Table 3.

Illustrative quotes of participant recommendations for handling stress in the medical visit.

Codes	Quotes
Medical system
Accessibility	I think insurance should pay for these things. We know these positive therapies help with overall health in the long run, so why wouldn’t the insurance company pay for this? You know, I’m on Medicare and they don’t pay for anything other than meds [so] you have to pay for massage, acupuncture, classes out of pocket and that’s frustrating.
Regular screening	When I go in to see almost any doctor they start out pleasant, ‘How are you doing today?’ ‘Oh fine.’ But sometimes it might not get beyond that, so the depression inventory would be a good thing.
Case manager or secondary person	This is like, we are expecting them to go from Joe Friday “Just the facts ma’am”, to “You’re stressed, now what is the problem?” you know, more of a therapy, psychology thing. And I don’t think a neurologist is the right person. Maybe someone trained in that kind of listening would pick up on those cues, but I don’t know that neurologists - maybe a secondary person to be inserted in a clinical setting to - I think we are asking too much of them.
Physician
Improved interpersonal skills	I think validation, it sounds obvious, but to me the validation right off the bat is still…so important, just as a starting point. Even if it seems obvious, for me emotionally it helps. And then being able to move on to suggestions…
A more holistic approach	Well I think the stress falls over into everything in your life. They need to be able to relate to everything you’re going through, not sleeping because you’re stressed…effects the rest of your day. So they’ve got to be aware of more of that kind of stuff.
Something other than medications	The rush to quick fix it with a pill isn’t generally what I’m looking for when I go to the doctor. If you’ve got a strep throat, well that’s what you need, but other than that you want to talk, you want to find out, because with MS there’s just so much to it.
Understands community resources	I keep thinking of a list of programs that are available that could be given to people newly diagnosed, well to anybody really, because there are so many therapies pertaining to stress that are gaining popularity. I think that would be helpful, because like you say, you don’t know, you don’t have the time to look it up because you’re just worried about trying to get your house clean, the regular stuff. Or even a mailer when new things become available.
Holds patient accountable	[I would like for my physician to make] suggestions which may be obvious ones, but ones I still maybe haven’t chosen to try or whatever, and for them not to give up on me because I may be stubborn.
Patient
Be an advocate	We have to advocate for ourselves because a doctor isn’t going to know to ask you, “Are you crying 45 minutes a day in the bathroom by yourself?” And so…they can’t fix what we’re not telling them. If they’re not asking, and we don’t say, then there is nothing, then there is a void there…So advocating for ourselves I think is one of the primary things we need to learn how to do.
Be selective about practitioners	You have to connect with them, so finding a good neurologist and a good doctor, and good medical support team, you have to like them and they have to like you and it’s important that they honor where you are and who you are and vice versa. That’s a real challenge, finding that core team.