Picture boards bridge hospital language gaps

After Hurricane Andrew these picture boards were developed but apparently just now are gaining popularity in more and more hospitals (especially emergency departments and EMS systems).

They let patients point to icons showing their problem (pain, burn, fall, breathing, heart problems) and also the part of the body they’re having problems with.

They can also let the staff know what their native language is so the hospital can get the appropriate interpreter.

Take a look at the article on the picture boards. Maybe you can use them in preparing yourself for your own doctor’s visit.

Terrie

This article received a Thinking Blogger Award!

 This is my proposal for the DSM inclusion of a new section that outlines and categorizes the features of Mental Health Professional Personality Disorders or MHPPDs.

This proposal begins with a general definition of Mental Health Professional Personality Disorder that applies to each of the 4 specific MHPPDs. An MHPPD is an enduring pattern of inability to empathize with or understand the inner experience and behavior of certain patient populations that deviate markedly from the MHP’s own expectations, individual culture, life experience, values, and personal lifestyle preferences. MHPPD is pervasive, inflexible, prejudicial and has an onset upon reading educational psychiatric literature, engaging in disparaging prejudicial discussion with “more experienced” colleagues, may be triggered by reading a chart with which includes a previous undesirable diagnosis for a patient, is stable over time, and leads to further distress or impairment in the condition of the MHP’s patient. The Mental Health Professional Personality Disorders included in this proposal are listed below.

Mental Health Professional Paranoid Personality Disorder is a pattern of distrust and suspiciousness such that patients’ motives are interpreted as malevolent or manipulative.

Mental Health Professional Antisocial Personality Disorder is a pattern of disregard for and violation of the rights of patients.

Mental Health Professional Narcissistic Personality Disorder is a pattern of grandiosity, need for the compliance of one’s patients, and a lack of empathy for the experience or suffering of those patients.

Mental Health Professional Coercive Personality Disorder is a pattern of dominant and aggressive authoritarian behavior related to an excessive need to be in control of patient treatment decisions.

Mental Health Professional Personality Disorder Not Otherwise Specified is a category provided for two situations: 1) the MHP’s personality pattern meets the general criteria for an MHPPD and the traits of several different MHPPDs are present, but the criteria for any specific MHPPD are not met; or 2) the MHP’s personality pattern meets the general criteria for an MHPPD that is not included in the Classification (e.g., mental health professional passive-aggressive personality disorder). It should be noted that MHPs frequently present with co-occurring personality disorders.

(more…)

Do you have an index card?

If so, you’re on your way to improving your health care.

If not, get one!

This index card should contain information on both sides:

On the top of each side - print in big letters:

NO ALLERGIES or ALLERGIC TO: PENICILLIN, DEMEROL

Side 1 - A list of your medications:

• The name (copied from the bottle)
• The dose (copied from the bottle)
• How often you take it (copied from the bottle)

Side 2 - A list of your medical problems - preferably current and past.

For example:

• HBP (for high blood pressure) or HTN (for hypertension) or High blood pressure
• Diabetes - last HgbA1c - 8.0 - not on insulin or "prone to hypoglycemic attacks"
• Epilepsy - controlled on meds or last seizure 3 months ago
• Asthma - taking advair
• High cholesterol - taking zocor

When you have this card in your wallet you have already helped any emergency care you need because if you need an ambulance this card can help save your life or at least speed up your care. Most people don’t feel like talking when they need an ambulance (or you may be unconscious) - the ambulance crew or the emergency department staff will be able to scan your wallet, find this card and know what not to give you and what your history is.

For example, if someone has diabetes mellitus and is subject to hypoglycemic attacks (blood sugar is way too low), that person may act drunk or stagger or even become unconscious. There are alot of conditions that may cause that - if someone is prone to that because of their diabetes, it helps the medical folks zero right in to what is most likely the cause.

So, whether or not you have a Capital One card in your wallet, I certainly hope you have an INDEX card there.

But in the entire three days I was not given a bath, offered anything with which to do it myself - not even a toothbrush or paste! I really found that pretty horrible. But, It is much more important that I received great care. I could, of course, have asked for these items, I suppose, but I was not feeling that great.

Preservation of Dignity was a very important practice in this hospital. And, although I have no modesty left after 30 years in the Navy, I was impressed. The nurses were skilled in putting on a new gown over the old one quickly and without exposing anything. They were like Houdini it seemed.

They were always keeping me updated on the timing of my tests and when I might go or not.

Keeping the patient updated on these things is vital to their comfort. The uncertainty of the unknown is what we must be vigilant about preventing.

Keep the patients feeling a part of their care is vital.

Just remember your toothbrush.

Terrie

So, I would venture to say that in addition to the expression "perception is reality" one has to add the word "expectation". Since you go into something with a certain expectation, that expectation is actually going to frame your perception.

What the heck am I talking about…well, consider this.

When you walk into the doctor’s office, do you expect people to look at you intensely? Do you expect them to be friendly when they ask "what can I do for you?" What do you expect? Are you putting your nervousness and fear in the way of what you expect? Do you "think" they will be mean and unfriendly? Are you judging from what others have told you about their "horrible" experiences with "The Doctor"? How have you come to form these expectations?

If you walk into the office expecting dull, unhappy, mean and unfriendly people, that’s probably what you’re going to get. And then, the vicious cycle has begun. You will assume that your perception of that encounter is a mirror of what’s to come. And that’s not necessarily the case. Maybe the person at the front desk is ill or has some major family problems. You don’t know what’s going on in his/her life that’s affecting the way he’s/she’s greeting you.

Don’t expect anything but the best. And if your perception of one thing isn’t the best, move right on to the next, knowing that that will be better.

One quick example to end this post for today (and I will post more later about this issue) -
If you go into the office thinking that since your appointment is at 10:00 you should be seen at 10:00, you’ll most likely be disappointed, right? Isn’t that what everyone talks about..hurry up and wait? So, why go in with the expectation that you’ll be seen at 10:00? Why set yourself up to be disappointed? Go in knowing that the doctor really does try to be on time but that maybe one or more other patients needed a bit extra or a return phone call and you’d like for the doctor to do the same for you - not say "oh, I’m sorry, I can’t do anything more than this because I have to be exactly on time." Go in prepared to wait and then you may be pleasantly surprised and if you’re not pleasantly surprised at least you’re not disappointed.

Take a look at your expectations….Until later….

Terrie

Make the most of your 15 minutes: how to make every second of you doctor’s visit count

So you only have 15 minutes with your doctor. Learn to make the most of every second. Try these techniques and see how much time you save - save for clarification and questions.

If you’ve kept up with your "index card system" you’re one step ahead of the game. You can read from the cards or give them to the doctor - the cards have your list of medical problems and your medications.

Keep the symptom diary and write out the list of symptoms, time of onset and any changes since they began. Practice talking about your symptoms ahead of time. Solicit the help of a spouse or friend to listen to you. Have that person practice looking away from you and looking at you so you experience both methods of exposure and you can get more comfortable talking about embarrassing symptoms to another person.

Remember to just list them with minimal conversational tone. That saves a ton of time.

Bring paper and a pencil so that you can take notes as the doctor asks you questions or says things you’re not sure of. Tell the doctor early on that you may need to interrupt to adequately understand what he’s asking of you or what he’s telling you. If you say this and ask "permission", you’ll get off on the right foot. But keep your notes anyway. While you’re waiting for the doctor, jot things down that you think of as you’re sitting there. After the doctor’s been in there, write down questions. Ask the nurses if you have the opportunity when they come in. Ask the nurses how to approach the doctor with questions if they can’t answer them.

Consider bringing a tape recorder- ask the doctor if you can record the encounter so that you don’t have to worry about misinterpreting what he said. Explain that you want your spouse to know what went on and "what the doctor said". You can even make a joke of it with him because I’m sure he’s heard many times before that the patient has problems remembering enough to satisfy the spouse.

Write, write, write. If you have chronic problems, you should get a stenographer’s pad and label that as your doctor pad. Use it to record your symptoms and take it with you to put your notes in. This way it’s always available for reference and you don’t have to worry about small pieces of paper and worrying about losing them.

Stop worrying about whether you’re saying the right thing or not or whether you’re answering questions correctly. Just say what comes to mind. There is no answer the doctor is looking for - he wants to hear what’s going on with you.

Don’t worry about whether the doctor looks at your or seems friendly. This will distract you from the purposes of your visit - to relay your symptoms accurately and succinctly and to receive information back. That should be your only focus.

Focusing on these two purposes will help you make the most of your time - those precious 15 minutes will seem a lot longer.

Hope this helps!

Well, I have a friend who was recently hospitalized (in ICU even) for a urinary tract infection that had spread through his body. Fortunately he got better but in the last month and a half has proceeded to tell me (of course, "as a friend - who just happens to be a doctor" - yeah right) bits and pieces of information about his past and even his current condition (he had to self-catheterize himself - putting a tube in his own bladder four times a day to get the urine out and he got another infection) than i’m sure any of his doctors know. And I’ve listened to him a heck of a lot longer than the 15 minutes your doctor might have with you. The things he tells me he didn’t think were IMPORTANT to tell the doctor - or they were things that he thought of when talking to an old friend. In fact, he must have talked to everyone about it and told everyone his symptoms EXCEPT his doctor. Then he wanted to know how I could have told him some of the stuff I have when I’m a thousand miles away and his local doctors aren’t able to tell him these things….just amazing…

But each time I get off the phone with him I realize that this is what real life is all about and that’s why it’s so important for each of you to keep a diary of your past medical history, your past procedures, your medicines and as importantly, your current symptoms. Then make sure you take that diary with you. You should even transcribe your symptoms onto another piece of paper to give the doctor. Summarize things - "I’ve had abdominal pain above my belly button and under my right rib cage for about 3 weeks now. It seems to come and go and it’s so very sharp that it doubles me over and I have to continually walk around until it goes away. I throw up several times while I have the pain. It even goes to my back and my right shoulder sometimes. Nothing makes it better - it just goes away by itself. It usually comes on about 4 hours after dinner though, especially when we’ve had greasy stuff. etc."

If you take that summary out of your diary, put it on a sheet of paper and give it to the doctor, he can extract so much information from it and can then ask more pertinent questions - rather than having to start from scratch and be like a dentist - pulling teeth!

Be thankful that your diagnoses are correct as many times as they are..and help your doctor along the next time.

Terrie

I was having lunch with a good friend and his wife (whom I’ve gotten to know fairly well in the past 2 years). She told me about her encounter with a new doctor recently for a sinus infection. She was adamant when she simply stated "I know enough about what’s going on in my body that by the time I go to the doctor, I just want them to give me the drugs I need." My internal reaction to that was very disconcerting. I understood what she was saying but my doctor-instinct was horrified - I know I’m telling alot about myself

I wanted to explain to her that sometimes she might not know exactly what was wrong with her because "after all, you’re not medical" but i restrained my tongue for once, knowing that what she believed was, in fact, reality to her - and therefore, she probably did know what she needed.

I recalled a very sad case where a mother did not want to take her twin daughters home from the ER because they did not seem "better" to her after their asthma treatment. The ER doctor (not me, thank goodness) told her that the girls were not wheezing so they "must" be better. So, reluctantly mom took them home. The outcome was not good - one of the girls ended up dying. I tell this not to be morbid but to emphasize to patients that they really do know their bodies better than anyone (and to remind the physicians to listen to the patients and pay attention). I learned such a valuable lesson that night, nearly 28 years ago - and I think that’s what held my tongue in abeyance with my friend’s wife.

The point is that doctors and patients have different perspectives and therefore the perception of each is most likely 180 degrees apart. Each of us has to ask for clarification or offer it if we want to be understood by the other - and if we’re not understood, we’re in deep trouble.

Doctors - throw away your judgments and open up your ears AND your minds.

Patients - stick up for yourself and make sure your doctor hears you and where you’re coming from. And then make sure you understand what he’s saying.

Perception really is reality

Til next time…..

Terrie

But you have to talk about them in order to get some resolution and help and more importantly reassurance. In some cases, the problems you are hiding might be very significant.

I’ve had two very memorable patients in my career that practiced denial to the point where it had become a way of life - but, unfortunately, in a bad way. Both of these people had growths on their body - where they could see and feel them constantly - and they let them become very big and open. Both were cancerous. I won’t go into the graphic details but for them to have been firmly planted in my memory forever, believe me they were bad. And I don’t want any of you to end up in that boat.

I think the one thing I can tell you from my side of the gurney or desk is that there isn’t much you can tell me or talk about that I haven’t heard before. I’m not sitting there waiting for some "juicy story" to come across so all of us in the office (or in my case, the Emergency Department) can have a good laugh. That is NOT the case at all. What’s the expression - "been there, done that, got the T-shirt" - and in my case you could probably tag on to the end of that "waiting for the DVD".

That knowledge may or may not help you but it ought to help. Knowing that the doctor isn’t going to laugh at you or demean you is very important. You should also know that you’re most likely not the only person in the world with this problem. The internet has helped in that manner but still, most people feel alone in their problem and do not really know that there are others out there with the same misery. That’s one reason (and probably the only one) I can accept the TV ads for Viagra and Cialis and Levitra and whatever. They at least are showing people that it’s ok to talk about it, that others have it and that there is help. It’s a very common problem and now more people are realizing they are NOT freaks because of it. The same applies to most anything you may be having a problem wtih.

It’s very helpful to practice saying what it is that’s bothering you. I recommend that you first write down your symptoms (I recommend this for everything, not just the embarrassing ones) and then practice saying it to someone - a spouse or a close friend. If you have neither, then use the mirror - just talk it out. That is the dry run, so to speak. Once the words are out of your head and spewing forth from your tongue, you will feel a sense of relief that you’ve never known. It’s really amazing how that happens. Even if you’re not saying the words to anyone who can do anything about it. You’ll feel a freedom and have a sense that you can tell it to a "stranger".

If the embarrassing (for me that’s almost as hard as Mississippi - is that right? -smile) problem is the real reason you’re going to the doctor, make it the first thing you talk about. Don’t couch it in a bunch of other things and "hope" the doctor will stumble upon it. This is not an archeological dig even though it appears to be sometimes. Spit it out. Tell your doctor why you’re REALLY there.

I try to preface a discussion of that sort with "I’m really embarrassed to tell you this, doctor. And, I’m not sure I can get it all out. Do you mind if I take some time? Maybe once I get started you can help me?" If you let the doctor know up front that this is an issue for you, the process will be alot easier.

Remember that a few paragraphs above I recommended you write things out. Do it! AND, take that piece of paper with you. Give it to whomever will take it. Make copies. If you know you just can’t get it out of your mouth, hand it to the doctor and say "this is really embarrassing. I wasn’t sure I could tell you about it so I wrote it down" and hand him the paper. You’ll be amazed at how that will open the door.

Not only will you be amazed, but you’ll probably get some help and feel immensely relieved as well. Always know that things are easier to handle when you have an ally - and telling your doctor about your embarrassing problem will then provide you with a very big ally.

Go ahead, practice with someone…..it works…practice even if you don’t currently have a problem.

Terrie