not?"
To be intolerant of the fact that the patient doubts something or asks questions: “Do you want to get well, yes or no?”.
Do not inform about possible side effects or inform about them without leaving time to reassure the patient: “It will make you sick, but it's not scary. Until next week".
Criticize the patient immediately after he confesses that he did not follow the medical instructions.
Having found difficulties, limit oneself to persuasion to start treatment again, without finding out exactly the reasons why the patient did not comply with the prescriptions.

A strategy to improve patient compliance requires:

do not forget that the patient is more anxious and less informed about his disease and treatment than the doctor;
allocate sufficient time to explain medical recommendations (after explaining the pathology);
give clear explanations (dosage, hours of administration, duration of treatment, side effects and behavior) taking into account the level of understanding of the patient;
present things as positively as possible: focus on the effectiveness of treatment, the absence or reversibility of side effects, etc.;
check how well the patient understood the instructions and agrees with them, and more often make sure of this by asking him questions;
actively investigate whether the patient is silent about anything that has happened since the start of treatment;
regularly check how the patient complies with the doctor's prescriptions in case of chronic diseases and devote special time to this.

"I want a clear answer, doctor!"

The modern practitioner, of course, never claims to be called a sage or a scientist, but in essence he is a "representative of science" in the field of "integrative" medicine, a researcher in everyday life. And to represent science today means, more than ever, to know the limits of its possibilities. But how to talk about it with the patient?
When is it useful to talk about your limits?

Most often, such situations arise when it comes to forecasts: when patients ask a doctor about the future, in many cases it is difficult to be sure.

What to say to a depressed patient asking if he will relapse; a cancer patient who wants to know how much he has left to live; parents who ask about the prospects for the mental development of a child with congenital cerebral insufficiency?

The doctor faces two problems. On the one hand, he is not sure what will happen, and there are no reliable statistics. On the other hand, he feels that he is not just being asked a technical question, but they want to hear words of reassurance, and often there is a tendency to give hope at the risk of lying a little, than to express conviction in a negative course of events. At the same time, he can remain confident that he is simply doing his job and protecting the patient's identity from traumatic information. But today information is becoming more and more accessible. Therefore, there is a risk that the doctor will have to deal with numbers or data that the patient finds himself. Of course, the time when the patient blindly trusted the doctor is gone: gradually, patients begin to consider doctors as persons providing medical services, and often look elsewhere for clarifications or answers to questions that they did not receive...

Why is it difficult for a doctor to admit to the limitations of his knowledge and abilities, while it is difficult for a patient to hear about it?

Recognizing the limitations of one's knowledge and capabilities means, to some extent, abandoning the role of an expert, especially if the doctor's usual communication style is based on the "trust me" formula. Renunciation of "omnipotence" therefore may seem not only as a wound to self-esteem, but also cause fear that the patient will listen less to the opinion and advice of the doctor and follow his prescriptions to a lesser extent.

Equally, some patients may feel uneasy if the doctor says "I don't know." Either due to the fact that, from their point of view, the doctor is a professional who should have answers to all questions, or due to their concern about the disease, when any ambiguity is alarming. Thus, hypochondriac patients have a hard time accepting the idea that medicine is not an exact science capable of explaining why they experience certain sensations at any given moment.

How to tell the patient about the limits of your knowledge?

In my time:

regularly remind the patient that, despite progress, medicine still does not give answers to all questions;
not to be annoyed by discovering the fact that the patient already has information that the doctor does not yet have;
build a relationship with the patient

What to answer the patient's questions?

Recognize the patient's right and need to know what is going to happen, and take the floor first ("I am well aware that it is important for you to know what may happen").
Demonstrate your active participation (“I would also like to tell you this”).
Emphasize your limits (“But today this is something that cannot be said with certainty”).
Show what is known at the moment (“Nevertheless, here is what can be said about many people”).
Indicate the patient's active role in their care. (“But it also depends on how much you follow medical prescriptions, how you organize your life ...”).
Assure the patient of your support (“In any case, I will try to answer your questions and give you my advice ...”).

Return to basics?

Paradoxically, the expansion of medical knowledge narrows the limits of medical knowledge: today it is impossible to have comprehensive knowledge in the field of therapy of both a specific disease and a specific patient. In difficult moments of your clinical practice, an appeal to the humility of doctors of the past can help, and we cannot but quote the famous phrase of Ambroise Pare; "I bandaged him, God cured him."

WHAT SHOULD YOU AVOID IN FACE OF THE PATIENT?

The desire to answer all questions: "Trust me, and everything will be fine."
Reject all the patient's doubts: "But don't ask all these questions."
Over-emphasizing your doubts: to say "I don't know" does not necessarily mean to resort to subterfuge, to hesitate, not to dare to make a decision.

Physician related situations
"Doctor, I'm under stress right now!"

"Me too!" - the practitioner often wants to answer. In most cases, the survey of general practitioners confirms that their profession is associated with stress, which affects their health. Are there any rules for better protection against occupational stress?

Signs of stress

Stress is not a disease, but nevertheless it can become pathogenic if it is excessive or continuous. What signs can be used to determine that a critical threshold has been reached? Signs of stress are classified into four broad categories:

Physical signs: muscle tension, high blood pressure, chest tightness...

Behavioral signs: a tendency to speed up one's activities, trying to do several things at the same time (writing and opening one's correspondence while on the phone, making phone calls while driving a car, reading on the go...), making mistakes or missteps.

Psychological signs: feeling overwhelmed, being under pressure (in this case they talk about “mental stress”), feeling that everyone is attacking you or haunting you (even in banal situations when they prevented you from talking on the phone or when you need to give someone then explanations...).

Emotional signs: increasing irritability, pessimism, loss of interest in what usually aroused interest.

If these symptoms are persistent or occur frequently, they should be treated as warning signs that should be taken into account urgently: Do you keep driving when a lot of red lights on the dashboard light up?
Risks associated with stress

Stress-related risks can also be roughly divided into four broad categories;

Health: today it is known that poorly managed stress affects health, contributes to the decompensation of problems that have arisen before, and the vulnerability of the individual. The effect of stress is still poorly understood. Of course, there is the mediation of the immune system (repeated reactions to stress alter the immune response) and hormones (stress, disrupts the secretion of endogenous corticosteroids).

Personal performance: if in small doses stress can increase personal productivity, then above a certain threshold, on the contrary, stress reduces creativity, flexibility (the ability to retreat in time), entails logical errors.

The quality of relationships with other people: relationships are often the first victim of stress due to bias due to the hostile emotions that often accompany stress (increased conflict, increased intolerance of irritants and criticism).

Well-being and comfort: in a stressful state, a person gets less pleasure and feels less pleasure, his feeling of general good condition and comfort changes; stress increases his tendency to anxiety and depression.

Some Ways to Directly Manage Stress

Become aware of how your body reacts to stress
As a rule, the individual discovers too late that he is in a stressful state, based on the reaction of irritability or pain associated with muscle tone.
Use momentary relaxation
Relaxation should not be considered only as a method of recuperation after a day full of stress, but should be practiced throughout the day in the form of small exercises lasting from one to two minutes.
Make sure you are in the most comfortable position.
Lower (relax) your shoulders and jaws.
Slow down and deepen your breathing, try breathing from your belly without taking large breaths (exhale to the end, then relax your muscles without making an effort to inhale ...).
Take regular breaks
The natural inclination of a person who is under stress is the desire to "string" one thing on another. For example, invite a patient to enter immediately after the previous one has left the office. In such a situation, there is no possibility for decompression. A good way to prevent excess stress is to take a one to two minute break between appointments to rest (mini-relax, stretch, etc.). The "lost" time is largely compensated by increased productivity, improved overall well-being and a sense of comfort at the end of the working day.
Try to reserve a free space in your working day
If possible, it is useful to systematically set aside half an hour (without meetings) in the middle of the day in advance in order to prepare for possible urgent or unforeseen situations. Even if there are no such situations, how nice it is to have half an hour at your disposal to put everything you have written in order!

desirable and possible

We are aware that all the advice given here is from among those that are called "good advice", that is, those with which; 1) everyone agrees and... 2) lament that there is no time to follow them. But should they be abandoned? Or is it better to try to gradually introduce them into practice, at least on the days when this can be done?

Some ways to manage stress long-term

The first stage is, of course, thinking about what factors are stressful.

What stressful situations can be avoided, which ones can be avoided? Aren't there a number of prescriptions to which one would have to say "no"? For example, from among those that are not necessary for financial and personal balance? Time management is based largely on stating the fact that before doing a task, we must ask ourselves three questions; is it possible to refuse it? Pass it on to someone else? Complete it in less time?

Develop stress "moderators"

It is not always possible to avoid stress factors. In this case, you need to make sure that you have enough funds at your disposal to resist stress. These tools are called "moderators" and their effectiveness has been confirmed in many studies. For example, social support: when in the face of big and small difficulties that you are facing, you use the opportunity to tell another person about your problems, to be listened to and receive advice. Or leisure activities and pleasure: how much time per week do you devote to activities that are enjoyable for yourself, and not activities with the goal of pleasing others? Or engaging in activities that add "value" to your life: people who participate in activities of a sporting or religious nature are known to be more stress-resistant...

WHAT SHOULD YOU AVOID IN THE FACE OF STRESS?

Deny the problem: “Am I stressed? Never!" Stress is easier to deal with when you are aware of its existence.
Deny the possibility of any action: “Nothing can be done, alas, such is our life!”. There are ways to reduce stress that have been evaluated to be effective.
Expect Immediate and Impressive Results: "Despite my best efforts, I felt stressed all the time, so I stopped everything." Stress management requires training and therefore time. Only after a certain time will this control become effective.
Treat stress with medication without thinking about its causes and our reactions to stress.

Regularly think about your priorities and limitations

Stress management is based on a voluntary attitude. You need to decide what our priorities are, determine the limits of your capabilities, clarify the main points of peace of mind that should be protected in the first place ... Stress all too often stems from the fact that a person forgets about himself in order to satisfy the requests of others. We do not do what benefits us, but only what we are asked to do. A person does not build his life, but only acts in response to requests. This is what the experienced professor wanted to show to the young graduates of the National School of Administration when he filled the vessel in front of them: first with large gravel (“Is the vessel full?” - everyone answered “yes”), then adding smaller pebbles (“Is the vessel full now?” , the disciples were careful and remained silent), and finally, adding fine sand to it, he asked: "What morality can be drawn from this?" The students responded (the professor was teaching time management): "When we use our time, there is always an empty space - even when we think there is none." But the professor objected to them: “No, I wanted to show you something else: if you don’t put large stones in the vessel first, then they won’t enter there. Proceed in the same way in your life: first place your priorities, the big stones, and only then the less important things: there will always be a place for them, because they will slip between the big stones. If you act in the opposite way, there will be no place for large stones in the vessel.

In real life and ordinary conversation, people often discuss possible acquaintances. You meet someone and tell them where you came from. They answer you: “Oh, my grandfather lives there”, they give his address and name, and you say whether you know him or not.

It’s logical to assume that friend recommendations work the same way: you tell the social network who you are, and it tells you which user you might know. However, Facebook's algorithms work at a much deeper level, and their results, which are visible in the You May Know Them tab, are anything but obvious. In the months I've been writing about the PYMK algorithm, as it's called on Facebook (People You May Know), I've heard hundreds of incredible stories:

Such stories seem impossible if you believe that Facebook only uses what you choose to tell. However, everything becomes clearer if we learn about another dossier maintained by Facebook itself - only here we can no longer control anything.

Behind the Facebook profile that you designed yourself, another one is hidden - information is transferred to it from a smartphone. Behind the Facebook profile that you designed yourself, there is another shadow one. Information is transferred to it from mailboxes and smartphones of Facebook users. This profile is associated with data that you never provided to the social network, thanks to which it can learn a lot more about your social life.

The existence of these shady Facebook profiles has been known for several years, but most users do not understand their real capabilities. Because Facebook's algorithms process these contact details inside a "black box," people don't realize just how deeply the social network enters their lives until another inexplicable recommendation pops up out of nowhere.

Facebook doesn't read that lawyer's work emails. But, most likely, this working postal address is recorded in some file, even if the lawyer himself did not provide it to the social network. If any person who knows this email address decides to give the social network access to their contacts, the company can connect the owner of this address with all the people who also have this address recorded - for example, with a defense lawyer.

Facebook refuses to disclose the source of specific recommendations. A company representative told me that those incredible stories may have other explanations - for example, the reason could be "mutual friendship" or "being in the same city / network." According to this representative, of the cases I mentioned, the story of a lawyer is most likely connected to shadow profiles.

Access to the contact list is one of the first steps that Facebook offers immediately after registering a new user. The Find My Friends feature on the desktop site is as simple as it gets:

You enter your email address, then your email password, and Facebook will offer to add all the users you know. In the meantime, all your contacts remain in the social network database.

The Find My Friends page in the Facebook app is much nicer, with flowers and a suggestion to "find out which friends you have on Facebook by sharing your contacts."

At the bottom of the page, under the "Get Started" button, it says in small print: "Contact information ... will be shared with Facebook so you and others can find friends faster." It sounds very vague, and even clicking on the "Read more" button will not help bring the necessary clarity:

Once this feature is activated, we will be able to use and securely store information about your contacts, including names and nicknames; Photo; phone numbers and other data you add, such as type of relationship or profession; as well as data from your phone associated with these contacts.

Just think how many different information can be associated with a particular contact on your phone. Then imagine how much data about all sorts of people - whether they are closest friends or casual acquaintances - is stored on your phone.

Facebook reminds users to treat this information with care. “Your contacts may contain information about work or personal life,” the company warns the reader on the “More” page. “Only add people as friends who you know personally and who are willing to accept a request.”

After this warning, and agreeing that not everyone in your address book will want to be your friend, Facebook does exactly what it was trying to talk you out of. When you agree to open access to your contacts, all this data is immediately at the disposal of Facebook, and the social network will begin to look for connections between all your acquaintances, even the most distant ones - without you noticing how this happens.

Facebook does not like or use the term "shady profiles". The company does not like this because it seems that Facebook creates hidden profiles of people who have not yet registered on the social network, which contradicts the company's statements. About the existence of shadow profiles actively started talking in 2013, when Facebook announced the discovery and fix "buga". The bug was that profile loading users saw not only contact information of friends, but also hidden contacts of other people.

For Facebook, the problem of the bug was not that user information was stored in one huge database - the bug proved the very existence of this database. It is assumed that the degree of development of the network of contacts that Facebook builds around each user should be known only to the company itself.

Facebook is doing its best to hide from the public's attention how much data is collected through contacts and how far the boundaries of its sphere of influence extend. "Friend recommendations can be based on the contact information we get from people and their friends," explained Facebook spokesman Matt Steinfield. - Sometimes this means that someone you know has uploaded contact information - such as email or phone number - that our algorithm will contact you. Signals like these help us make sure you only see people you already know or would like to become friends with in your recommendations.”

Photo credit: focal point/Shutterstock

With such incredible reach, Facebook can do a lot more than just connect you directly with those who have your contact details. The network can build entire chains: if two different people have saved your number or email in their contacts, it is quite possible that they are familiar with each other. Moreover, for this, the address or phone number that you indicated in your profile is not necessarily used.

Information from the Internet, the dentist writes:

So, if this is the first time for your critter.
Let's start with the fact that a trip to the dentist consists of several parts: home preparation, the visit itself and summing up.

In preparation:

Never say that the doctor will not hurt and scare you - they cheered me up! If you are recommended to go for a regular massage and are constantly told and assured that there is absolutely no pain and no fear, will this alert you? So is the child.

Do not say that he will be the most daring in the family, because. all the rest of the family are madly afraid of this doctor - hmm, but what about dad's indisputable authority? After all, he can eat boiled carrots in soup, go into a dark room and protect him from courtyard children, and then the fear of the dentist ... Scary? Here is your child in the same confusion.

Do not use such words as “prick”, “tear out”, “drill” in your story about the dentist ... Be more romantic and resourceful, it’s at an adult reception that you can get an injection and pull out a tooth, but children ... They don’t have injections , they have a special jam, after eating which the microbes will definitely fall asleep (this is if we are talking about application anesthesia), and then they will pour freezing syrup on them sleeping (this is already about an injection). They don’t “drill” children, they draw different princesses and supermen on their teeth, or conduct a sea battle with enemies. And there are no fillings, but there are sooooo tasty chewing gums that seal the houses of microbes so that, God forbid, they don’t return there.

It is useful to play dentist so that the baby can imagine what will be discussed in the office.

Never scare children with doctors in general and dentists in particular! Now I can understand the horror of the third grader Sasha, who squealed like a ship's siren as soon as he saw me in the office!

It seems that everything, you are theoretically prepared, now we are going to visit the doctor:

Carefully choose a doctor and clinic, the doctor must be a child doctor, because. Pediatric dentistry differs from adult dentistry both in the skills of doctors and in the materials used. Do not save at first, here you are laying the foundation for the whole life of the child.

Come to the doctor without any problems, just without waiting for exacerbations (in such cases, the child is doubly sick and scared). Let your baby know that this doctor has a space chair to ride on (for courage, you can sit with your child the first time, but then give him a seat. Let Him feel his importance). This doctor also has a tube that drinks water (saliva ejector), a special pen with rods that draw pictures on the teeth (a drill with burs) and much more.

Sign up children under 4 years old for visits only in the first half of the day, otherwise at 8 pm your undertaking will fail, receiving in response misunderstanding, tears and requests to return to their native walls. This is a really important point, do not ignore it, checked! Let my patients not lie!

Do not start treatment on the first visit. Risky. The kid can give a start, but in the course of treatment he wants to. But here it is already necessary to finish treatment and then tears are inevitable. Do not rush into this matter. The most you can do is brush your teeth. It doesn't hurt and it's fun!

Do not be too emotional and anxious, the child will definitely feel it. And, as a result, he will manipulate a too soft mother, groaning and sobbing even at the sight of a cotton swab, or he himself will be alert, not giving the doctor the opportunity to make friends with him.

If you are afraid yourself or know that you will give up in the office, ask more courageous relatives to accompany your child. Or wait in the hallway.

Come for a visit to the doctor at a strictly appointed time, and not 40 minutes before, explaining this by the fact that you were within walking distance from the clinic and decided to wait here. The kid: a) gets tired of waiting, and already entering the office, will want to get out of it; b) can hear the cries of children who already have negative experiences. Do you need extra impressions?

You can buy something that your little one has been wanting for a few days, and secretly give it to the doctor to be solemnly presented to the “hero of dentistry” when the examination is over. The doctor will immediately be equated with the rank of wizards, which will add bonuses to him in the eyes of the child.

Now you can say goodbye to the doctor, having agreed in advance on the next visit with both him and the little patient. And when you come home, don't forget to tell us what a superman your Kolya was, how great he opened his mouth and what wonderful teeth he had. Just do not praise him for "how he rebuffed the doctor", or "turned the office into ruins." You will reap the rewards...
And if your baby cannot see Nyusha from Smeshariki, which the doctor drew for him, then turn on your imagination. Have you forgotten that Nyusha appears only when the child is brushing his teeth?

It's all good when your child is prepared, his first doctor turned out to be “so smart”, and the kid is forced to fool you that he has something with a tooth in order to visit the dentist again (don't be surprised, there were such patients in my practice).
But, most often, we see the opposite result - the child is scared. Not only the doctor can be to blame for this, but also the “kind” children at school, who are authoritative for him, or the parents themselves, who love to tell their dental horror stories from the past. Other tips are already included here.

Find another doctor. Children cannot be deceived, they feel the attitude of a doctor from a kilometer away, answering him with confidence or not. You shouldn't rape him, you don't get a manicure from a master who is always dissatisfied and annoyed.

Replace "dental lexicon". If earlier your baby was inflated with a balloon, doing anesthesia, now you can “sprinkle with snow”, or “conjure with an ice stick”.

Again, do not insist on treatment here and now. Let the doctor make friends with the child. To be honest, we, doctors, are also scared, since there is much more responsibility, you can’t lose authority in the eyes of a distrustful child.

Do not shout, do not punish the child in front of a doctor. Will not work. You will only scare more. Let the doctor demonstrate what he will use and why, after removing all piercing and cutting objects. You can even give a large mirror to the patient, let him control the work of the doctor. He has a right to it, these are his teeth, after all!

Keep your promises, so be careful. If you promise to buy a Sony PlayStation, buy it. Otherwise, you will take pride of place in the ranks of liars and deceivers, by the way, along with your dentist.

If you are a “weak link” and the child feels this, constantly being distracted by you and stretching out his hands to you with a prayer, take pity on yourself, the doctor and the one asking, wait in the corridor. I assure you, the treatment will go much faster and more efficiently, because. the main spectator made an adult decision and left.

For courage, you can give your baby something that is valuable to you: a fountain pen, a ring, car keys, etc., while promising that this is all for the daredevils, and when you enter a dark room, be sure to take it with themselves, that's why they are so brave.

Praise, but within reason. You should not rush to the neck with kisses after anesthesia, the patient will immediately suspect a catch. You risk failing the operation.

Hmm…… That's probably the most advice I could give you. Most importantly, do not give up if your child has refused treatment. Come next time, and again, and again. There will be positive results! The main thing is to believe in yourself, in the doctor and ...... in your dental superhero!

Doctors are educated people who usually love their job, so a relationship with a doctor can be a wonderful experience. In this case, certain difficulties may arise. Spending time together will not always be possible, as doctors have variable work schedules. It is important to understand that their plans can change frequently. The life of a doctor is full of stress, so at the end of the day, help your partner de-stress. Review your own priorities. Your relationship with a doctor may be different than romantic relationships with other professions.

Steps

Part 1

spend time together

Be flexible. Doctors are often very busy, especially when working in a hospital. Occasionally have to work weekends and non-holidays. If you are going to see a doctor, it is important to understand that plans can sometimes be cancelled.

Plan back-up dates. Set aside a few free times a week in which you will be ready to meet with a partner.
Discard plans that are difficult to change. So, buying tickets to the theater or to a concert is not a good idea if the partner may have things to do that day. Use more flexible options like dining out at a restaurant, where you usually don't need to reserve a table.

ADVICE OF THE SPECIALIST

Maya Diamond is a dating and relationship coach based in Berkeley, California. She has 7 years of experience helping people with relationship problems gain inner confidence, deal with their past, and build healthy, lasting, loving relationships. She received her master's degree in somatic psychology from the California Institute for Integral Studies in 2009.

Dating and relationship coach

Dating a doctor who has a lot of work can be difficult. Maya Diamond, dating and relationship expert, says: “When you're dating a very busy person, you need to make an effort to spend time together. You may need to plan ahead to be with him, and sometimes you need to plan quickly. However, it is important that your chosen one has enough time and energy for you. If a person is not available physically and emotionally, you will very often be unhappy, upset and lonely.

Don't talk about medicine during dates. Everyone needs a break from work. Doctors are no different and often find it even harder to balance their personal and professional lives. The work of a doctor is stressful, so a person may be inclined to talk a lot about it. Such conversations can only create tension, since not everyone likes to discuss anatomical details. Try to talk about other topics.

Ask your doctor, “How was your day?” is not always a good idea. It is better to choose a different direction of conversation. Discuss your favorite shows or news from the lives of your mutual friends.
It is important to feel the situation. If your partner is having a hard day, they will want to talk about it. Sometimes let him lament over hard work. Try to be an attentive and understanding listener.

Plan meetings around treats. Doctors are often hungry. Long shifts and a large number of patients often do not leave time to eat. If your partner has worked a long shift, you might be better off having a date with delicious treats.
- Make a nice gesture and prepare food for the moment your partner has to get home from work. Spend time in the kitchen or order ready-to-eat meals.
Do not ask to remove the phone. During certain hours, doctors must remain in touch at all times. The reason may be severe patients or a possible call from the hospital. Try to understand the job responsibilities. Leaving your phone on the table during dinner is not always good manners, but in the case of a doctor, the rules of courtesy change.

Learn to spend time alone. If you're dating a doctor, you'll often find yourself alone. You should not count on everyone's attention, so in the evenings you will often have to entertain yourself on your own.
- Spend time with friends. If the partner works in the evening on a day off, then meet friends at this time.
- Find a hobby for yourself. Learn to knit or read books.
- Time alone can be pleasurable. Free time allows you to know yourself and your hobbies.
Part 2
Help relieve stress
1. Watch for signs of stress. Doctors are under a lot of stress. Periodically help your partner relax after work. If left unrecognized, stress can cause tension in a relationship. Learn to recognize the signs of stress in order to effectively deal with such a problem.
  - In case of stress, the partner can be irritated and moody. There may be withdrawal or outbursts of anger and mood swings.
  - In such a situation, you do not need to be angry in response. Quietly ask: “What is bothering you? Is there any way I can help you?"
2. Give support and comfort. If a person is in a bad mood, then we often seek to give him advice. In case of stress, it is always more appropriate to try to comfort your partner. Unsolicited advice can be taken with hostility even with good intentions.
  - Try to get into position. Listen carefully to your partner and speak words of comfort. Say that you are always there and ready to help.
  - If you need to resolve a specific issue, then return to it later. First you need to comfort the person, and then think about the problem. Express your thoughts clearly. Explain that you do not want to command, but to help in finding an effective solution.
3. Offer help. In the early stages of a relationship, the nature of the comfort that a partner needs is not always clear. Ask what is the best thing to do when your partner is depressed. Listen to the answer and treat it with respect.
  - Find out how you can help in this situation. Sometimes it is enough to do simple household chores to alleviate the situation.
  - Your partner's needs may be different from yours. Everyone deals with stress in their own way. It is important to remember that otherwise does not mean bad. Respect your partner's needs.
4. Look for ways to ease tension. If you're seeing a doctor, it's important to act prudently when it comes to stress. The doctor has to deal with excessive stress during working hours, so your help is simply needed. Plan activities to help relieve stress.
  - Sometimes it's good to take a break. Have an evening of movies or your favorite TV shows.
  - Suggest doing meditation or yoga together.
5. Encourage physical activity. Exercise is a great way to deal with stress. So, regular physical activity helps partners avoid many problems in relationships. Go for walks or go to the gym together.
Part 3
Rethink your priorities
1. Focus on the benefits of a relationship with your doctor. Sometimes the situation may seem unbearable to you, but remember the positive aspects. Doctors are usually very smart and attached to their patients. They know how to empathize and perceive their work as a calling. Moreover, you did not just want to meet this particular person. Remember what attracted you when you met and why you value relationships.