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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July 2, 2007

Health Media Campaign to promote Better Doctor-patient communication

 

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

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

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

"HealthMedia initiated this campaign because there is often a lack of important communication and information sharing between patients and their healthcare professionals," said Ted Dacko, HealthMedia President and CEO. "Patients are often intimidated by their visit with their doctor. They often don’t remember to ask the questions that they wanted to ask, don’t understand parts of what their doctor tells them, don’t know how to use reflective listening (repeating back what they think they heard) to make sure that they understand advice, and can be unsatisfied with their overall relationship with their doctor and their health plan. HealthMedia offers specific products that help patients improve their communication and overall trust with their doctor. This has proven to improve outcomes."

The video will be used primarily as an advocacy campaign for health professionals and consumers. In addition, it will be used as a tool to help recruit participants into disease management web interventions focused on a better working doctor-patient relationship. Finally, the video will be used as part of the successful HealthMedia Care(TM) for Your Health program, an online intervention designed to improve clinical disease management efforts by helping people with chronic conditions develop the self-management skills necessary to take charge of their health. Current estimates indicate that more than 85 percent of disease management is self-management.

"Improving the doctor-patient relationship can improve outcomes, medication adherence, and satisfaction with the health care provider and the health plan. Shedding light on this issue, in an unconventional and humorous manner, will help both doctors and patients better appreciate the importance of overcoming fear of doctor’s visits and better communications," said Dacko. "The use of an entertaining and engaging medium is just one more example of HealthMedia’s revolutionary approach to behavior change."

"The relationship between patient and doctor is the very foundation of the healthcare system," said Vicki Rackner, MD, a surgeon who now focuses on improving the health of the doctor-patient relationship through her company, Medical Bridges. "HealthMedia recognized the importance of the relationship, developed tools that guide patients beyond their comfort zones and collected the data to confirm what I always knew to be true-improving the patient-doctor relationship enhances patient experiences and outcomes."

In "The Appointment," HealthMedia provides the following tips for patients in creating a successful partnership with their physicians:

Be honest with your physicianAsk questions if you do not understand something your physician has said — Bring a list of medications and vitamins you are takingTake notes during your appointment — Bring a family member or friend along if you need help — Alert your physician to changes in your life and/or health About HealthMedia, Inc.

HealthMedia Inc.

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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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April 19, 2007

Doctor-Patient Communication Has A Real Impact On Health

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

Doctor-Patient Communication Has A Real Impact On Health

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

A systematic review of studies published over the past four decades has confirmed that good doctor-patient communication makes a difference not only in patient satisfaction but in patient outcomes including resolution of chronic headaches, changes in emotional states, lower blood sugar values in diabetics, improved blood pressure readings in hypertensives, and other important health indicators. The review, published by researchers from the Indiana University School of Medicine and the Regenstrief Institute, Inc. and colleagues from the Centers for Disease Control and Emory University, appears in the April 2007 issue of Medical Care, a journal of the American Public Health Association.

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

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

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

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

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

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June 26, 2007

The Patient-Physician Encounter

 What a great article from About.com - even though it’s primarily about arthritis, the concepts are exactly the same for every patient-physician encounter. Read about it.

The Patient-Physician Encounter

From Carol & Richard Eustice 

The good physician treats the disease; the great physician treats the patient who has the disease ~ William Osler (Canadian Physician, 1849-1919) 

The Patient-Physician Encounter 

What do patients want from a medical encounter with a physician?

In the thoughts of one physician (Delbanco,1992)

  • Patients want to be able to trust the competence and efficacy of their caregivers.
  • Patients want to be able to negotiate the health care system effectively and to be treated with dignity and respect.
  • Patients want to understand how their sickness or treatment will affect their lives, and they often fear that their doctors are not telling them everything they want to know.
  • Patients want to discuss the effect their illness will have on their family, friends, and finances.
  • Patients worry about the future.
  • Patients worry about and want to learn how to care for themselves away from the clinical setting.
  • Patients want physicians to focus on their: 
                      pain
                      physical discomfort
                      functional disabilities  

The Relationship Between Patient And Physician 

The relationship between patient and physician has been analyzed since the early 1900’s. Prior to when medicine was more science than art, physicians worked to refine their bedside manner, as cures were often impossible and treatment had limited effect.

In the middle of the century when science and technology emerged, interpersonal aspects of health care were overshadowed. There is currently a renewed interest in medicine as a social process. A physician can do as much harm to a patient with the slip of a word as with the slip of a knife. 

Instrumental And Expressive Components 

The patient-physician encounter crosses two dimensions:

  • The "instrumental" component involves the competence of the physician in performing the technical aspects of care such as:

    • expressive
    • performing diagnostic tests
    • physical examinations
    • prescribing treatments
  • The "expressive" component reflects the art of medicine, including the affective portion of the interaction such as warmth and empathy, and how the physician approaches the patient.

  • 3 Common Patient-Physician Relationship Models

     #1) The Activity-Passivity Model - Not The Best Model For Chronic Arthritis

    It is the opinion of some people that the differential in power between the patient and physician is necessary to the steady course of medical care. The patient seeks information and technical assistance, and the physician formulates decisions which the patient must accept. Though this seems appropriate in medical emergencies, this model, known as the activity-passivity model, has lost popularity in the treatment of chronic conditions such as rheumatoid arthritis and lupus. In this model the physician actively treats the patient, but the patient is passive and has no control.

    #2) The Guidance-Cooperation Model - The Most Prevelant Model

    The guidance-cooperation model is the most prevalent in current medical practice. In this model, the physician recommends a treatment and the patient cooperates. This coincides with the "doctor knows best" theory whereby the doctor is supportive and non-authoritarian, yet is responsible for choosing the appropriate treatment. The patient, having lesser power, is expected to follow the recommendations of the physician.

    Part 2 of 2 - The Patient-Doctor Relationship Can Impact Success of Treatment

    3 Common Patient-Physician Relationship Models - 

    #3) The Mutual Participation Model - Shared Responsibility

    In the third model, the mutual participation model, the physician and patient share responsibility for making decisions and planning the course of treatment. The patient and physician are respectful of each others expectations and values.

    Some have argued that this is the most appropriate model for chronic illnesses such as rheumatoid arthritis and lupus, where patients are responsible for implementing their treatment and determining its efficacy. The changes in the course of chronic rheumatic conditions require a physician and patient to have open communication so as to determine the success of a treatment plan. 

    What Is The Optimal Patient-Physician Relationship Model For Chronic Arthritis? 

    Some rheumatologists feel that the optimal patient-physician relationship model is somewhere between guidance-cooperation and mutual participation.

    In reality, the nature of the patient-physician relationship likely changes over time. Early on, at the time of diagnosis, education and guidance is useful in learning to manage the disease. Once treatment plans are established the patient moves towards the mutual-participation model as they: 

  • monitor their symptoms
  • report difficulties
  • work with the physician to modify their treatment plan  

    The Efficacy Of Treatment 

    Arthritis is not a single disease. There are over 100 types of arthritis and related conditions. The effectiveness of treatment is largely dependent on the patient carrying out the directions of the physician. Treatment options for arthritis may involve: 

    Non-adherence to the physicians treatment plan does imply a negative outcome. In this regard, non-adherence suggests a complete failure to follow a prescribed treatment. The assumption here is that: 

  • the treatment is appropriate and effective
  • there is an association between adherence and improved health
  • the patient is able to carry out the treatment plan  
  • What Are The Effects Of An Effective Patient-Physician Relationship?

    What are the effects of an effective patient-physician relationship? When the PATIENT-PHYSICIAN RELATIONSHIP includes:

  • competence
  • communication
  • an effective style
  • These factors can provide for PATIENT SATISFACTION WITH CARE which leads to better ADHERENCE TO TREATMENT.

  • When better ADHERENCE TO TREATMENT combines with PATIENT SATISFACTION WITH CARE, this often promotes IMPROVED HEALTH with a BETTER QUALITY OF LIFE.

    BOTTOMLINE: The adherence to a treatment plan by a patient and the success of the treatment can be greatly impacted by the patient-physician relationship. 

  • Source: Understanding Rheumatoid Arthritis by Stanton Newman, Ray Fitzpatrick, Tracey A. Revenson, Suzanne Skevington, and Gareth Williams
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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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    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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    June 29, 2007

    Can You Know Too Much?

     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. 

    • Is it possible though for a patient to know too much?
    • Is it possible that a patient can believe they are more knowledgeable than they actually are?

     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.

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    June 28, 2007

    Join me tonight!

    On IN SHORT ORDER, Thursday, June 28th at 9:00PM EST, Sue Vogan and Dr. Terrie Wurzbacher will be talking about healthcare and taking questions that have been on your mind.

     Patients: Do you ever wonder why your concerns were not being addressed at your doctor’s visit? Is there a way to prepare for an upcoming trip to see your physician? Do you think your doctor is talking in a foreign language? Do you understand the gatekeepers’ jobs? Do you get nervous at your appointment or are embarrassed to discuss your symptoms?  Is there anything you can do to help your physician take better care of you? 

     Doctors: Do you have a patient who never answers the questions you ask? Do you get the feeling that you’re working on an assembly line? Do your patients have that deer-in-the-headlight look when you speak? Are you truly hearing your patients? Is there anything you can do to help make the visit easier on your patient?

     Well, tune into In Short Order and take the mystery out of your doctor/patient relationship! Dr. Terrie Wurzbacher and Sue Vogan will be talking about ways to prepare, communicate, and, if all else fails, move on when it comes to your healthcare.

     You are invited to call in with questions, comments or your best doctor/patient story.

     The call-in hours are Thursdays, 6PM Pacific - 8PM Central - 9PM Eastern USA and Canada Toll Free Line is 1-888-762-8153 extension 897 International Callers may call

    1-321-253-9667 The worldwide show at www.highway2health.net

     Sue Vogan is a published author, journalist, book reviewer, and Lyme disease advocate – www.suevogan.com.

     Dr. Terrie Wurzbacher has been a physician for over 30-years, retired from the U.S. Navy, and is currently an ER doctor in Texas. She is also the author of, “Your Doctor Said What?” – www.yourdoctorsaidwhat.com

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    October 20, 2006

    Inside a doctor’s mind

    I think back to some of my encounters with patients and feel lousy that I probably acted as if I were not really "there" with the patient. Even though as an ER doctor I learned to multi-task very early on, the patient never knew that I really could pay strict attention to them and what they were saying while still hearing and seeing everything that was going  on around me in the ER.

    I imagine they thought I wasn't interested in them and therefore didn't think their problem was very important.  And that's not the case at all.

    So, I caution people to not make snap judgments about whether your doctor is listening to you or not. You cannot really tell just based on how they do or don't look at you. On a personal note, I have to tell people I'm talking with (including my best friends) that if I'm looking away, I'm probably trying to concentrate/think and listen to a greater degree. I find that when I look at you and try to pay attention to you, I get distracted - usually by your eyes for they ARE the window to your soul and you can learn so much from someone's eyes. But, if I don't tell the other person this, they might think that my looking away is a sign of boredom. And it's just the opposite. A fine line to walk.

    Use all your senses to accumulate an entire picture about what's happening with the doctor before you judge that he or she is not "interested" in you or your problem.

    Terrie

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