April 27, 2007

How to Talk to Other People About Your Medical Problems

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:

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Enclosures

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May 19, 2007

BlogTalkRadio - Patient Advocacy, Doctors Get Angry Too…

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

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

Enjoy the show and see you next Friday night!

 

Terrie

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October 21, 2006

Women have special issues dealing with doctors…

 There are some communication issues that apply to men and women alike. However, there are many problems that women have with doctors today that men could not even imagine.

Unfortunately, this often applies to both male AND female physicians.

I remember one of the physicians I worked with was about 4 feet 11 inches, 85 pounds, never smoked, drank or did anything else that might ever be deemed by the Surgeon General to be possibly bad.

She would lecture her female patients about how they had to lose weight, blah, blah, blah and they would just sit there and look at her like I did. Silently thinking "What the heck do you even think you could know about losing weight?"

There are many such instances when women go to their doctor for "help". We'll explore them here.

Terrie

Copyright ©2006 Terrie Wurzbacher

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August 3, 2007

How to Talk to Your Doctor About Embarrassing Medical Problems

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 

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July 12, 2007

How to talk to your doctor about embarrassing medical problems

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 

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May 5, 2007

Patients AND Doctors have complaints about the other…

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

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

Doctor Complaints                                            Patient Complaints

Patients Didn’t Follow Directions Time Spent in the waiting room
Patients waited too long before making an appointment Couldn’t schedule an appointment within a week
Patients were reluctant to discuss their symptoms The doctor spent too little time with them
Patients requested unnecessary tests The doctor didn’t provide test results promptly
Patients requested unnecessary prescriptions Doctor didn’t respond to phone calls promply

 Enjoy the show:

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June 28, 2007

Should You Change Doctors?

More from About.com

Should You Change Doctors?

"C" if your needs are being met.

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

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

Communication 

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

  • There must be an ease and comfort when you talk.
  • The doctor must be willing to listen to your concerns, be open to all of your questions and be candid, yet caring with his/her responses.
  • The rapport you have established must be completely based on trust. 

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

Cost

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

  • Does your doctor make it easier for you by allowing you to pay co-pays by credit card?
  • Does your doctor offer you free samples of medications whenever appropriate?

    Obviously, your specific health insurance should be congruent with your choice of doctor. Health insurance coverage can make it a more narrow field from which you can choose your doctor. 

  • Is the doctor you are seeing part of the HMO (Health Maintenance Organization) you belong to?
  • Does your doctor accept Medicare assignment or Medicaid? 
  • Is your doctor on a preferred-provider list which is offered by your place of employment?

    Convenience

    Ideally, the location of your doctor’s office should be convenient.  Having to travel far for frequent appointments can be aggravating.

  • Is the time you spend in the waiting room within what you consider reasonable limits?

     A longer-than-acceptable wait is understandable when it occurs rarely, but if it is the norm or if the entire office operation seems chaotic, that is not the convenient situation which a patient needs. Consider also: 

    • How long it takes to get an appointment
    • Can you easily get prescription refills called in?
    • Can you easily get a phone message to your doctor and does your doctor respond in a timely fashion?
    • Is your doctor affiliated with the hospital of your choice if you were to require hospitalization?

    Continuity of care

    Continuity of care is important.

    • If you have multiple health problems or comorbid conditions, is your doctor diversified enough to handle the entire situation?
    • If your doctor specializes, does he have a good team of associate doctors?
    • Can you be assured that there will be continuity of care even if other doctors are called upon?

    Doctors must share their diagnoses and treatment plans so the whole patient is being treated.  Your primary doctor must take charge and coordinate, so that continuity of care is achieved. 

    Confidence 

    There is no other way to say it - your doctor must exude confidence and be conversant, having knowledge and experience. 

    • Your doctor must leave you feeling that your health matters are under control.
    • You must have confidence in what your doctor says today and in what your doctor expects will happen tomorrow.  

     The confidence you have in your doctor is directly proportional to how compliant you will be with your treatment plan.

  • Contemporary / Cutting Edge 

    Your doctor should be knowledgeable about the latest treatment options.

    Your doctor must not be complacent with older treatments, but needs to be aggressive and see the wisdom in trying the new cutting edge drugs, when the patient is an appropriate candidate.

  • Should You Change Doctors? / Are Your Needs Being Met?

     Assess the issues in your own care such as:

    • communication
    • cost
    • convenience
    • continuity of care
    • confidence
    • cutting edge 

    Don’t settle for less than an optimal situation.

     

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    October 21, 2006

    About Dr. W.

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

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

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    May 15, 2007

    Looking for Patient Advocates

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

    Terrie

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    August 9, 2007

    It’s All a Matter of Perception

    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

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