~Part 2~ A ToolKit to Communicate with Your Doctor and Take Charge of Your Health!!

Today, for Medical System Tuesday (well it actually is a Wednesday this week because I didn't have time to complete the post earlier!) we continue to focus on outpatient topics to optimize your health BEFORE you become acutely ill.  As I mentioned last post, I completed my inpatient series of "Insider Tips" and now we've moved out the outpatient series.  


Before we get started, I wanted to ask you that after you read this post, could you please share in the comments below if you have ever had problems communicating with your doctor and/or understanding why various tests or medications were ordered?  What do you do to make sure you are getting high quality care? Any tips to share with your fellow readers?


My goal by the end of this outpatient series is for you to be able to:

• get the BEST out of your doctor--in other words, to do your part to empower your doctor to optimally use their expertise to your benefit
• understand what is going on with your own health--knowledge is power
• learn how to organize your health information to improve the quality & efficiency of your medical care
• know how to advocate for appropriate preventive care according to your age, gender & medical history
• learn how to prevent medical errors (check out the last two of my reader Christy's comments on one of my older posts--she followed the communication tips from my previous post and actually was able to help prevent her doctor from making an error with her medications!!!-note--there are a lot of comments on that page, scroll down to the end to see what I'm referring to!)
• be an active teammate in your wellness journey as opposed to a passive participant

Part 1 outlined the the first steps to seize control of your own health. How many folks followed through on the assignments?  Don't worry if you didn't--even if all you do is read these posts to become aware of ways to improve your ability to receive excellent quality healthcare, that is an important beginning!!!  


Oh!  And for all of you who haven't been to a doctor in years--please go.  As you can see by Part 1, you may be due for some important preventive screens that can actually save your life!!

Ok moving on.


Today, in Part 2, we'll get specific about what data your doctor need to really get a comprehensive view of your health.  Why does this matter? Lets look at an example:


You come into your doctor's office for a check-up and says the following:  "I'm feeling good doc--a few headaches over the last few weeks, but other than that, I'm ok."  The doctor has 15 mins to see you.  The doctor checks the chart--your vital signs (blood pressure, heart rate, etc) look good, your "finger stick" to check your blood glucose is mildly elevated.  So the majority of the visit you and the doctor talk about your headaches--what do they feel like, how long do they last, how severe are they, what makes them worse, what makes them better?  And then you get a quick physical exam, a prescription for some migraine medications and are sent to the lab to get your blood drawn.


Sounds ok right--well there is just one problem.  You forgot to mention that you've been urinating a lot more than usual, you feel thirsty all the time, and you actually came in this morning after not eating dinner last night or breakfast this morning because of your headache.  So when your doctor looked at your blood glucose "finger stick" they didn't become alarmed because they assumed you'd eaten breakfast that day and the elevation was due to that.  Instead, you may have diabetes.  It might show up on your labs but maybe not.  Next thing you know, three weeks later you are being admitted to the hospital with severe hyperglycemia and require IV insulin & an ICU stay.... 


Ok this is an extreme example, I know, but it could be really be anything--a black mole on your leg that is getting bigger but you forget to mention, some weight loss that wasn't intentional but didn't seem important to bring up, some increased shortness of breath with activity that you downplay to the doc....etc.  It is VERY hard to hit on all the points needed to make a good clinical diagnosis in a short interview.  That is where you come in!!  Docs need data from the patient to get the right diagnosis!!!!!!  It is 100% a team effort!!! And you can help them ask the right questions based on how organized you are before you come to the visit & how well you understand what is important to share with your doctor!


So to get you organized and keyed into the important parts of your history to share with the doctor, here are your assignments for Part 2. These are all key tasks to complete in the two weeks prior to your appointment. Your goal is to enter your doctor's appointment organized (see Part 1 as well) AND make sure you leave the appointment with a clear understanding of what your doctor recommended and most importantly, WHY!

1)  If you have any of the following chronic diseases, prepare CLEARLY PRINTED OR TYPED logs for your doctor on ONE PAGE:

• If you are a diabetic or have hypertension (high blood pressure) and you don't keep a log of your blood sugars or blood pressure, in the 2 weeks before you go to the doctor record daily at least 2 "finger-stick" values (at least one before breakfast) and get your blood pressure measured each day (use a home blood pressure cuff or grocery stories sometimes have them).
• If you have angina record the number of times you have been symptomatic in the two weeks prior to your visit and what you were doing at the time.
• If you have an inflammatory bowel disease or irritable bowel syndrome, write down your daily bowel symptoms for two weeks prior to the appointment as well.
• If you have depression or anxiety try to keep a "mood diary" for the two weeks prior to the appointment
• If you have a pain disorder, try to keep a "pain diary" of your pain levels at four different points throughout the day, when you needed to take your "as needed" medications and what effect the medication had on your pain level.  

2)  For EVERYONE:  Sit down before the doctors appointment & review your health in every body system you have so you will able to answer your doctor's questions quickly & clearly.  


Here is a link to good old Wikipedia's "Review of Symptoms". (currently down due to the Jan 18th protest--check it out tomorrow!)  There are also twenty million "review of symptoms" forms that pop up on a google search.  Don't get overwhelmed.  Just quickly go through each category and not any abnomalities.  For example:  Eyes: blurry vision, Heart: nothing, Lungs: cough, etc.

6) Read through everything you have organized (including the medical info sheet & history from Part 1) and make a list of questions to ask your doctor.  


Try to limit the list to less than 5 questions in order of priority.  Make at least two questions the following:

"Doc if you could pick two things for me to work on healthwise this year what would you choose?"

 And 

"Are there any medications I could potentially get off of if I changed my eating habits or exercise level?"

You can also use this Free Online "Question Building Tool" that the AHRQ put together to help patients prepare for doctor's appointments!

7) Once you have finished your question sheet, clearly PRINT/TYPE it and make 3 copies:  


1) Give 1 to the receptionist at check-in and ask her to give it to your doctor's nurse so your doc can look over the questions (if they have time) before entering your room. 



2) Give 1 to the doc when he/she walks in the room--just say: "I made this brief list because I want to make sure that I ask you the questions I have but also help you stay on schedule because I know you are very busy" (the doc will LOVE this statement).


3) Keep one in your lap with something hard to write on. leave enough room after each question on your copy so you can write down AS THE DOC IS TALKING so before they leave the room you can *quickly* repeat what they said so you make sure you understand.  Just say:  "Doc, I want to quickly repeat what you said to make sure I understand so I can follow through on what we discussed."  Don't be intimidated if you doctor appears to be in a hurry--keep it short but make SURE you repeat everything back to them--you'd be surprised how many errors can be prevented this way!!!


Ok!  Well that concludes this series!  I am hopeful that with this information you will be able to overcome the extremely frustrating & dangerous constraints on the patient-doctor relationship due to insufficient time to do a proper clinical interview!!!    


If you do end up using any of these techniques, please report back and let me know how it goes!!  I hope that this information is helpful to all of you! 


The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.

A Toolkit to Communicate With Your Doctor & Take Charge of Your Health! ~Part 1~

Its Medical System Tuesday, a New Year and time for a new way of operating with regard to your health!  After spending the last part of 2011 sharing my "insider tips" on how to get the best medical care in the hospital, with the New Year upon us I'm going to shift to talk about outpatient topics to optimize your health BEFORE you become acutely ill.  I'll also throw in a few posts over the coming months specific to my medical specialty--like how to use rehab techniques to prepare for a joint replacement surgery or how to use multi-disciplinary interventions to treat chronic pain. 

Today I'm going to talk about how to take the first step to seize control of your own health.  This step begins with your primary care doctor.  


Outpatient clinics are hectic--you have a very short period of time to communicate your health concerns & give your doctor the opportunity to use their professional training & clinical judgment to assist you.  The result is often leaving appointments feeling confused about the treatment plan and having forgotten to ask about a key medical symptom that has been worrying you!  


But this doesn't have to be the case!  There are a few simple things that you can do to get the professional best out of your doctor and leave appointments feeling empowered to take charge of your own health!


It will require some work on your part but the benefits are tremendous!  Are you ready to get started?  In the comments section of this post let me know if you are COMMITTED to taking these steps and then lets check in next week to see if you were able to follow through!!:-)

Your first goal is to organize yourself as a patient to enable your doctor to get all the data they need to fully focus on and address your key medical problems.

As you can probably tell, I like writing lists so guess what?  Its time for another list!  This time its YOUR list of assignments for the months of January and February 2012. :-)  

Here are the first three tasks (lets take it step by step and don't get overwhelmed!)

By next Sunday, January 15th:

1) Make an appointment with your primary care doctor to be seen in one month from today.  When you make the appointment ask for either the first appointment of the day or the first appointment after lunch.  This will make it more likely that you will be seen close to on time.

2) Make time to sit down and organize all your health information before you go into the doctor (make a medical info sheet, put all your health-related paperwork in one binder, call ahead and make sure the doctor's office has all your updated information in their files.)

3) Research what recommended health screens you should have based on your age and exposure.  Make a written list of any tests that haven't been done that are appropriate for your age range. 

MEN:  print this PDF file out: http://www.ahrq.gov/ppip/healthymen.pdf or visit the Agency for Healthcare Research & Quality (AHRQ) website at: http://www.ahrq.gov/ppip/healthymen.htm 

WOMEN: print this PDF file out:  http://www.ahrq.gov/ppip/healthywom.pdf or visit the website: http://www.ahrq.gov/ppip/healthywom.htm

Ok now lets get to it!  Tune in next week for the key tasks to complete in the two weeks prior to your appointment and the techniques you can use to make sure you leave the appointment with a clear understanding of what your doctor recommended and most importantly, WHY!

Coming Up:

• Build a Healthy Immune System with Food: Part 2 of SuperImmunity for Kids!
• The Clear Skin Diet and My New Soy-Free Life!
• Treating Pain with Food--more thoughts
• Foods That Make You Feel Good (A New Series Featuring Individual Foods & Their Nutrient Power)

Coming Up on Medical System Tuesdays:

• Part 2: A Toolkit to Communicate With Your Doctor & Take Charge of Your Health

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.

ONE DAY LEFT to contribute medical stories to the Holiday Happiness Marathon!! Join us!! :-)

If you are a patient, have you ever had a good medical experience that made you grateful for your healthcare provider and modern medicine?  Or, if you are a healthcare provider do you remember any moments with patients that made you happy you became a doctor, nurse, etc?  


Are you willing to briefly share one of those stories with my other readers?  (stories should be no more than 1-2 paragraphs in length).
From December 19th to December 25th I'm going to host the "Holiday Happiness Marathon:  Doctors, Nurses & Patients Share Special Medical Moments!"  In the midst of all the chaos of the season, this post series is a special week to pause for a quick moment & smile as you read positive stories about healing :-)


I already have doctors, nurses & patients lined up to share their stories (I've gotten some already from the docs & they are AMAZING), but there is room for some more!! 


So if you want to take a quick break from the holiday madness & join the story-telling marathon, shoot me an email with your story (no more than 1-2 paragraphs long) to happyrehabdoc@gmail.com and I'll add you to the marathon!  I need all the stories by no later than the end of the day on THIS Wednesday, December 14 (THAT IS TOMORROW!!).  It doesn't have to be perfect, it just needs to come from you! :-)

 Hope to hear from you!  

This is AMAZING! I'm the Herbie of the Week & the blog explodes :-)

Ok so I got an email from Lindsay (The Wonderful Happy Herbivore herself) this afternoon just as I was rushing out from the hospital to travel to a conference!  She told me that she just posted my story on her blog as the Herbie of the Week!!!!!!  I had an exciting read from my iPhone and some quick frenetic Facebook typing and then I had to get on the road!!  


Now I'm safe and sound at my destination and can take a deep breath and check out the blog.  WOWOWOW!  I've never seen my Feedjit so busy!  It just keeps scrolling!!  


Thank you thank you thank you Lindsay for sharing my story with your readers!  I can't stop smiling from reading the comments--I love the warmth!!  So for those of you joining our little blog community here--WELCOME!  Excited to have you join us & ridiculously happy right now :-)  


I hope that my story helps you believe that ANYONE can recover--our body's incredible resilient capacity has been proven time after time if we are willing to ask for help & change our lifestyle!  I believe that there is no need to live life in pain or ill health.  I'm passionate about trying to find even more ways to keep healing and I will share what I discover along the way.  I hope you will too! Hearing your stories inspires me & helps me learn so please feel free always to share in comments--I love to hear what you have to say!! 


My goal is to have the blog serve as a resource to help make your life healthier, happier and pain-free!  And this includes YOU too my fellow health care providers (docs, nurses, techs, RTs, NPs, PAs, etc)!  When we engage in healing ourselves, we can truly be of service to our patients.  At least that has been my experience :-)


***By the way, Lindsay was kind enough to answer some questions about her own health quest & her NEW cookbook the Everyday Happy Herbivore .  Tune in for the interview in my next post!!***

Tip #7: Know Your Doctors: A Short Guide to Hierarchy! ~ More Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Who are all these people who introduce themselves as doctors in the hospital?  Here is a short guide to what each title means:  

Attendings:  These are the most senior physicians.  In a teaching hospital they are in charge of the fellows, residents, interns, "observers" & medical students. 

• All of the junior physicians are operating under this doctor's license as most of the fellows/residents/interns have their MD or DO but do not have their license.  Therefore the attending tends to oversea the teams work to make sure it is safe & also spends a lot of time using patients to teach the junior physicians.  
• You will not see the attending physician very often except usually briefly on morning rounds with the whole team.  
• They tend to not be aggressively involved in patients care because they want to train the fellows & residents to make independent clinical decisions under their oversight. 
• The attending often only knows what the resident presents to the team--so make sure that your resident gets all the details on your condition so they can present your case as accurately as possible to get the BEST guidance (and the BEST care for you!)  That said, when the attending rounds in your room in the morning & you don't hear him or her mention your most concerning issue than absolutely bring it up--it may not have gotten included in the resident's presentation.
•  In the operating room, the attending usually either does the most challenging part of a procedure or carefully oversees the fellow/resident's surgeries & the PAs/NPs.

Fellows:  These are M.D.'s or D.O.'s who have completed their residency & are now going for an additional level of training in a very specialized area. 

• For example, in my field, when you finish residency you can become a "board certified Physical Medicine & Rehabilitation" doctor.  But if you want to do interventional pain, then you need to do an accredited fellowship to become "Board-Certified" in Pain!
• Most of them are licensed in the state they practice in.

Residents:  These are the people most involved in your daily care.  They are junior physicians, M.D.'s & D.O's at approximately 2-6 years out of medical school. Their job is to learn to be an independent clinician.

• The attending physician is usually a hands off supervisor unless safety is involved.  This is to try to teach them as much independent clinical decision making as possible.
• They are often the closest line to the attending physician but more importantly, these people are responsible for managing all your daily orders, your admission, your discharge & your medications. If they have interns under them, than they supervise the intern's executions of these activities.
• They usually lead a team of interns and other junior residents (if they are past 2nd year). 
• At night they will often be totally on their own at the hospital--no senior physician is in-house.  They can call the attending if a major crisis occurs but this is relatively rare.
• They generally RUN the codes (when a person has a cardiac arrest or is found unresponsive, etc
• They are on call frequently (this means that they spent the night in a small bed in the hospital & may or may not have gotten any sleep depending on the specialty)  and may seem quite tired.  Be patient with them when this appears to be the case.

Interns:  First year doctors.  The worker bees.  Their job is to do all the paperwork associated with your admission & discharge:  orders, prescriptions, etc. AND simultaneously be learning as much as possible.

• They will usually be the ones to write your admission note, your daily progress notes and your discharge summary.  
• They will usually be the first person to your bed in a crisis or code.  
• They are generally awake all night long when they are on call & take turns covering nearly all the patients in the hospital. 
• They will be the first person you see in the morning & the last person you see at night.  

Medical Students:  These are "doctors-in-training" and should introduce themselves as such even if the staff addresses them as doctor (as I was addressed during my training).  

• They will usually manage the daily notes for 1-5 patients under the supervision of the resident & intern.  
• They should NEVER be the only person who examines you daily and if this happens, make SURE that the resident & intern & even the attending know that the student is being allowed or told to operate independently as if they are a doctor.  
• Third year medical students are in their first year of clinical exposure.  
• Fourth year medical students are in their last year of training & should be preparing for intern-level responsibilities.

Ok! That should be everyone!  Hope this helps!


Coming Up on Next Week's Medical System Tuesday: 

• Tip #8 For The Best Hospital Care:  Be Nice ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~ 

Coming Up THIS Week!

• SuperImmunity Foods for KIDS (Calling All PARENTS!)
• RECIPES & Ideas: Snacks!  YUMMY & Portable Plant-Based Snack Food--all sugar-free, gluten-free & without adding oil or fat!!

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.

MONDAY MEDITATIONS FOR HEALING: A Commitment to Self for Caregivers & "My Symphony"

Good morning!  I've decided to start a new tradition on the blog of posting "Meditations for Healing" every Monday morning.  I wanted to share these meditations because taking a few moments to myself for reflection everyday helps me maintain my sanity! Maybe by sharing these meditations with you all it will help me follow through on my commitments to healing myself!!


These Monday Meditations for Healing will include a "commitment to self" for caregivers (whether you are a health care provider or a family member caring for a loved one!) &  an inspirational quote to reflect on for the week.

A Commitment to Self for Caregivers:

This week I will try to find 15 minutes of quiet time everyday.  I will sit alone, breath deeply & relax in the stillness of not having to do anything for anybody but myself for just one moment.  

Today's Quote (a favorite of my Mom's):

"To live content with small means; 

to seek elegance rather than luxury, and refinement rather than fashion; 

to be worthy, not respectable, and wealthy, not rich; 

to study hard, think quietly, talk gently, act frankly; 

to listen to stars and birds, to babes and sages, with open heart; 

to bear all cheerfully, do all bravely, await occasions, hurry never. 

In a word, to let the spiritual, unbidden and unconscious, grow up through the common. 

This is to be my Symphony." 

1. ~William Henry Channing

I hope you have a WONDERFUL week!