From their years of experience providing care, our psychiatrist consultants know that sometimes what a patient says to their medical provider may not be entirely what they mean. It could be a matter of not finding the right words, or relying on memory when it’s not reliable, or maybe being too embarrassed to go more deeply into an issue. Whatever the reason, there is often a deeper meaning behind what patients tell their providers about their behavioral health.
We asked our psychiatric consultant team for some common examples of what patients say when talking about their behavioral health … and the meaning that’s sometimes sitting below the surface. When we start to understand what patients really mean, we have a much better chance of addressing their concerns and helping them make improvements.
Everyday interactions
When a patient says
"Can I see you again sooner than we planned?"
…What they sometimes mean is
"I am afraid I won't get better."
—N.S.
When a patient says
You [their provider] are very "new" or "young".
…What they sometimes mean is
"Do you have the knowledge and experience to adequately care for me?"
—M.C.
Anxiety
When a patient says
"My brain won't stop."
...What they sometimes mean is
"I’m dealing with constant worry, restlessness, irritability, headaches, jaw clenching, poor concentration, low self-esteem tied to body image and parenting abilities, worries about becoming like her parents."
—D.C.
Clinical terminology
When a patient says
"I've been super OCD/manic/bipolar lately."
...I respond with
"Tell me what you've been experiencing."
—M.C.
Women’s health
When a patient says
"No thanks, I'm OK, I don't need an antidepressant. Maybe I'll think about that later on."
...What they sometimes mean is
"I am afraid I'll harm my baby if I take medication while I'm pregnant/breastfeeding." …or… "I don't want you to think I am an unfit mother if I need medication."
—N.S.
When a patient says
"I feel anxious/depressed, but I'm sure it's normal for new moms."
...What they sometimes mean is
"Is this normal?! Do all moms feel like this?!. When will this end?"
—N.S.
Substance use
When a patient says
"I have a couple of glasses of wine a night."
...What they sometimes mean is
"I'm drinking a bottle each night and have been for years but have been trying to hide that from everyone around me."
—J.L.
When a patient says
"I smoke cannabis to sleep."
...What they sometimes mean is
"I'm a daily cannabis user and physiologically dependent on it but potentially open to other options if they would help me sleep."
—J.L.
Sometimes patients can get caught up in terms they’ve heard in the media and it obscures their personal experience. When it comes to substance use, the initial response often needs clarification. And pregnancy/postpartum concerns can suggest a deeper conversation is needed. Patients may not always say the quiet part out loud when talking with their provider, but when we recognize the hidden meanings in their words and the need to go deeper, we can begin to make real progress toward improving their health.