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 

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.

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.

Here’s a replay of my interview by Sherry Anshara of Conscious Healing. We had a great talk on the 14th of March 2007. She even liked the book. 

Sherry is a medical intuitive and you can tell just from listening to her that she has the exact combination of understanding and compassion to help bridge the gap between the "traditional" medical community and the "alternative" side. I am sure you’ll enjoy listening to her and then visiting her QuantumPathic website. I know I was impressed - and not just because she was interviewing me. Anyone who knows me knows it takes alot to impress me.

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

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.

 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

Medical doctors are trained diagnosticians - experts at assessing a cluster of symptoms and results of diagnostic tests. Sometimes, as human nature would dictate, patient education breeds amateur diagnosticians. Patient education can empower patients in a good way, but beware, too much knowledge can be a dangerous thing.

Patients can consume health information that they don’t totally understand. Overlapping symptoms, symptoms which fit more than one condition, can cause confusion. Patients may be prone to create and present theories to their doctor, rather than merely presenting detailed symptoms.

Example 1: Doctor, I have had a sharp pain in my hip for 2 weeks. The pain is worse after activity and is relieved following periods of rest.

Example 2: Doctor, I have pain in my hip and I think it’s arthritis. My neighbor has arthritis.  

In Example 1, the patient is very specific in describing the type of pain (dull, sharp, or ache) and specific about the duration of the symptom and when it occurs. The doctor has useful information which will lead to more questions and the proper diagnostic testing. In Example 2, the information is vague and the thinking is disconnected.

Use patient education in positive ways 

To be a partner in your own health care and be able to use patient education in a positive way: 

• Always give full details of the symptoms you are experiencing when you consult with your doctor.  
• Learn about your disease or medical condition. Patient education will help you understand the decisions and direction your doctor offers.  
• Learn about treatment options and medications. Patient education regarding treatments and medications will inform you about the expected benefits, and help you recognize possible drug side effects and adverse events.  
• Discuss all issues and concerns openly with your doctor. Your doctor is most effective if all pertinent information is disclosed. Your medical history is as valuable a diagnostic tool as a newly ordered test.  
• Present your doctor with all of your questions. Do not make the mistake of thinking you know an answer before discussing a specific concern with your doctor. Do not leave your doctor’s office with unanswered questions.  
• Be a compliant patient. Recognize that you and your doctor are indeed a team working towards the same goal - managing your medical condition.  
• Be honest. Your doctor can only work with the facts. If you didn’t take your prescribed medication as directed, don’t pretend you did.

 Patient education is for better understanding 

It may be time to find a new doctor if you genuinely feel you are smarter than your doctor and are unable to build good rapport. Consider, though, that patient education may have improperly empowered you. 

• Recognize that patient education is for the purpose of better understanding.
• Patient education must not diminish the role of your doctor who ultimately must lead, direct, and decide the best course of medical treatment for you.

 In the end, you must be able to trust your doctor and respect his advice. It is with that trust and respect that you build a strong doctor-patient relationship.

(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