I've dealt with social anxiety for most of my life. When I started seeing a rheumatologist regularly, I struggled to effectively communicate. I was afraid of talking too much, saying the wrong thing, saying something stupid, or saying something that would "get me in trouble" with my doctor. The brain fog doesn't help.

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When they would ask "Do you have any questions?" I would always reply with a meek "Nope, I'm good!" even though I had a million (very important) questions.

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I realized down the road that my inability to talk to my doctor was affecting my treatment. How could I advocate for myself if I wasn't...advocating?

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Here are a few tips that have helped me tremendously and I hope they help you, too.

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1. There is no such thing as you talking too much.

Doctors see every personality under the sun. They see patients who come into the office talking and they don't stop talking until they leave. They tell the doctor what they ate for breakfast, every symptom they've ever had, and what they're gonna eat for dinner. And your doctor isn't phased one bit. I promise there is no such thing as you talking too much. Say what you need to say — even if you stumble through it, even if you need to pause multiple times to gather your thoughts. Your doctor only knows what you tell them. Blood work, labs, x-rays, etc. only tell the doctor a small part of your story. It's up to you to tell the rest.

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2. You can bring cheat sheets.

If brain fog is an issue for you, don't rely on yourself to remember everything you want to address. It is 100% okay for you to bring notes — on your phone, on paper, on the back of a napkin. (By the way, you can have your phone during appointments! It doesn't have to stay on the chair in the corner on silent.) You can also show your doctor photos and videos that could help them understand you better. Maybe your hands swell to the size of softball — take pictures! Giving your doctor a visual of what you go through can help them build a more effective treatment plan for you.

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3. You're allowed to say no and/or explore other options.

How many times has your doctor made decisions about your treatment and you felt like all you were allowed to say was "okay"? If your doctor wants to put you on a medication — you have every right to say no, ask to take a few days to think about it and research, or ask questions to better understand their reasoning. You also have the right to ask about administration methods since many medications come in a few different forms. Let's say you live an hour from your doctor and they want to put you on a monthly infusion. If you don't think you can feasibly travel for an infusion each month, ask about alternative administration methods like pills or self-injections you can do at home.

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4. Practice standing up for yourself.

A few years ago I was going through a horrible, long-lasting flare. At a routine appointment I explained how hard the last few months had been and asked about pain medication. My doctor quickly and forcefully said "No, I don't prescribe pain medication." and moved on. I felt a lump in my throat and tears welled in my eyes. Just as my doctor was moving on to the next subject, something came over me and I interrupted her. Through tears I said "I feel completely helpless during flares. I have panic attacks when flares come on because I know that I'm about to experience pain with nothing to help me through. I NEED something, anything, in my arsenal to put my mind as ease when a flare begins. I feel like I'm drowning." My doctor took a long pause and then prescribed a low-level muscle relaxer. Even though it's not pain medication, it does help me during flares and I'm so happy I said something.

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Communicating with your doctor will take practice. It will feel awkward and near impossible sometimes, but if you keep these tips in mind and utilize them when you can, it could make a big difference for you.

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Lastly, it's worth noting that I am a young, white woman with a classically presenting disease. I do not have the barriers that many folks do. For resources on how to protect yourself during medical appointments and a list of culturally competent doctors, visit Hued.

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