Another one of my articles - on SeniorNet.org

The Index Card Solution

by Dr. Terrie Wurzbacher
June 2007

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

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

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

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

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

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

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

What’s in your wallet?

Do you have an index card?

If so, you’re on your way to improving your health care.

If not, get one!

This index card should contain information on both sides:

On the top of each side - print in big letters:

NO ALLERGIES or ALLERGIC TO: PENICILLIN, DEMEROL

Side 1 - A list of your medications:

• The name (copied from the bottle)
• The dose (copied from the bottle)
• How often you take it (copied from the bottle)

Side 2 - A list of your medical problems - preferably current and past.

For example:

• HBP (for high blood pressure) or HTN (for hypertension) or High blood pressure
• Diabetes - last HgbA1c - 8.0 - not on insulin or "prone to hypoglycemic attacks"
• Epilepsy - controlled on meds or last seizure 3 months ago
• Asthma - taking advair
• High cholesterol - taking zocor

When you have this card in your wallet you have already helped any emergency care you need because if you need an ambulance this card can help save your life or at least speed up your care. Most people don’t feel like talking when they need an ambulance (or you may be unconscious) - the ambulance crew or the emergency department staff will be able to scan your wallet, find this card and know what not to give you and what your history is.

For example, if someone has diabetes mellitus and is subject to hypoglycemic attacks (blood sugar is way too low), that person may act drunk or stagger or even become unconscious. There are alot of conditions that may cause that - if someone is prone to that because of their diabetes, it helps the medical folks zero right in to what is most likely the cause.

So, whether or not you have a Capital One card in your wallet, I certainly hope you have an INDEX card there.

(and I'm almost as short as the guy in the commerical - you know, that Geico commercial) 

 It's my birthday and this reminds of me one of the better stories in the book.

One physician was loved by her patients. Amongst all the other little things she did for them (as well as providing great medical care) she would CALL them on their birthdays.

This a.m. when I was opening the cards I received (from people I didn't expect at all), I was touched by their thoughtfulness. It really doesn't take that long to send a card or even an e-card and it means so much to the person receiving it.

I love having positive stories like that.

Terrie

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

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!

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 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?

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

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

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

Enjoy the interview. I did.

Terrie

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

This is a very disheartening situation and unfortunately happens more than it probably should. It was on the front page of  USA Today and I felt I had to talk about it.  Interestingly it was one of three most emailed articles from the Web page today.

Misdiagnoses do occur. But if the doctor works very hard at getting an accurate history (and the patient works very hard to help the doctor), the index of suspicion should be raised high enough to help avoid some of these events.

Do NOT minimize your symptoms just because you may feel better lying in the bed or because you’re scared or humiliated lying there in the bed with everyone staring down at you.

Listen here and comment if you wish. Blessings to this family in their time of sorrow.