What a great BlogTalkRadio show tonight! Rebecca McCulloh (pastor and mental health counselor) was my guest again. Tonight she did most of the talking because the topic was about things that occur outside the doctor’s office. We discussed how to talk to others about your medical problems. One thing that came up was that if you ask someone about their medical problem and they can’t really describe things to you (and you know it’s not out of embarrassment), then that’s a big red flag that they may not understand what it is the doctor was telling them. You could then try to suggest that they call the doctor’s office to ask a few more questions.Rebecca also mentioned that it’s not a great idea to tell someone to call you if you need anything. The reason is that the person you’re talking to probably will never call you because they have no idea what it is you can do for them. Rather, you should say “hey, I can take you to the doctors or I could come over and babysit for you if you need a rest” etc.. Be specific about what you can do for the other person.Rebecca also discussed CaringBridge.com again and explained that it’s not just for terminally or severely ill folks but for anyone who might need to or want to be able to spread the word in a less intimate manner.Listen to the rest of the show:

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 

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 

Join me this Sunday at 4 p.m. Central (2 p.m. Pacific, 3 p.m. Mountain, 5 p.m. Eastern) for a special guest, Dr. Signe Dayhoff.

Dr. Dayhoff will talk about self-presentation anxiety in  speaking with authority figures, such as physicians. She’ll be on the show and available to take calls too. Visit her website at http://www.Effectiveness-Plus.com

Remember to ASK your questions about anything to do with Doctor-Patient Communication (not medical advice) here.

Talk to you Sunday!

Terrie

This is pretty cool. It’s called BlogTalkRadio and you can listen on the internet.

The first show for "Your Doctor Said What" is tomorrow, Sunday 1 April 2007 at 4 p.m. Central time.

You can call in and discuss any doctor-patient communication issues you have (no medical advice is given).

Call-in Number is 718-664-9958 - Listen here 

Talk to you tomorrow!

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

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:

Excellent article discussing compliance (following directions) and who’s responsible when it’s lacking - and what can be done about 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.

Revealing Statistics The following statistics illustrate how widespread noncompliance really is among Americans: Only 55 percent of tuberculosis patients, 48 percent of diabetics, 46 percent of asthmatics, and 42 percent of glaucoma patients use their medicines correctly. From 14 to 21 percent of patients never even fill their original prescriptions. 10 percent of adolescent pregnancies result from non-compliance with birth control medication. 60 percent of all patients cannot identify their own medicines. From 30 percent to 50 percent of all patients ignore or otherwise compromise instructions on how to take medication. Nearly one-fourth (23 percent) of nursing home admissions are related to improper self-administration of medicine. From 12 percent to 20 percent of patients take other people’s medicines. The cost of hospital admissions is an estimated $8.5 billion annually just for patients who do not take their medications as prescribed. (Sources: The Food and Drug Administration and The National Council on Patient Information and Education)

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:

Many medicines cause uncomfortable side effects, so when patients have disorders such as hypertension, which have few or no discernible symptoms, it is hard for them to see the benefit of taking a drug that makes them feel worse. For the same reason, noncompliance is very high when medication is prescribed to prevent an illness from developing.

Some patients with threatening health problems, such as high blood pressure or high blood cholesterol, refuse to take the necessary precautions because they believe heart attacks only happen to "other people."

Many patients have a difficult time making prescribed life-style changes, such as quitting smoking, exercising regularly and changing their eating habits.

Some people hate feeling dependent on drugs, so they stop taking their medication to deny they are sick. Others stop taking medicine to see if they are "cured" yet.

Many people, particularly those with chronic ailments, feel a need to take control of their problem. And they try to do so by taking control of their medication dosage.

Many prescription drugs are extremely expensive.

Due to hectic schedules, people sometimes find it hard to stick to their treatment regimen.

What You Can Do to Maximize Your Treatment

The most important factor in making the most of your medical care is good communication between you and your doctor. Here are some practical steps you can take to accomplish that goal:

1. Tape record or write down what the physician says.

2. Make sure you understand the prescription schedule, and let the doctor know if you think your activities will interfere with it. Call your physician if you find that you cannot take your medication at the appropriate times. Together, you can work out a schedule that meets your needs. (See Make the Most of Your Medications.)

3. Ask what you should do if you miss a dose of medication or a therapy session and whether you should discontinue treatment when you feel better.

4. Let your doctor know if you have had bad experiences in the past with any portion of the prescribed treatment plan and if you are currently being treated for another condition. Find out how to manage both treatment plans simultaneously.

5. Find out what side effects you should expect and which aren’t normal and should be reported to your doctor.

6. Ask for a referral to a support group that deals with your ailment. If your therapy calls for lifestyle changes you feel will be hard for you to make, ask for a referral to a professional who can help, such as a dietitian for changes in your diet or a smoking program for quitting smoking.

7. Don’t be afraid to ask the doctor to simplify instructions by using less technical terms or giving you concrete examples. If your doctor seems impatient with your questions or brushes them off, explain that it is important to you to understand the recommendations clearly because you want to be able to follow them. If your physician still is not responsive, you may want to consider finding another doctor who appreciates an involved patient.

8. If you cannot afford the prescribed drug, ask your doctor about manufacturer aid. Most major drug companies now have programs to give drugs to patients who either don’t have insurance or the means to pay for their medications. The details of such aid vary widely depending on the manufacturer, but all of them require that the doctor put in the application for you

Many patients discontinue medications or other forms of therapy as soon as they feel better, even though the healing process is not yet complete. This is particularly true with antibiotics.

 How much wonderful info comes from About.com!

Patient Education - Can You Know Too Much?

Patient Education Should Enhance The Doctor-Patient Relationship

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

Patient education is vital to good health care 

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

 Patient education does not replace a proper diagnosis

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?