Although a company’s press release, this gives good information.

HealthMedia(R) Kicks Off National Campaign to Promote Better Doctor/Patient Communications

ANN ARBOR, Mich., May 21 /PRNewswire/ — As part of its ongoing initiative to promote health awareness and improve healthcare outcomes, HealthMedia(R), Inc., the global leader in the delivery of scalable behavior change interventions for health and wellness, disease management, behavioral health, and medication compliance, is kicking off the first annual Doctor/Patient Advocacy Week.

HealthMedia Inc.

This is a really good article that I found in Science Daily (and they took it from a press release from Indiana University)

Doctor-Patient Communication Has A Real Impact On Health

Science Daily — Good doctor-patient communication makes a difference not only in patient satisfaction but in patient outcomes including resolution of chronic headaches, changes in emotional states, lower blood sugar values in diabetics, improved blood pressure readings in hypertensives, and other important health indicators.

"In looking at these 36 studies we learned many things. For example, research on non-adherence to doctor’s instructions has focused on bad or poor behavior by patients rather than on the clarity of the physician’s instructions or whether the physician actually checked to see if his or her instructions were understood by the patient. The physician assumed that the patient understands and thus will comply.

But is this a logical assumption? We don’t assume that when a pilot and an air traffic controller converse that they have understood each until there is an affirmation of understanding. That acknowledgement is lacking in most patient-physician encounters," said Richard Frankel, Ph.D., IU School of Medicine professor of medicine and Regenstrief Institute research scientist, senior author of the study. Dr. Frankel is a sociologist who studies ways to improve the doctor-patient relationship. He is currently investigating how behavioral changes by both doctors and patients impact medical care.

"From previous work, including a well regarded 1999 study from the University of Washington, we know that doctors ask patients whether they understand what was discussed during a medical appointment only about 1.5 percent of the time," said Dr. Frankel. "It is extremely important that a patient be given the opportunity and probably even encouraged to ask questions. Doctors should be trained to routinely check for understanding to ensure that there is neither miscommunication nor mismatch between what the patient wants and what doctors assume the patient wants."

Co-authors of "Communication Interventions Make A Difference in Conversations Between Physicians and Patients: A Systematic Review of the Evidence" are Jaya K. Rao, M.D., M.H.S. of the Centers for Disease Control; Lynda A. Anderson, Ph.D. of Emory University; Thomas S. Inui, M.D. and Richard M. Frankel, Ph.D., both of the IU School of Medicine and the Regenstrief Institute.

Note: This story has been adapted from a news release issued by Indiana University.

 This is about heart disease from About.com but the info is still pertinent

Getting What You Need From the Health Care System

There’s nothing more frustrating, or more dangerous, than having to solve your own medical problems. No matter how many hours you spend searching the Internet, listening to the accumulated wisdom of your Great Aunt Hilda, or engaging in games of Twenty Questions with taciturn medical personnel, you can never be sure you’ve got the right answer. 

It’s not supposed to be like that. When you’re sick and need help, you’re supposed to be able to rely on a doctor - a doctor who is knowledgeable, who really cares what happens to you, and who will leave no stone unturned in seeing that you get exactly what you need.  Unfortunately, having such a "model" doctor is becoming rare. Patients are on their own much more often, and to a much greater extent, than they used to be - and it’s getting worse all the time.  

If you’ve read Part 1 of this series, you’re acquainted with our contention that patients are feeling abandoned by the health care system because they really have been abandoned; and that (because widespread covert rationing is systematically destroying the doctor-patient relationship,) the abandonment of patients is happening by design rather than by chance. But even if you don’t buy DrRich’s explanation of the problem, the problem still remains. When you’re sick and find yourself engaged in a hostile health care system, you need somebody in your corner who knows what she’s doing, and who cares about you.  And that somebody is supposed to be your doctor.

Choosing the right doctor for yourself, and nurturing a good relationship with him, is probably the most critical step you can take in becoming an effective patient. With the right doctor at your side, the path to good health care becomes clear and wide. Without that doctor, you’re lost and alone in the enchanted forest.  Accordingly, this article discusses two aspects of dealing with your doctor: Choosing the Right Doctor, and The Care and Feeding of your Doctor-Patient Relationship.

Rule # 1. We ought to begin with the first rule of choosing a doctor, to wit: You hired him; you can fire him.

Choosing a doctor is different than, say, choosing a car. When you buy a new car, you can shop around to your heart’s content, but once you plunk down your money and bring that baby home, you’re pretty much stuck with it. If it’s not everything you hoped it would be, you can’t just get rid of it - why, it lost 50% of its original value the minute you drove it off the lot. Besides, it’s not life and death, it’s just a car. So if your new car turns out to be a disappointment, you’ll usually shrug your shoulders and resolve to live with it for a few years, at least until you can justify buying another one. 

It’s different with doctors. For one thing, it’s harder to shop around before you make your move. For another, starting with a new doctor doesn’t require an up-front investment of tens of thousands of dollars. Early on, all you’ve invested is some time and inconvenience. And finally, choosing the right doctor potentially is a matter of life and death.

Many patients have the same attitude when they’re dissatisfied with their doctors that they would have if they were dissatisfied with a car - "Oh, well, guess I’ll just have to live with it." This is the wrong attitude, since, indeed, in this case you may not live with it. Doctors are serious business.  Choosing a doctor is an important decision, but it’s not an irreversible one. It’s not uncommon for discerning patients to run through two or three doctors before finding the right match. And there’s nothing wrong with doing it that way. So if you’ve tried a new doctor and you’re not satisfied with him, get another one. Remember: You hired him; you can fire him.

The most important factor in choosing a doctor: Communication.  If you can’t communicate well with your doctor, you’re in trouble. This is the person, after all, who will need to understand your wishes and values regarding your health care. She is the one who will need to explain to you, so that you can understand it, the nature of your medical problems - the causes, the testing that may be needed, the potential treatments, the pros and cons of the various therapeutic options, and why she’s recommending one option over the others. She’s also the one who has to convince your insurance carrier that the course of action you and she have decided upon is the right one, that it’s medically necessary, and that they - the insurance carrier - ought to pay for it. Communication has always been important in medicine. Now it’s vital.

Is your doctor really listening to what you are saying? Does he show he understands your concerns by responding meaningfully to them? When he explains medical issues to you, does he make them understandable? Does he have more than one way of explaining a difficult concept? Is he patient with you, waiting for you to grasp what he’s saying, or does he try to embarrass you into saying you understand, with shakes of his head or rolling of his eyes? Do you like him, and more importantly, does he seem to like you? (This may become very important when it’s time for him to go to bat for you.) 

The inability to communicate effectively with your doctor is sufficient reason to move on to someone else. Without communication, you’ve got nothing.

The second most important factor: Does your doctor know what she’s doing?

Sometimes its hard to know for sure how knowledgeable your doctor is. But at a minimum you should check to see if your doctor is board-certified in her specialty.  At least two sources can help. The Directory of Physicians in the United States and the Official American Board of Medical Specialties Directory of Board Certified Medical Specialists list doctors who are board-certified. These books are available in most public libraries, and your doctor should appear in them.

Does your doctor seem smart to you? When you ask a question about one of you health problems, are the answers quick, logical, and cogent? Do the answers jibe with what you know to be true? Are her answers given confidently, or is she dissembling? Keep in mind that it’s often fine for a doctor to answer, "I don’t know," as long as she promises to find out the answer, and then follows through on that promise.

For specialists you will be seeing only once or twice, or who you are going to for some complex or esoteric medical procedure, their experience, knowledge and ability are often much more important than how well they communicate. If I’m having a heart valve surgery, I care much less about how warm and fuzzy the surgeon makes me feel during the pre-op interview, and much more about how many similar procedures she’s performed, and what have been her surgical results.

The third most important factor:  Is your doctor respected by his peers?

Doctors watch each other perform in the trenches, and in general, are pretty good at sizing each other up. If you can get a recommendation on a doctor from another doctor you know you can trust, that’s likely to be a good starting point.  If you know some doctors, ask them what they think. Would they send their own patients to your doctor? Or, better yet, do they send their own family members to him? Do they use him as their own doctor?  And, if your doctor is invited to participate in the training of medical students or medical residents at the local university, that’s a reasonably good sign that he’s held in high regard by his peers.

Other factors to consider. 

• Where is your prospective doctor located? Is her office convenient to you?
• Which hospitals does she have admitting privileges to? Are these hospitals convenient to you, and do the specialists there (since the specialists in those hospitals are the ones she will be referring you to) have a good reputation?
• What are her practice arrangements? Who covers for her when she is away?
• Is her age, gender or race important to you?
• What is her office staff like? Are they reasonably competent, friendly, and helpful, or is their main job to keep you out?
• What are her office hours and office policies?
• What insurance plans does she participate in? This may be especially important if you are likely to be changing jobs (and thus changing insurance carriers.)

Where to look.

Start with your family and friends - people whose opinions you trust. Find out who their doctors are, and whether they are happy with them. Find out why they like them.  Also, talk to medical specialists, and especially to nurses and (if you know any), physicians’ assistants.  See which doctors they respect and admire, and why.

Another place you might consider looking is www.bestdoctors.com.  This is a listing of American physicians chosen through a survey of other American physicians.  For a doctor to make the list, a large number of physicians have to assert that they would want that doctor to take care of them or their family members if they were sick. Best Doctors is a business, however, and currently requires a $35 subscription fee.  A problem with Best Doctors is that it is sometimes weighted toward academic physicians, and there are potential drawbacks to academics - doctors often sing the praises of academics not because they are especially good doctors, but because they have published a lot, or are in positions of power. Some of the most famous university doctors are not especially good clinicians. The bottom line is that while you may find Best Doctors useful, it should by no means become your chief searching tool.  The large majority of excellent doctors in the U.S. are not listed there at all. If you strictly limit your search in this way you may be cheating yourself.

Once you have made your list of doctors, check for them in the Directory of Physicians in the United States or the Official American Board of Medical Specialties Directory of Board Certified Medical Specialists in your public library to make sure they are board certified.  Finally, call the office of one or two of the doctors still remaining on your list. See what you have to do to get an appointment.  See whether the office personnel seem friendly and efficient, or whether they’re obstreperous and obstructive.  Remember that you may need to deal with these people fairly often, and that before you ever get in to see the doctor, you’ve got to get past them. And remember that the doctor’s front office is a reflection of his own personality.  If his receptionists and nurses are difficult to deal with, you’ve got to assume that the doctor likes it that way. 

 The remaining step is to pick one of the "finalists" on your list, and make yourself an appointment.  If after meeting with the doctor you decide this isn’t going to work out, remember Rule # 1.

If you’ve read Part 1 of this series, you know that the traditional doctor-patient relationship is in deep trouble.  The problem, of course, is that the health care system simply can’t afford the traditional doctor-patient relationship anymore. There’s no way that HMOs, hospitals, insurance carriers, or federal regulators can allow doctors to continue directing the spending of health care dollars as if the only important consideration is the welfare their patients. In thousands of ways doctors are being coerced into giving the needs of each of these other parties a higher priority than the needs of their patients. So in becoming an effective patient, you’ve got to take the weakened state of the doctor-patient relationship into account.

The effective patient’s strategy 

Simply assuming that your doctor is always going to be acting in your best interests - no matter how good a doctor he is, or how ethical - is a big mistake.  The effective patient understands this, but she understands something else, too. She understands that her doctor (if she’s chosen her doctor wisely) deeply wants to honor the traditional doctor-patient relationship, since honoring that relationship is his first duty as a professional. She understands that, despite all the coercive pressure to the contrary, her doctor will occasionally go up against an HMO for the benefit of a patient. He needs to do this as a matter of professional pride - just to be able to live with himself. (The HMOs understand this, too. Letting the doctors win one now and then - only, of course, after putting up a stiff resistance - costs them some money, but in the long run keeps the doctors mollified. It keeps the doctors working, and it keeps them quiet. It’s just one of the costs of doing business.) The effective patient also understands that, as much as he may want to, her doctor cannot go to the wall for every patient, or for every issue that comes up for a given patient. The process would be too grindingly difficult, and fatal to his career. She knows that her doctor must choose his battles carefully.

The effective patient understands all this, and nurtures her relationship with her doctor accordingly. She tailors the relationship in such a way that, when the chips are down, she is likely to be one of those her doctor will go to the wall for.  To be such an effective patient, consider following these three general strategies:

Strategy 1 - Be empathetic.  Show that you understand the constraints under which your doctor is laboring, and adjust your expectations accordingly. Don’t be too demanding, especially regarding the small stuff. Show that you respect your doctor’s skills, and that having his skills working for you is worth a few minor inconveniences. After all, you make clear, you know how hard it is to be a good doctor these days, and you’re thankful he’s there for you despite everything. 

Strategy 2 - Align your interests with those of your doctor. Remember: you and your doctor are in this together. He feels your pain, and you feel his. You both want the same things. You both want the patient (you) to get good health care; and you both want the doctor’s practice - and professional integrity - to thrive. So while you fully expect to get the care you need from your doctor, you will help him to deliver that care as efficiently and as cheaply as posible.

You will not bother him needlessly, or thoughtlessly. You will make the most efficient use of your time with him. You will learn how his office operates, and cooperate with his office staff in minimizing interruptions and special requests. (For instance, inquire as to the best time to call the office with questions, or to speak with the doctor.) The main idea is: you are interested in making the doctor’s job as easy for him as possible, while still having your own vital needs served. 

Strategy 3 - Become engaged in your own good health. Nothing makes doctors crazier than patients who completely neglect their own health, then expect their doctors to pull out all the stops for them when they get into medical difficulties. The fact is, your doctor simply cannot afford to vigorously advocate for every problem for every patient. This being the case, which patient is your doctor more likely to fight for when they get sick - the obese smoker who has made no visible effort to take care of himself, or the diabetic who has carefully tried to follow her difficult diet and drug regimens?  

Maybe it isn’t fair, but it’s nonetheless true. If a doctor is considering stepping out of line and jeopardizing his own security to fight for his patient’s best outcome, you can be sure he’s more likely to reserve that action for a patient who’s fighting right at his side for the very same thing. 

You greatly increase the likelihood that your doctor will go to the wall for you if you are fully engaged in maintaining your own good health. You need to stop smoking, lose weight, exercise, take an interest in disease prevention, and during your visits to your doctor, demonstrate how involved you are with your own health care. Make yourself into the kind of patient that doctors find it rewarding and fulfilling to fight for.

Summary

By understanding how and why the doctor-patient relationship is under fierce attack, you can "manage" your own doctor-patient relationship to make yourself a more effective patient. 
Any doctor worth her salt will respond favorably to patients who seem to understand the duress she faces each day in the practice of medicine, who try to help her keep her head above water while she provides health care, and who take an active role in maintaining their own health. Patients like that are worth their weight in gold, and doctors try hard to provide them with the best health care they can possibly manage.

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

These folks are terrific. I really enjoyed being a guest on their radio show.

I’m very fortunate to have been able to share my message with them and their listeners.

Hi There,

Another fun time on the radio tonight - that’s BlogTalkRadio! We talked about several things on the show:

1) I discussed an entry from a malpractice lawyer’s blog where he said that many people call his office to discuss medical care they or a loved one received which resulted in some type of problem. Many believe that JUST because some complication occurred that the doctor or the hospital must have done something wrong and therefore they think they have a viable malpractice lawsuit.  He said that frequently the real problem is lack of good communication between the doctor and the patient (or family). Often his clients say the doctor never told them what happened or fully discussed the problems or complications. He urged patients to open a dialogue with their phyicians and ask as many questions as possible. I felt this was an excellent assessment of the communication problem we have in the U.S.

2) Then I talked about the new recommended reform from the American Academy of Family Physiicans "America’s Family Physicians Join Major Employers and Other Physicians to Revolutionize America’s Health Care System". 
“In a health care environment where there is a growing unease among patients and employers alike about the rising costs and declining quality of health care, America’s family physicians believe every patient should have a personal medical home – a trusted source of primary care,” said Rick Kellerman, M.D., President of the AAFP. 

The patient-centered medical home model promises value not only to patients but to the health care system as a whole. Unlike the current system, which rewards high-volume, over-specialized and inefficient care, the patient-centered medical home is based on the premise that the best health care has a strong primary care foundation and strives for quality and efficiency. Most importantly, it returns the focus back to the patient and is built by an ongoing relationship between a patient and his or her personal physician. 

In a patient-centered medical home:

What a terrific concept, don’t you think? Thanks to the American Academy of Family Physicians!

3) I talked about a "Clinical Empathy" (bedside manner) course being presented at the Medical College of Virginia. Empathy is what I knew as "Bedside Manner" - you know the old Marcus Welby, M.D.  This course teaches young doctors and medical students the interviewing techniques that will show the patients that they really do care and are listening to them and their problems. Unfortunately as technology advances, the interpersonal relationship between the physician and the patient suffers - to the detriment of each. Doctors do not know how to listen or talk to patients - they know how to Diagnose - that is primarily what they are taught. This is a great concept and  I certainly hope this pilot program persists.

4) Finally I shared 3 things that inhibit effective communication between physicians and patients:

• The patients are only able to spend 7-10 minutes with the doctor
• Few patients remember more than the first and last thing the doctor tells them
• Doctors do NOT know they CAN’T communicate.

 It was a fact filled night. Enjoy the replay.

Terrie

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

This is a pretty cool post from Dr. Levister on Black Voice News Online.

Choosing a Doctor You Can Talk To

Dear Dr. Levister:  I get frustrated when I have to see my doctor. He’s usually in a hurry. The communication is always one way. He speaks I listen. Is it time to find a new doctor?  D.C.

Dear D.C. How well you and your doctor talk to each other is one of the most important parts of getting good health care. Poor communications is the number one driving force behind race and sex based health disparities. Unfortunately, choosing a doctor you can talk to isn’t always easy. It takes time and effort on your part as well as your doctor’s.

In the past, the doctor typically took the lead and the patient followed. Today with the complexities and costs of health and managed care, a good doctor, patient relationship is more of a partnership with patient and doctor working together to solve medical problems and maintain the patient’s good health. Becoming a strong  advocate for your own health is essential.

If you are not at ease with the doctor you currently see, now may be the time to find a new doctor. The first step in good communication is finding a doctor with whom you can talk. Having a main doctor (often called a primary doctor) is one of the best ways to ensure your good health. He or she can help you make sound medical decisions and can communicate your health needs with other specialists and health care providers you may need.

Decide what you are looking for in a doctor. Identify several possible doctors. Consult reference sources. Learn more about the doctors you are considering. Make a choice. Don’t be shy about asking questions. Talking about your health means sharing information about how you feel both physically and emotionally. Knowing how to describe your symptoms, discuss treatments, and talk with specialists will help you become a better partner in your health care. Taking an active role in your  care puts the responsibility for good communication on both you and your doctor. 

This is a pretty cool post from Dr. Levister on Black Voice News Online.

Choosing a Doctor You Can Talk To

Dear Dr. Levister:  I get frustrated when I have to see my doctor. He’s usually in a hurry. The communication is always one way. He speaks I listen. Is it time to find a new doctor?  D.C.

Dear D.C. How well you and your doctor talk to each other is one of the most important parts of getting good health care. Poor communications is the number one driving force behind race and sex based health disparities. Unfortunately, choosing a doctor you can talk to isn’t always easy. It takes time and effort on your part as well as your doctor’s.

In the past, the doctor typically took the lead and the patient followed. Today with the complexities and costs of health and managed care, a good doctor, patient relationship is more of a partnership with patient and doctor working together to solve medical problems and maintain the patient’s good health. Becoming a strong  advocate for your own health is essential.

If you are not at ease with the doctor you currently see, now may be the time to find a new doctor. The first step in good communication is finding a doctor with whom you can talk. Having a main doctor (often called a primary doctor) is one of the best ways to ensure your good health. He or she can help you make sound medical decisions and can communicate your health needs with other specialists and health care providers you may need.

Decide what you are looking for in a doctor. Identify several possible doctors. Consult reference sources. Learn more about the doctors you are considering. Make a choice. Don’t be shy about asking questions. Talking about your health means sharing information about how you feel both physically and emotionally. Knowing how to describe your symptoms, discuss treatments, and talk with specialists will help you become a better partner in your health care. Taking an active role in your  care puts the responsibility for good communication on both you and your doctor. 

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