Episode 56: How To Advocate For Yourself in a Medical Setting with Sara Hughes Zabawa

This week, Sara Hughes-Zabawa LCSW, CDWF joins me to talk about advocating for yourself in a medical setting. Sara is a therapist, licensed clinical social worker, Certified Daring Way™ facilitator, yoga instructor, & wellness coach. She’s passionate about helping clients thrive as they enhance the quality of their lives through fostering improved awareness, insight, skill-building, and quality education and resources. She also has first-hand experience with self-advocating in medical settings. Health issues leave us vulnerable. We're so used to deferring to an authority figure that rather than asking the hard questions, we often stay silent. Advocating for ourselves can be challenging but it's so beneficial to learn how. We have a right to be treated with integrity. If you need guidance and support, look for a patient advocate. Can’t wait for you to listen.

Find Sara H Z here:
https://sarahugheszabawa.com/
https://www.instagram.com/beinginbalancewellness

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https://sarafisk.coach
https://www.instagram.com/sarafiskcoach/
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https://www.youtube.com/@sarafiskcoaching1333
https://www.tiktok.com/@sarafiskcoach
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Transcript

0:51

You are listening to the Ex Good Girl podcast episode 56. My guest today is the 1 and only, Thera Hughes Dibawa, who is 1 of my favorite people on the planet. And, Sarah, I don't know if I've told you this, but your episode that we did previously about people pleasing as a trauma response has among the very highest download numbers of all of my podcasts. That makes my heart so happy that people are hopefully resonating it and taking it with the intention in which it was given. It it's an amazing episode. And as you and I have continued to talk about how learning about your people pleasing, um, has shaped your experience, That's kinda where we get to today's topic. But before we jump in, what do people need to know about you as the context for what you're gonna share today? Um, I would love them to know that I'm a licensed clinical social worker and therapist as well as wellness coach. Specifically, today, we're gonna be talking about, I'm a people pleaser in recovery and definitely, um, really resonate with the fawning trauma response as a way that I kept myself safe and, um, or perceived sense of safety as a young person and then recognizing that no longer served me as I grew up. And in today's conversation, Sarah, we're gonna be talking about something that I've been thinking a great deal about over the last few years in relationship to people pleasing, which is how do recovering people pleasers advocate and learn to self advocate within medical settings and situations. For the listener to know, I've I've had a chronic pain condition since I was 19 as as a side effect of an adverse react reaction to a vaccine, um, and as a result, developed multiple autoimmune disorders as a result. So I've been navigating being a patient, um, throughout my life as well as being someone who is a a provider and have also worked in medical settings, um, in helping clients advocate for themselves. So that's what I'd like the audience to know. Oh, and I I just wanna add that the adverse reaction you had to the vaccine would be classified as very serious. Right? Yes. And Catastrophic. What catastrophic to your health. And so when when Sarah is talking about, you know, I am a medical patient because of this adverse reaction, it is a it has been the biggest part of a lot of your existence over the last period of time. At what kind of context or what information do you want people to know about that? I think what would be helpful for people to know is that I think whenever someone has a rapid onset illness or a rapid onset diagnosis, um, particularly if it's chronic, like a chronic disease, um, a chronic, um, pain condition, which is my circumstance, and then developing into a variety of autoimmune challenges that chronic illness takes up in a tremendous amount of space in someone's life Yeah. In the amount of time and energy, um, it requires in just existing. Um, and so it has been my health has been 1 of the primary factors of, like, everyday consideration and has resulted in, um, um, a great deal of emergency room situations, chronic, um, outpatient situations, advocating for specialists, engaging in a variety of treatment plans. Um, and we'll talk about a little bit, Sarah, the level of desperation someone gets into at times of chronic chronic health challenges where it it absorbs a huge portion of your life. And then, um, more recently in 20 20, I was diagnosed with rheumatoid arthritis, and it was severe and rapid progressing. And so having to completely pause my life as much as physically possible with also realizing my life continues, and I have 2 little people who depended on me and, um, a private practice that I love and appreciate and having to completely shift and change kind of ongoing, like, skill set. Like, this is not something that is simple. It's not it's a it's it's an art as well as, um, my practice. And so just really, really humbly I've sat in infusion chairs. I've sat in really devastating conversations. I've experienced a high risk pregnancy, um, and the fear and kind of complexity associated with trying to do really natural things with my body that other people can really engage in without the level of consideration or risk, um, that I have to consider in making some of those decisions. I want people to understand those things about you and to understand that a large portion of the people who we just kinda walk around with every day are in these chronic pain situations or are in doctor's offices quite often with someone else who's in chronic pain. And so our goal in producing this episode is to help people pleasers reorient and recenter themselves, whether they are the patient or if you are the advocate, recentering the patient. Because you and I have talked a lot about how often it is that we get in these medical situation, and we are so used to being uncomfortable. We are so used to deferring. We are so used to, um, just letting an authority kinda tell us what's next and what to do that we don't notice how we are really making the doctor's feelings and not hurting the doctor's feelings, the the the top the the the number 1 worry on the list of concerns or, you know, not wanting to seem hard to work with, not wanting to, um, be troublesome or rock the boat. Like, that is sometimes more important to people pleasers than asking hard questions that challenge some of the things that are happening to them. So that's really our goal for today, and Sarah has some amazing, um, points for us to to reference. How do you wanna start? You have it, um, you and I have been talking enough about this that we we have a we have a fantastic plan. I know. Karen and I have talked about this for hours and hours. And I think where I wanna begin is what are the contributing factors, Sarah, in our tendencies as people pleasers or individuals who experience fawning as their number 1, um, trying to default trauma response. Why is it so hard to learn self advocacy skills within a medical situation? Because it can be hard enough just in a very low risk, no no challenges in authority or sense of high or hard decision making. Like, it's hard just in general. I wanna really acknowledge that it can be can be additionally challenging in medical situations. So first, let's let's just talk about some of the contributing factors. 1 of the things that we know as people users, is there's usually a default of respecting, um, listening to, and over prescribing in many ways to authority. Why would that be a challenge in medical situations as a people pleaser? Most of the time when you're entering a relationship with the medical industry and you're going as a patient, you are working with someone who comes with a societal understanding of authority. If that's a doctor, if that's a specialist, if that's a surgeon, if that is, you know, anyone who claims to really be, um, healing or willing or capable of helping you, that there's an authority. There is an immediate power differentiation. And as people pleasers, that is 1 of our biggest barriers in self advocacy is even recognizing and repositioning ourselves as the person who has the authority, the power, or the knowledge to make decisions. So first, let's talk about authority. Why could authority and people pleasing in a medical situation be so challenging? Well, we are taught that we don't know and someone outside of us knows. If you wanna boil it down to, like, what what a people pleaser and and if you are socialized as a woman in our country, in our kind of western patriarchal way of doing things, you don't know, and you need someone to tell you. And the ultimate authority is somebody who has gone to school for, you know, tons and tons of years and is a is a I mean, even just the the title of a doctor in our society comes with a level of respect and deference, and, um, that's I think that's just baked in. Absolutely. And when that happens, I think we're surprised as people pleasers that, like, oh, we just thought people pleasing showed up, with our with our family of origin, or people pleasing just showed up in our communities or our cultural communities, or when we really feel, um, insecure or when we really feel ungrounded in our sense of belonging. Right? Like, we have we know exactly where people pleasing tendencies show up. I think we're surprised as people pleasers that, like, it just walks right on in with us to the doctor's office. Like and I think we have to laugh about that because when we don't have additional skills and self advocacy and challenging people, Pleasing is actually a skill. It's something people have to learn, develop. That's a lot of the tools and techniques that you teach, Sarah, are providing the concrete tools to challenge the default setting of doing what someone else's wants for you. I I come with, 1, a sincere respect for education. So my my respect for physicians is also granted in, like, a sincere reality of, like, I recognize how much schooling they went to. I have also had to realize that they don't know always more than I do, but they can be a partner in the process. But because there's such an authority dynamic, it's really hard for a lot of us as people pleasers to view ourselves as partners or to reorient ourselves in a position of power. Like, I'm actually the 1 who is here. I'm the 1 whose health is in jeopardy. Um, so that's just 1 pack 1 really common challenge is there's immediate power differentials, social, economic, knowledge, education, and that can be incredibly intimidating. And I think when we are intimidated, it is easier when we're practice and doing what other people want for us to do what other people want for us instead of even considering what our wants are. I also wanna name that many people enter a relationship where they need medical care in a state of desperation, in a real state of desperation if that's coming in with acute pain or an emergency to an emergency room. I mean, you are in probably 1 of the most vulnerable settings and situations of your life where you're saying something is wrong and I need help. Oftentimes that puts us in a position where that level of desperation can hijack our own understanding of our needs and our our wants because what we're needing feels so immediate, and anyone who can give us any solution feels like, well, thank goodness. Yeah. Right? So I wanna have so much humility that a part of why this can take so long for us to reorient ourselves in our own caregiving and our our self advocacy is we're put in really desperate situations. And I I the hardest part is I think we really need a name. Sarah, I don't know about you, but I do not make always the most informed, thoughtful, holistic decisions when I'm desperate. Yeah. Desperate and when gratitude is gratitude for care. Right? I I have been in some medical situations where I was just so grateful to have someone taking a look at the thing that was very scary, that I didn't know what was going on, that I was was full of fear of myself. And so you're absolutely right. Just the desperate state that we're in, the how grateful we are, um, the overwhelm that we're often feeling in those medical situations, um, the fact that it can be very high pressure. 1 of the things that is important to name is that we have in the west, you know, a medical industrial complex that does not always have our health and wellness as its highest goal. It it's making money, and so there is a lot of high pressure in getting an appointment with a specialist that you had to wait 3 months to get. And now you have your 20 minutes with them. You're overwhelmed. The stakes are high. There is a lot of, you know, things that you don't know, and you were trying to be grateful in desperation. It's a real kind of combination of unique feelings and pressures that you don't get in many places sitting in a medical office. I would agree. We're also in a state of we're not in necessarily the no. Right? So there is a power differential in level of education and awareness. Working within the medical community has its own language. It has its in-depth understanding, and I think many people, I know myself included, is when I feel incompetent or I feel dumb, not by the nature of being dumb, but not knowing what I don't know. It is often easier to shut down, to receive, to be told than have to really admit in those moments, I don't know what I don't know. Right? Like, I don't even we've talked about this before, Sarah. Like, if someone sat you and I down, you probably would be better at this than I would, but in the middle of Wall Street in New York and, like, a day trader comes up and is like, Sarah, what questions can I answer for you? I wouldn't it's so far from my professional world and understanding and, like, everyday Yeah. Vocabulary just, like, for some people who entering a medical the medical industry that, like, you don't even know what you don't know. And so once again, that increases overwhelm. That increases fear. That increases desperation. And sometimes, we really don't have our ourselves oriented. Also, as people pleasers, we're often you keep me honest about this, sir, but we're often used to having large decisions made by external authorities. Um, if that's, you know, where we go to school, if that's when we get married, if that's, you know, what we can study, with what our life would look like. Sarah and I both work with individuals from high demand face and a lot of there's beauty and challenge in any high demand face. And what 1 of the 1 of the challenges is oftentimes large decision decisions are typically made or presumed made for someone else. And there that's really complicated. Oftentimes, when we enter as someone who hasn't made a lot of decisions or someone who hasn't been given a variety of decisions throughout their life. They are not as practiced in knowing what they want, asking themselves what they want, asking themselves for what they need. And so with that lack of, like, skill set, you enter that into a medical situation as a patient, and it can really, really increase, um, the people pleasing tendency and the complexity of advocating for your own wellness. Absolutely. And if you we wanna, you know, bring into the discussion other identities. If you are an immigrant or if you are from a cultural background background where challenging authority is not 1 of your culture's, you know, values. We're talking about people with gender or race, those different orientations and, um, different identities. If you're from a different class, you know, you see you perceive you're from a different class in terms of either education or money. All of those things can contribute to not feeling like you have the space or can take the space to speak up and advocate for yourself. And I wanna name that as someone who's had the privilege of an, you know, of advanced education, as someone who's had the privilege of health care insurance, and has had the privilege of being able to see a variety of physicians, which is a privilege within the context of the American medical system. Even with that privilege, there has been times, Sarah, where I am so overwhelmed by what is happening, what's being told, my lack of understanding, the complexity of what's happening within the relationship of chronic illness or the complexity of a multifaceted diagnosis that you're so overwhelmed that being easy, being an easy patient and just doing whatever they say, really, in that moment, feels like the best decision. And I wanna name that because that that previously, that behavior, um, of being easy, easygoing, simple, not challenging, not taking up space, not asking for the time that usually is necessary to understand a complex problem allowed us in previous moments of our life to stay safe or well. Right? And so I want you us to know that there's a reason that comes forward especially within the fawning trauma response response is being easy, not taking up space, doing exactly what you told. If you were in a previously domestic silent relationship, that might have kept you from being hit. As a child, that might have kept you from having food, um, withheld from you. Right? So these tendencies, especially in critical moments, you better believe we're gonna rely on what worked for us even if it's not working for us now. Because in previous situations, that what we were trained for the greatest outcome. So I think that's where we really need to understand our own trauma histories when we're facing really challenging situations with authorities and in and in circumstances we do not fully understand ourselves. So let's talk about what are some of the 6 questions that I really, really invite myself to ask, invite my clients to ask if they are have a tendency for people pleasing or fawning, and they're entering a decision of self advocacy regarding their physical health. This is also appropriate for mental health. Um, it's appropriate for a lot of reasons and a lot of different scenarios, but I really want us to talk through them if that's okay with you. Absolutely. Um, understanding that this might not be realistic in an emergency or an emergency situation, it is good to consider these things in advance. And if you have the opportunity to go into a doctor or working with your medical provider, your wellness coach, your, um, therapist, is asking yourself what is your goal? So before before someone comes in front of you, before someone tells you their goal, their hopes, their perspective, what is your goal? What are you wanting to know or experience or not experience? I wanna name how crucial it is for clients to have the permission to name what they do not want to experience. I do not want to be, um, treated less than. I do not wanna be talked down to. And the reality is it may happen, but the clarity of the experience you want, being able to go in the beforehand will allow you to have a little bit more fortitude and recognizing that that does not work for me. That does work for me. Um, let's be have a concrete, um, goal. So what is your goal? Like, my goal oftentimes, um, having a chronic condition that I recognize with the humility and love that it likely will not be something that goes away. It's something that I will need to partner with, um, and be thoughtful about the rest of my life, um, is I'm usually asking, what else can I be doing to improve my quality of life? Like, that is usually my goal. Um, having that clarity has completely changed the conversations I've had with doctors. Because oftentimes, when you go into a physician's, um, appointment, the kind of medical and industrial complex is I come, you provider I come to your office, you provide a medication to solve a symptom. That's kind of just how it has been formulated. I wanna name that there's different providers and different holistic opportunities, but that's not uncommon. Right? We're definitely a goods for service kind of community. Oftentimes, I do not want an a new medication. I'm wanting clarity. I'm wanting education. I'm wanting information. And so when you go in knowing what you're wanting or like to discuss my options regarding the symptom, the clearer you are, it creates a foundation for them, the the provider to have the opportunity to partner and meet your expectations. The hardest part is when you don't even know what you want other than you don't want to feel this way. Mhmm. But even being able to articulate what you don't want to feel, what you no longer want to experience can be so beneficial in creating a self advocacy. And once again, like, really reorienting that you belong to you. Like, there's so much of your wisdom in the people pleasing class of, like, you belong to you. You have to name what you want. You have to name your needs. And not because you're selfish or you don't you're being a hard to work with client because literally no 1 else can do that for you. People can support you. People can support you, but we have to belong to ourselves. And I think many people, please, there's haven't even realized they belong to themselves because they've never really allowed themselves to be considered a real person with real complex needs that only they sometimes understand. Um, anything you wanna say about that, sir, just being really specific about your goal, being clear about what you want or what you don't want? I, uh, recently had a doctor's appointment with, uh, a doctor who my my husband loves, which is interesting because I got in to the situation, and I could tell immediately he was in a hurry. He wanted to just get through what we wanted to get through. And so I just asked him. I just said, I'm a person who's gonna have a lot of questions. Do you have time for that right now? And even just naming, I have a lot of questions. Do you have time for me right now? Because if not, we don't have to do this right now. I'm happy to reschedule for another time when there's time for that. And just saying that kinda slowed her down. He put his pen down, kinda sat back in his shirt. He's like, yeah. We have time for questions. So naming the fact that what you want is the space to ask questions, the space to take your time, the space to not make any decisions in a time frame that doesn't feel good to you. And, again, with I think your caveat at the beginning is important. This might not work in an emergency medical situation. But in nonemergent situations, it's something to consider. What do you want the pace to be? What do you what space do you want to allow yourself to pick up? Absolutely. I also want and we're gonna talk about that a little bit further too is the permission to know who we are. Right? So if we know that we're someone who are eager to please, um, eager to be easy, eager to agree to what other people would want for us without considering our ourselves. We need to we can even name that and say I'm usually someone who really appreciates and respects authority. I'm really in a desperate situation. I'm gonna have to before I commit to any major decision, I'm gonna need to step away and think about it and get back to you. Yeah. You have have to know yourself. And I think, Sarah, 1 of the greatest lessons in the people pleasing course was really talking about the pause. If you are a people pleaser, building in when available in your medical care a pause. So discussion, pause, decision instead of making really rapid decisions because oftentimes we'll default into the easiest, simplest choice, which usually has very limited awareness of our own needs, wants, capacity, or limitations. The second question I really love is if is giving permission to ask. If I choose to do nothing right now, what should I anticipate or expect? Oftentimes, people pleasers come with a hyper aroused nervous system. Um, sometimes that's experienced as anxiety. Oftentimes, we feel like doing is the only right answer. Right? We have to do something in order for it to go away, in order for to change, in order to meet an expectation, to say that we're trying to get help. Where oftentimes, many of my clients need the permission to manage their anxiety and say, if I chose to do nothing right now, what should I anticipate or expect? It creates more awareness. More awareness gives greater insight into making informed decisions. Our greatest I mean, our healthiest decisions, if possible, are well informed decisions united with want and desire. And it's our want and desire, not someone else's want and desire. Right? So just having the permission to pause and recognizing that sometimes in medical and chronic health conditions, um, and complicated health conditions, there is a permission to do nothing. And that's not failure or neglect. It's actually a choice. And sometimes for many people, that's an informed and wise decision. 3, once again, big question. What are all my options right now? And I love, Sarah, that some physicians are not don't wanna discuss that. You can ask that gentle question. Do you have time to explore all my options right now? If not, who could or when could we? Right? You have to hold that space for yourself. Um, time is money. We are in a medical industry where we have to stand up and take some space or oftentimes we won't be able to make an informed decision because we haven't been given the amount of information that's necessary. And it's also totally appropriate for a physician to just send you home with more information for you to read that, to consider that prior to making a decision and or filling a prescription. Right? But what are all my options right now? Um, I want to make sure that those options also include nonmedical intervention. Like, what lifestyle choices, which is is, um, question number 5 that we'll go to in just a minute. Number 4, what are the pros and cons of that decision? Um, in my own medical journey in the last 3 years, we had to really sit down as we were exploring medication, um, as a way to reenter remission. And we had to get really conscious. Like, we had to get really clear about the pros and cons of making some of the medical intervention decisions that we made because they had incredible risks. Um, understanding the pros and cons from your physician's perspective and then asking yourself those same pros and cons and if they match up in moving forward or not moving forward is really important. So 1 of the greatest challenges in disappointing a provider is their pros and cons were not in alignment with my pros and cons. Right? So they're pro that this could be an incredibly aggressive treatment that would, you know, quickly put me into remission, that I could understand their pro. The cons for me were a quality of life that I was so exceptionally ill that I couldn't take care of the people I was trying to stay alive for. And so being able to understand your own pros and cons is really, really essential. It also can help you see help you understand that your medical provider's thinking and why they're suggesting what they're suggesting. It also gives you permission to know your own life. I can't be on a medication where I am throwing up 5 out of 7 days a week in all day every day because that's not the quality of life that's sustainable regardless of disease progression with my family, my hopes, my dreams, and what where I want to be my goal. My goal is to be well. It doesn't mean I'm disease free, but I wanna be well in ways that I can continue to take care of myself and others. Number 5, what lifestyle choices outside of medical, um, medical intervention or medication are recommended to try? Once again, doctors are put in an impossible position often where when they go when a client comes to a doctor, there is something in America that requires them to prescribe a prescription. Because if not, it feels like this this the challenge was not met or the symptom is not going to be reduced. Doctors also have so much education and wisdom, and if not, we need to provide more or ask for more about lifestyle choices that can have of equal significance, if not more, to a medical intervention. Now that is not always the case. We need to recognize the reality of, like, terminal care, cancer treatment. There needs to be a holistic approach, um, to recovery or to treatment. But you have the right to ask what lifestyle choices can I be making or changing or considering, and that really repositions you in a place of power? Oftentimes, Sarah, in my medical situation, it has felt like there's not a whole lot I can do. I, like, I can't I can't, like, will my ANA to go negative. Like, I can't there's some parts of chronic disease and wellness that can feel really disempowering. However, 1 of the core parts of taking back control and taking back and reorienting myself as as my as the person who's in charge of my wellness is looking for the little things I can do. The little things I can do within my lifestyle, within my capacity, within my income, within my education, that while it might feel small, is 1 way I am contributing to my wellness. And so lifestyle choices are not to be I think sometimes we're like we within a health community and within disease and chronic illness community, there's a lot of judgment about someone is ill because of their lifestyle or someone isn't managing their lifestyle, and that's a portion of their illness. I think we need to be really careful in how we shame or blame other people in relationships to their illness. However, 1 way about really regaining a sense of power is looking at what we can do. Right? What can we do? What do we want to be doing? What and that is a really important part of recentering, um, and it's made a huge difference. And I wanna really name vulnerably that many of us who have a relationship with our, you know, our illness or a disease or our mental health status or our mental diagnosis, there are moments that can be victimizing. It can feel like we're a victim to this experience, and there needs to be a safe place to discuss that, to name that, to understand our relationship to what's happening or what we were born with or what has occurring. However, huge part of treatment and a huge part of emotional wellness is reconsidering where we have choice even in moments where it feels hopeless. And that crosses the span of challenges, right, in the context of grief and loss. Where is their choice in the meaning I'm I'm defining in this person's loss? Right? So once again, lifestyle choices do matter. They're also not the be end end all. But what can we be doing outside of our medical appointments, outside of this prescription to be contributing to our wellness? And there's actually so much more there than we often allow ourselves to think about. Um, anything you wanna say there, Sarah? No. I think I I I think that's very thoughtful and very insightful. And then something, Sarah, we've talked about a lot is number 6, permission to consider and circle back. Not feeling like we need to commit right away. People pleasing tendency help me explain this, Sarah. But we're so comfortable being uncomfortable that we would rather them be comfortable and that there was a decision made right there in an appointment or a decision or an agreement decided than having to feel the discomfort of naming kind of who we really are, which is, thank you so much for this information. It's been really helpful. I'm gonna need to take some time to really consider what I want in the context of what you're telling me. Can I please circle back? Like, just the permission to pause can make some of the biggest advocacy choices in our wellness. I think that a really important part of what you're talking about that I wanna name is that when we are in those face to face situations, they can feel high pressure and high state. And when your nervous system is pinged, aroused when you are feeling activated, you actually lose access to the best, most important part of your brain for that decision making. And so I encourage clients and people that I work with to just memorize a phrase that they can either write down on their phone, write down on their hand, keep in their back pocket. And you just gave a couple of great ones. Like, hey. Thank you. You've given me a lot to think about. Um, I'm gonna be taking some time to think everything through, and I will come back for an appointment when I'm ready. Or thank you for this appointment. I've got some thinking to do. You'll hear from me when I'm ready. Some type of memorized phrase so that you're not in the pressured moment trying to think of the thing that you wanna say when your nervous system arousal has has made it really hard to think. And I feel like in some of those situations, I literally lose my word. And so doing the work ahead of time to be able to come up with a memorized phrase or 2, I think, is really helpful. And the permission that if that sounding response comes forward, Sarah, and we just see ourselves agreeing and pleasing and walking ourselves out of the office with and this was a game changer in my thirties, sir, and this is a huge part of the work that you have done and we've done together in relationship to people pleasing is I had 1 of those experiences. I asked a lot of group questions. I was really proud of myself. I took up time. I was really annoying, I'm sure, in this person's perspective perspective of me. We did the pros and cons list because these are really serious decisions I was having to make. And he the physician walked me through his thinking. He showed me the pros and cons, and he circled a prescription and then gave me a prescription to try, um, or to consider trying. And in that moment, I was flooded. I was overwhelmed. The thought of having to try another daunting and overwhelming. I heard him I saw where his reasoning was. I took the prescription and then just went home. And then, like, gave myself a few days to, like, breathe through that. The level of anxiety and PTSD as someone who's experienced medical cold trauma is very real. And sometimes we just wanna get the hell out of those situations instead of recognizing that we need to use those situations for our wellness. And then I was able once again, like, I belong to me. Like, literally, this is my body. What I'm putting in my body, I should probably agree with or if not, have some questions about. And I know myself well enough to know that this is not what I'm comfortable with. And so being able to call back even 3 days later and say, help me understand. These are my 3 concerns about this medication given my history, given my knowing of myself. Can you please bring this up with the provider and ask if what would be the alternative? Um, that took 30 years and 15 years of being a professional client in the medical industry where before I felt safe enough and capable enough to do that. So I wanna name this as a practice. I want everyone who's listening, who's a people pleaser in recovery to go get a second opinion on anything just for the practice of the second opinion that you are worth more than 1 perspective on any aspect of your wellness within your capacity. I know that there's financial privilege there and wanna be very sensitive. But, also, we need to talk, Sarah, and the last part about this is being okay with disappointing our providers. There is a part of us, especially as women who are recovering from people pleasing, who don't wanna hurt our doctor's feelings. And many of us who are in chronic care conditions, like, these doctors are not just, like, we've seen them once. Like, oftentimes, these doctors Even if it's not working for us, people pleasers will accept it because it feels easier. Once again, we would rather fill 30 seconds of discomfort and saying, I'm actually gonna go see a second opinion, then experience 3 years of discomfort of not getting better. And I say that as someone who knows that, like, deeply personally. Um, we're scared to fire our doctors. We're scared to disappoint our doctors. And I just want you to know and, sir, I know you can echo this as a wellness coach, and I can echo this as a wellness coach and therapist as well as a patient. You are allowed to disappoint your doctors. You're allowed to disappoint your therapist. You're allowed to push back. You're allowed to change doctors. You're allowed to get second opinions. Um, the reality is your wellness is more important than what ever another person's consideration or thought of you as a patient is. And guess what? Our relationships with our providers change. For example, there are some clients that we went through as a therapist. We went through some really amazing work together with my client and me as a therapist. We did some beautiful, beautiful work. And then there was a point in time where a new challenge came forward that was not within my realm of expertise or not within the realm of how I could support them, and they absolutely benefited from going to someone else. Right? There are seasons, but there's something in people pleasers, and this is part of trauma, everyone, that doesn't think we can end relationships even if the relationships aren't working for us. Please end relationships that are not working for you, especially the ones you're paying for and especially the ones where your health is dependent on. Any thoughts about that, Sarah? Like, what is it about us that we're scared to disappoint a doctor? It's really that worry about someone being mad at me and what that means. I think when we get down to the heart of it, everything we do is for safety and connection. And if I don't feel safe to fire this doctor or if I feel like my dissenting opinion will cause disconnection, that is a very real thing. And I think, especially in some of these medical situations, we forget that we are the client. We are the paying customer because of the way medicine is set up. It I mean, can you imagine going through, um, the sandwich line at Subway and just watching them put a bunch of stuff in and handing you the sandwich when you're done that you didn't have any say in putting together and you pay for it, and now you gotta sit down and eat it. We we just wouldn't do that. Right? We would advocate for it. No. I don't like salami or bacon. I want these other things. And so I think sometimes we just forget that we are the paying customer or the paying client even in medical situation because the medical industrial complex has kind of hidden that from us. And instead, they're acting like they're doing us a big favor by making time for us and giving us the pill that we need for the symptoms. So just keeping that in mind as well. And also honoring those sense of desperation for individuals who feel really limited in the care they can receive or the care that's available to them, oftentimes, we're so grateful like you talked about before. We're so grateful for the opportunity to be in set in front of someone who may have answers that we forget that we also have a right to be treated fairly. We have a right to be treated with integrity. We have a right, um, and these are, like, protected also by law. So I wanna, like, name that. And that there also now our resources are understanding how complicated this is from a variety of socioeconomic factors, education factors, identity factors, and racial, um, experience factors, that there are patient advocates now that are in hospital setting, especially in emergency settings, to help patients even know how to self advocate. So I wanna name that if you're in an emergency situation. If you are in a situation where you're seeing a specialist given a new disease or a chronic condition, ask if there is a, um, a patient what did I just call it? Their self advocacy experts or patient advocates. Because sometimes they can be that tool just like a wellness coach in knowing and helping you know what you need. And a lot of insurance companies now are even paying for nurses, wellness coaches, dietitians to come up and serve as an advocate in your wellness knowing that there's gonna be more time, energy, and consideration necessary, um, given the complexity of what you're experiencing. But it's, like, this is where I need us to disappoint. Like, I need I need us to have as women, as people pleasers, as humanity to be comfortable disappointing someone else and putting ourselves first, and I wanna name that as that's what saved my life. I mean, it really disappointing someone, a physician, going and getting a second opinion, traveling to Mayo Clinic, having a second opinion, also going in very clear about my goals, what my hopes were, what my wants were, and also being open minded and flexible and respectful to the wisdom that I was that I received with my medical provider. That saved my life, Sarah. Like Yeah. And I wanna name that fear of disappointment ended up being a 30 second phone call with their practice when this is this when the nurse who I loved I just love this nurse. She was so amazing with me for 3 years. Like, I mean, we were I felt like we went to war together. And I just told her I really needed to seek out, uh, I'm gonna be changing providers. And, like, there was that moment of discomfort, but, also, I was able to express my gratitude and thank them so much for their their kindness, their their dedication, their effort because that was really the provider who really meant a lot to me with that nurse. Because there was a relationship there or a sincere relationship. That 30 seconds was over in 30 seconds instead of having to wait another 3 years, which is discomfort over long term resentment. What would Brene Brown tell us? Yes. And and oftentimes, the thing that we have in our mind as the worst case scenario doesn't often happen. Right? We imagine doctors being enraged that we would dare to question their medical experience and it being, you know, an an awkward or awful situation. And would that happen? Absolutely. Most of the time, what I see happen with my clients and with myself is that that worst case scenario doesn't actually happen. And more often, it's what you described, which is like a 30 second, 60 second, 90 second exchange of words where we feel some anxious feelings, and then it's over. And then we have this freedom that we didn't have before to make different decisions and pursue different path. Absolutely. And I think the ability to be uncomfortable and then ask ourselves as people pleasers or those who have a deep trauma response kind of related to safety is this new question that a lot of trauma research are asking is am I safe enough? While this feels uncomfortable and this physician thinks I'm crazy for getting a second opinion, or this nurse is like, we just spent 3 years trying to get this girl helping this person. Right? And the disappointment that may or may not feel for her. I'm assuming that first and foremost. I do not know their experience of me having to make a decision that's best for me. So I just wanna name that. We're usually mind readers. We're really good mind readers as people pleasers even though we have no experience accurate experience. Um, we really need the permission to realize I am uncomfortable, but I am safe enough because I have my own back. I have my own back. I belong to me. I'm gonna take care of me regardless of how uncomfortable this is because I belong to me. Yeah. And that if I could add 1 more thing just kind of as we wrap up this conversation, it's that having a plan to take care of yourself as you feel, whatever you're going to feel in this situation, I often think it's incredibly helpful. Um, all of my clients and if you listen to me for even 5 minutes, you'll know that 1 of the things they do is put your hands on your chest, make conscious contact with your body, and feel the the the present connection. Oftentimes, in medical situations, that's not gonna be super comfortable to put your hand on your stuff. What could you do instead? Link your fingers together. Hold 1 of your hands with your other hand. Stroke your thumb with your other thumb so that you can remind yourself, I'm here with you. I'm taking care of you. We have a plan to take really good care of ourselves through this awkward, you know, potentially anxiousness, you know, that all of the feelings we're feeling. And then afterward, we are gonna celebrate the hell out of the fact that we took our self advocacy up a notch. We're gonna celebrate. We're gonna call friends and family if that's a a good idea. We're gonna talk to people about how you know what? I was really uncomfortable, but I told the doctor, you know what? I'm a person who needs a lot of time. I'm gonna ask a lot of questions, and I don't plan on making a decision today. That is a huge uplevel in in self advocacy. And so I have a plan going in. This is how I'm gonna take care of myself, and then this is how I'm gonna celebrate my steps afterward because they really, really matter. And the permission that if it doesn't go as intended, which is really human, we have the permission to circle back, pause, reorient with ourselves, ask what do we want now given what just occurred. Right? Yeah. Re centering ourselves as the person that we belong to, the person that we're advocating for and we're worth advocating for. Um, Yeah. Is my hope for everyone. And I hope today's conversation at least provided some really introductory skills in recognizing how people pleasing shows up in our medical journeys and ways that we can reorient ourselves as the person who has our back in partnering with the medical community. Well, thank you for sharing your perspective as someone who has really, you know, done a lot of time in doctor's offices and under under really, really challenging conditions with a lot at stake. I really am just grateful for you sharing what you've learned. Okay. Cool. Thank you, Sarah.