In another post I referred to my Patient Power Manifesto.  This is an idea I got from Havi Brooks, the amazing creator of the Damnit list – which is basically all the ideas that she’s discovered that help her create a business and a life that works for her.

The Patient Power Manifesto is my ongoing list of what helps and what hurts when it comes to my health care. 

This section is about dealing with doctor’s offices:

  • Come Prepared:  I bring an Appointment Preparation Worksheet (see link on right to download for free)  to every appointment along with a copy on a clipboard with a pen to take notes – every single time.
  • Think Ahead:  Before I schedule a doctor’s appointment, I know what I want help with and write it down on my Appointment Preparation Worksheet – every time.
  • The Details Matter:  Along with my Appointment Preparation Worksheet, I bring a complete list of medications and supplements.  If it is a supplement that has more than one ingredient in it, I bring the bottle or copy the lsit of ingredients from the bottle.
  • We’re in this Together:  I give the doctor the time and space they need to do the physical portion of our examination so they can get the information tney need
  • Silence is Golden:  I don’t talk to the doctor as she is writing notes or prescriptions to encourage her to concentrate completely on what she is doing.
  • Listening Carefully/Asking Questions:  I make sure to ask questions when I get confused.  If the doctor is still talking explaining things that may help me get it, I continue listening as I write my question so I don’t forget to ask it.
  • Clarifying My Understanding:  I look at my list of questions and make sure I have the answers I need before leaving the doctor’s office.  If I don’t have the answers I need and it’s unlikely the doctor will have time to answer them before I leave, I schedule another appointment.
  • Timing Matters:  I allow enough time when I schedule an appointment for the doctor to run late and I leave enough time afterwards to hang around to allow the doctor to go on to other concerns as needed and get back to me when she has more time to talk about my concerns.  If that doesn’t happen, I ask the nurse whether I should make another appointment or leave my question in writing.  I also ask when I should check back for an answer to my concern if I leave a written question.
  • Honoring the Doctor’s Payment Policy:  My doctor has a policy of paying copays when you sign in.  When I sign in, I have my credit card, license and insurance handy for them at the window to simplify the process. 
  • Routine Physicals:  I schedule my yearly physical every year at the same time to stay on track. 
  • Testing Protocol:  I leave all orders for bloodwork, xrays, etc  in the car in the glove compartment so I always know where they are.
  • More Testing Protocol:  When I receive an order for a test in the mail, I make a note on my calendar about what date to take care of this and put the requisition slip in the car in the driver side glove compartment.
  • Expressing Gratitude:  I thank every staff member who is helpful to me and explain briefly how they’ve been helpful.
  • Handling Difficulties:  I let the doctor and staff member know if something isn’t working for me directly and diplomatically.
  • Getting the Right Chart:  Because I’ve been with my doctor many years, they have more than one chart on me.  Before we start, I check to be sure that they have the most current chart (it has happened that they’ve had the wrong chart before which is why I”m vigilant about this).  I do this by having them verify my current list of medications and ask them what date is at the top of the slip.
  • Giving Clear Concise Information:  I frequently have to track my basal body temperature.  I follow the instructions and contact the doctor once I’ve got all the readings they’ve requested.  They then advise me what to do with my thyroid medication.  If I don’t hear back from them in a day, I call them back and ask about it.
  • Getting Instructions by Phone:  When I get instructions over the telephone, I repeat them as I’m writing them down to be sure I’ve got them accurate.  I ask questions as needed.
  • Giving Instructions by Phone:  When I’m leaving a message for the doctor, I have the nurse read back exactly what she’s written down to be sure she has it right.  I talk slowly enough and double check with her as I’m talking as frequently there are a lot of details.  She appreciates I’m willing to go slowly and I appreciate her willingness to be sure she’s got it correct for the doctor.
  • Cancellations:  If I need to cancel an appointment, I give them as much notice as possible

What are the key ingredients for your relationships with your doctors?  If you’re having challenges with this,  feel free to share them here.   As we share our experiences with others, we have so many opportunities to learn by example.  Sometimes, just thinking out loud by posting on a blog or writing things down for ourselves helps us think it through too.

Let me know your thoughts.

Happy Healthy New Year to you and your loved ones!!!!!

One of my readers phoned me today to let me know she had trouble downloading the Appointment Preparation Worksheet that I mentioned and have linked to in my previous posts.  She thought it may be “user error”.  I emailed the form to her as an attachment and asked her for more information so I could describe the problem to my web designer.  She was kind enough to call me to describe her experience today.

We went to the blog page and then the link together and she said she couldn’t see from her computer where to sign up for the Appointment Preparation Worksheet.  It was then that I realized that what she was referring to as “user error” was actually my error in not being more specific with my instructions.

If you scroll to the right of this blog entry and scroll down, you will see a spot to sign up for the free Appointment Preparation Worksheet.   You can sign up right on this page. I didn’t realize that when I linked the sign up sheet to the blog, I was linking you to a description of the sign up sheet rather than a spot to actually sign up.  You still need to do the same thing. . . . . scroll all the way to the right and scroll down and you’ll see it on the right side.

The moral of the story here:  It’s very easy for all of us humans to miss something that’s right in front of our eyes unless someone points it out to us.  I am so used to looking at my own website that I didn’t see how this could be confusing to someone else.  I unintentionally confused this dear reader (and most likely others) and she was kind enough to give me some really helpful feedback for my web designer who will deal with this when she returns from vacation.

Another point of this story is misunderstandings happen. What do we do when we’ve had a misunderstanding?

This “user error” story above is a great example of how we have misunderstandings with our doctors and how to go about dealing with them, and I’m grateful to this reader as I’ll use this story to illustrate my point today about what to do when you have an impasse with your doctor.

Yesterday’s post was about what to do when you can’t understand what your doctor is telling you.  I gave you some strategies to help you through these situations and you can find them here.  I left you with the question of what to do if you still can’t get the information you need from this doctor despite all your efforts to slow him down.

I have a colleague who says:  “Don’t make the complex simple”.

The relationships you have with other professionals who are helping you when you are sick are often complicated – whether you’re the one who is ill or the family member or friend whose trying to help out, there’s a lot going on during a doctor’s appointment. You are doing your best to get all your questions answered,  give clear and complete information and decide what to do.  Add to that that it seems like everyone is in a hurry, you are feeling sick, uncomfortable, scared, sad, afraid, overwhelmed, etc – and you have a basic prescription for a misunderstanding.

Just like this reader who thought it was “user error” when she couldn’t figure out how to sign up for the Appointment Preparation Worksheet, it’s very easy for a doctor to think they’ve communicated clearly when you can’t figure out what they’re talking about.

So, like I said – your relationship with your doctor  can be stressful (not like sitting by a warm fire drinking your favorite brew relaxing)  and complicated.

This colleague also says to me “Likewise, don’t make the simple complex.”

When I think of this as it pertains to being at the doctor’s office, you’re there for one reason only.  You’re there because something isn’t working for you – whether something is physically, mentally, and/or emotionally out of alignment, something is out of place.

There are three simple aspects to being at a doctor’s office:

  • Why you’re there is simple:  it’s because you don’t feel good
  • What you deserve is simple:  you deserve good health care
  • What your responsibility is:  you are in charge of your health so you are the one who gets to choose who has the privilege of helping you and whether what they’re offering is a match for your needs.

So, how do you take charge of your health?  You take charge of your health by providing clear concise information to your doctor about what’s going on with you in their area of expertise. For example, if you’re at your primary care doctor for back pain, it’s in your best interest to focus on that issue only.  Where’s your pain?  What makes it better?  What makes it worse?  What medication are you taking for it?  How are you responding to the medications?  On a scale of 1-10, how do you feel today? – that sort of thing.    Answering those questions precisely is what I mean by giving clear and complete information.

Continuing with this same example, you’re also there to understand what they are recommending you do. Are they recommending tests, xrays, or ultrasounds?  What for and why?  Are they recommending physical therapy?  Who do they think you should see?  Do you need a prescription for that?  Are they recommending using heat, ice, ibuprofen, etc?  Are they referring you to a surgeon, orthopedic doctor, pain clinic, etc?   Do they have a diagnosis for you?  What is it and what does it mean?  You need clear answers with directions for follow through that you understand and that are do-able for you.  If you don’t understand what they’re offering, you need to clarify things til you understand it completely.

The last post I wrote asked what to do when you’ve reached an impasse and either can’t understand what they’re telling you or don’t like the options suggested. Here’s where the rubber meets the road.  One of the simple things here is you deserve good healthcare and you are the one responsible for making sure you get it.  There simply is no way around this – you are in charge of your life.

If you’ve tried to understand what they’re suggesting and you just don’t get it, there is nothing wrong with you.  Just like I didn’t understand what this reader’s problem was with downloading my form, there was nothing wrong with either the reader or me.  It was a technological issue and, truthfully, the error was on my part for not giving clearer instructions for how to download the form.  But no one was right or wrong here.  I had the good fortune that this reader was willing to take the time to fully bring this to my attention.

So, there’s an option for you.  You can fully bring it to your doctor’s attention that you don’t understand what they’re talking about and you need them to slow down and explain things in a way that you can get it.  If you’ve been down that road too many times for your comfort level, then it’s time to find another doctor.  There simply isn’t a better way to take care of yourself than “knowing when to fold ’em”.  You are also the one who gets to choose when the time has come to stop seeing this doctor and find a new one.

Again, the buck stops with you and at the end of the day, you’re the one who has to live with yourself and your decisions.

The same thing is true if the doctor is offering you options that you aren’t comfortable with.  Once you are clear about what your choices for treatment are, it’s time to ask yourself whether what they’re offering is a match for you. It may take you some time to do this and you may need to go home and think about it a bit if the situation isn’t one requiring an immediate decision.  (In my experience,  we usually can take a day or so to think over most decisions but this is certainly not the case if you’re in the middle of a life threatening emergency obviously)

If your doctor says you need to decide something immediately or risk potential harmful consequences, you are the one who has to decide whether they have good reason for what they’re saying – they’re aren’t any magic answers here and far be it from me to undermine anyone’s determination of what truly constitutes an urgent situation.

Again, the buck stops with you – you get to determine if the options the doctor is offering you are a match for you. If they’re not, then you owe it to yourself to find another doctor or other type of professional to get the help you need.   It may take some time, be inconvenient, you may not know who to turn to, and finding a different doctor may be the last thing in the world you want to do right now – and that’s all very very difficult.  I completely empathize with what a tough spot that is when you need help so desperately.

That’s why I encourage people who have consciously selected their doctor’s to do their best at working with them as partners.  Partners do their best to work things out before “closing shop”.

I personally have been through many ups and downs with my own primary care physician who I”ve had for over 20 years.  Things aren’t always smoothe between us.  I have had many moments where I’ve felt confused, frustrated, overwhelmed, and angry.  Yet, each time I’ve felt that way I’ve learned to do my part of sharing with her when I don’t understand what she’s talking about, why I’m questioning her recommendation and clarify the follow up that I need.  It has strengthened my confidence in her abilities as a professional and I truly feel like we work as a team.

I have had the same experiences with her office staff.  Every time I deal with a misunderstanding, it strengthens my patience and my ability to communicate my needs clearly as well as understand precisely what they’re recommending.  I have yet to walk away from the situation though I’ve had my share of frustrations.  This particular practice meets my needs for professionalism and I am am proud that I do my part by communicating clearly, verifying my understandings, making sure what they’ve said  makes sense to me and also following through with their recommendations.

It takes all of this to keep me feeling good. . . . and it’s all worth it.

At the same time, if I found that despite all my attempts at this we’d reached an impasse, I’d move on knowing that there’s another doctor out there who will be able to understand my needs and communicate with me in a way that makes sense.

Relationships with doctors are partnerships, not dictatorships – and the more we step into our role of communicating our needs clearly, undertstanding the options available, figuring out whether they make sense, and doing our part the more likely it is that we will truly have the healthcare we deserve.

Make sense?  I’d love to hear your thoughts and experiences.

Knowledge is Power. . . .

December 29th, 2009

This is a continuation of yesterday’s post where I shared a story of someone following up with their doctor about some test results which resulted in an “anything but ordinary” visit.  The question I posed at the end of that post was, “What do you do when you don’t understand what your doctor is talking about?”

Before going there, I’d like you to imagine yourself in this situation.

Picture yourself going to the doctor’s office.  Right there, many of you may want to unplug because you may be phobic about doctor-ing. Totally understandable.

It may bring up so many feelings that you may not want to imagine this at all.  I get that – I hear it all the time.  I’ve been there myself.

No need to change anything if that’s how you feel.

Your feelings aren’t lying to you. . . . they are giving you information that something isn’t sitting well with you.  That’s completely understandable and in fact good feedback for you to notice.

Perhaps a whole slew of bad experiences come up in your head . . . . . or maybe nothing in particular shows up at all except a vague feeling of dread, confusion or something in between.  It’s all okay. . . . whatever it is, it’s okay.

If you are one of these people who can’t stand the idea of needing a doctor in the first place, let’s first acknowledge that very real scary vulnerable piece.  It is hard when you don’t feel well and know you need help. Most people feel this way regardless of whether they’ll actually talk about it – it’s human to be scared when we don’t know what’s going on with our bodies.  Just knowing you aren’t the only one who feels this way can be helpful.

Let’s now take this story one step further and imagine this doctor is  saying something that makes no sense to you.

In fact, it’s all going so fast because everyone is in a hurry.  The irony of the situation is that it may seem like you’ve been waiting a long time  to see the doctor and now everything is moving too fast.

The doctor is talking, you’re doing your best to listen and you don’t even know where to begin to ask questions.  Or, maybe you have some idea that there should be some questions here – but you don’t know how to frame them. You  may have definite questions but you think there really isn’t enough time here to ask them or they aren’t important.

Here’s my suggestion should this happen to you.

Stop the conversation right there and say:  “I don’t understand what you’re talking about.”  Period.

If the doctor continues talking, repeat the same phrase.   This exact phrase is a good phrase to keep in mind.  You can use it as your default option  when you first notice that they’ve lost you.

Maybe the doctor will say: “What don’t you understand?”  Maybe the doctor won’t acknowledge what you said and just continue on with their monologue which you still don’t understand.

Now what?

You can say, “Let’s start over and I’ll stop you to let you know what I’ve understood so far.” Say this diplomatically and unapologetically.  If the doctor starts going too fast again,  feel free to interrupt the conversation so you don’t lose your train of thought with this phrase:  “Let’s see if I got this part right.”

Then, repeat what you understood – and if you get  interrupted,  which often happens – keep going back to your understanding to clarify that you got it right.

What I want you to know is that you’re a smart, bright, capable person who has some legitimate reason for being at the doctor’s in the first place.  It’s your body and there are ways for you to give and get clear information. It’s your job as the patient to slow the conversation down enough to be sure you understand what the doctor is telling you.  The doctor is not in your head and can’t  know what you are taking in which is why this is happening in the first place.

No one is right or wrong here – it’s just the way it is.

He/she may get impatient or annoyed – and we’ll talk about what to do about that in another post.

The important point for you to understand is that you have a right to understand completely and clearly what a doctor is telling you.

You can do this even if you’re overwhelmed, exhausted, in pain or any combination of these things.   It can be very challenging to do this. . .  and also very empowering as you find ways to take good care of yourself and get the healthcare you deserve.

So, again – the message for today is:

  • If you don’t understand what a doctor is telling you, slow down the conversation and say “I don’t understand what you’re talking about.” or use your own language to let them know.  Have that statement in your back pocket at every visit.   If you have a specific question ask it.
  • If they continue talking and you still don’t understand, repeat that same statement.
  • If they say something that you do understand, say something like “Let me see if I got this part right.” and repeat back your understanding.   Slow the conversation down enoughto be sure you get it straight.

I also recommend that you refer to your Appointment Preparation Worksheet during your appointment as well as have a pen available to take notes.  I personally remember things better if I write them down.

In the next post, we’ll talk about what to do if you’ve reached an impasse at your appointment and can’t figure out what your doctor is telling you or don’t like the options suggested.

In the meantime, I’d love your feedback about how this article landed with you.

Today’s question is this:  “What do you do when you have no idea what to do?”

What are you TALKING about – you may wonder.  This has no context.

Well, neither does being sick.  We are only sick when we compare ourselves to some other state we were once in that “felt better”. So, by comparison, when we feel “sick” – we don’t feel as good as we have at an earlier time.

OK – got that?

Back to the question again:  “What do you do when you have no idea what to do?”

So, now we’re talking about when something has gone haywire (at least compared to the way things once were), what do we do when we don’t know what to do.

Well, again, that’s one of those questions that has a million answers.

What’s do you think?

Since I love making an example out of myself, I’ll tell you what I do when I have no idea what to do as a general rule.  I learn something.  Or, if I don’t have energy for that, I try and remember something that I once learned.

I recently went to my primary care doctor’s office where we’re beating this issue of insomnia to death.  Forgot to prepare an Appointment Preparation worksheet so I felt unprepared.  I didn’t know what to talk about when I was there  –  I was just too tired to even think about it.  I’ve spent way too much time at her office lately trying to work this thing out and I’m so confused and sick of the entire subject.  I wish to God it would make me tired enough to make me sleep already . . . . for a long time too.

Anyway, I was in that situation where I was sick and had no idea what to do.  And I knew that.

So, I asked myself this question which I’ve borrowed from my colleague Janet Bailey– if I knew what to do WHICH  I Do what would I do right now?  – and you know what?  I knew immediately what to do.  I pulled out my calendar where I’d jotted down some notes of when I’d stopped sleeping, when we’d started certain supplements, their effects on me and on the back of a receipt – I put it all together.  In 30 seconds or less, I knew what I wanted to accomplish in my visit.

Ideally, I’d have had it together and come with my Appointment Preparation Worksheet in tact and had a copy for her as well.  Well, that’s not the way it happened.  But, what I knew how to do was to ask myself those same questions and communicate my needs clearly.

It dovetails nicely with my Patient Power Manifesto where I’ve committed to communicating clearly and succinctly what my needs are and also listened clearly to her instructions, not leaving there til I get it straight.

It all worked together – without the forms but with the learnings that come from training myself to be attentive both to my symptoms, my structure and use my primary care doctor for the things she’s good at – making sense of lab tests, giving clear instructions, and telling me how to follow up.  We got things straight, we’re still working this out, but I’m getting things sorted out.

Here’s my question for youHow do you cope when you’re feeling sick?  What do you know about yourself that helps you through it?

I know you may feel like you want to throw up your hands at this question (or maybe slug me for asking it) but YOU DO KNOW what helps you so draw on that if you can.

And if you can’t draw on that, then be willing to just listen to whatever comes up including the frustration, pain, angst, or overwhelm for clues about what might help you given your situation.

Comment Zen

  • Share how you feel, ask questions if you want, give feedback.
  • Support and insights are most welcome.  But, please – no criticism or judgments of me or others.
  • You are welcome to mention websites or authors you’ve found helpful.  Refrain from giving medical advice.