How to get what you want discussion
Julia Dionian gave a very interactive presentation at one of our meetings. We were delighted to have Julia leading this session; she is a long supporter of the Pelvic Partnership and has a wealth of experience as a trainer, life coach and speaker. We asked Julia to speak to us about “Getting what you want!” because this has been the theme within a number of recent articles and we thought it would make a good subject for a discussion. The discussion was lively, interesting and informative. We have tried to be true to the main gist of the evening’s discussion here but this account will never do justice to Julia’s session.
The idea for the interactive session was that we would look at times when we had got what we wanted and compare the way we asked or what we did, with the times when we didn’t get what we wanted to see if we could come up with some common factors that might help in the future. Although we felt that “Getting what you want!” could be in relation to anything, we started with the idea of getting help with PGP, for obvious reasons. However, the group agreed that some of the approaches could work equally well if they are applied to other areas in our lives where we might be looking for some help, support or service.
We talked first about the fact that although there may be ill informed doctors and midwives etc who do not know about PGP, we felt that overall, it was important for us all to take responsibility for our own care. We may not be responsible for how professionals respond to us but we do have the responsibility to recognise that something isn’t right with our health and to be the person responsible for taking action.
We thought that there were a number of ways we could take responsibility for our own care. Again, in relation to PGP (but it could have been about anything), we looked at what we did or said that showed we were taking responsibility for ourselves. For example we could be proactive in sending off for information, finding out about the condition on the website, joining a support group, talking to friends, family or professionals we meet about it in case they know anything that would help. We recognised that it could be time-consuming and frustrating but that it was also a source of satisfaction in that you felt you were busy doing something and moving forward. We also discussed that it often requires persistence to keep going when at first we might seem to make little progress. Julia pointed out that we were all together for the AGM because we had persisted in finding support and good information from the Pelvic Partnership which had led us to being involved as members of the charity.
Getting what you want and need from your care
We then looked at our approach when we had started making progress in our care. For example, we looked at who we saw (a GP, physio, midwife) and what we could say to them to encourage their participation and action. A number of us had found that we didn’t achieve a successful outcome in our relief for PGP with our first contact with the GP, physio, osteopath, etc. In fact, most of us had found that we had to keep changing practitioner until we found one who was right for us – sometimes more than just once or twice. Often this meant finding one who seemed to know their facts but also had a good ‘bedside manner’. Most of us had found that even if a practitioner seemed well informed, if they didn’t listen or respond to what we had to say, they probably wouldn’t help us to get what we wanted.
We also looked at the need to look within the NHS or outside. We discussed the fact that there were pros and cons with using the NHS, and although it is free to us (mostly), there are times when we decide that it is worth going outside the NHS to private practitioners. We realised that private practitioners could be very expensive and it wasn’t always easy to see if they were doing us any good. So we agreed that we had to keep checking and assessing whether the experience was helping.
We also looked at the fact that whoever we saw, we needed to give them a chance. With PGP, just one session of hands on treatment to address a misalignment may not sort out the problem. So we recognised that our expectations must be realistic and we could help ourselves by checking the literature on the subject, talking to our support group and generally giving an appropriate length of time for the improvements to appear. So we agreed that we needed to see steady, slow improvements and if this didn’t appear to be happening, we had the right to question the care.
Confidence in asking
We recognised that sometimes it gets easier to be assertive and to ask questions with confidence, if you keep practising. However, we did also agree that sometimes we feel too ill, too upset or too vulnerable to do the asking on our own. So we discussed the various options that could help and would be much better than failing to confront a situation and just saying nothing. We discussed when it can be useful to have a friend with you or to take your partner, so that if you are asking the questions, they can back you up or be requested to come up with the questions you don’t feel confident to ask. Sometimes, just having some-one there can help you to feel empowered to ask or probe a practitioner.
What do you want from care?
Next we looked at what we wanted and needed from care. Again, we discussed this in terms of PGP but recognised that it could be a similar approach to other problem solving issues for health or something completely different. We discussed what we didn’t like about some aspects of healthcare to help us home in on what we did want.
The aspects that were not what we wanted included: being ignored by the medical profession, being told our pain was ‘normal’ in pregnancy, being fobbed off, not getting to see the ‘right’ person (physio, chiropractor, etc) and not being offered the chance to see this person quickly. We also felt that it was difficult when a practitioner was sympathetic but not providing good care. It is almost harder for us to stop seeing someone who is useless but friendly than it is to stick with someone who may not have a good bedside manner but is giving appropriate treatment and you are starting to improve.
We also discussed the fact that sometimes the system can get in the way. For example, we found that some physios within the NHS can give a limited number of treatment sessions and then say that they cannot see you anymore. This is often due to budgetary considerations rather than any treatment protocol and we discussed how, in that situation, a new referral from your GP or midwife can start you off on another course of treatment. However, you might not be aware of this and just stop getting treatment altogether. We thought that making the time and effort to persist if you weren’t happy was important. However, we did also recog-nise that even appropriate care can take time to give positive results. We needed to recognise what was realistic and not to expect too much too soon. We also discussed what happens if a practitioner is rude, bullying or incompetent as various members had stories to tell over treatment when giving birth or when they were seeking help with PGP, where the care was not appropriate and really poor. We discussed how to find redress through the ombudsman and how to start that process. We also agreed that talking to someone who is empathetic and can let us tell our story can be very cathartic, for example, phoning the Pelvic Partnership helpline.
How did you find the right person and quickly?
We were also reassured in that practically everyone in the group had found a really good and effective practitioner and we discussed how we went about it and whom we saw. It was encouraging to see that there were routes to finding good people. We also recognised that sometimes the help came from places you might not expect at first. For example, a number of people had received excellent care for PGP from sports physios rather than through the more obvious route of through a midwife to a physio attached to the maternity hospital. A number of us had found a good practitioner from talking to Sarah at the Pelvic Partnership or someone else in the group! It was reassuring to see that we weren’t all still looking for what we wanted over PGP and it was important for our sanity to keep that in mind.
What are some questions to ask?
We recognised that it was useful to plan and organise what questions to ask during a session and to ask direct questions. So we looked at some key questions that would be useful during a visit to a GP, a physio or a midwife. The questions might include:
- Have you ever seen this before?
- Have you ever treated this before? How many times?
- What is the condition and how is it best treated?
- Can I talk to someone who has this?
- How quickly am I going to start to improve?
Keeping the questions and the preamble short and simple would make the most of our time with the practitioner.
How we ask questions and get the answers we need
Julia also encouraged us to look at how we ask questions, our body language, assumptions and how these can sometimes get in the way of what we are asking. She alluded to Transactional Analysis (TA) to discuss how a person’s personality can be expressed through a mixture of behaviours, thoughts and feelings. Eric Berne put forward his theories in the 1950s about TA but it is still useful today in helping to explain some of the behaviours we all use every day and how they may come across to others and help or hinder us. Just as a quick summary (thank you to information from Julie but also on the website from Wikipedia about this), according to TA, there are three ego-stages that we consistently use, often by moving from one to another depending on the situation we find ourselves in:
Parent: a state where we unconsciously mimic how our parents or (other parental figures) behaved. For example, a person may seem patronising, impatient or issue instructions while assuming that what they say will be obeyed. They may do this because that is what they have seen an adult do (when they were a child) and if the behaviour seemed to be effective then, they may have borrowed it in later life.
Adult: this is a state where we behave and respond to everyday life and other people using an adult, considered approach to what is going on around them. It usually characterised by calm, direct, assertive but non aggressive behaviour and where the emotions are balanced (for example without shouting from anger or irritation). It is considered to be the ideal ego state to use because it is a more objective approach.
Child: this is a state that is characterised by using behaviours that we probably used as children. It might mean using very emotional language, whining or be-coming personal during a conversation, or to use other behaviours (crying or sarcasm, for example) that were learnt in childhood. Now grown up, a person who receives a poor evaluation at work may respond as they did as a child by looking at the floor, feeling shame or anger just as they did when scolded as a child.
These three ego states can be used to help us to understand how people may or may not behave in any situation. It can be a useful tool for looking at our behaviours and perhaps recognising which are the most appropriate to a given situation and which may hinder us. For example, in the work place an adult manager may adopt the Parent role to tell an employee that their performance is lacking. By adopting this role, the manager may come across as patronising, belittling and unprofessional so that genuine feedback comes across as a put down or a scolding, as if the employee were a child. The result may be that the employee becomes unhelpful, sullen and unmotivated. Similarly, a child may adopt the Parent ego-state to scold their actual parent as though the parent were a child – again this may not be the best way to reach the desired outcome!
The reference to TA was helpful during our discussion because it aided the group to recognise that we can use all three of the ego states during a day and actually, it might be best to aim to use the Adult role as much as possible to treat others with respect but also to stand up for ourselves.
A number of us agreed that when we meet our GP, midwife or someone we see as being in authority, we often become under-confident and feel uncomfortable. This can mean that we revert to the behaviours of the child role so that we are eager to please, apologise a great deal or become very emotional. This approach may encourage the GP or whoever to assume the Parent role and come across as patronising and controlling. In this situation we may succeed in getting what we want if we remain clear headed, calm and speak to the GP or midwife as a fellow adult (as in the Adult role). It isn’t easy, we all agreed, but it can be done with practice. We also agreed that it can be very useful to write down a few short questions that we want to cover when we see the GP, midwife or whoever so that we are more confident about asking the questions we really want answered rather than waffling because we feel uncomfortable with them.
Around the group, we all agreed that sometimes we can almost encourage an unhelpful or negative response because of the way we have approached a subject. For example, talking to someone we see as an authority figure by starting a conversation with “Sorry to bother you but could you…” which suggests that we are not worth seeing, treating and so on. Similarly, if we experience anger in a situation (perhaps echoing an experience as a frustrated child), the anger is unlikely to be helpful if we are short or rude to someone while trying to obtain information or a service. This is particularly understandable if we have had a lack of success in asking for a referral, the kind of treatment or birth we want, for example, in the past and quite rightly feel a strong sense of injustice. However, we all agreed that getting cross and irritated seldom got us what we wanted! If at all possible, it might be much more productive to adopt an Adult role here.
We all agreed that sometimes it is hard to stay composed and to maintain the behaviours of the Adult state when we are faced by someone who perhaps isn’t well trained, respectful or helpful themselves. However, we discussed ways to avoid confrontation that might help.
To illustrate this, Julia gave an example of having paid some money for a spa day and then finding that she was no longer able to go on that particular day.
When she asked the receptionist if she could have her money back, the response was unhelpful: “Our policy is that we don’t do refunds.” Asking if refunds are ever given, the receptionist said, “We don’t have authority to provide these,” and the conversation seemed to close down with the receptionist harking back to what couldn’t be done. So instead, Julia took a new approach which again was-n’t critical, confrontational or assumed that the employee had no authority. So she asked the receptionist, “What can you do for me?” This very open and non-confrontational approach helped to widen the discussion, recognising that the receptionist had resources and options. The receptionist was able to consider for a moment and then to say, “Oh well, we could change the day you come to the spa,” so that the resolution suited everyone.
We then considered a number of other approaches that might help because they are powerful, direct, and open but without confrontation, even when the other person we are talking to may not be using the Adult role. For example:
- “What are my options?” This shows that you have a choice and implies that it is your prerogative to choose.
- “I’m feeling (as no-one can counter that with “no you are not!”) and I was wondering, what can you do for me?”
- “When you raise your voice like that, I feel uncomfortable, could we discuss…what do you think could be done?”
The group felt that it was useful to have a go at asking questions with friends or family so that we feel more comfortable with a new approach and more confident in the real situation. We thought that although it might take us out of our ‘comfort zone’ it might be useful to try different approaches if we were not obtaining the treatment we wanted or getting what we want. We all felt that this could be useful and empowering. Staying with our old approaches and ways of trying to get what we need might not succeed in the future, they had not helped in the past. In other words:
“If you always do what you did, you will always get what you’ve got”.
Once again, many thanks to Julia for a constructive and very empowering presentation. Thanks, too, for enabling us to write up the key points from this lively and entertaining discussion so that we can pass on some helpful and thought-provoking suggestions and approaches for the benefit of our members.