I just got discharged after three and a half days in a Chest Pain unit. Other than my ER visit (more about that later and I believe I should write an article on ER Karma ) my care was phenomenal. I felt like a person and like the staff really did care. They talked to me as a person, not an object (and certainly not as "how are WE feeling today").

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

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.

What is non-compliance?

• Not filing a prescription initially
• Not refilling a prescription when still needed
• Taking a medication at the wrong time
• Stopping a medication before medication course is completed without your physician’s advice
• Taking the wrong dose
• Taking a medication incorrectly
• Skipping doses
• Taking someone else’s medication

Do you know what your medications are? What each of them are for? How you’re supposed to take them?

Can you remember them? If not, you should write them down and keep them with you at all times. Use an index card to write down the names, the dosages, how often you take them and if you have room, jot down what condition each one is for.

Look at these statistics:

• Approximately 125,000 people with treatable ailments die each year in the USA becaue they do not take their medication properly.
• Fourteen to 21% of patients never fill their original prescriptions.
• Sixty percent of all patients cannot identify their own medications.
• Thirty to 50% of all patients ignore or otherwise compromise instructions concerning their medication.
• Approximately one fourth of all nursing home admissions are related to improper self-administration of medicine.
• Twelve to 20% of patients take other people’s medicines.
• Hospital costs due to patient noncompliance are estimated at $8.5 billion annually.

Noncompliance is typically cited as occurring in from 50%-70% of patients.  In other words, 50%-70% of patients do not properly take prescribed medication. The rate of noncompliance is even higher in patients with chronic illnesses.

Absorb these statistics - look in your own medicine chest……go from there.

Til later,

Terrie

 Got a question?

It never ceases to amaze me how any doctor is able to accurately diagnose patients. With as little information as they are able to get from the patient, it’s kind of a miracle that things turn out right…What am I talking about?

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

 How much wonderful info comes from About.com!

Patient Education - Can You Know Too Much?

Patient Education Should Enhance The Doctor-Patient Relationship

Being An Informed Patient Is Not A Substitute For Trusting Your Doctor. Can You Know Too Much? 

Patient education is vital to good health care 

Patient education is an important aspect of managing chronic illness. Patients are often encouraged to learn all they can about their disease, to become informed, and take a positive approach to managing their condition. 

 Patient education does not replace a proper diagnosis

This is a great article found at CNN - they have cutting edge information and everyone should take a periodic look at their health section.

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

 Another clip from Medical News Today about the number of pills and Daily Adherence to medication. Although it focuses on certain conditions, the issue is applicable to everyone and every condition. Compliance (adherence to instructions) is such a big factor in health success that we all (doctors and patients alike) must pay attention to what will improve a person’s ability to follow the advice/instructions:

New Study Suggests Number Of Pills Not A Factor When It Comes To Daily Adherence To Medication

There is no correlation between the daily number of pills a patient is prescribed to take and how well a patient will adhere to a dosing regimen, suggests a new study presented recently at the 19th Annual Meeting of the Academy of Managed Care Pharmacy (AMCP) held in San Diego (April 11-14). The large-scale study looked at patients taking a variety of high blood pressure medicines, specifically calcium channel blockers (CCBs), and provides more supportive evidence that adherence to prescribed medication is influenced by a multitude of factors. The study specifically examined dosing regimen to see if there was a relationship between that factor and adherence in patients with a co-payment of at least $20.

More on Do You Take Your Medicines As Prescribed?

This is cool. My article got published on MySeniors.com . It was also in HealthNewsDigest.com

Your Doctor Said What?

Make the Most of Your 15 Minutes

By: Dr. Terrie Wurzbacher DO 

Doctor-Patient Communication What your doctor does (and doesn’t) need to know

     Ok, you’ve got your appointment scheduled. You’ve kept your symptom diary. Now what? What is it your doctor needs to know – and conversely, what is it he doesn’t need to know? After all, you’ve only got those infamous 10 minutes to get everything accomplished – tell your problem, be examined, get a diagnosis, and ask your questions.

    What does the doctor need to know? Just about everything – but not in the conversational manner you’re used to. What’s your predominant problem and how long have you been experiencing it. Have you had this before – sometime in the past perhaps? If so, what was your diagnosis (if you went to have it checked)?    

    In addition, you should list the associated problems – pain, weight loss, nausea, vomiting, urinary symptoms, loss of appetite, cough, fever, chills, headaches, etc. It’s important to make sure you separate the two issues.

    What’s the character of the symptoms? Are they intermittent? Or constant? Are there periods of time when you don’t have any symptoms and feel pretty good?

    Have there been any changes in severity or location? Changes can indicate a lot about what’s going on.

    Why did you decide to come see the doctor now? Was it that it became intolerable? Was it that you finally realized it wasn’t going to go away?

    Remind the doctor about your past medical problems and your current ones. Take your index card and read off of it to him. Often times, your current symptoms may be related to your other problems or to their treatment.

    Likewise use your other index card – the one with your medicines listed on it.

    Tell him if you’ve had any other problems that you’ve seen another doctor for. Have your medicines changed? Have you run out of your medications? If so, when? If you’ve stopped your meds because of your symptoms, tell him when you stopped them.

    Have you been taking any herbal medications or other naturopathic remedies?

    What’s changed in your daily living or activities or abilities? Do you get out of breath faster, are you unable to walk up your stairs or go for your usual walk since you got sick?

    What doesn’t your doctor need to know? He doesn’t need to know all the details that go along with you telling your story. This is not a good way to describe your problems “I felt worse than when cousin Charles died” or “It started 3 weeks ago on a Friday and then that whole weekend we were at a high school reunion – you know my 30th – it wasn’t bothering me as much except when I went to bed. The long car ride made me more carsick than usual though. When we went to dinner with the Sullivans I wasn’t able to eat as much but I really didn’t have any bowel problems.”

    Eliminate the natural conversational patterns to get more out of the time you have with the doctor. Short and to the point makes it easier for him to hear the pertinent points.

    The doctor doesn’t need to know what you think the diagnosis is – unless you’ve had this same condition/symptoms diagnosed by a physician before. If you try to convince the doctor it’s something, then you may mislead him or lead him down the wrong path.

    Give your doctor your story in bullet points and don’t elaborate unless asked. Practice and write things down and you’ll do great!

 What a great article from About.com - even though it’s primarily about arthritis, the concepts are exactly the same for every patient-physician encounter. Read about it.

The Patient-Physician Encounter

From Carol & Richard Eustice 

The good physician treats the disease; the great physician treats the patient who has the disease ~ William Osler (Canadian Physician, 1849-1919) 

The Patient-Physician Encounter 

What do patients want from a medical encounter with a physician?

In the thoughts of one physician (Delbanco,1992): 

• Patients want to be able to trust the competence and efficacy of their caregivers.
• Patients want to be able to negotiate the health care system effectively and to be treated with dignity and respect.
• Patients want to understand how their sickness or treatment will affect their lives, and they often fear that their doctors are not telling them everything they want to know.
• Patients want to discuss the effect their illness will have on their family, friends, and finances.
• Patients worry about the future.
• Patients worry about and want to learn how to care for themselves away from the clinical setting.
• Patients want physicians to focus on their: 
                    pain
                    physical discomfort
                    functional disabilities  

The Relationship Between Patient And Physician 

The relationship between patient and physician has been analyzed since the early 1900’s. Prior to when medicine was more science than art, physicians worked to refine their bedside manner, as cures were often impossible and treatment had limited effect.

In the middle of the century when science and technology emerged, interpersonal aspects of health care were overshadowed. There is currently a renewed interest in medicine as a social process. A physician can do as much harm to a patient with the slip of a word as with the slip of a knife. 

Instrumental And Expressive Components 

The patient-physician encounter crosses two dimensions:

• expressive
• performing diagnostic tests
• physical examinations
• prescribing treatments

What Are The Effects Of An Effective Patient-Physician Relationship?

What are the effects of an effective patient-physician relationship? When the PATIENT-PHYSICIAN RELATIONSHIP includes:

These factors can provide for PATIENT SATISFACTION WITH CARE which leads to better ADHERENCE TO TREATMENT.

Great article on how to talk to your doctor about embarrassing medical problems - Dr. Vicki Rackner has the same sense of teaching patients how to take charge of their own health and care as I do - of course, she’s much younger and seemingly more energetic so Bravo to her for championing the cause! Check her out.

The realization hit Natalie like a ton of bricks. Her mother, Joann, had literally died of embarrassment! Joann had noticed blood in her stool almost a year before she was diagnosed with colon cancer. At first she told herself it must have been those beets she ate. Then she thought it was most likely her hemorrhoids, although she had not had a flair-up of hemorrhoids since Natalie’s birth 52 years earlier.

The truth was that Joann was embarrassed to talk with her doctor about private topics such as her bowel habits. She didn’t raise the concern with her doctor until she had bloating, cramping and abdominal pain. This led to the diagnosis of colon cancer that ultimately took her life. Natalie’s brother-in-law, who was a nurse, wondered whether Joann would still be alive if she had told her doctor about the blood in her stool when she first noticed it.

Let’s face it; certain topics are embarrassing to talk about with your doctor. I call them the 5 P’s:

• Peeing
• Pooping
• Paying
• Procreating
• Psychic moaning

Although at first blush the challenge of talking with your doctor about embarrassing medical topics seems simple enough, for some people, it can cause significant suffering.

Hillary, for example, had what’s now called a shy bladder. She had not used a public restroom in over 20 years. She was too embarrassed to talk with her doctor about this; instead, she remained a prisoner to her bladder.

Ed was laid off from work and could no longer afford his asthma medications. Instead of talking with his doctor about it, he decided to do without He wound up in the emergency room with an asthma attack that could have been avoided with regular medication.

Tom had some sexual side effects from his blood pressure medicine. Instead of talking with his doctor and getting a different medicine, he just stopped taking it. The doctors wonder if this might have contributed to his heart attack.

Jerry noticed his loss of appetite and sleeping problems as his caregiver responsibilities for his aging father mounted. He wondered if he might be depressed, but dismissed the thought because real men don’t get depressed.

Imagine how each of these stories might have been different if these individuals who suffered in silence could have talked with their doctors.

Here are 6 tips that can help you talk with your doctor about embarrassing medical topics:

1. Own the embarrassment.

Say to your doctor, “This is a taboo topic in our family, so it’s hard for me to ask. Is it normal to have a funny smell coming from your belly button?"

2. Find the words.

Your doctor speaks a specialized language acquired through years of training. Sometimes patients are embarrassed because they don’t know the “right words" or have a hard time describing the problem.

Remember that your job is to communicate. You don’t need to know the fancy words to do that. If a patient said to me, “Dad had an operation on the dingle-ball thing at the back of his throat", I would know just what he meant. And, the patient would seem relieved when I said, “Oh, you mean the uvula."

The best way to make sure you and your doctor understand each other is to use anatomically correct words. Get a basic anatomy atlas. Use anatomically correct words with your children.

3. Practice saying the words.

Sometimes embarrassing words can be hard to get out of your mouth. Gertrude, a 90-year-old patient said to me, “You youngsters don’t understand how much things have changed. When I got breast cancer in the 1962, the words ‘breast’ and ‘cancer’ were not uttered in polite company." Some words are still embarrassing to say. Practice saying these words out loud when you’re alone! That will make it easier to say them at the doctor’s office

4. Find the right person to ask.

You may have an easy rapport with the nurse or physician’s assistant at your doctor’s office. You can bring up the sensitive topic with them. Say, “Trish, could you please give the doctor a heads up. I want to know why I should say no to those steroids my buddies at the gym are offering me. I would love to look like they do."

5. Find the right way to ask.

Maybe it’s easier for you to drop a note or a cartoon to your doctor rather than ask in person. Find the style that works best for you.

6. Remember that your doctor is there to help you, not to judge you.

Your doctor has heard it all before. I promise! Your doctor will not think less of you for asking an embarrassing medical question; in fact, your doctor with think more of you for overcoming your fear and helping you take charge of your health.

Dr. Vicki is a board-certified surgeon who left the operating room to help families take the most direct path from illness to optimal health. Her book, “The Personal Health Journal", can save your life today by helping you understand your health story. Empower yourself with the tips and tools that will help you direct your story and partner with your doctor more effectively at: http://www.drvicki.org/drvicki-store-health-journal.html