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Prescribe an app for your anxious patient

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You know the story well.
A young, otherwise fit and healthy, patient complaining of non specific chest pain, shortness of breath and/or palpitations. Maybe this is their first presentation to your emergency department, or maybe they came to see you many times before. Maybe they already saw their family doctor, and maybe they had some further work up and were even put on some medication.

So, here they are. They go thru triage and have an ECG. And you know that this is not some weird and rare cardiac case. You know this is anxiety. Depending on how busy and stressed you are, you might approach them in various ways. Maybe you’ll even brush them off, because you don’t have time for non life threatening nonsense. “Your ECG is OK, you can go now, and see your family doctor if you have any further problems.”

Sure, to us in emergency department anxiety is not sexy or important like pulmonary embolism, septic shock, broken bones, etc. But it is quite a big deal to the patient in front of us. Going into a full blown panic attack can be quite scary. It feels absolutely real to those in it, whatever it might look to us from the outside. Not to mention the huge impact such disorders can have on people’s everyday lives. Emergency department might not be the best place to deal with such problems and you might feel like the other parts of the healthcare system have failed you and the patient. But you and the patient are together here and now. Are you going to utilize this encounter to their advantage?

I truly believe that every patient encounter is an opportunity. Opportunity to educate, to do some good, to get the ball rolling in the right direction. So I do two things with such patients. I communicate honestly and give them advice, including a smartphone application.
Such patients can be in various stages of how they perceive their problem and how receptive they’re to your advice. Some are still 100% convinced they have heart disease and are not open to any other options, but others are starting to realize or are fully aware that there is something else at play here. Nevertheless, I always believe that being honest is the way to go. It might actually be very refreshing to the patient to hear what you really think, because often other healthcare professionals beat around the bush. It seams these days some are still afraid to express their opinions to patient, like there is still some stigma about various diseases, including anxiety and panic attacks. So regardless if they consciously think that this is something they want or do not want to hear, I tell them my opinion. I plant the seed, I start the acceptance and the healing process. I do not feed their anxiety. Because the sooner they expose it, the sooner they accept it, and the sooner they can start dealing with it.

As for the advice part, I focus on teaching them how to contain the anxiety and stop its progression into a panic attack. I quickly teach them a couple of breathing exercises that will make their mind busy and more focused, as well as slow their breathing and subsequently heart rate. Read about tactical breathing to learn more.
And it is during this time that I usually notice that they carry a shiny and new smartphone. Aha! They are never more than 2 feet away from this thing, so why not use it as a tool to help their anxiety.

You might be surprised with the number of anxiety controlling apps out there. Healthline brings an overview of 15 different ones.
They can help patients track their anxiety, keep it at bay or combat it when it starts building up. Most of these apps will guide the user thru relaxation exercises, including meditation or hypnosis like states.

Here are two of my favourites among many to try. Both have been very popular on app stores and highly praised for their design and user interfaces.

Calm

calm.com
Calm app

Headspace

headspace.com
headspace

Invest a bit of time with these patients, it is worth it.
And think about using these apps for your benefit as well. Why not relax and focus while taking a break during your busy shift.

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Emergency physician, blogger (ivor-kovic.com), innovator (ivormedical.com), researcher (researchgate.net/profile/Ivor_Kovic), speaker (youtu.be/Q-E-B3Pc8mk)...

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