I wish I could just start appointments by asking “So, do you prefer mildly condescending platitudes, or medications with a bunch of side effects?”, and then people could just tell me, and I wouldn’t have to guess, and they couldn’t get angry if I gave them the one they wanted.
And if they said “Neither!”, I would answer “Oh, so you must want placebo. I know a really great acupuncturist, let me give you her number.”
I’d also include “or (1) actual examination of what you’re doing that makes your life better and what you’re doing that makes your life worse, and how you can do more of the former and less of the latter, and (2) examination of what important life skills you lack, and exploration of ways for you to develop them and/or work around their absence,” with selection of that one to be followed by “okay, let me refer you to a therapist, that’s not really something I can provide in 20 minutes once a month.”
My impression is that the chance of this reducing to “mildly condescending platitudes” varies with the patient’s intelligence and social class, from “wait,you’re saying I should get a good night’s sleep? I never thought of that before!” among confused schizophrenics, to “of course I’ve used black-market d-cycloserine to potentiate the effects of cognitive-behavioral self-help workbooks, what kind of moron do you think I am, you’re wasting my fucking time” among people I talk to on Tumblr.
When I tried the “Wow, you mean diet and exercise help lose weight? Goodness me, in all the years I’ve been fat, I never heard of that, much less tried it!” retort to the “mildly condescending platitudes”, it didn’t end well.
So you’ll have to take the platitudes plus the side-effects if you want any treatment at all. Be nice to get the “talk to me like a human being and even an averagely intelligent one at that” option but doesn’t happen often (did happen with one doctor which is a refreshing change but not too frequent, alas!)
Be even nicer if the “I can’t take that medication you want to prescribe me and are pushing me to take, because it will react badly with a medication I’m currently taking, and no I didn’t just read that off the Internet, the last time I got prescribed that I turned blue in the face and had to be rushed to the ER” option was on offer, but we can’t expect miracles, now can we?
Though re: social class and judgements of status and intelligence, I don’t know if this is more pronounced over here, but because I’m (a) fat (b) naturally talk widda native aksent like, bye, I do tend to get the “plainly thick as two short planks, do the condescending talking down bit and the ignoring what they’re saying bit” unless I use my “the nuns at school taught us elocution lessons” voice and then I get the “hey, evidence of a brain here, talk to them like a real person!” reaction. But it needs to be finely judged, if you show too much intelligence that triggers the “who do they think they are, I’m the doctor here” reaction which also goes badly.
Which is kind of a shame, given that I have the same level of comprehension and intellect in both instances, and only my vocabulary and diction has changed.
I think the problem is that there are lots of genuinely…let’s politely call them “confused” people who don’t realize even very obvious things, and if you don’t know your patients well enough to predict who they are you might as well just give the “eat well, exercise, and get a good night’s sleep” spiel to everybody. But it sure does sound condescending if you’re not the right target.
(and this gets harder when we go into subtler things like “have you tried sleeping in a cool room with good white noise” or “have you tried melatonin” etc)
Again, I wish I could just ask “Are you aware of basic things that it would be very surprising if you weren’t?” but everyone would define this differently and it would be useless.