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Going For The Throat: Improving Patient Care, The Doctor’s Perspective, Part II: My Crude Analysis

Post Published: 03 February 2010
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Category: Column, Health Care Column Thyroid Diseases and Thyroid Cancers
This post currently has 8 responses. Leave a comment

Written by Robyn Davis Hahn

Last week, I shared some unedited responses from several physicians to 3 simple questions I had posed to them.   Basically, it asked them to comment, from their perspective, on the biggest mistake patients make, the biggest mistake doctors make, and the biggest overall obstacle to improved patient care.   You can read the article and detailed answers here.   This week, I’m offering my take on their answers, and what this means for patients.

The doctors all had very different answers on the biggest mistake they perceive coming from their patients.   Two commented on the internet being a double-edged sword of both information and misinformation, leading to possible preconceived ideas or mistrust.   One stated that not discussing all symptoms, or not describing them accurately was an issue.   Others included being closed minded (entering the discussion with prejudice), not asking for clarification about treatment plans and/or diagnoses, and lack of understanding of the time stresses on the doctors.

To me, this boils down to errors in education (information) and/or communication: either entering the exam already thinking you know what’s going on and how to treat it, or not accurately representing your symptoms or feelings and/or your understanding of your diagnosis and treatment plan.   Certainly, commencing a relationship with a doctor and feeling that you know as much, or more, than they do about your disease is not going to be popular with them, even if it’s true.   To be fair, almost anyone would be defensive if faced with someone who acted like they knew more about a subject to which you devoted a huge portion of your life and education!,   I think this attitude can get us in trouble with ourselves as well–having a strong opinion in any direction is less likely to lead us down the appropriate path.   Better to have thoughts or insights while keeping an open mind, then to pridefully think we have all the answers and view our doctors as a stumbling block or just a medication dispensary!,   We can make our knowledge and information known, relevant, and non-threatening when we approach our doctor as a team mate.

“What are your thoughts on T3 therapy?,   Is this relevant in my case?,   What are the pros and cons of this approach?,   Have you seen cases like mine that benefited from any additional or different treatments?,   Should we be exploring other causes of my symptoms–could you tell me about adrenal fatigue? Contrast these questions with these: “Synthetic hormones aren’t working.   I want Armour…,   “I’ve done research online and just know I have adrenal fatigue.   I want testing for this or cortisone… You may very well know more about a subject than a particular doctor–and you absolutely know your body better than anyone, but open ended questions will begin a dialogue, and you may both learn something by communicating this way.   Your doctor may have not considered you a good candidate for T3 therapy because you are at high risk or have underlying heart disease, or some other scenario which you may have not considered.

Remarkably, all the doctors had the same opinion of the biggest mistake doctors make in patient care.   Not having or taking the time to develop a relationship and listening to patients was described in some manner by EVERY doctor. For many of us, this is not breaking news.   Some aspects we are not going to be able to change–none of us can expect bevies of personal phone calls for results or a doubling of allotted appointment times–but with this knowledge we can tip the balance in our favor.

How do we get our doctors to listen to us?,   Really listen?,   There are two primary components–open communication and actively listening ourselves.   Make sure that when you speak to your doctor, you are specific (instead of “I’m tired all the time say “In the past month, I’ve slept 8 hours each night, and still need a 1-2 hour nap several days each week), concise (instead of “So, it seems like I feel cold a lot–I often need to wear a sweatshirt around the house.   And I’m just really run down, I never seem to have any energy and I could fall asleep standing up if wasn’t careful.   Oh, and I have to wear socks to bed, too… say “My primary continuing symptoms are cold intolerance, increased need for sleep), and direct (be clear and assertive, but kind, “My symptoms tell me my thyroid is still not optimally balanced.   I would like to discuss additional testing/T3 therapy/etc…).   Then, it’s our turn to actively listen–repeat what your doctor says back to him or her, so that you are both sure you understand (“You are concerned about initiating T3 therapy for me because I have been extra sensitive to medications in the past…).   As stated above, open ended questions also promote a team approach–your doctor can talk with you, not at you, and you both can feel confident you are on the same page.   Make sure you end each appointment knowing the short term plan (such as increasing medication dosages), the long term goal (such as lab values in an acceptable range AND feeling improved), when to expect any results, and when to schedule follow-up appointments.  ,   Personally, I also ask at the end of each appointment if my current response to treatment is typical in my doctor’s experience (and if not, what he feels is the cause), how our plan will change if I am not responding as presumed, and if there are any other factors or problems we have not yet considered or discussed that could be part of my particular case.   If all your best efforts fail, ask your doctor (really!) or friends for a recommendation for another physician.

Lastly, the doctor responses touched on two overall obstacles to improving patient lives.   The influence of health insurance was one–lack of good coverage, insurance dictating allowable treatments, and placing the doctor and patient at odds with each other.   My (admittedly superficial) research on insurance is that it is one tangled mess–like the tax code–and will be difficult to navigate globally to be of any help individually (although I will do my best in the future). The other major response was a lack of compliance–patients not following treatment plans, and resisting lifestyle changes such as improving diet and exercise to improve their general health.   This is the part of our health that we have the greatest ability to control–it is our responsibility to do our part to maintain our body and give it the best chance to manage and heal.

To many of you, I may be starting to sound a bit repetitive.   I think better communication is the essential ingredient to a better relationship with our doctors.   By improving our side of the communication, and learning how and why most doctors communicate the way they do, we can ultimately guide our health management in a positive direction.   At the very least, we can begin to recognize our (doctors and patients) communication weaknesses–we can only fix what we know is broken!

Robyn

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8 Responses to “Going For The Throat: Improving Patient Care, The Doctor’s Perspective, Part II: My Crude Analysis

  1. HD in Oregon says:

    Robyn,

    Great response and wonderful, right on, advise on the communication issues.

    Repeating or para-phrasing back what the doctor said, like “Doctor, do I understand that right, you think I should… etc” works great for me! Being a foreigner and English not being my first language, I also make sure that I get an explanation of medical terms (Like it took me a little to absorb the difference between hypothyroid vs. hyperthyroid – it needed to sink in first, that one is too little and the latter too much). It literally was Greek to me.

    Having a physician as a good personal friend, I can corroborate that doctors are under quite a bit of time and performance pressure and stress. Her administrative office (the bean counters) are constantly on her case that she does not see enough patients in a given time period. Well, she does take her time to talk to patients and to establish a rapport with the patient, and to ask the right questions in order to make the right diagnosis.

    As to describing ones symptoms I feel the doctors (or the nurse in the pre-check before the visit) should have a checklist of sorts. I, as a patient, don’t have enough knowledge to know what symptom may be relevant to my condition and what is not.

    Again, great article. I think it is really helpful when dealing with your doctors.

    HD in Oregon
    Thycan+survivor
    http://www.hd-una.com/hd-cancer.html

  2. Dear Thyroid says:

    HD;

    I love the paraphrasing aspect, too. What I do because I’m so forgetful, is write down everything she says and reiterate what’s been said to ensure that I understand everything very clearly.

    Even though English isn’t your first language and is mine, it was all Greek to me. None of it made sense.

    I do completely agree with you regarding symptoms and better educated nurses; that is a wonderful point.

    Thanks for sharing your two cents.

    xo

  3. Lori says:

    Great job Robyn. Very good advice on communication. I really like the whole article and I think a lot of people will find this very helpful.

    The only question I would have back at those doctors is did you miss the history taking part of medical school? There job is quite detective-like and I think a bit more of the responsibility in this area should be placed on the docs. They need to know how to ask the right questions. When you have any new illness or trying to find out what is wrong, you really need a doctor that digs a bit with questions.

    For my most recent new doctor visit they sent out all paperwork ahead of time, which was great. This packet included their office procedures/responsibilities and also besides the regular standard questions, it had a very long symptom check list. It was very good because as I read the symptom check list it helped to jog my memory and think of other things I probably would not have thought of or remembered otherwise, but it pretty much covered everything.

  4. Robyn says:

    Whew. Today was a day for me at work (I rarely work on Wednesdays) where I struggled to be a good doctor. Staff accidentally booked 2 in the same slot, and a walk-in critical emergency. Let’s just say I got quite a bit behind, but every client was gracious!

    Anyhoo, I appreciate the responses. Lori, your observation is keen. There has been much talk in the medical community about not only the lost “art” of a good history, but the lost “art” of a good physical. Docs are quick to do a fast look over and send out tests for the answer. Granted, that helps with their time management short term, but not long term if the issue would be easily caught by being thorough to start.

    HD, also an excellent point. If you don’t know that your generic symptom *is* a symptom, it’s difficult to communicate with your medical team! It’s hard for us, and the docs, to separate what is relevant and what is not–that is where AWARENESS is so important!

  5. natasha says:

    Robyn – You are wonderful!!! I love these columns and the discussion!!
    🙂

  6. Jackie Kipilo says:

    Great article! I have run across docs in the past when you check off the symptoms, etc. on the checklist I have been told…”You can’t just check everything off. Pick a symptom and stick with it.”

    I went armed with photographs of myself only to be told that those couldn’t possibly be pictures of the same person.

    After 10 different endocrinologists in 10 years, I found one that actually listened. He looked at the pictures and decided something was wrong, then he looked at previous blood tests and asked me why these other doctors couldn’t see there was something wrong when all the test results were abnormal.

    I truly believe that doctors are more prejudiced than they let on. Just as an experiment, my new endo told me to take my lab results to one of my old endos.

    My old endo wanted to know if my new endo’s license had been pulled yet for prescribing medications “that I didn’t need” because all I needed (in old endo’s opinion) was a liquid diet and if that didn’t work…gastric bypass surgery.

    Old endo actually accused new endo of doctoring test results because “I have been in practice for over 20 years and I’ve never seen anyone with all of those abnormalities.”

    New endo is trying to talk to the AMA about my old endo being too old to keep his license. Old endo is about 75 years old.

  7. Robyn says:

    Yay, more responses!
    Natasha, you made me blush–no mean feat!

    Jackie, for sure there are docs “beyond hope”, and I feel sorry for every story I hear about them. I am sure they exist in all disciplines as well.

    What is difficult to focus on for us patients is that when it comes to diseases, there may not be one RIGHT answer. Just like there are different recipes for carrot cake (mmmmm….carrot cake) so there are different schools of thought on treatment of some disorders. What we need to do is COMMUNICATE if we are not happy with how our treatment is going, ask about alternatives, and then MOVE ON if we don’t feel the doc is willing to work WITH us.

    There is an issue with horses that can arise as a primary (or secondary to other disease) problem called “founder” or laminitis. There are literally HUNDREDS of treatments, none of which works all the time. Some docs “swear” by a treatment, or “pooh pooh” another, but the bottom line is that with many complex, multifactorial diseases, there may never be ONE RIGHT/PERFECT/GOLD STANDARD, whatever, way to treat. You have to be willing to explore, roll with it, and be a patient patient, and your doctor has to be willing to explore, listen, research, and refer you on if they feel they can’t help.

  8. You really make it seem so easy with your presentation but I find this topic to be actually something that I think I would never understand. It seems too complicated and extremely broad for me. I’m looking forward for your next post, I will try to get the hang of it!

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