It’s hard to think clearly when you’re under stress. Your blood pressure and heart rate rise, adrenaline and cortisol flood your body, and your survival instincts kick in — all of which interfere with decision making. To avoid making bad decisions when you’re stressed, pay careful attention to your physical symptoms. We all have an inner “lookout” that helps us monitor our reactions. Tap into that part of your mind and look for physical sensations or emotions that indicate your stress level is rising: a tightness in your stomach or a feeling of anxiety or panic. By noticing these reactions, you can hold yourself back from acting rashly. For example, when you get an annoying email, and you notice that you’re irritated, you can hold off on replying until you’ve calmed down. Use your “lookout” to recognize these impulses before you act on them.

Adapted from “Manage Your Stress by Monitoring Your Body’s Reactions to It,” by Erica Ariel FoxI 

I read this early morning and my mind went back to a bad feedback I received recently. Two young ladies brought their mother for an opinion from me. Their mother was hardly able to walk because of severe pain in her legs. They goo geld her symptoms and thought she was suffering from arthritis and took her to a rheumatologist. The rheumatologist told them that their mother had severely worn out knees and most probably would need a knee replacement surgery. She then mentioned a few surgeons names who would do the surgery. I was one of the surgeons named and very close to here this lady was staying so they came to me.

During the examination, I realized that this lady was obviously depressed probably because the bad knees had severely affected her quality of life. She had stopped going out for nearly one year because of her pain. She also complained of pain in both her legs on standing which is usually a sign of nerve compression in the back.I told the daughters that we need to get MRI of her back to make sure that there is no nerve compression in that area before we post here for her knee replacement surgery. Ignoring the spine problem would also mean that she would not benefit from a knee replacement surgery. They asked me what other factors would affect a bad outcome after a knee replacement surgery. I mentioned that her depression would affect the result because it is a proven fact that mental toughness helps in fighting any disease and affects the recovery after a surgery.

They then asked me whether I really felt their mother was mentally not normal. I replied in an affirmative statement that it is pretty normal because of the quality of life going down due to pain in her legs. She also could not answer questions easily and looked withdrawn. She looked distracted while the daughters asked many questions about the surgery etc. The last question was what happens if the MRI is normal? I mentioned in view of her complaints which are not related to her knee issues and  MRI being normal we need to consider major depression as an issue and we should then consult a psychiatrist before we post her for her knee surgery.

Next few minutes were spent explaining to them the mind-body connection and how a diseased mind can cause physical signs and symptoms.

The next thing I received after 2 days was a feedback from the daughters mentioning that their mother had become very negative about the knee surgery because I had mentioned about a psychiatrist consult! I was accused of not being patient friendly! They accused me that I thought their mother was a psychiatric patient just because she could not answer a few question!I, therefore, began the article with a quote from a famous book on stress management.

 These ladies could have avoided writing negative things and thought about their mother’s stress and the helpful hints I was providing. The sheer ignorance of stress can lead to bad outcomes not only in the field of medicine but it leads to complicated issues in life. 

The biggest stressor in this case probably was the mention of the word “psychiatrist”, still taken as a taboo rather than a helpful person! It is high time that our patients start understanding the mind and body connection.

The stress, in this case, leads to a bad decision of getting a negative feeling about the doctor rather than getting their mother evaluated for stress and helping her.