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Tuesday Dec 22, 2015

Family Physicians Can Help When Holidays Aren't Merry

Happy holidays?

My clinic, like many, is festively decorated for the holidays. At the end of a visit, my patients often wish me a Merry Christmas. In general, this time of year is known for its holiday cheer and all that comes with it -- good food, fun parties, time off and being with the people you love.

But it's not a happy holiday for everyone. This time of year can be extremely stressful. For some patients, the holidays trigger anxiety and worsen depression. Financial concerns (Can I afford all these gifts?), relationship issues (Can I avoid family conflicts?) and work pressures (Will I meet all those end-of-the-year deadlines?) can have a cumulative effect.

Many people are remembering the loved ones they've lost, while others aren't able to travel to be with their families. Even for patients who don't have an underlying mental health condition -- but particularly for those who do -- the holidays can bring an overwhelming flurry of activity and demands on their time and emotions. All the commercials, songs and decorations are constant reminders and possible triggers.

For patients with chronic medical conditions such as diabetes, hypertension or obesity, the onslaught of unhealthy foods can add an extra challenge to making it through the season.

And let us not forget that there are patients who do not celebrate anything that "Happy Holidays" encompasses.

So how do we as physicians avoid contributing to the stressors our patients might be experiencing? Moreover, what can we do to screen, monitor and support our patients who are struggling this time of year?

We can start with cultivating awareness during each encounter and among our staff. Make an effort to ensure your routine screening for depression is, in fact, happening appropriately. (The AAFP recommends screening provided that support services are available.) In your encounter, take a moment to ask an open-ended question such as, "Do you have any plans for this holiday season?"

For patients who are struggling with their weight, diabetes or high blood pressure, help them develop a plan for eating some of the foods they love and that they think make the holidays more special, but in a way that doesn't derail their overall health goals. Emphasize that eating well (and getting exercise) during stressful times can help them feel better.

Offer ways to manage stress with simple breathing techniques or meditation or by listening to calming music or going for a walk. YouTube(www.youtube.com) (for patients who have access to the Internet) is a great free resource for finding meditation, yoga and mindfulness techniques that can be tailored to whatever time restrictions your patients have. Give your patients a prescription -- virtual or paper -- to take at least five minutes a day for themselves.

For patients who mention feeling lonely or withdrawing from events because they find them too overwhelming, find out if they have friends or family they can reach out to who might be willing to get together on a smaller scale. Connecting with people one-on-one or in a less intimidating setting can help them feel less alone.

If a patient is worried about the financial stress of buying presents, you might suggest giving gifts of time or experiences, such as "gift certificates" that can be redeemed for spending a day together or taking routine walks together. Remind them that homemade gifts are often more heartfelt and appreciated.

A common misconception that is perpetuated in many articles is that suicide rates increase during this time of year. In fact, the opposite is true. According to the CDC, suicide rates are lowest during the holidays(www.cdc.gov). So remember to ask the appropriate questions and follow up if someone does have suicidal thoughts or a plan, but know that the time of year does not necessarily put your patients at increased risk.

Ultimately, we all want to take advantage of all the good things the season can bring. Being sensitive to our patients' potential conditions and offering our support will, hopefully, help keep as many people as possible in good spirits.

So on that note, take a few deep breaths and think about the things that bring you joy this time of year. And may you all have the happiest of holidays, however you choose to celebrate!

Margaux Lazarin, D.O., M.P.H., provides comprehensive family health services, including osteopathic manipulation, at a community health center in the Bronx, N.Y. She is actively involved in teaching residents and medical students to deliver evidenced-based care to underserved communities.

Posted at 02:06PM Dec 22, 2015 by Margaux Lazarin, D.O.

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