Be sensitive to patients this holiday season

Not all your patients look forward to the holidays. For a number of reasons, while the people around them count down the days with anticipation, other people dread December. Sometimes the reasoning is something those patients could change, but other times the dread comes from sources they cannot avoid.

UNCHANGEABLE SOURCES OF HOLIDAY DREAD

Non-Christians, such as Buddhists, Muslims, Hindus, Jews, Jehovah’s Witnesses, atheists and agnostics, find themselves surrounded by Christmas, from the nearest department store to every television series’ special holiday episode. When others act like these non-Christians should participate in Christmas activities, they may feel resentful.

Kwanzaa, Hanukkah and Christmas are all gift-giving holidays, meaning that those who participate have an extra crunch on their wallets in December. Patients may be feeling financial pressure, causing stress throughout the season.

Throughout the years, the holiday season may have been marked with financial hardship, with disappointment, or with loss, so that even as adults those patients can’t enjoy the holidays. The bad memories follow them and take the joy out of the season.

Survivors of trauma — sexual abuse, gun violence, emotional abuse — may suffer especially during the holidays, when society generally accepts that children should be able to enjoy the magic of the season. Neither Hallmark movies nor the patient’s favorite sitcom’s Christmas special show much representation of people dealing with the same issues, so these patients may feel alone and singled out.

Holidays are generally experienced together, as families, so when your patients are forced to look at an empty chair, they’ll likely have feelings of sadness or depression. Distance, loss or other circumstances may separate families. Patients who have lost loved ones, especially in the previous year, will likely feel the loss acutely at a time of family togetherness.

Most of your patients will see some degree of family dysfunction if they get together with extended families for the holidays, but for some the degree is overwhelming. Families torn from bitter divorces and other betrayals will often experience considerable distress around custody and being forced to occupy the same space.

Finally, cold and dark weather in the Northern Hemisphere affects the time your patients spend outside getting the vitamin D their bodies need. The weather can cause winter-onset seasonal affective disorder (SAD), a form of depression, that manifests in feelings of anxiety, apathy, fatigue, hopelessness and social withdrawal.

WHAT HEALTH CARE PROVIDERS CAN DO

All of these sources of seasonal dread are unchangeable, in that, while symptoms may be treated, the root causes are rigid. As a health care provider, you can help patients recognize some of these issues and point them to the right sources for help. Health care providers can start the conversation by asking exploratory questions, such as:

• Are you doing anything special this month?
• How are you feeling, with the holidays coming up?
• Is there anything keeping you from joining in the holidays this year?

Monitor patients’ responses not only for the substance of their answers, but also for the tone of voice they use. Does the patient sound different than usual? If you find that your patients are in need of help with these issues, you might recommend talking with a therapist or some other action to deal with these issues.

CHANGEABLE SOURCES OF HOLIDAY DREAD

On the bright side, other reasons your patients might not be looking forward to the holidays may be dealt with once they understand and accept what is causing their stress.

Of course work is on the list of things that stress out your patients. Since the end of the year is so close, many of your patients may face deadlines in their jobs. If in your conversation with the patient, you drill down to find that work is the main issue causing their distress, they may need to ask for help from a colleague, present their case and ask for an extension from their boss or eliminate other obstacles to allow them to concentrate on the task at hand.

Considering the holiday emphasis on desserts and cocktails, a lot of your patients may be fatigued and gaining weight from their December diet. Poor eating and drinking habits can affect not only their outlook on the holidays, but also their physical health. Having healthy snacks on hand can help curb sugar intake, and counting drinks can help patients refrain from overindulging.

With the advent of social media, the holidays have gotten harder. Seeing what friends do for the holidays can guilt your patients into trying to incorporate way too many activities or tasks into their month. Between seeing only the best parts of others’ holidays on social media and watching Hallmark movies in which everyone ends up in love and with eye-popping decorations and gifts, your patients may set unrealistic expectations for themselves. Overcommitment causes undue stress, as does comparing patients’ own holidays with those of everyone else they know. Open your patients’ eyes to the fact that the movies are just fantasies, and social media only shows what their friends want to show, not the whole story.

SUGGESTIONS YOU AS A HEALTH CARE PROVIDER CAN MAKE

For those who still dread the holidays, a variety of activities can help patients feel better. Suggest that they:

• Plan something for the day after the holiday. That way patients still have something to look forward to.
• Volunteer to help someone else. In doing so, patients will reap all of the joy and satisfaction that comes from participating in meaningful activities and doing good.
• Be flexible. Your patients may be type A personalities. Remind them that just because things don’t turn out the way they planned, that doesn’t mean they turned out badly or wrong.
• Simplify. Patients who pare down what they expect of themselves teach others what to expect from them.
• Preserve meaningful traditions. Sifting through everything they do during the holidays can help your patients identify what means the most to them and eliminate the rest.
• Talk about feelings. Patients who have experienced loss need to accept that it’s hard before they can step forward and enjoy the holidays.
• Try something new. If old ways of doing things can no longer be, decide on a new way to celebrate.
• Call an old friend to reconnect. People with significant relationships are more likely to live longer.
• Be grateful. Gratitude correlates with better mental and physical health. Patients can go all out with gratitude journals, keeping track of anything they have to be grateful for each day, or just have a conversation where they tell someone all the good things they have to be grateful for.

WHAT HAVE YOU LEARNED FROM PATIENTS?

Have you had conversations about holiday dread with your patients? What were your recommendations for them? Tell us on our Facebook page.