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

 Enjoy the show:

I want everyone to see who I am and know that I’m a normal person!

This is my first video and if I get it right, we’ll be having alot of them. Enjoy this brief introduction.

Terrie

Revealing Statistics

The following statistics illustrate how widespread noncompliance really is among Americans: Only 55 percent of tuberculosis patients, 48 percent of diabetics, 46 percent of asthmatics, and 42 percent of glaucoma patients use their medicines correctly.

(Sources: The Food and Drug Administration and The National Council on Patient Information and Education)

 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.

Check out this article in USA Today! Thanks to my friend Joyce for alerting me about this.

The title is "Experts say lying patients at risk".

I’m so glad they published this article…and published it where lots of people will read it.

As embarrassed or unsure as you are about what a doctor’s reaction might be, it’s so vital that you tell the truth, the whole truth and nothing but the truth.

People tend to avoid subjects such as sex, depression (or other psych problems), herbal medicines, taking old medications (such as previously prescribed antibiotics), drinking habits, other conditions.

If you don’t tell the doctor about everything, you risk getting medications that will adversely interact with what you are taking. Many herbal medicines have dangerous interactions too.

Do not make the mistake of compartmentalizing your doctors. You may think that a specialist is taking care of a problem completely unrelated to anything else you have. But everything in your body (and everything you put into your body) is interconnected. So, tell them about everything. Oh, and don’t withhold information because you think that telling the doctor about everything is wasting his time. That is not the case when it comes to understanding what is happening in your body.

This is the reason I am such an advocate of carrying a list of your medical problems AND a list of your medications!

Read this article and pay attention, please.

Terrie

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

What is non-compliance?

• Not filing a prescription initially
• Not refilling a prescription when still needed
• Taking a medication at the wrong time
• Stopping a medication before medication course is completed without your physician’s advice
• Taking the wrong dose
• Taking a medication incorrectly
• Skipping doses
• Taking someone else’s medication

Do you know what your medications are? What each of them are for? How you’re supposed to take them?

Can you remember them? If not, you should write them down and keep them with you at all times. Use an index card to write down the names, the dosages, how often you take them and if you have room, jot down what condition each one is for.

Look at these statistics:

• Approximately 125,000 people with treatable ailments die each year in the USA becaue they do not take their medication properly.
• Fourteen to 21% of patients never fill their original prescriptions.
• Sixty percent of all patients cannot identify their own medications.
• Thirty to 50% of all patients ignore or otherwise compromise instructions concerning their medication.
• Approximately one fourth of all nursing home admissions are related to improper self-administration of medicine.
• Twelve to 20% of patients take other people’s medicines.
• Hospital costs due to patient noncompliance are estimated at $8.5 billion annually.

Noncompliance is typically cited as occurring in from 50%-70% of patients.  In other words, 50%-70% of patients do not properly take prescribed medication. The rate of noncompliance is even higher in patients with chronic illnesses.

Absorb these statistics - look in your own medicine chest……go from there.

Til later,

Terrie

 Got a question?

We discussed all that tonight on BlogTalkRadio Show - Your Doctor Said What!

It’s important that your expectations be realistic. Patients tend to diagnose themselves by talking to their friends, neighbors, co-workers (or going online) and that is not a great thing to do.

Patients judge a doctor’s  office based on other offices they’ve been at.

If the doctor spends more than 10 minutes with you, dont expect that every time.

How to judge your doctor’s communication skills:

- Does he smile?

- Is there open body posture? Does he lean forward?

- Does he make eye contact with you?

- Does he nod?

- Does he interrupt you - studies say that doctors interrupt patients 23 seconds into the interview.

- What’s his tone of voice like?

- Does he summarize what you discussed?

- Does he paraphrase your symptoms for you?

- Do you feel empowered?

Then we talked a bit about perception. Probably not enough though.

Listen in and see what you think..

Terrie

I found an article the other day that discussed use of the ER for non-emergency conditions. I thought it would be a good discussion topic so here it is:

Overuse of Emergency Departments Among Insured Californians

October 2006

One of the key challenges facing emergency departments (EDs) nationwide is a marked increase in use, driven primarily by insured patients who do not have true emergencies. With the troubling trend in California of emergency room closures, it is important to examine the factors that lead to inappropriate emergency room use.

A recent Harris Interactive Inc. survey found that nearly half of recent ED patients felt their problems could have been handled by a physician’s office visit, had one been available, rather than using the ED.

CHCF commissioned Harris Interactive to conduct two sets of surveys, one of emergency room patients and one of primary care physicians and ED physicians. The patient survey found four key factors that drive increased ED use by insured patients who are not critically ill:

• Lack of access to medical care outside the ED (e.g., same-day appointments with a primary care physician, or evening and weekend appointments);
• Lack of advice on how to handle sudden medical problems;
• Lack of alternatives to the ED (e.g., nurse advice lines or urgent care clinics); and
• Positive attitudes about the ED as a site of care.

The lack of options for Medi-Cal patients, who have even more trouble with access to primary care than privately insured patients, is especially severe. The study also noted that patients with chronic conditions made more ED visits, suggesting that their primary care providers may need to improve their methods of chronic disease management.

This issue brief summarizes the key findings of the survey, recommends strategies to increase alternatives to ED use, and calls for streamlined ED processes, as well as improved communication between physicians and patients.
 
Overuse of Emergency Departments Among Insured Californians - CHCF.org  –  http://www.chcf.org/topics/hospitals/index.cfm?itemID=126089

The one good thing from this (remember, I’m an ER doc) is the last bullet - that people had positive attitudes about the ED as a site of care. They may complain about the wait they have to get the care and to complete the care, but it’s apparent that people do think that ED physicians and staff are on the cutting edge. That’s a very important point but not a good reason to use the ED.

Not only is it bad for you when the EDs are so crowded but it’s bad for everyone coming in. Fortunately the ED staff is used to getting the story quickly and barking off orders for this bed or that bed and they all get done. But this is NOT a good way to get personalized care. I hope that physicians look at this brief and say to themselves that they need to look at the services they offer. As I talk about in "Your Doctor Said What?", we have to get sick on the doctor’s schedule and I can tell you from expeirence on both sides of the fence (as a doctor and perhaps, more importantly, as a patient, that rarely occurs. The Urgent care clinics have been a great boost there but a greater review of the situation is needed.

Terrie