Last night’s radio show was great. We discussed the reason that angry and frustrated doctors pull even further into their communication shell and in so doing, they interfere with a patient’s adherence to instructions and modalities intended to get them well. This discussion was based on research done by Dr. Jodi Halpern

Then we discussed 5 mistakes effective patient advocates can avoid. This discussion came from an article by Dr. Vicki Rackner.

Enjoy the show and see you next Friday night!

Terrie

Last night’s BlogTalkRadio show was alot of fun. I found an article about patient complaints but the neat thing about it was that it discussed complaints doctors had about patients.

Here’s a summary of each group’s complaints - in future posts I will discuss each of these:

Doctor Complaints                                            Patient Complaints

 Enjoy the show:

More from About.com

Should You Change Doctors?

"C" if your needs are being met.

A doctor-patient relationship is a lifelong relationship for someone with chronic arthritis.

Since the illness is chronic, and without a cure, regular appointments are scheduled with your doctor to diagnose and problem-solve. It’s a process and a journey you take together with your doctor.  It is imperative that your needs are being met. Consider these 6 C’s: 

Communication 

It is clear that if you and your doctor are going to problem-solve and work towards achieving quality of life for you within the framework of your chronic illness, you must be able to communicate with each other. 

You must trust you will be heard, trust that his/her decisions are sound, and trust your options will be fully explained to you.  

Cost

 The financial impact of chronic illness can approach exhorbitant, so cost needs to be a factor. 

If you are or know of someone who is a Patient Advocate, I’m interested in hearing your experiences dealing with doctors from a more objective perspective than how we each deal with doctors when we’re having a problem.

Terrie

 Dr. Terrie Wurzbacher is a retired Naval Officer and an Emergency Physician. She spent 29 1/2 years in the Navy and devoted much of her time trying to teach interns and medical students the fine "art" of communicating with patients. She does NOT claim to be an expert in that field but knows that once she realized that she was not getting the point across to her patients and began to concentrate on ways to help them understand, she was way ahead of most of her peers. There are great doctors out there and some of that greatness is based on technical skill. However, the majority of the great doctors are great because they make the patient a big part of the entire gameplan. Dr. Wurzbacher has always aspired to be that kind of doctor. She knows she's not great but hopes that patients will help their own doctors get to "great".

Perhaps a more important qualification for authoring materials about doctor-patient communication is that she's been a patient herself. Although she is very fortunate to have had excellent health, she has had to visit the doctor for several things and has had a sampling of pretty poor physicians and also wonderful ones. So, she does have the "credentials" to talk about doctor-patient communication.

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 on earth do I mean by that? What is perception? All I know is that perception is reality. How many times have we heard that? And how often do we think of that when we’re in the medical environment? Probably not as often as we should…..

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

Compliance is often a dirty word to most patients. In fact, it was a long time before I knew what it even meant - I kept thinking it was where I heated my coffee every day - you know, the microwave or the refrigerator. But, I finally learned what compliance was and how very important it is to the quest for a cure. One of the problems, though, is that doctors often forget that patients haven’t a clue why they NEED to take something the way they prescribe it. And in this day and age, the doctor’s word is NOT simultaneous with that of God - much to the chagrin, I think, of many doctors.

It’s essential that the doctor explain why you need to be compliant (follow their orders) and what might happen if you’re not compliant. In some cases, not following the physician’s orders can REALLY be life-threatening - for example, stopping certain medications ‘cold-turkey’.

Anyway, listen to the audioblog and see if it helps. You can also read my article on compliance. Our home website has many other articles that you can take a look at too.

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