Here are some articles I’ve written. They are pdf files so you need Adobe Reader

Keep a symptom diary

Don’t be embarrassed talking to your doctor

What the heck is compliance?

Are "TV Drugs" really good for you?

What does it mean when you hear "There’s Nothing Wrong"?

Making a list and checking it twice

Doctor Shopping

What if he doesn’t examine me?

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

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 cool. My article got published on MySeniors.com . It was also in HealthNewsDigest.com

Your Doctor Said What?

Make the Most of Your 15 Minutes

By: Dr. Terrie Wurzbacher DO 

Doctor-Patient Communication What your doctor does (and doesn’t) need to know

     Ok, you’ve got your appointment scheduled. You’ve kept your symptom diary. Now what? What is it your doctor needs to know – and conversely, what is it he doesn’t need to know? After all, you’ve only got those infamous 10 minutes to get everything accomplished – tell your problem, be examined, get a diagnosis, and ask your questions.

    What does the doctor need to know? Just about everything – but not in the conversational manner you’re used to. What’s your predominant problem and how long have you been experiencing it. Have you had this before – sometime in the past perhaps? If so, what was your diagnosis (if you went to have it checked)?    

    In addition, you should list the associated problems – pain, weight loss, nausea, vomiting, urinary symptoms, loss of appetite, cough, fever, chills, headaches, etc. It’s important to make sure you separate the two issues.

    What’s the character of the symptoms? Are they intermittent? Or constant? Are there periods of time when you don’t have any symptoms and feel pretty good?

    Have there been any changes in severity or location? Changes can indicate a lot about what’s going on.

    Why did you decide to come see the doctor now? Was it that it became intolerable? Was it that you finally realized it wasn’t going to go away?

    Remind the doctor about your past medical problems and your current ones. Take your index card and read off of it to him. Often times, your current symptoms may be related to your other problems or to their treatment.

    Likewise use your other index card – the one with your medicines listed on it.

    Tell him if you’ve had any other problems that you’ve seen another doctor for. Have your medicines changed? Have you run out of your medications? If so, when? If you’ve stopped your meds because of your symptoms, tell him when you stopped them.

    Have you been taking any herbal medications or other naturopathic remedies?

    What’s changed in your daily living or activities or abilities? Do you get out of breath faster, are you unable to walk up your stairs or go for your usual walk since you got sick?

    What doesn’t your doctor need to know? He doesn’t need to know all the details that go along with you telling your story. This is not a good way to describe your problems “I felt worse than when cousin Charles died” or “It started 3 weeks ago on a Friday and then that whole weekend we were at a high school reunion – you know my 30th – it wasn’t bothering me as much except when I went to bed. The long car ride made me more carsick than usual though. When we went to dinner with the Sullivans I wasn’t able to eat as much but I really didn’t have any bowel problems.”

    Eliminate the natural conversational patterns to get more out of the time you have with the doctor. Short and to the point makes it easier for him to hear the pertinent points.

    The doctor doesn’t need to know what you think the diagnosis is – unless you’ve had this same condition/symptoms diagnosed by a physician before. If you try to convince the doctor it’s something, then you may mislead him or lead him down the wrong path.

    Give your doctor your story in bullet points and don’t elaborate unless asked. Practice and write things down and you’ll do great!

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.

Here’s an interesting article that hinges around communication differences between men and women and the diagnosis of  complex pain conditions.

More Difficult For Doctors To Diagnose Complex Sources Of Pain In Women Than In Men

It is more difficult for doctors to diagnose complex sources of pain in women than in men and the reasons for this are rooted in language use. This finding, which is of major importance for both doctors and patients, is revealed by a now completed project by the FWF Austrian Science Fund. The results of this research into how the two genders typically describe pain are to be presented at the 2nd International Congress of Gender Medicine on 2nd and 3rd June in Vienna.

For quite some time, we have all known that men are from Mars and women from Venus, but scientific research has now proven that, when it comes to describing complex pain, men and women are worlds apart. This finding comes from studies that investigated patients suffering from complex headaches. While female patients give doctors brief and vague illustrations of their complaints, men describe their pain in an extremely concrete manner. This means that male patients are at an advantage when it comes to treatment as an accurate analysis of pain is essential for both diagnosis and therapy. 

{Terrie’s note - I do not necessarily agree with the statement that women give brief and vague illustrations of their complaints - or if they do, perhaps it’s for multiple, complex reasons - perhaps it’s perceptions of how the doctor is dealing with them or many other things…this statement is not well qualified to me and it gives women a bad "name" again}

LACK OF COMMUNICATION

A team headed by Prof. Florian Menz of the Department of Linguistics at the University of Vienna established that these different approaches to describing pain are caused by language barriers. Prof. Menz believes that "Women are rather vague and less detailed when portraying their pain, often focusing on the day-to-day situations in which the pain occurs. However, this does not constitute a description of pain in medical terms, as doctors develop a largely symptom-oriented language over the course of their careers. Men, on the other hand, describe their pain in very concrete terms focusing on their symptoms, which is very compatible with medical diagnostics and makes it easier for doctor and patient to understand one another."

{Terrie’s note - so maybe doctors need to be aware of this and change their approach to women?}

By investigating other patients suffering from chronic pain, the study showed that doctor-patient communication is also inadequate on other levels and leads to misunderstandings. While doctors are again primarily concerned with analysing pain when they speak to patients, the patients themselves ¬ who have lived with their pain for a number of years ¬ are more focused on treatment options for example. In such a scenario, doctor-patient discussions often fall short of patient expectations, as they are keen to be involved in the decision-making process.

 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

Kristen Gerencher is a reporter for MarketWatch in San Francisco.

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.

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