Make the most of your 15 minutes: how to make every second of you doctor’s visit count

So you only have 15 minutes with your doctor. Learn to make the most of every second. Try these techniques and see how much time you save - save for clarification and questions.

If you’ve kept up with your "index card system" you’re one step ahead of the game. You can read from the cards or give them to the doctor - the cards have your list of medical problems and your medications.

Keep the symptom diary and write out the list of symptoms, time of onset and any changes since they began. Practice talking about your symptoms ahead of time. Solicit the help of a spouse or friend to listen to you. Have that person practice looking away from you and looking at you so you experience both methods of exposure and you can get more comfortable talking about embarrassing symptoms to another person.

Remember to just list them with minimal conversational tone. That saves a ton of time.

Bring paper and a pencil so that you can take notes as the doctor asks you questions or says things you’re not sure of. Tell the doctor early on that you may need to interrupt to adequately understand what he’s asking of you or what he’s telling you. If you say this and ask "permission", you’ll get off on the right foot. But keep your notes anyway. While you’re waiting for the doctor, jot things down that you think of as you’re sitting there. After the doctor’s been in there, write down questions. Ask the nurses if you have the opportunity when they come in. Ask the nurses how to approach the doctor with questions if they can’t answer them.

Consider bringing a tape recorder- ask the doctor if you can record the encounter so that you don’t have to worry about misinterpreting what he said. Explain that you want your spouse to know what went on and "what the doctor said". You can even make a joke of it with him because I’m sure he’s heard many times before that the patient has problems remembering enough to satisfy the spouse.

Write, write, write. If you have chronic problems, you should get a stenographer’s pad and label that as your doctor pad. Use it to record your symptoms and take it with you to put your notes in. This way it’s always available for reference and you don’t have to worry about small pieces of paper and worrying about losing them.

Stop worrying about whether you’re saying the right thing or not or whether you’re answering questions correctly. Just say what comes to mind. There is no answer the doctor is looking for - he wants to hear what’s going on with you.

Don’t worry about whether the doctor looks at your or seems friendly. This will distract you from the purposes of your visit - to relay your symptoms accurately and succinctly and to receive information back. That should be your only focus.

Focusing on these two purposes will help you make the most of your time - those precious 15 minutes will seem a lot longer.

Hope this helps!

This is very long but well worth the read (to me anyway). Although it’s about the mental health professionals, it could certainly be applied to any physician. Know anyone who fits this bill?

This article received a Thinking Blogger Award!

 This is my proposal for the DSM inclusion of a new section that outlines and categorizes the features of Mental Health Professional Personality Disorders or MHPPDs.

This proposal begins with a general definition of Mental Health Professional Personality Disorder that applies to each of the 4 specific MHPPDs. An MHPPD is an enduring pattern of inability to empathize with or understand the inner experience and behavior of certain patient populations that deviate markedly from the MHP’s own expectations, individual culture, life experience, values, and personal lifestyle preferences. MHPPD is pervasive, inflexible, prejudicial and has an onset upon reading educational psychiatric literature, engaging in disparaging prejudicial discussion with “more experienced” colleagues, may be triggered by reading a chart with which includes a previous undesirable diagnosis for a patient, is stable over time, and leads to further distress or impairment in the condition of the MHP’s patient. The Mental Health Professional Personality Disorders included in this proposal are listed below.

Mental Health Professional Paranoid Personality Disorder is a pattern of distrust and suspiciousness such that patients’ motives are interpreted as malevolent or manipulative.

Mental Health Professional Antisocial Personality Disorder is a pattern of disregard for and violation of the rights of patients.

Mental Health Professional Narcissistic Personality Disorder is a pattern of grandiosity, need for the compliance of one’s patients, and a lack of empathy for the experience or suffering of those patients.

Mental Health Professional Coercive Personality Disorder is a pattern of dominant and aggressive authoritarian behavior related to an excessive need to be in control of patient treatment decisions.

Mental Health Professional Personality Disorder Not Otherwise Specified is a category provided for two situations: 1) the MHP’s personality pattern meets the general criteria for an MHPPD and the traits of several different MHPPDs are present, but the criteria for any specific MHPPD are not met; or 2) the MHP’s personality pattern meets the general criteria for an MHPPD that is not included in the Classification (e.g., mental health professional passive-aggressive personality disorder). It should be noted that MHPs frequently present with co-occurring personality disorders.

More on Satire - But, Oh So True!

This is important information on strokes from Harvard Health Beat

3 Warning Signs of Stroke You know the signs of a stroke. Or do you? You’d probably recognize the classic symptoms, such as sudden weakness on one side of the body or blurred vision, but often the signs are much less obvious. A crushing headache may come on without warning. Your face may feel numb. You may have inexplicable trouble speaking or following what people say. How to tell when someone’s having a stroke Crooked smile. Have the person smile or show his or her teeth. If one side doesn’t move as well as the other or seems to droop, that could be sign of a stroke. Arm drift. Have the person close his or her eyes and hold his or her arms straight out in front for about 10 seconds. If one arm does not move, or one arm winds up drifting down more than the other, they may be having a stroke. Slurred speech. Have the person say, “You can’t teach an old dog new tricks,” or some other simple, familiar saying. If the person slurs the words, gets some words wrong, or is unable to speak, that could be sign of a stroke. Knowing all the warning signs of a stroke may one day save your life and well-being. That’s because the faster you recognize the symptoms, the sooner you can get medical help. And prompt treatment is the key to shielding your brain from a stroke’s damage and sparing you serious disabilities such as paralysis, speech impairment, and dementia. Every 45 seconds, someone in the United States has a stroke. Stroke is the third leading cause of death in the United States and other industrial countries, trailing only heart disease and cancer. In the United States, about 700,000 people have a stroke each year. If you have a stroke, the risk of dying from it increases with age: 88% of deaths from stroke are in people 65 and older. About two-thirds of people who have a stroke have some resulting disability and require rehabilitation. The odds of having a stroke more than double for each decade after age 55. Two-thirds of strokes involve people over 65. Men and women are about equally likely to have a stroke, but women have a greater risk of dying from one. Race is another risk factor. African-Americans, for example, are almost twice as likely to suffer a stroke as are whites. Although you can’t change your age or race, you can take steps to reduce other risk factors for stroke, especially ischemic stroke. The most common risk factors for both ischemic stroke and TIAs (transient ischemic attacks, or "mini strokes") are high blood pressure (hypertension), diabetes, unhealthy cholesterol levels, and obesity. All of these factors affect the health of your blood vessels — increasing the risk not only of stroke, but also of heart disease. That’s why medications and other steps you take to reduce the risk of an ischemic stroke will also benefit your heart. Some types of hemorrhagic strokes are more likely to occur in people with chronic high blood pressure. But other types of hemorrhagic strokes seemingly strike out of the blue. Although abnormal blood vessel conditions such as an aneurysm (a bubble in the blood vessel wall that could rupture) or an arteriovenous malformation (an abnormal tangle of blood vessels) increase the risk, these conditions may only be discovered inadvertently while you are undergoing testing for something else or may not be discovered until a stroke occurs. Fortunately, medicine has made considerable strides in understanding how to treat and prevent strokes. Medical imaging devices now enable medical teams to begin to diagnose a stroke accurately within minutes. Large studies have clarified which medications and other treatments are best for which patients. For those who need rehabilitation, experimental techniques are showing promise in helping patients make better progress than was possible even just a few years ago.

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.

Each of us has our own idea of what particular outcome we want no matter what the scenario. We don’t usually go into a situation blindly…we know what we would LIKE to happen. Whether that happens, is not the point.

So, I would venture to say that in addition to the expression "perception is reality" one has to add the word "expectation". Since you go into something with a certain expectation, that expectation is actually going to frame your perception.

What the heck am I talking about…well, consider this.

When you walk into the doctor’s office, do you expect people to look at you intensely? Do you expect them to be friendly when they ask "what can I do for you?" What do you expect? Are you putting your nervousness and fear in the way of what you expect? Do you "think" they will be mean and unfriendly? Are you judging from what others have told you about their "horrible" experiences with "The Doctor"? How have you come to form these expectations?

If you walk into the office expecting dull, unhappy, mean and unfriendly people, that’s probably what you’re going to get. And then, the vicious cycle has begun. You will assume that your perception of that encounter is a mirror of what’s to come. And that’s not necessarily the case. Maybe the person at the front desk is ill or has some major family problems. You don’t know what’s going on in his/her life that’s affecting the way he’s/she’s greeting you.

Don’t expect anything but the best. And if your perception of one thing isn’t the best, move right on to the next, knowing that that will be better.

One quick example to end this post for today (and I will post more later about this issue) -
If you go into the office thinking that since your appointment is at 10:00 you should be seen at 10:00, you’ll most likely be disappointed, right? Isn’t that what everyone talks about..hurry up and wait? So, why go in with the expectation that you’ll be seen at 10:00? Why set yourself up to be disappointed? Go in knowing that the doctor really does try to be on time but that maybe one or more other patients needed a bit extra or a return phone call and you’d like for the doctor to do the same for you - not say "oh, I’m sorry, I can’t do anything more than this because I have to be exactly on time." Go in prepared to wait and then you may be pleasantly surprised and if you’re not pleasantly surprised at least you’re not disappointed.

Take a look at your expectations….Until later….

Terrie

It never ceases to amaze me how any doctor is able to accurately diagnose patients. With as little information as they are able to get from the patient, it’s kind of a miracle that things turn out right…What am I talking about?

Well, I have a friend who was recently hospitalized (in ICU even) for a urinary tract infection that had spread through his body. Fortunately he got better but in the last month and a half has proceeded to tell me (of course, "as a friend - who just happens to be a doctor" - yeah right) bits and pieces of information about his past and even his current condition (he had to self-catheterize himself - putting a tube in his own bladder four times a day to get the urine out and he got another infection) than i’m sure any of his doctors know. And I’ve listened to him a heck of a lot longer than the 15 minutes your doctor might have with you. The things he tells me he didn’t think were IMPORTANT to tell the doctor - or they were things that he thought of when talking to an old friend. In fact, he must have talked to everyone about it and told everyone his symptoms EXCEPT his doctor. Then he wanted to know how I could have told him some of the stuff I have when I’m a thousand miles away and his local doctors aren’t able to tell him these things….just amazing…

But each time I get off the phone with him I realize that this is what real life is all about and that’s why it’s so important for each of you to keep a diary of your past medical history, your past procedures, your medicines and as importantly, your current symptoms. Then make sure you take that diary with you. You should even transcribe your symptoms onto another piece of paper to give the doctor. Summarize things - "I’ve had abdominal pain above my belly button and under my right rib cage for about 3 weeks now. It seems to come and go and it’s so very sharp that it doubles me over and I have to continually walk around until it goes away. I throw up several times while I have the pain. It even goes to my back and my right shoulder sometimes. Nothing makes it better - it just goes away by itself. It usually comes on about 4 hours after dinner though, especially when we’ve had greasy stuff. etc."

If you take that summary out of your diary, put it on a sheet of paper and give it to the doctor, he can extract so much information from it and can then ask more pertinent questions - rather than having to start from scratch and be like a dentist - pulling teeth!

Be thankful that your diagnoses are correct as many times as they are..and help your doctor along the next time.

Terrie

You know what I mean - those questions that you "just can’t talk about".

But you have to talk about them in order to get some resolution and help and more importantly reassurance. In some cases, the problems you are hiding might be very significant.

I’ve had two very memorable patients in my career that practiced denial to the point where it had become a way of life - but, unfortunately, in a bad way. Both of these people had growths on their body - where they could see and feel them constantly - and they let them become very big and open. Both were cancerous. I won’t go into the graphic details but for them to have been firmly planted in my memory forever, believe me they were bad. And I don’t want any of you to end up in that boat.

I think the one thing I can tell you from my side of the gurney or desk is that there isn’t much you can tell me or talk about that I haven’t heard before. I’m not sitting there waiting for some "juicy story" to come across so all of us in the office (or in my case, the Emergency Department) can have a good laugh. That is NOT the case at all. What’s the expression - "been there, done that, got the T-shirt" - and in my case you could probably tag on to the end of that "waiting for the DVD".

That knowledge may or may not help you but it ought to help. Knowing that the doctor isn’t going to laugh at you or demean you is very important. You should also know that you’re most likely not the only person in the world with this problem. The internet has helped in that manner but still, most people feel alone in their problem and do not really know that there are others out there with the same misery. That’s one reason (and probably the only one) I can accept the TV ads for Viagra and Cialis and Levitra and whatever. They at least are showing people that it’s ok to talk about it, that others have it and that there is help. It’s a very common problem and now more people are realizing they are NOT freaks because of it. The same applies to most anything you may be having a problem wtih.

It’s very helpful to practice saying what it is that’s bothering you. I recommend that you first write down your symptoms (I recommend this for everything, not just the embarrassing ones) and then practice saying it to someone - a spouse or a close friend. If you have neither, then use the mirror - just talk it out. That is the dry run, so to speak. Once the words are out of your head and spewing forth from your tongue, you will feel a sense of relief that you’ve never known. It’s really amazing how that happens. Even if you’re not saying the words to anyone who can do anything about it. You’ll feel a freedom and have a sense that you can tell it to a "stranger".

If the embarrassing (for me that’s almost as hard as Mississippi - is that right? -smile) problem is the real reason you’re going to the doctor, make it the first thing you talk about. Don’t couch it in a bunch of other things and "hope" the doctor will stumble upon it. This is not an archeological dig even though it appears to be sometimes. Spit it out. Tell your doctor why you’re REALLY there.

I try to preface a discussion of that sort with "I’m really embarrassed to tell you this, doctor. And, I’m not sure I can get it all out. Do you mind if I take some time? Maybe once I get started you can help me?" If you let the doctor know up front that this is an issue for you, the process will be alot easier.

Remember that a few paragraphs above I recommended you write things out. Do it! AND, take that piece of paper with you. Give it to whomever will take it. Make copies. If you know you just can’t get it out of your mouth, hand it to the doctor and say "this is really embarrassing. I wasn’t sure I could tell you about it so I wrote it down" and hand him the paper. You’ll be amazed at how that will open the door.

Not only will you be amazed, but you’ll probably get some help and feel immensely relieved as well. Always know that things are easier to handle when you have an ally - and telling your doctor about your embarrassing problem will then provide you with a very big ally.

Go ahead, practice with someone…..it works…practice even if you don’t currently have a problem.

Terrie

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 

Excellent article from the University of Chicago’s Medical Center 

Talking to Your Doctor about Asthma

Good communication between people with asthma and their health care providers is essential for making the most of health care, and for ensuring that quality of life is the best it can be. Communication isn’t always easy, though, and both sides have to work to make sure that understanding is reached. Being "the patient" can sometimes feel intimidating and confusing. Many of us have had the experience of leaving a doctor’s office never having asked a question we went in meaning to ask.

Here are some things to think about to make your interactions with your health care provider the best that they can be.

Prepare for each visit. Write out any questions you have, or anything particular you have to report. That way, even if you get flustered during the visit, you can refer to your list and make sure not to forget anything important.

Take along any records that you keep at home. Many people with asthma keep symptom diaries, and/or logs of daily peak flow measurements and medication use. It can be tremendously helpful to your care provider to be able to go over these, to track how you’ve been doing from day to day.

Take along all of your inhalers and other medications (including the ones that are not for asthma). This is vitally important, especially if you are taking more than one or two medicines.

Be assertive (not aggressive). Speaking up is not always easy, but it is important for your care provider to know what your concerns are. If you don’t get a response initially to your question or your worry, just ask again. If you don’t understand what you are told (doctors and other health professionals sometimes forget and lapse into medical jargon), ask for clarification. Be both persistent and polite. You should be able to keep interactions respectful and friendly while still being firm about getting the information that you need.

Similarly, if you do not feel comfortable with a proposed treatment or test, make that clear to your care provider. There may be alternatives available, and you can’t know until you bring it up!

Be truthful. A health care provider needs to know what is really going on with you in order to make good (and safe!) decisions about your care. If you have not been taking a prescribed medicine, or have not been doing your peak flow measurements, say so! (Giving incomplete or false reports in these situations can be DANGEROUS, because your health care provider is basing your treatments on the information.)

If you have not been following the recommended plan, it is also very helpful if you can explain the reasons that you haven’t. That starts the conversation. Then you can work out a plan together that comes closest to fitting all of your needs (health, safety, convenience, comfort, and cost).

Find a health care provider you can work with. Even the smartest, most accomplished doctor in the world might not be the right one for you if you can’t communicate with each other. Most health plans offer a choice of different physicians and other care providers (such as nurse practitioners). Don’t be afraid to shop around until you find someone who is right for you:

• Someone you trust
• Someone who listens to you
• Someone who respects you
• Someone who answers your questions and explains things in a way you can understand
• Someone who is willing to negotiate with you and take your concerns into account

Be a partner in your own care. You are the person who has the most power over your health. Doctors and nurses have expert knowledge and can guide you in choosing a treatment path, but you are still the one caring for yourself day in and day out. Take an active role!

BE YOUR OWN EXPERT. Learn what you can about asthma, especially about your different treatment options, and steps you can take to keep yourself healthy. Know what to do if you start having worse symptoms or if your peak-flow measurements go down (signalling the possible start of an asthma episode). Know when to call your health care provider, and when to go to the emergency room. (If possible, get written instructions to keep on hand.)

BE YOUR OWN HISTORIAN. Keep records of your asthma care. Know the names of medicines you are taking, and medicines you have tried in the past. Be able to report how well they worked for you, and whether you had any side-effects from them. If a symptom diary or peak-flow log is part of your care plan, keep it up to date and organized. Keep a list of things that have triggered asthma episodes for you.

BE YOUR OWN ADVOCATE. Health care is not one-size-fits-all. Your preferences and priorities are important in determining the asthma care most appropriate for you. Let your care providers know what is important to you. Do you just hate taking pills? Are you unable to take medicine in the middle of the day while you are at work? Is sleeping through the night your top priority? Speak up! Negotiate!

BE YOUR OWN DRILL-SERGEANT. There are difficulties with maintaining any kind of daily regimen, whether it’s exercise or diet or doing one good deed every day. Staying faithful to a medication and inhaler regimen can be even trickier, because we don’t like to be reminded of illness, especially when we’re feeling healthy. But remember that it’s sticking to your treatment plan that keeps you healthy. Be strict with yourself, and stay on your program

Expect good asthma control. Some people with asthma are so used to having their activity limited and feeling crummy all the time that they have grown to accept this as normal. It doesn’t have to be!

With careful treatment (and sticking to the treatment plan), the vast majority of people with asthma can achieve good asthma control. Good asthma control means:

• sleeping through the night without being awakened by coughing or wheezing
• being able to exercise as much as a person without asthma
• not missing school or work days due to asthma
• not having to go to the emergency room or into the hospital for asthma · using a quick-relief inhaler once a day or less
• being able to do the things you want to do without asthma getting in the way

If you do not have good asthma control, talk to your health care provider about changing your treatment plan.

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