It’s Friday the 13th so I thought we ought to start the show tonight by talking about bad luck and how to avoid it with your doctor!Join me at 8 pm Central (6 p.m. Pacific, 9 p.m. Eastern), won’t you?Terrie

Another great show. The media player on the left sidebar seems to have the volume low. I hope it wasn’t like that on the actual show. But I have a recording here that you can play and should have better luck.

I had two terrific guests:

Dr. Signe Dayhoff is a Social Psychologist and author. A coach & trainer for over 20 years, she helps individuals struggling with self-presentation anxiety (which includes fear of small talk, stage fright, and self-promotion reluctance) to present themselves confidently and competently. She also helps you master interpersonal communication skills so you can be socially effective in almost any personal or work situation. Check out her website at http://www.effectiveness-plus.com .

My second guest was a long time friend of mine, Wendy Gelberg. She has been a career coach/advisor and resume writer since 1995, working with people at all stages in their careers and in a multitude of occupations and industries, from entry level to executives. Prior to that, she held jobs as a high school history teacher, a college instructor (educational tests and measurement), a secretary at a university, and a career coach at a career center. Her passion is teaching, in classroom/workshop settings and one-on-one, and she loves facilitating those “aha” moments when people discover information that is meaningful and helpful to them. Check her website at http://www.gentlejobsearch.com .

Both these women discussed the fact that there isn’t much difference between dealing with authority figures in everyday life  and dealing with doctors. I hope you enjoy the show.

I also mentioned two great websites that I’m going to put on the links. These are terrific patient advocate sites and have excellent information for you.

They are www.everypatientsadvocate.com and www.diagKNOWsis.com

Check ‘em out and see if they don’t give you good information.

Terrie

Here’s the show:

You know what I mean - those questions that you "just can’t talk about".

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

Excellent article on compliance (following your doctor’s directions) and what influences it 

Most people follow only half of their doctor’s advice. The half they don’t follow often means the difference between a successful treatment and a lingering illness or even death. Find out what you can do to get the most out of your health care. It is so common for patients to disregard their doctor’s advice that there is a term for it in medical circles: Noncompliance. In fact, numerous studies and countless seminars and educational materials have been dedicated to solving this problem. A noncompliant patient is one who simply forgets to take medications on time, misunderstands the directions, cannot make the lifestyle changes required for certain treatments or simply ignores medical advice. Such neglect often has tragic consequences. It is estimated that 125,000 people with treatable ailments die each year simply because they do not take prescribed medications properly or they skip them altogether.

The blame for noncompliance, however, does not lie entirely with the patient. Health care professionals frequently fail to take the time to clarify a treatment, make sure the patient understands why it’s important to follow the plan precisely, explain possible side effects, or ask if a patient’s lifestyle might interfere with the therapy so that it can be customized.

Ideally, a patient and doctor should work together as a team to ensure the most effective medical care. But it doesn’t always work out that way. So don’t assume your health care provider is giving you all the pertinent information. Whenever treatment is prescribed–even if it’s a simple course of antibiotics–make sure you have all the facts, including the possible results of not following through with your doctor’s recommendations.

Why Patients Don’t Comply

Often, people do not follow their physician’s instructions because they don’t have adequate information regarding their condition or medication. Other reasons for noncompliance:

Excellent article discussing compliance (following directions) and who’s responsible when it’s lacking - and what can be done about it

Most people follow only half of their doctor’s advice. The half they don’t follow often means the difference between a successful treatment and a lingering illness or even death. Find out what you can do to get the most out of your health care. It is so common for patients to disregard their doctor’s advice that there is a term for it in medical circles: Noncompliance. In fact, numerous studies and countless seminars and educational materials have been dedicated to solving this problem. A noncompliant patient is one who simply forgets to take medications on time, misunderstands the directions, cannot make the lifestyle changes required for certain treatments or simply ignores medical advice. Such neglect often has tragic consequences. It is estimated that 125,000 people with treatable ailments die each year simply because they do not take prescribed medications properly or they skip them altogether.

The blame for noncompliance, however, does not lie entirely with the patient. Health care professionals frequently fail to take the time to clarify a treatment, make sure the patient understands why it’s important to follow the plan precisely, explain possible side effects, or ask if a patient’s lifestyle might interfere with the therapy so that it can be customized.

Ideally, a patient and doctor should work together as a team to ensure the most effective medical care. But it doesn’t always work out that way. So don’t assume your health care provider is giving you all the pertinent information. Whenever treatment is prescribed–even if it’s a simple course of antibiotics–make sure you have all the facts, including the possible results of not following through with your doctor’s recommendations.

Revealing Statistics The following statistics illustrate how widespread noncompliance really is among Americans: Only 55 percent of tuberculosis patients, 48 percent of diabetics, 46 percent of asthmatics, and 42 percent of glaucoma patients use their medicines correctly. From 14 to 21 percent of patients never even fill their original prescriptions. 10 percent of adolescent pregnancies result from non-compliance with birth control medication. 60 percent of all patients cannot identify their own medicines. From 30 percent to 50 percent of all patients ignore or otherwise compromise instructions on how to take medication. Nearly one-fourth (23 percent) of nursing home admissions are related to improper self-administration of medicine. From 12 percent to 20 percent of patients take other people’s medicines. The cost of hospital admissions is an estimated $8.5 billion annually just for patients who do not take their medications as prescribed. (Sources: The Food and Drug Administration and The National Council on Patient Information and Education)

Why Patients Don’t Comply

Often, people do not follow their physician’s instructions because they don’t have adequate information regarding their condition or medication. Other reasons for noncompliance:

Many medicines cause uncomfortable side effects, so when patients have disorders such as hypertension, which have few or no discernible symptoms, it is hard for them to see the benefit of taking a drug that makes them feel worse. For the same reason, noncompliance is very high when medication is prescribed to prevent an illness from developing.

Some patients with threatening health problems, such as high blood pressure or high blood cholesterol, refuse to take the necessary precautions because they believe heart attacks only happen to "other people."

Many patients have a difficult time making prescribed life-style changes, such as quitting smoking, exercising regularly and changing their eating habits.

Some people hate feeling dependent on drugs, so they stop taking their medication to deny they are sick. Others stop taking medicine to see if they are "cured" yet.

Many people, particularly those with chronic ailments, feel a need to take control of their problem. And they try to do so by taking control of their medication dosage.

Many prescription drugs are extremely expensive.

Due to hectic schedules, people sometimes find it hard to stick to their treatment regimen.

What You Can Do to Maximize Your Treatment

The most important factor in making the most of your medical care is good communication between you and your doctor. Here are some practical steps you can take to accomplish that goal:

1. Tape record or write down what the physician says.

2. Make sure you understand the prescription schedule, and let the doctor know if you think your activities will interfere with it. Call your physician if you find that you cannot take your medication at the appropriate times. Together, you can work out a schedule that meets your needs. (See Make the Most of Your Medications.)

3. Ask what you should do if you miss a dose of medication or a therapy session and whether you should discontinue treatment when you feel better.

4. Let your doctor know if you have had bad experiences in the past with any portion of the prescribed treatment plan and if you are currently being treated for another condition. Find out how to manage both treatment plans simultaneously.

5. Find out what side effects you should expect and which aren’t normal and should be reported to your doctor.

6. Ask for a referral to a support group that deals with your ailment. If your therapy calls for lifestyle changes you feel will be hard for you to make, ask for a referral to a professional who can help, such as a dietitian for changes in your diet or a smoking program for quitting smoking.

7. Don’t be afraid to ask the doctor to simplify instructions by using less technical terms or giving you concrete examples. If your doctor seems impatient with your questions or brushes them off, explain that it is important to you to understand the recommendations clearly because you want to be able to follow them. If your physician still is not responsive, you may want to consider finding another doctor who appreciates an involved patient.

8. If you cannot afford the prescribed drug, ask your doctor about manufacturer aid. Most major drug companies now have programs to give drugs to patients who either don’t have insurance or the means to pay for their medications. The details of such aid vary widely depending on the manufacturer, but all of them require that the doctor put in the application for you

Many patients discontinue medications or other forms of therapy as soon as they feel better, even though the healing process is not yet complete. This is particularly true with antibiotics.

Kristen Gerencher is a reporter for MarketWatch in San Francisco.

Here’s an interesting article that hinges around communication differences between men and women and the diagnosis of  complex pain conditions.

More Difficult For Doctors To Diagnose Complex Sources Of Pain In Women Than In Men

It is more difficult for doctors to diagnose complex sources of pain in women than in men and the reasons for this are rooted in language use. This finding, which is of major importance for both doctors and patients, is revealed by a now completed project by the FWF Austrian Science Fund. The results of this research into how the two genders typically describe pain are to be presented at the 2nd International Congress of Gender Medicine on 2nd and 3rd June in Vienna.

For quite some time, we have all known that men are from Mars and women from Venus, but scientific research has now proven that, when it comes to describing complex pain, men and women are worlds apart. This finding comes from studies that investigated patients suffering from complex headaches. While female patients give doctors brief and vague illustrations of their complaints, men describe their pain in an extremely concrete manner. This means that male patients are at an advantage when it comes to treatment as an accurate analysis of pain is essential for both diagnosis and therapy. 

{Terrie’s note - I do not necessarily agree with the statement that women give brief and vague illustrations of their complaints - or if they do, perhaps it’s for multiple, complex reasons - perhaps it’s perceptions of how the doctor is dealing with them or many other things…this statement is not well qualified to me and it gives women a bad "name" again}

LACK OF COMMUNICATION

A team headed by Prof. Florian Menz of the Department of Linguistics at the University of Vienna established that these different approaches to describing pain are caused by language barriers. Prof. Menz believes that "Women are rather vague and less detailed when portraying their pain, often focusing on the day-to-day situations in which the pain occurs. However, this does not constitute a description of pain in medical terms, as doctors develop a largely symptom-oriented language over the course of their careers. Men, on the other hand, describe their pain in very concrete terms focusing on their symptoms, which is very compatible with medical diagnostics and makes it easier for doctor and patient to understand one another."

{Terrie’s note - so maybe doctors need to be aware of this and change their approach to women?}

By investigating other patients suffering from chronic pain, the study showed that doctor-patient communication is also inadequate on other levels and leads to misunderstandings. While doctors are again primarily concerned with analysing pain when they speak to patients, the patients themselves ¬ who have lived with their pain for a number of years ¬ are more focused on treatment options for example. In such a scenario, doctor-patient discussions often fall short of patient expectations, as they are keen to be involved in the decision-making process.

Another one of my articles - on SeniorNet.org

The Index Card Solution

by Dr. Terrie Wurzbacher
June 2007

Sometimes the simplest things can impact your life in ways you never could imagine. Using index cards to help communication with your doctor is one of those simple things. You can use the index cards in various ways.

You should always have an index card where you record your list of medications and the dosages and how many times a day it’s taken. Write this in pencil so you can adjust it when the dosages are changed. All medical personnel will be so appreciative of this one thing because the last thing they want to hear when they ask “what medicines do you take” is “well, there’s a little blue pill but I don’t know what it’s for. And the orange tablet and a green capsule.” Not knowing your medications or having this card can actually be detrimental to your health because often your symptoms might be caused by or exacerbated by your medicines.

Another use for an index card is to record your medical problems (e.g. high blood pressure, GERD, etc). Use the back (or another one) for your procedure history. Put the procedure, the reason you had it and the results (e.g. colonoscopy 2004 – routine – polyps or mammogram 2006 – routine – normal, etc).

If you’re having a procedure done and have concerns about some of your medical problems, but are worried that the surgeon or anesthesiologist won’t have time to listen to your issues, write them down on an index card. Give the card to the specialist you need to discuss things with. For example, if you’re having surgery and are going to have general anesthesia and are worried about your bad neck being bent back to put the tube in your throat, write it on the index card. If you’re scared how the anesthesia drugs will affect you, write that down too. Be concise – for example: “Neck arthritis – positioning head” on one line and then on the next write “Interaction of anesthesia drugs with mine” or something similar. Be sure to use separate lines.

Use an index card to remind yourself of questions for your doctor. Use keywords or phrases. Make sure you have it out when you start to ask questions. Tell the doctor up front that you have questions.

Another use is to briefly write all your symptoms. That way you won’t forget something while the doctor is talking to you. You can even give him the list. You can take notes on an index card too. This might help you remember things the doctor tells you.

There’s a myriad of uses for an index card (and you can use 4 x 6 cards if you have a lot to write or have trouble seeing). The point is that it’s convenient and a great memory cue to help you at a time where it’s easy to become flustered. The more information you have at your hand, the more powerful and knowledgeable you become with your doctor.

How lucky can I be - interviews two days in a row - and on the weekend when my time is much more flexible.

Today’s interview was for the Deborah Ray Show on Healthy Talk Radio.

Deborah is very much into healthy living and lifestyle medicine. As an ER doctor, that’s not something that I dwell on as much as Family Practice Physicians or other specialists. But it certainly makes sense when we’re trying to combat all these preventable diseases.

Enjoy the interview. I did.

Terrie

You’d think I’d learn. I had this whole post done and linked and entered the code for the audio and instead of saving before the audio was added, I lost everything. But maybe that makes you lucky because i’m not going to bore you with the good fortune I had all day today. Suffice it to say that even though the New York Yankees lost, I had a terrific day.

This funny guy, Ed Shiflett, from "Your Health Comes First" interviewed me and it was the most fun I’ve had doing this kind of "work" (except for doing Sue Vogan’s shows - I laugh all during them and I can’t thank her enough for that opportunity). He had great questions and lots of fun interacting.

He asked poignant questions that I had not been asked before and gave me new ideas for my updated book.

Enjoy the interview and learn alot….

Terrie