Are You Stuck Playing These Three Roles in Love?
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The psychology of Transactional Analysis holds that our interpersonal dynamics can be modelled in the following fashion:
The roles
- Child: vulnerable, trusting, weak, and support-seeking
- Parent: strong, dominant, responsible—but also often exhausted and critical
- Adult: balanced, thoughtful, creative, and kind
Ideally we’d be able to spend most of our time in “Adult” mode, and occasionally go into “Child” or “Parent” mode when required, e.g. child when circumstances have rendered us vulnerable and we need help; parent when we need to go “above and beyond” in the pursuit of looking after others. That’s all well and good and healthy.
However, in relationships, often it happens that partners polarize themselves and/or each other, with one shouldering all of the responsibility, and the other willfully losing their own agency.
The problem lies in that either role can be seductive—on the one hand, it’s nice to be admired and powerful and it’s a good feeling to look after one’s partner; on the other hand, it’s nice to have someone who will meet your every need. What love and trust!
Only, it becomes toxic when these roles stagnate, and each forgets how to step out of them. Each can become resentful of the other (for not pulling their weight, on one side, and for not being able to effortlessly solve all life problems unilaterally and provide endlessly in both time and substance, on the other), digging in to their own side and exacerbating the less healthy qualities.
As to the way out? It’s about self-exploration and mutual honesty—and mutual support:
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Further reading
While we haven’t (before today) written about TA per se, we have previously written about AT (Attachment Theory), and on this matter, the two can overlap, where certain attachment styles can result in recreating parent/child/adult dynamics:
How To Leverage Attachment Theory In Your Relationship ← this is about understanding and recognizing attachment styles, and then making sure that both you and your partner(s) are armed with the necessary knowledge and understanding to meet each other’s needs.
Take care!
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Palliative care as a true art form
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How do you ease the pain from an ailment amidst lost words? How can you serve the afflicted when lines start to blur? When the foundation of communication begins to crumble, what will be the pillar health-care professionals can lean on to support patients afflicted with dementia during their final days?
The practice of medicine is both highly analytical and evidence based in nature. However, it is considered a “practice” because at the highest level, it resembles a musician navigating an instrument. It resembles art. Between lab values, imaging techniques and treatment options, the nuances for individualized patient care so often become threatened.
Dementia, a non-malignant terminal illness, involves the progressive cognitive and social decline in those afflicted. Though there is no cure, dementia is commonly met in the setting of end-of-life care. During this final stage of life, the importance of comfort via symptomatic management and communication usually is a priority in patient care. But what about the care of a patient suffering from dementia? While communication serves as the vehicle to deliver care at a high level, medical professionals are suddenly met with a roadblock. And there … behind the pieces of shattered communication and a dampened map of ethical guidelines, health-care providers are at a standstill.
It’s 4:37 a.m. You receive a text message from the overnight nurse at a care facility regarding a current seizure. After lorazepam is ordered and administered, Mr. H, a quick-witted 76-year-old, stabilizes. Phenobarbital 15mg SC qhs was also added to prevent future similar events. You exhale a sigh of relief.
Mr. H. has been admitted to the floor 36 hours earlier after having a seizure while playing poker with colleagues. Since he became your patient, he’s shared many stories from professional and family life with you, along with as many jokes as he could fit in between. However, over the course of the next seven days, Mr. H. would develop aspiration pneumonia, progressing to ventilator dependency and, ultimately, multi-organ failure with rapid cognitive decline.
What strategies and tools would you use to maximize the well-being of your patient during his decline? How would you bridge the gap of understanding between the patient’s family and health-care team to provide the standard of care that all patients are owed?
To give Mr. H. the type of care he would have wanted, upon his hospital admission, he should have been questioned about his understanding of illness along with the goals of care of the medical team. The patient should have been informed that it is imperative to adhere to the medical regimen implemented by his team along with the risks of not doing so. In the event disease-related complications arose, advanced directives should have been documented to avoid any unnecessary measures.
It is important to note, that with each change in status of the patient’s health status, the goal of treatment must be reassessed. The patient or surrogate decision-maker’s understanding of these goals is paramount in maintaining the patient’s autonomy. It is often said that effective communication is the bedrock of a healthy relationship. This is true regardless of type of relationship.
This is why I and Megan Vierhout wrote Integrated End of Life Care in Dementia: A Comprehensive Guide, a book targeted at providing a much-needed road map to navigate the many challenges involved in end-of-life care for individuals with dementia. Ultimately, our aim is to provide a compass for both health-care professionals and the families of those affected by the progressive effects of dementia. We provide practical advice on optimizing communication with individuals with dementia while taking their cognitive limitations, preferences and needs into account.
I invite you to explore the unpredictable terrain of end-of-life care for patients with dementia. Together, we can pave a smoother, sturdier path toward the practice of medicine as a true art form.
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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The Cough Doctor
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The Cough Doctor
This is Dr. Peter Small, who worked in epidemiology since the beginning of HIV epidemic. He became a pioneer in the field of molecular epidemiology. As such, his work was a guiding beacon for the public health response to the resurgence of tuberculosis. He’s travelled the world spending years in various institutions studying all manner of respiratory illnesses…. These have ranged from tuberculosis to pneumonia to lung cancer and (back to epidemiology) Covid-19.
He’s now the Chief Medical Officer at…
Hyfe
Hyfe, a medical AI company, was founded in 2020. Its objective: to build acoustic tools for respiratory diagnostics and monitoring.
In other words: it records coughs and collects data about coughing.
❝It’s ironic how much people focus on counting steps while ignoring cough, which is far more consequential. Hyfe is a science-driven company with the technology to make cough count. Particularly now, with increased awareness of cough and the rapid growth of digital health driven by Covid-19, this technology can improve the lives of patients, the care provided by doctors, and the efficiency of health systems.❞
~ Dr. Peter Small, CMO, Hyfe
How does it do it?
Hyfe’s AI monitors the number of times a person coughs and the sound of the cough through any smartphone or other smart device.
This data collected over time provides increasingly more reliable information than a single visit to the doctor! By constantly listening and analyzing, it can detect patterns that might otherwise go unnoticed.
How big is this “big data” effort?
Hyfe maintains the largest cough dataset in the world. This means it can compare the sound of a patient’s cough with more than 400 million cough-like sounds from 83 countries across all continents.
The human brain doesn’t handle big numbers well. So, just to illustrate: if the average cough is 1 second long, that means it’d take more than 12 years to listen to them all.
Hyfe, meanwhile, can:
- listen to many things simultaneously
- index them all against user and location,
- use its ever-growing neural net to detect and illustrate patterns.
It’s so attentive, that it can learn to distinguish between different people’s coughs in the same household.
❝Companies like Google Health see even basic information such as getting an accurate count of the number of times a person coughs a day as a useful resource, and part of a larger need to collect and chronicle more health information to refine the way doctors diagnose disease and manage treatments in the future.❞
What are the public health implications?
The most obvious application is to note when there’s a spike in coughing, and see how such spikes grow and spread (if they do), to inform of contagion risks.
Another is to cross-reference it with data about local environmental allergens. Knowing how things like pollution and even pollen affect individuals differently could be helpful in identifying (and managing) chronic conditions like asthma.
What are the private health implications?
❝It’s going to transform the whole clinical approach for this common and chronic symptom. Patients will come in, have the data on how much they are coughing, and the physician can suggest a treatment based on that information to see if it makes the coughs better❞
~ Dr. Peter Small
Dr. Small’s colleague Dr. Cai, speaking for Google Health on this project, sees even more utility for diagnostics:
❝When I was in medical school, never ever did they teach us that we could listen to somebody cough and identify whether that person has TB (tuberculosis), COPD, or a tumor. But I keep seeing more and more studies of people coughing into a microphone, and an algorithm can detect whether somebody has TB with 95% specificity and sensitivity, or if someone has pneumonia or an exacerbation of COPD❞
~ Dr. Lawrence Cai
And the privacy implications?
Perhaps you don’t quite fancy the idea of not being able to cough without Google knowing about it. Hyfe’s software is currently opt-in, but…
If you cough near someone else’s Hyfe app, their app will recognize you’re not the app’s user, and start building a profile for you. Of course, that won’t be linked to your name, email address, or other IDs, as it would if you were the app’s user.
Hyfe will ask to connect to your social media, to collect more information about you and your friends.
Whether you’d like to try this or perhaps you’re just curious to learn more about this fascinating project, you can check out:
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What Happened to You? – by Dr. Bruce Perry and Oprah Winfrey
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The very title “What Happened To You?” starts with an assumption that the reader has suffered trauma. This is not just a sample bias of “a person who picks up a book about healing from trauma has probably suffered trauma”, but is also a statistically safe assumption. Around 60% of adults report having suffered some kind of serious trauma.
The authors examine, as the subtitle suggests, these matters in three parts:
- Trauma
- Resilience
- Healing
Trauma can take many forms; sometimes it is a very obvious dramatic traumatic event; sometimes less so. Sometimes it can be a mountain of small things that eroded our strength leaving us broken. But what then, of resilience?
Resilience (in psychology, anyway) is not imperviousness; it is the ability to suffer and recover from things.
Healing is the tail-end part of that. When we have undergone trauma, displayed whatever amount of resilience we could at the time, and now have outgrown our coping strategies and looking to genuinely heal.
The authors present many personal stories and case studies to illustrate different kinds of trauma and resilience, and then go on to outline what we can do to grow from there.
Bottom line: if you or a loved one has suffered trauma, this book may help a lot in understanding and processing that, and finding a way forwards from it.
Click here to check out “What Happened To You?” and give yourself what you deserve.
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How Primary Care Is Being Disrupted: A Video Primer
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How patients are seeing their doctor is changing, and that could shape access to and quality of care for decades to come.
More than 100 million Americans don’t have regular access to primary care, a number that has nearly doubled since 2014. Yet demand for primary care is up, spurred partly by record enrollment in Affordable Care Act plans. Under pressure from increased demand, consolidation, and changing patient expectations, the model of care no longer means visiting the same doctor for decades.
KFF Health News senior correspondent Julie Appleby breaks down what is happening — and what it means for patients.
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Primary Care Disrupted
Known as the “front door” to the health system, primary care is changing. Under pressure from increased demand, consolidation, and changing patient expectations, the model of care no longer means visiting the same doctor for decades. KFF Health News looks at what this means for patients.
Credits
Hannah Norman Video producer and animator Oona Tempest Illustrator and creative director KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Ear Today, Gone Tomorrow
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Have just had microsuction to remove wax from my ears. A not unpleasant experience but would appreciate your guidance on how best to discourage the buildup of wax in the first place.❞
Well, certainly do not prod or poke it, and that includes with cotton buds (Q-Tips, for the Americans amongst us). That pushes more down than that it extracts, and creates a denser base of wax.
There is no evidence that ear candles help, and they can cause harm.
Further reading: Experts update best practices for diagnosis and treatment of earwax (cerumen impaction)
Ear drops can help, and if you want a home-remedy edition, olive oil or almond oil can be used; these oils dissolve the wax quite quickly (in fancier words: they are cerumenolytic agents); washing with water (e.g. in the shower or bath) is then all that’s needed. However, to avoid infection, ensure you are using a high-purity oil, and get one to use just for that; don’t just grab a bottle from the kitchen.
For your convenience, here is an example of medical grade almond oil (with dropper!) on Amazon
❝Every article had relevance to me. I ❤️ whole fruit, it’s my go to treat. I use ice packs to ease my arthritic knee pain, works well. I’ve read and loved Dr Gawande’s books. Great handful of almonds today❞
While this wasn’t a question, and we don’t usually publish feedback here, I (your writer here, hi) misread that as “ice picks” in the first instance, an implement we’ve probably all wanted to use to relieve pain at some point, but certainly not recommendable! Anyway, the momentary confusion made me smile, so I thought I’d share the silly thought. Smiling is infectious, and all that… And it’s certainly good for the health!
More seriously, glad you enjoyed!
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Dark Calories – by Dr. Catherine Shanahan
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You may be wondering: do we really need a 416-page book to say “don’t use vegetable oils”?
The author, who was a biochemist before becoming a family physician, takes a lot of care to explain in ways the non-chemists amongst us can understand (with molecular diagrams very well-labelled), exactly why certain seed/vegetable oils (both of those names being imprecise and unhelpful as umbrella terms) cause metabolic problems for us, when in contrast olive oil, avocado oil, and even peanut oil, do not.
Understanding is, for many, the root foundation of compliance. We are more likely to abide by rules we understand the logic behind, than seemingly arbitrary “thou shalt not…” proclamations.
So that’s an important strength of the book, demystifying various fats and how our body responds to them on a biochemical level, not just “is associated with such-and-such, based on observational population studies”. This kind of explanation clears up why, for example, seed oils correlate with obesity more than calories, sugar, wheat, or beef—having as it does to do with affecting our body’s ability to generate and use energy.
She also offers practical tips/reminders throughout, such as how “organic” does not necessarily mean “healthy” (indeed, many poisonous plants can be grown “organically”), and nor does “organic” mean “unrefined”, it speaks only for the conditions in which the raw product was first made, before other things were done to it later.
We learn a lot, too, about the processes of oxidation, the biochemistry behind that (more diagrams!), and of course the inflammatory response to same (an important factor in most if not all chronic disease).
The style is mostly very easy-to-read pop-science, though if you’re not a chemist, you’ll probably need to slow down for the biochemistry explanations (this reviewer certainly did).
Bottom line: this is more than just a litany against vegetable oils; it’s a ground-upwards education in metabolic biochemistry for the layperson, and what that means for us in terms of chronic disease risks.
Click here to check out Dark Calories, and learn what’s going on with these oils!
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