Psychotherapist Artūrs Miksons is talking with Skrinings.lv ambassador and obstetrics & gynaecology resident doctor Laura Lūse.
L: In your opinion, what are the main factors that contribute to low breast screening uptake among women in Latvia?
A: Initially a lot of people approach the topic of screening by questioning ‘What am I going to gain from this? What is it that I am going to find out?” In instances where people do not have a particular problem and concern, the idea of screening comes down to whether a person is going to find an unfamiliar formation or not. Essentially, the value of breast screenings lies in early detection and prevention. If a person is not aware of what prophylaxis is and what are its benefits, then this is a factor that prevents them from engaging in screening practices. The second factor - let's imagine that a tumour is in fact found. Best case scenario it is benign but worst case it is malignant. The consecutive question that usually follows is whether the person believes that they are able to overcome this situation. Usually this leads to the imagining of catastrophic scenarios of what if something is found, what will happen next - will it be treatable, if I don't manage to recover what will happen next? Those thoughts are often interlinked with concerns about disability, inability to work, chemotherapy, and inevitable sacrifices. And this does even include questions to do with femininity, sexuality and whether people will look at me differently. All of these thoughts can be overwhelming! Of course, if the person is even able to acknowledge them. A large majority of people do not even come to these realisations and stop at the incomprehension of what screening is and what are its benefits. It does not even register as something that holds value. In my opinion, currently we are far away from reaching public awareness of the necessity that preventive screenings have as a method of taking care of our health. On top of this there are a lot of other things that are prioritised when it comes to health. I would not say that these things are more important but it definitely comes off this way. In many cases these things have a smaller impact on real health consequences. These practices assist in maintaining conventionally beautiful body shapes, youthful faces, attractiveness levels and desirability. Here we can mention various diets, healthy lifestyles and participation in exercise, which are all great to take part in, but in reality they have very little impact on gynaecological health, which requires screening.
L: Female breasts are over-sexualised in our society. Do you believe this can be an underlying reason as to why we talk so little about breast health? And how can we change this?
A: Some correlation between the two definitely exists. Of course, the presence of the previously mentioned oversexualisation of breasts in society and culture is ever-changing, but one thing that I believe we categorically cannot do is dissect a woman’s body into separate parts, like the breasts. If a part of the woman's body is ripped apart from the whole and viewed as its own entity, the woman becomes split in half. I have had personal experience with patients who usually as a result of family influence and later other forms of trauma have completely divided their body into distinct parts. Meaning, my legs are this way, my nose looks like this and my hips are that… The whole body is dissected into pieces. The more these separate pieces carry shame and fear the more women are scared to talk, discuss and bring this up as a necessary topic of conversation.
L: Similarly women in society these days are immediately assigned the role of a mother. It is no secret that women often take on the biggest portion of family responsibilities when it comes to domestic work. In your opinion based on personal experience with patients, do you think this could be a contributing factor as to why women often forget about their own health?
A: I believe that is definitely one of the aspects that plays a role. In my personal practice, the topic of whether a patient is proactively involved in their health maintenance comes up a bit less often, but I have undoubtedly spotted a pattern of women voicing the need to be a super mom, super wife, super employee, super manager etc. And when asked: “When do your own needs come in?” The answer is: “Later!” With time this comes to include medical screenings and examinations as well. Here we are no longer talking about particular pathologies but health in general - regular check-ups with a physician should be the absolute norm. However if this is something that consistently gets pushed back, because she is needed somewhere else then at the end of the day the person is completely hollowed out. As Laura Denler perfectly put it one time: “If everyone gets Arthur, then one day no one will have him”. That’s why, dear ladies and women, and it does not matter if you are a mother or not - remember that if you are constantly there for everyone, one day you will no longer be there for anyone. And not to say that you will die immediately! I hope not. But you will definitely burn out and negatively impact your health. And that will be a bummer. It is a bit of a vicious cycle because on the one hand due to the symptoms you will experience freedom, but on the other hand you will not be able to function in the same regime as set previously. Symptoms will hinder your ability to do so. Therefore it is important to dedicate some time to yourself. This does not mean expecting a complete utopia in which you return to a ready bubble bath each night, but it can be as little as half or an hour each day to yourself. It is important to start this dialogue! And this dialogue is not limited to just the doctor. It is a dialogue with children, with your partner about personal needs and boundaries, whether that is a walk, a bath, reading a book or visiting the doctor. The same conversation similarly needs to happen in a work context. And this cannot involve going behind someone’s back or keeping it a secret. No! This is done for the benefit of your personal health. If someone tries to interfere or say they do not understand, accept it as merely their opinion. You know why you are doing this and that on this particular day you need a free half hour to see your gynaecologist. You go to the doctor, to check that everything is functioning normally and to get the reassurance that everything is okay. Or in the opposite case, that some medical intervention is necessary. This is better than leaving it till later.
L: To summarise, this is a way that we can begin to form healthy habits. Respectively, we need to set personal boundaries. Time for ourselves to relax, time to schedule an appointment and visit the doctor and take care of our health.
A: Yes! I would like to emphasize that asking questions about our health and visiting the doctor should not be something radical or unique. In my opinion, this creates an unnecessary elephant in the room. If we state that we are going to the doctor, it automatically implies that something is wrong. No, this should not be the case. Going in for regular check-ups should be the norm in society.
L: A question from a listener: “There are times when a specialist is very knowledgeable, yet is lacking in effective communication. What would you recommend doing in cases where a patient encounters a doctor that they are not able to productively communicate with?”
A: My recommendation would be to address the doctor directly. This does not have to include an offensive undertone, implying the doctor is speaking in an inadequate way, yet rather explaining your personal feelings and attitudes about the ways the current dialogue between the patient and physician could be improved. You do not have to hold back on stating that you do not understand the information about the illness or treatment, the way it is currently being presented. Unfortunately, among doctor’s there will always be colleagues that will disregard the remarks and continue communicating in the same way, even after bringing up the concern. If they continue to remain blunt and at times harsh in their speech, refusing to explain and adapt to the patient, then it is worth switching to a different doctor. This is the reality. This can be difficult at times if the treatment process has already begun, trust has been built and suddenly there is a need to repeat the waiting process to find an alternative - I fully understand this. Particularly because of this it is worth attempting to resolve the misunderstandings and difficulties in communication with the current doctor, before leaving without voicing complaints beforehand.
I do not mean to say that it is the patient's responsibility to educate the doctor. No! Please do not take it this way. Rather if a blip in the communication has happened it is better to point it out. Of course, there are doctors that will not consider any suggestions and will go on stuck in their old ways, but there will be other ones that will take your complaints into consideration. Why is this valuable? If the doctor personally is not aware that they are doing something wrong, it is unlikely that other people will point it out, continuing the cycle of adverse behaviour.
There are many wonderful professional specialists that do not get enough attention. Those that approach their work from a place of love, respect and limitless passion. They are the ones that make the biggest impact on patients' lives. Of course there are also a few bad apples that bring bad reputation to the entirety of the institution. Unfortunately, this taints the overall perception that people have about other professionals in the field. This translates to imaginary scenarios that make people believe that if they turn to a doctor like you Laura, that they will be met with insincerity and rudeness. There are times that we do not let people be who they really are, but rather build a perception of the specialist based on personal assumptions we have created. We need to try to change this.
L: In short, I would suggest not to fear and actively seek out doctors that put effort into building a relationship with their patients that allows for fruitful conversations and the ability to ask any questions.
L: Moreover the listeners want to know: what is the best way to support a person who is currently going through treatment?
A: There is a great book by Elizabeth Kubler-Ross called “On Death and Dying” that I would strongly recommend. The book covers the stages of dying, which are similar to the five stages of grief. It goes through each stage of denial, anger, bargaining, depression and finally acceptance. In great detail, she describes various situations involving personal encounters with patients, which in my opinion make up the best part of the book. The book examines how the person goes through each stage of death, when presented with a fatal diagnosis. Even if the diagnosis is promising, the stages catalyse in one way or the other. The people closest to the person go through similar stages. This book does a particularly fascinating job portraying and analysing the ways the various stages can correlate or not depending on the person. Insight into when the stages do not line up provide deeper understanding of the emotions one person is going through and what emotional support is necessary in that moment. For example, there can be a situation when a person goes to therapy but is in complete denial. Or possibly overtly angry about symptoms, the treatment process or resulting consequences. It is natural to want to help and free this person from the burden of these emotions, but the best thing to do in my mind, similar to assisting people during panic attacks, is to ask what their current needs are. Maybe it is physical assistance, such as driving them somewhere or delivering a package, or maybe they are in need of emotional support - someone to console with, rant and have a shoulder to cry on. The needs people might have can be drastically different. At the same time the saddest thing to consider is that the person who is dying or has just been confronted with the serious diagnosis might never come to the awareness and acknowledgement that you have come to. The other sad thing that is much harder to accept is that you might be the person that has yet to come into terms or acknowledge something.
L: What would you like women to take away from this conversation? How should women take care of themselves and not forget about screening?
A: I would say that it is not just about screening. It is about health in general. The goal of attending examinations, conducting tests and visiting specialists is not to find or eliminate the possibility of disease. The point is to check up on health in order to determine whether the stress levels, diet or a certain situation falls into the norm or not. And most importantly not to drag it out till the last moment. If in any other sphere of life we can postpone a deadline or leave the essay writing till the last day and the stakes are a bad grade, then we cannot do this to our health. It is normal to be scared or experience feelings of guilt. Do not put yourself down if you feel this way, but rather give yourself the opportunity to overstep those emotions and find a specialist you feel safe, understood and accepted with, allowing you to trust these people to help you in the best way possible.
The full conversation in video format is available on Skrinings.lv Facebook page. There you will find out more about how we pass on our fears of doctors to our children and other questions relating to the topic of prophylaxis.