Anxiety a Barrier to Care for Some Patients

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By Mark DiFilippo, Associate Director of Behavioral Health

P is an educated woman with a nice home and a solid support system who once held a position of high responsibility for a local social service organization.  She is not a typical Care Transitions Team (CTT) patient.  Yet, somehow, P had visited the city’s emergency rooms six times in the six months prior to intervention by the CTT.

Upon further engagement by the CTT, our staff learned that P was experiencing a great deal of anxiety in response to interactions with the healthcare system.  She had even been seeing a psychotherapist and was receiving cognitive behavioral therapy (CBT) to help with the anxiety.  We still couldn’t quite figure out, however, exactly why her utilization was so high.

The CTT asked me to visit P for a consult to see if there was anything I could do.  After less than 30 minutes, I learned that P had been experiencing a type of dissociation since the placement of a pacemaker some months before. She felt that her body was no longer hers and that she had no control over what had happened to her body. This lack of control left her with a sense of dread and distrust any time she had to interact with healthcare providers – even her primary care provider. When P would begin to feel this dread, her anxiety would rise to the point of panic, which almost always led to atrial fibrillation (irregular heartbeat). She sought help in the emergency room (ER) each time this happened.

I knew immediately that P would make no progress until she was able to accept her current circumstances—including the foreign object in her body. This acceptance would lead to a greater sense of ownership and control over her body so that she could act effectively during times of panic. After six consecutive weeks of mindfulness meditation instruction and acceptance and commitment therapy, P developed new relationships with her body, her pacemaker, and her anxiety. She accepted her circumstances and learned coping skills to better identify and handle dread and panic. She became more vibrant and alive. Her hand tremor disappeared quickly, and her voice became strong. She has not yet returned to a Camden ER.

This story is indicative of the type of high-touch intervention necessary to truly understand our patients and their needs. Through consistent, authentic relationship-building with P, we were able to get to the core of her distress and offer relevant interventions. Without this level of engagement, P may still be struggling with her body and her mind, hopelessly seeking answers in the emergency room.

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