I’ll tell you that the title of this turned me off but I forced myself to read it and then found it captivating…take a gander and see what you think. Thanks to Scott Wanless and the Business Intelligence Network. I’ve removed much of the business related info though. I think it’s interesting.

Increasing patient satisfaction is a critical goal for healthcare organizations of all types, especially in these times of increased competition, scrutiny and demand for services. Business intelligence based on satisfaction analytics can help you compete.

Our family doctor cements my loyalty as a patient every time I go to see him. He accomplishes this with one simple action combined with two sophisticated uses of patient intelligence. The simple action is to put notes into my care record that indicate what satisfies me. Currently, two of the notes in my record read: “Likes patient population statistics” and “Likes ideas that came from patients.” He has, for example, used both of these statements in a recent visit to diagnose and treat a sleep disorder I was experiencing. During our conversation, he asked one of the nurse practitioners to share statistics on the percentage of the clinic’s population who are experiencing the same type of sleep disorder, and then drill into the percentages for men vs. women and for men of my age group. This type of insight takes deep intelligence to be gathered, stored, processed and shared among the providers. This is business intelligence.

Taking this use of information one step further, our doctor then walked through a one-page sequence of events for my treatment. This included consult with a pulmonologist, an overnight study at a local hospital, education from a home health and medical equipment specialist, and finally follow-ups with both the pulmonologist and with him as my primary care physician. At each stage of this treatment, I was given information on what to expect and why, as well as homework I needed to do in preparation for the specific stage. He sealed the deal with me by telling me that this sequence of events originated with an idea from one patient, and has grown through refinements made in using it with a variety of patients over the past few years. This too is business intelligence.

What is Patient Satisfaction?
At first blush, patient satisfaction sounds like its cousin customer satisfaction. There are, however, significant differences between the two. Topping the list are the licensing and professional restrictions placed on healthcare providers, who must first consider what the patient needs before what the patient wants. In most businesses, trying to sell people what they need versus selling them what they want is an efficient way to go out of business because the competition will gladly reverse this order. I am free to buy just about anything I want in a grocery or hardware store without any regard to whether or not I need it. But I cannot just get an MRI scan or a prescription I saw advertised just because I want one.

In addition to these restrictions are the financial rules from payers, purchasers and the patients themselves. As a provider in a fee-for-service situation, another x-ray may be called for medically, and help the practice financially, but could very well be denied by the patient’s insurance plan. In a capitation situation, this additional x-ray comes out of the provider’s bottom line. Once again, need trumps want.

Patient satisfaction is the subject of numerous books, articles and studies. In Crossing the Quality Chasm, the Institute of Medicine identifies patient-centeredness as one of the six ingredients of quality healthcare. The book uses terms to describe this focus such as empathy, responsiveness to needs/preferences, involvement, respect, information, communication, education, emotional support, physical comfort, value, transparency and heeding expectations. Irwin Press (co-founder of Press-Ganey) discusses the importance of patient experiences and perceptions, and the need to go beyond technical quality to encompass service quality in his book Patient Satisfaction: Defining, Measuring and Improving the Experience of Care. Furthermore, the Gallup Organization has extended the concept of patient satisfaction to become patient engagement. In other words, involving the patient in their care and in the delivery of their care increases satisfaction, loyalty, cooperation and respect.

Common satisfaction measures were summed up in a recent study by DrScore and included:

• Accessibility – both physical access and financial access to care.
• Communication skills – of the doctors, nurses, PAs, NPs and others involved in direct patient care.
• Personality and demeanor – of the same group.
• Quality of medical-care processes – as provided directly to the patient.
• Care continuity – regarding the handoffs made provider-to-provider, as well as across time.
• Quality of healthcare facilities – in terms of having the appropriate equipment, supplies and peripheral resources available.
• Efficiency of office staff – in handling scheduling, billing, etc.

As you can see from these lists, the focus of patient satisfaction relies on providers going beyond the mechanical delivery of medical care to the delivery of a true health service.

Driving Forces for Increasing Patient Satisfaction
The list of benefits of paying attention to patient satisfaction is long and extends to virtually every corner of the healthcare organization whether hospital, physician practice, home health, long-term care and so forth. This makes sense, since the range of factors making up satisfaction is quite wide.

With greater patient satisfaction comes:

Clinical Benefits

• Greater patient trust and acceptance with treatment plans.
• Increasing buy-in for treatment plans more quickly, making best use of scarce physician time.
• Increasing trust, which allows physician to discover more factors that may affect the care needs of the patient.
• Enhancing patient involvement in their own care through preventative measures, corrective measures and so forth.

Operational Benefits

• Driving efficiency into the organization by focusing on what works well with patients, and eliminating what does not work well.
• Cross-over trust is enhanced. For instance, a good experience in scheduling appointments can cross over into a better experience with the care provider. In addition, a good experience with the patient’s PCP can cross over into a more positive experience with specialists that the PCP has referred.
• Increased internal support for other quality improvement efforts, such as timeliness improvement, care process improvement, etc.

References:
White B. Measuring Patient Satisfaction: How to Do It and Why to Bother. Family Practice Management; January 1999, Vol. 6, No. 1, pages 40-4.

I found an article the other day that discussed use of the ER for non-emergency conditions. I thought it would be a good discussion topic so here it is:

Overuse of Emergency Departments Among Insured Californians

October 2006

One of the key challenges facing emergency departments (EDs) nationwide is a marked increase in use, driven primarily by insured patients who do not have true emergencies. With the troubling trend in California of emergency room closures, it is important to examine the factors that lead to inappropriate emergency room use.

A recent Harris Interactive Inc. survey found that nearly half of recent ED patients felt their problems could have been handled by a physician’s office visit, had one been available, rather than using the ED.

CHCF commissioned Harris Interactive to conduct two sets of surveys, one of emergency room patients and one of primary care physicians and ED physicians. The patient survey found four key factors that drive increased ED use by insured patients who are not critically ill:

• Lack of access to medical care outside the ED (e.g., same-day appointments with a primary care physician, or evening and weekend appointments);
• Lack of advice on how to handle sudden medical problems;
• Lack of alternatives to the ED (e.g., nurse advice lines or urgent care clinics); and
• Positive attitudes about the ED as a site of care.

The lack of options for Medi-Cal patients, who have even more trouble with access to primary care than privately insured patients, is especially severe. The study also noted that patients with chronic conditions made more ED visits, suggesting that their primary care providers may need to improve their methods of chronic disease management.

This issue brief summarizes the key findings of the survey, recommends strategies to increase alternatives to ED use, and calls for streamlined ED processes, as well as improved communication between physicians and patients.
 
Overuse of Emergency Departments Among Insured Californians - CHCF.org  –  http://www.chcf.org/topics/hospitals/index.cfm?itemID=126089

The one good thing from this (remember, I’m an ER doc) is the last bullet - that people had positive attitudes about the ED as a site of care. They may complain about the wait they have to get the care and to complete the care, but it’s apparent that people do think that ED physicians and staff are on the cutting edge. That’s a very important point but not a good reason to use the ED.

Not only is it bad for you when the EDs are so crowded but it’s bad for everyone coming in. Fortunately the ED staff is used to getting the story quickly and barking off orders for this bed or that bed and they all get done. But this is NOT a good way to get personalized care. I hope that physicians look at this brief and say to themselves that they need to look at the services they offer. As I talk about in "Your Doctor Said What?", we have to get sick on the doctor’s schedule and I can tell you from expeirence on both sides of the fence (as a doctor and perhaps, more importantly, as a patient, that rarely occurs. The Urgent care clinics have been a great boost there but a greater review of the situation is needed.

Terrie

Physician-patient relationships Business Editors/Medical Editors BOSTON–(BUSINESS WIRE)–May 17, 2007–As part of its ongoing commitment to patient safety, ProMutual Group, a leading provider of medical liability insurance in the Northeast, is pleased to announce that on behalf of its insured physicians, it has negotiated a discount on annual subscriptions to EmmiPrep(TM), an innovative, web-based, patient education and risk management tool. The reduced cost of Emmi will be effective immediately for all policyholders that purchase an annual subscription.

Developed by Emmi Solutions, LLC, the innovative Emmi system is designed to help healthcare providers improve the quality and reduce the costs of healthcare. At the heart of the Emmi system are engaging, interactive programs that help patients and their families understand what to expect before, during and after a medical procedure. The Emmi program’s interactive nature allows patients to ask specific and confidential questions of their physician and alerts physicians to specific concerns the patient may have. This important attribute further enhances communication and strengthens the physician-patient relationship. The program also provides detailed documentation of each patient interaction with the program and provides physicians with a powerful risk management tool to ensure patients understand their role in ongoing care before and after a procedure. 

We are constantly looking for new and innovative ways to promote patient safety," said Maureen Mondor, vice president of risk management for ProMutual Group. "Emmi provides an excellent means of educating patients, improving the informed consent process and mitigating risk. We think Emmi will be an ideal complement to ProMutual Group’s ongoing efforts to provide superior risk management services to our insureds so they can better meet the needs of patients and the challenges of healthcare practice today."

Studies indicate that patients who fully understand what to expect from medical procedures are more satisfied with the outcomes and less likely to file medical malpractice claims. Not surprisingly, a 2006 survey conducted by Emmi Solutions found that of the 18,000 patients who had viewed an Emmi program, 96 percent developed a better understanding of their procedure. Additionally, 79 percent of patients found that the program provided new and important information and 85 percent reported that the program increased their confidence in their doctor and comfort level with the procedure.

"I want to do everything I can to increase patient safety and reduce risk in procedures that I perform," said Dr. Murray Goodman, an orthopedic surgeon in Salem, Mass. "A large part of that is educating patients and helping to bring their expectations in line with reality. I always have an informed consent conversation with my patients, but using Emmi helps many of my patients more fully understand the proposed procedure, the reason behind it, and its risks and benefits."

By utilizing Emmi in their practices, ProMutual Group policyholders will be able to build relationships with patients, further improve patient satisfaction and increase patient safety.

"We are pleased to be collaborating with ProMutual Group in introducing Emmi to the physicians they insure," said Jordan Dolin, vice chairman of Emmi Solutions, LLC. "Emmi is a unique, innovative system that has been adopted by some of the most progressive healthcare providers in the country. We think it’s a great fit for ProMutual Group and its insureds to enhance the healthcare experience for everyone involved."

For more information about the Emmi Solutions program, to schedule an interview with a ProMutual Group representative or speak with a physician currently utilizing the system, please contact Nina Akerley at ProMutual Group via telephone number (617) 946-8665 or by email at nakerley@promutualgroup.com.

About ProMutual Group

ProMutual Group is the largest provider of medical malpractice liability insurance in New England, insuring more than 18,000 physicians, surgeons, and dentists as well as a large number of hospitals, health centers and clinics. It is one of the top 10 medical liability insurance providers in the country based on direct written premium. ProMutual Group has more than $2 billion in admitted assets, over $500 million in policyholder surplus, and nearly $340 million in direct written premium. ProMutual Group has a Best’s Rating of A- (Excellent), and is a leader in providing risk management and claim services.

Based in Massachusetts, ProMutual Group member companies also operate in Connecticut, Maine, New Hampshire, New Jersey, Pennsylvania, Rhode Island and Vermont. ProMutual Group distributes its products through independent agents. For more information, visit ProMutual Group’s web site at www.promutualgroup.com.

About Emmi Solutions

Emmi Solutions, LLC is the producer of the Emmi healthcare communication system, helping health organizations connect more intimately and effectively with patients and their families. In a field where trust and good communication is critical to quality and safety, Emmi is highly regarded as a one-of-a-kind intervention that clarifies complex information using a conversational voice to engage patients and affect behavioral change.

Created in 2002 by a surgeon and a computer game designer, Emmi facilitates physician-patient communication by providing multimedia programs to help patients understand what to expect. Whether it’s preparing for a procedure, living successfully with a medical device, or helping people manage a chronic disease, every detail of the Emmi system is designed with a single goal in mind: to improve quality by helping patients, their families and caregivers take an active role in their care. Better-informed patients who are engaged in their care drive benefits that cascade across all healthcare organizations and interests.

This is very long but well worth the read (to me anyway). Although it’s about the mental health professionals, it could certainly be applied to any physician. Know anyone who fits this bill?

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 on Satire - But, Oh So True!

This is important information on strokes from Harvard Health Beat

3 Warning Signs of Stroke You know the signs of a stroke. Or do you? You’d probably recognize the classic symptoms, such as sudden weakness on one side of the body or blurred vision, but often the signs are much less obvious. A crushing headache may come on without warning. Your face may feel numb. You may have inexplicable trouble speaking or following what people say. How to tell when someone’s having a stroke Crooked smile. Have the person smile or show his or her teeth. If one side doesn’t move as well as the other or seems to droop, that could be sign of a stroke. Arm drift. Have the person close his or her eyes and hold his or her arms straight out in front for about 10 seconds. If one arm does not move, or one arm winds up drifting down more than the other, they may be having a stroke. Slurred speech. Have the person say, “You can’t teach an old dog new tricks,” or some other simple, familiar saying. If the person slurs the words, gets some words wrong, or is unable to speak, that could be sign of a stroke. Knowing all the warning signs of a stroke may one day save your life and well-being. That’s because the faster you recognize the symptoms, the sooner you can get medical help. And prompt treatment is the key to shielding your brain from a stroke’s damage and sparing you serious disabilities such as paralysis, speech impairment, and dementia. Every 45 seconds, someone in the United States has a stroke. Stroke is the third leading cause of death in the United States and other industrial countries, trailing only heart disease and cancer. In the United States, about 700,000 people have a stroke each year. If you have a stroke, the risk of dying from it increases with age: 88% of deaths from stroke are in people 65 and older. About two-thirds of people who have a stroke have some resulting disability and require rehabilitation. The odds of having a stroke more than double for each decade after age 55. Two-thirds of strokes involve people over 65. Men and women are about equally likely to have a stroke, but women have a greater risk of dying from one. Race is another risk factor. African-Americans, for example, are almost twice as likely to suffer a stroke as are whites. Although you can’t change your age or race, you can take steps to reduce other risk factors for stroke, especially ischemic stroke. The most common risk factors for both ischemic stroke and TIAs (transient ischemic attacks, or "mini strokes") are high blood pressure (hypertension), diabetes, unhealthy cholesterol levels, and obesity. All of these factors affect the health of your blood vessels — increasing the risk not only of stroke, but also of heart disease. That’s why medications and other steps you take to reduce the risk of an ischemic stroke will also benefit your heart. Some types of hemorrhagic strokes are more likely to occur in people with chronic high blood pressure. But other types of hemorrhagic strokes seemingly strike out of the blue. Although abnormal blood vessel conditions such as an aneurysm (a bubble in the blood vessel wall that could rupture) or an arteriovenous malformation (an abnormal tangle of blood vessels) increase the risk, these conditions may only be discovered inadvertently while you are undergoing testing for something else or may not be discovered until a stroke occurs. Fortunately, medicine has made considerable strides in understanding how to treat and prevent strokes. Medical imaging devices now enable medical teams to begin to diagnose a stroke accurately within minutes. Large studies have clarified which medications and other treatments are best for which patients. For those who need rehabilitation, experimental techniques are showing promise in helping patients make better progress than was possible even just a few years ago.

Each of us has our own idea of what particular outcome we want no matter what the scenario. We don’t usually go into a situation blindly…we know what we would LIKE to happen. Whether that happens, is not the point.

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!

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

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 

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: