Tag Archive for: physician

Finding Your Health Partners

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I finished Thursday’s Memo by saying there may be hope for physicians when dealing with overweight patients. It was another viewpoint written by two clinicians. They say learning about diet and nutrition and how to interact with patients were not priorities in medical school; I’ve confirmed that with physicians I know. The authors put together ABCs of steps to treat obesity in patients. The very first one was the most important.

A stands for Ask for Permission: permission to speak to an overweight patient about his or her weight before discussing ways for the patient to begin to address excess weight. I’ll take that any day as the best first step. If physicians will do that, it shows respect for the patient. They further recommend addressing the purpose of the visit first and then asking if they could address excess body weight. That’s the way it should be. You can read the full article at the link below.

Paula, my family, and I have been blessed with some pretty special physicians and healthcare professionals who always listen to us and work with us to reach our health goals. Based on the feedback from the Thursday Memo, so have some of you. Too many haven’t, but there’s hope based on recognizing that it’s a problem in medical training as expressed in the article I cited.

If your doctor isn’t a partner to you, find a different one; that goes for specialists, dentists, physical therapists, and others. (Maybe not surgeons—I don’t care if he’s a jerk, I want the best I can find.) Ask friends and family for recommendations and check reviews online; as with anything online, take it with a grain of salt and read as many reviews as you can. If you’re staying in the same practice, find a graceful way to explain your desire to switch; you’d feel more comfortable with someone older (or younger), someone male (or female), and so on. Don’t be rude and demanding, but you’re the customer and if your optimal health isn’t the goal of the practice, maybe it’s time to start over.


The Bottom Line

I’ve spent the past two weeks addressing a different way to look at our health based on the books of Jane Austen and learning to love and respect ourselves. I’ve talked about healthcare professionals changing how they treat obese patients. But make no mistake about it: part of learning how to love yourself the way you are is to gain the confidence to address the issue to improve your health—not with the idea of being rail thin or running marathons, but by becoming the best version of yourself you can be, because that’s also a part of loving yourself.

What I envision is finding the physician or healthcare professional who will be your partner in the journey toward better health. You both have the responsibility to put forth your best efforts to try to do that. In every audio I record, I always say your physician should be your partner in reaching better health. I mean just that. So when you find that doctor, do your part; keep an open mind, do what you say you’ll do, and don’t make promises you know you won’t keep.

It all comes down to one question: what are you prepared to do today?

        Dr. Chet

Reference: JAMA Online. doi:10.1001/jama.2019.2352

Getting What You Need from Your Office Visit

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Here’s what we know. Patients get frustrated with office visits because they don’t always feel that they’re being heard. Research confirms that even when the physician asks “What brings you in today?” patients are usually interrupted before they can finish their reason. Where does that leave us?

Let’s take a look from the physician’s perspective. They have a limited amount of time to determine what the problem is, and they’re faced with patients who may take a long time to explain their problem. They may interrupt to ask a question about a symptom. While the physician may ask it with good intentions and think it will save time, it may redirect the patient to somewhere other than their main issue.

Don’t forget that physicians are trained to be problem-solvers. That’s different from being trained to take a healthy person and help them to attain optimal health. They’re trained that when people come to their office, something’s wrong and they need to fix it. Nothing wrong with that approach, but it’s also possible they miss issues during that process.

What can you do? Here are three steps to getting what you need from your office visit:

  1. Be organized before you go to the office. You’re going to be asked what medications you’re taking and any dietary supplements you’re taking. Write them all down, names and dosages, preferably in a printable document separating prescriptions from supplements. You’ll be asked about other doctors you’ve seen and why, plus any medical tests or procedures you’ve had. Note them on your list. Then write down the most significant symptom or symptoms you have.
  2. Take control of the visit. If you’re not asked, state as succinctly as possible what’s bothering you. Then answer the questions that are most likely to be asked. When did this begin? How bad is the pain? What have you already tried? You can anticipate questions and be prepared to answer them. If you’re interrupted, there’s nothing wrong with saying, “Please let me finish before I lose my train of thought.” Keep it on point; don’t stray into health issues that aren’t your objective that day.
  3. When you both decide on a course of action, get a verbal summary and written instructions if necessary. Ask questions. “We’re doing this blood test in order to test whether my blood sugar level is high? Do I have that right?” You want to leave that office with a plan of action. Understand that this visit may not completely resolve your issue until there’s more information to evaluate, but it starts the process. It’s up to you to follow through on what the doctor ordered and the steps you agreed to take.

The Bottom Line

Being healthy—and that includes when you’re not healthy and need to get back to it—requires teamwork. You have to find a way to make your physician listen to you, and you have to be precise in how you talk to him or her; remember they’re scientists at heart.

In my observation, many physicians haven’t been trained to treat patients as human beings. It isn’t that they can’t, it’s just the inherent weakness in their training as problem-solvers. Some doctors will be naturally good at listening and understanding, but it’s probably their personal instincts or experience rather than training.

Understand one thing about this process: you’re the customer and they’re selling their services. Patient satisfaction is becoming an important measure of how healthcare services of all kinds are evaluated. You’re the one in charge. I don’t say this lightly because I know access to healthcare can be challenging in some areas, but if you don’t get the service you need, fire that doctor and find another who will listen to you as a human who needs his or her expertise. Then do your job to be ready to help them do theirs. It’s the only way this crazy system will ever work.

What are you prepared to do today?

Dr. Chet

 

References: J Gen Intern Med (2018). https://doi.org/10.1007/s11606-018-4540-5

 

You Have 11 Seconds: Go!

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Did you ever leave a doctor’s appointment feeling that you never really described what the problem was or that you got sidetracked onto less important issues? Even if you went in organized to the extent that you could, your real concerns were shoved aside? I know hundreds of people who’ve felt that way. Let’s get back to the study I described Tuesday.

The researchers examined a randomized sample of the office visits, which were viewed independently and then ranked as to the nature of the visit. They first looked at whether the physician attempted to elicit a reason for the patient’s visit or not: turns out that the physicians asked only about a third of the time.

If they did ask, the researcher then timed how long the patient was given to explain their health issue before the physician interrupted the patient. The average was 11 seconds. The researchers did not explain the reason for the interruptions, but that’s all the time the patient had. Only the speedy patients who could somehow get it said in six seconds weren’t interrupted. The researchers concluded that not asking why the patient was in the office may not have set the priority of the visit towards what mattered most to the patient. Easy to see how that could happen.

What can you do to make sure that doesn’t happen to you? I’ll give you my thoughts on Saturday.

What are you prepared to do today?

Dr. Chet

 

References: J Gen Intern Med (2018). https://doi.org/10.1007/s11606-018-4540-5

 

The Unproductive Office Visit

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I recently got an email from a long-time listener to my local radio show Dr. Chet’s Straight Talk on Health. The gist of what she wrote went something like this. “You always tell me to work with my physician for my better health, that they should be my partner for good health. What if I can’t get their attention to listen to what I have to say? I had to get a new primary care physician (PCP). They didn’t really listen to me and just wanted to order a bunch of tests for no specific reason.” I’ve heard that before.

When we lived in Buffalo, Paula got an appointment with a new PCP. Paula goes to the doctor prepared; she always takes a list of her medications and because this was a new PCP and she knew she might forget something critical, she had printed a list of symptoms she wanted to discuss in hope of arriving at a diagnosis. The physician threw the list on the desk without looking at it and proceeded with his agenda. That’s not the way to get along with Paula; it went downhill from there.

Is this a common problem? Physicians who don’t take the time to listen to what ails us? Researchers wanted to find out. They examined video and audio tapes of office visits that were recorded for training purposes. This is a complex task because in some cases, a nurse may inquire about the nature of the visit while getting baseline information. In others, residents working with the physician may interview the patient to determine the purpose of their visit. In many cases, it was the first contact between patient and physician. What they found was interesting and disturbing; more in Thursday’s Memo.

Tomorrow night is the July Conference Call for Insiders. If you want to take part, simply go to DrChet.com and join as an Insider. I’m going to be discussing several topics including the effectiveness of complementary medicine in cancer treatment. As always, I’ll be answering Insiders’ questions as well.

What are you prepared to do today?

Dr. Chet

 

References: J Gen Intern Med (2018). https://doi.org/10.1007/s11606-018-4540-5