A goodbye to healers who listened-Squirrel Hill mourns and heals

I was horrified by news that another mass shooting had occurred, this time at a synagogue in a community called Squirrel Hill. A few days later, I realized I had seen that name before. I had met someone who lives and works there.

In early October of 2018 I received an email from a physician I had never met. He had written a book and asked me to read and review it on my blog. I agreed and soon received another email with a PDF copy. I read it and posted a review here.

A couple of weeks later I was horrified by news that another mass shooting had occurred, this time at a synagogue in a community called Squirrel Hill. A few days later, I realized I had seen that name before.

The physician who wrote to me, Dr. Jonathan Weinkle, practices at the Squirrel Hill Health Center. And he is Jewish.

Pitchwerks podcast - #115:Dr. Jonathan Weinkle

Squirrel Hill, Pittsburgh, Pennsylvania

Squirrel Hill is considered a historic center for Jewish life in Pittsburgh. It is home to more than a quarter of Jewish households in the Pittsburgh-area, according to a Brandeis University study of the Greater Pittsburgh Jewish community.

I wrote to him and was relieved to learn he was safe. He had attended a Bat Mitzvah there just the week before the attack.

And as I had feared, some of the victims were friends and colleagues.

I’m not going to repeat the details of the horrific event as it was widely reported in the news. Here is a link to a news report.

How a deadly shooting unfolded at the Tree of Life synagogue

One of the victims I had learned about through our professional organization, the American Academy of Family Physicians, AAFP. Dr. Jerry Rabinowitz’s death was reported on the organization’s Facebook page. He was a friend and colleague of Dr. Weinkle.

Also killed was dentist Dr. Rich Gottfried who worked at the Squirrel Hill Health center where Dr. Weinkle practices.

a building with sign-Squirrel Hill Health Center
THE SQUIRREL HILL HEALTH CENTER

Dr. Weinkle eulogizes his friends

Dr. Weinkle wrote reflections about his two friends and colleagues, shared them with me, and graciously consents to my sharing with you.

 

This message was posted on the Squirrel Hill Health Center Facebook page

Dr. Rich Gottfried

The Hebrew letters often hint at a common object: bet hints at bayit, a house.  Gimel hints at gamal, a camel.  And shin?  Why, shen, of course – tooth.

I like to think that the reason for this is that shin, or rather sin, which is the same letter with the dot moved to the other side, is also the first letter in sameach, happy.  And what do we do when we are happy?  We smile and show our teeth.

My colleague Rich Gottfried smiled all the time; as people spoke at his funeral, or around the office this week, almost all took note of his smile.  He was the Hines Ward of dentists, it would seem – always smiling.

Rich brought happiness to people through their own teeth, too.  Poor dentition is a major source of shame for people, afraid to smile or look someone in the eye for fear of having their decayed teeth be the only thing the other person will see.  For a person without dental insurance, or without substantial means, dental work or even preventive care can be prohibitively expensive.  A Hobson’s choice – shame, or bankruptcy?

Rich listened to that struggle.  Even when he was in full time private practice, he blocked off time to do pro bono work for the uninsured .  And as he and his wife Peg Durachko, who was not only his life partner but his dental partner, wound down their practice as they approached retirement, they brought their services to us, at a community health center that treated many people who had never seen a dentist in their lives. 

They overcame the fear that one dental cleaning might lead to all the teeth falling out, and got things set right for the first time ever.  Culturally competent dentistry – now those are healers who listen.

Shin stands for something else, too – Shadai, the almighty God.  It is the letter on every mezuzah on every Jewish door, reminding us that God has our backs, and that we need to refresh ourselves on what God wants from us every time we enter or leave a room.  And for Rich Gottfried, what God wanted from him was to be a blessing to others around him, through his talents in taking care of their shin-ayim.

a Jewish passover seder plate with a lit cancle
photo from the Lightstock.com collection, an affiliate link

Dr. Jerry Rabinowitz

“Do not console a person whose deceased relative lies before him” Pirke Avot 4:23

Well, now we have begun to bury them; the time of consolation for the families and community of my murdered friends has begun.  They are no longer lying before us and we must begin to fix their memories in our minds.

Among the dead October 27th were two men who epitomized the title of this site: “Healers who Listen.”  A third still clings to life and with God’s help may recover to help the rest of us heal.  Over the next three days I will remember each of them.

Jerry Rabinowitz was laid to rest yesterday, October 30th.  In the hour before the funeral I was with a friend who told me that Jerry had been his doctor.  With a wry smile, he told me,

“The first time I went to him we were in there for an hour and a half – and the first thirty minutes had nothing to do with my health.” 

He listened to get to know the person sitting in front of him before diving into the rabbit hole of the purely physical.

At the funeral, Jerry’s partner Ken Cieselka spoke of “their finest hour” as a practice – the late 1980s, when they began caring for patients with HIV/AIDS.  The disease was then incurable, and the people suffering from it were then considered by many to be untouchable. 

But not by Jerry and Ken.  They listened to the voice of suffering that no one else would ease, and understood it was their responsibility to do so.

At the synagogue, Jerry heard gunfire.  In that sound, he did not hear a warning to get out.  He heard people being hurt, of people who would need his help. 

There is a Jewish concept that the choleh l’faneinu, the ill person in front of us, should get our attention first.  For Jerry even being aware of that person’s illness or suffering, even in danger, even where he could not see them, put them l’fanav, right in front of him, where he had to help them. 

He listened, and met his end as he lived his life, caring for people.

I assume Jerry did not have a chance to read Healing People, Not Patients; it was only published a month ago and he was as busy as I was.  The truth is that he did not need to read my manifesto of compassionate, personal healing.  He lived it; he could have written it himself.

a male doctor talking to a middle aged woman
Dr. Weinkle with a patient

 

 

 

 

Here are profiles of Dr. Gottfried, Dr. Rabinowitz, and the other nine victims of this attack.

Tree of Life Congregation Shooting Victims

Dr. Weinkle concluded his note to me, writing,

“ The good news is that unlike other pogroms that have afflicted my people over the centuries, this one was carried out by a lone wolf and the majority of our neighbors are on our side, not the side of the perpetrators. There is strength and hope in that beyond measure.”

Visit Dr. Weinkle’s website , Healers Who Listen

sharing the HEART of health

Thank you for joining me to honor Dr. Weinkle’s colleagues. Please share this post and my review of his enlightening book, HEALING PEOPLE, NOT PATIENTS.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

Why we need a National Doctors’ Day

Along with the honor of being a physician,  comes the problem of burnout. Leaders in the medical community recognize the high and increasing rate of burnout in physicians. In burnout, physicians feel exhausted,  lack enthusiasm about work, lose motivation, and feel cynical about the value of the medical profession.

National Doctors’ Day

Did you know there is a national day to honor physicians? In 1990, the U.S. Congress established a National Doctors’ Day,first celebrated on March 30, 1991.

Along with the honor of being a physician,  comes the problem of burnout. Leaders in the medical community recognize the high and increasing rate of burnout in physicians. In burnout, physicians feel exhausted,  lack enthusiasm about work, lose motivation, and feel cynical about the value of the medical profession.

Statistics suggest that a majority of physicians experience feelings of burnout and compassion fatigue at least sometime during their career. At any given time, that could be your doctor.

Physician burnout can arise from the technological and bureaucratic hassles in medical practice that hinder doctors from spending adequate and quality time with patients and interfere with our ability to care for patients in the way we believe is best.

Studies suggest that burnout causes physicians to spend less time providing direct care to patients, and that care may be less efficient and effective. a medical person holding a stethoscope

Doctors are less likely to experience burnout when they have rewarding relationships with their patients.

Most of us went into medicine because we wanted to help people, and that still brings us the most satisfaction. A successful doctor-patient relationship depends on both persons showing mutual respect.

March 30 is Doctors' Day

The first Doctors’ Day observance was March 30, 1933, in Winder, Georgia. The idea came from a doctor’s wife, Eudora Brown Almond,  and the date was the anniversary of the first use of general anesthetic in surgery.

The Barrow County (Georgia) Medical Society Auxiliary proclaimed the day “Doctors’ Day,” which was celebrated by mailing cards to physicians and their wives and by placing flowers on the graves of deceased doctors.

You may not have a chance to honor your doctor in person, but I suggest you commit to doing your part to establish a trusting, respectful relationship with your doctors. It will be good for both of you.

Let me share some ways to enhance communication with your doctors-

Be open and honest about your medical history,lifestyle, and concerns. 

Sometimes patients leave out important information due to forgetting, thinking it’s not important, embarrassment, or fear. But that may be the very piece of data I need to pinpoint what’s wrong.

So tell the doctor

  • If you can’t do something you’re asked  to do,
  • if you can’t afford the medication,
  • if your insurance doesn’t cover something,
  • if you are afraid to go for the test
  • if you are seeing other doctors for anything,
  • how much you smoke,drink, or other habits

Learn more tips on talking with your doctor here-

How to talk to your doctor to improve your medical care a male doctor holding a tablet

Give details about your problem, explain what you feel

I find that patients often have difficulty describing how they feel. They may say they hurt, cough, itch or get short of breath, but give few details. Maybe because we use  text messaging with its brevity, abbreviations and emoticons. We have forgotten how to use descriptive words.

I don’t think we doctors expect our patients to always recite a rehearsed narrative  about “why I came to the doctor today.” But it does help if you come prepared to answer questions as specifically as possible. You might try thinking about your problem using the PQRST mnemonic. It will help your doctor identify possible causes for your symptoms, and may also help you understand your problem and even suggest ways you can help yourself.

Find out what PQRST means at this post-

How to tell your doctor what’s wrong with you.

Female doctor looking at an xray

Recognize your doctors are people first

As physicians, our patients’ “social histories” help us understand factors in your life that impact your health -where you live, your job, your family, your hobbies . Besides that, we enjoy getting to know you, especially the things that make you and your life unique and interesting. That feeling can go both ways.

Exchanging a few social words can make the encounter more satisfying for you and your doctor. Some of us will be more open about sharing our personal lives, and some subjects may be off limits. But I don’t think any of us will object to polite,  caring interest in our lives outside of medicine.  a woman in white coat with mask over mouth

You may cry when you read about a unique doctor-patient relationship in this post-

A simple way to help your doctor beat burnout

Finally, in honor of Doctors’ Day, meet some physicians with unique experiences to share, just a few of the many doctors who work tirelessly to provide us all with the HEART of health.

INTERNATIONAL HEALTHCARE

Dr. Kent Brantly awoke feeling ill- muscle aches, fever, sore throat, headache and nausea. As his condition progressively worsened to include difficulty breathing, he learned the cause of his illness- the Ebola virus. Having spent the past few weeks caring for patients caught up in the Ebola epidemic that swept Liberia in the spring of 2014, Dr. Brantly had contracted the disease himself, and would likely die, as almost all victims do.

Continue this story at-

Surviving Ebola, “Called for Life”- Dr. Kent Brantly

affiliate link

 DISASTER HEALTHCARE

When she applied for a position in New York City at the NYC Office of the Chief Medical Examiner (OCME), Dr. Judy Melinek never imagined that decision would plunge her into the nightmare of September 11, 2001. She was at the ME office that day when the Twin Towers were attacked and fell, killing thousands of people.

She and the other staff collaborated with the team of investigators who worked night and day identifying remains of the victims, a task she vividly describes in the book. This was basically their only job, since the cause of death was for the most part irrelevant, and impossible to determine. Sometimes they had only a small body part, as little as a finger, to extract DNA to identity a victim. Such identification was critical to bring closure to the families who lost loved ones, people who left for work that day, and never came home.

Read more about Dr. Melinek at this review of her book-

Working Stiff: Two Years, 262 Bodies, and The Making of a Medical Examiner- a review of words worth sharing

affiliate link

Meet the 91 year old still practicing physician, whose grandfather was a slave- Melissa Freeman, M.D.

Photos in this post are from the LIGHTSTOCK.COM collection, an affiliate link. Consider Lightstock for your photo and graphic needs. You will get quality media and help support the mission of this blog-to inform and inspire us all to discover the HEART of health.

Thank you for reading Watercress Words.

Dr. Aletha 

5 spring health risks you need to prepare for now

Spring forward with some health tips for outdoor activity #daylightsavings#spring#allery#sunscreen

Remember it’s Spring forward to Daylight Savings Time

Most of the United States will change to Daylight Savings Time on Sunday March 11, 2018.

So you will either be going to bed an hour later than usual, or awakening an hour earlier.

Either way, your body will tell the difference until your sleep cycle adjusts; I know mine always does.  WebMD offers these tips to make the change easier.

If getting a good night’s sleep is a persistent problem for you, check out the information I shared in this post.

Expert advice to sleep well every night

We welcome the  first day of Spring, March 20,  in the northern hemisphere, with the occurrence of the vernal equinox.

This link to The Weather Channel explains what the vernal equinox means.

graphic of the earth explaining equinox and solstice
original source not known

With more hours of sunlight and warmer weather you may spend more time outdoors.While that may mean greater fitness from the physical activity, you will be at risk of several outdoor injuries. Be proactive and prevent warm weather ailments with these tips.

Protect yourself against mosquitoes and other insects.

5 insect repellents to keep you safe this summer

Protect your skin with  sunscreen while you’re outside.

(These are affiliate links placed here for your convenience. This blog can earn a commission from sales from these links. This does not imply endorsement of these products.)

Protecting your feet.

Whether walking, jogging,  gardening, or sports, our feet can take a beating from outdoor activity.

You probably don’t worry much about blisters- until you get one. Then the pain can inhibit walking, or even  wearing a shoe.

At worst, blisters can become chronic wounds, get infected, and threaten limbs in susceptible persons like those with diabetes or poor blood flow.

 

I wear Skechers shoes for walking.

Ways to prevent blisters include-

  • Proper fitting shoes, not too tight or too loose
  • Breaking shoes in before activity likely to cause a blister, like running, dancing, long walks, sports
  • Wearing absorbent cushioned socks, perhaps 2 pair together
  • Applying protective padding over pressure points on the feet. Even plain paper tape can accomplish this, according to this study published in the New York Times.

What to do about seasonal allergies

Often called “hay fever”, allergic rhinitis doesn’t cause a fever but it can make us miserable with its characteristic symptoms-

  • runny nose, sneezing, congestion

    diagram of the nose and sinuses
    Allergies commonly affect the nose, throat, sinuses, ears, and eyes.
  • scratchy, itchy, or tickly throat
  • cough
  • ear itching and pressure
  • watery, itchy, red eyes

 

 

 

 

Even those  people who have these symptoms year round may have seasonal exacerbations, usually spring and fall.

 

Wearing a filter mask while outdoors may help minimize allergy symptoms.

 

 

 

Here is information about allergy management from the American College of Allergy to discuss with your doctor.

Seasonal Allergies

 5 spring health risks you need to prepare for now- watercresswords.com

 

 

I appreciate your sharing  this post on your social media pages.

And please follow Watercress Words for more information and inspiration to help you explore the HEART of HEALTH.

Thank you for  viewing  the advertisements and using the affiliate links  that fund this blog; with your  help, we can grow, reach more people, and support worthy causes that bring health and wholeness to people around the world.

 

                                                         warmest regards, Dr. Aletha 

stethoscope with a heart
exploring the HEART of health

How to face your health challenges with hope

Learn how to understand your doctor and make yourself understood #physician#patients

Featuring Weekend Words from

James chapter 5, verses 2-5, Common English Bible

My brothers and sisters, think of the various tests you encounter as occasions for joy. After all, you know that the testing of your faith produces endurance.

Let this endurance complete its work so that you may be fully mature, complete, and lacking in nothing.

But anyone who needs wisdom should ask God, whose very nature is to give to everyone without a second thought, without keeping score.

Wisdom will certainly be given to those who ask.

Be passionately in love with understanding. St. Augustine
St. Augustine, early North African Christian theologian and philosopher graphic from Lightstock.com, affiliate link

 

 

 

 

 

Proverbs chapter 2, verses 2-10, Common English Bible 

Turn your ear toward wisdom,
    and stretch your mind toward understanding.
Call out for insight,
    and cry aloud for understanding.
 Seek it like silver;
    search for it like hidden treasure.
Then you will understand the fear of the Lord,
    and discover the knowledge of God.
The Lord gives wisdom;
    from his mouth come knowledge and understanding.

 Wisdom will enter your mind,
    and knowledge will fill you with delight.

 

Thanks to Sarah Forgrave for permission to use this excerpt from

Prayers for Hope and Healing

Seeking God’s Strength as You Face Health Challenges

by Sarah Forgrave

Prayers for Hope and Healing by Sarah Forgrave
Prayers for Hope and Healing by Sarah Forgrave

 

“When you’re confused by medical jargon”

“Medical staff talk to you, but they might as well be speaking a foreign language. Whether they’re explaining your condition or giving instructions for the next steps of your care, their words go into your ears like a secret message you can’t decode. You know they’re talking about your body, but the disconnect to your brain leaves you helpless and frustrated.

a prayer-

I’m so thankful for the doctors and medical staff  You’ve charged with my care. Even though I don’t always understand their words, it’s comforting to know You’ve given them the knowledge they need to treat my condition. ”

 

 

Learn how to understand your doctor and make yourself understood with these previous posts-

Do you know the best questions to ask about your healthcare?

“You may think your doctor knows exactly what you mean, but sometimes we are left trying to read between the lines of what you tell us.  We doctors need to understand our patients’ expectations, concerns and obstacles.”

How to talk to your doctor to improve your medical care

“You may think doctors make a diagnosis based on lab tests or xrays. But much of the time, those tests only confirm what we already suspect  based on your symptoms.

If we misunderstand what you describe, or fail to get complete information we may  start testing for something far removed from what is wrong with you.”

And have a cup of tea with me.


 Thank you for considering  affiliate links that support this blog.

Weekend Words-

sharing words of faith, hope, and love

(1Corinthians 13:13)

What Patients Say, What Doctors Hear- a book review

What Patients Say, What Doctors Hear helps patients understand the complexity of what physicians do in our encounters with patients and how that impacts our subsequent decision making and treatment decisions.

What Patients Say, What Doctors Hear

by Danielle Ofri, M.D. , an associate professor of medicine at the New York University School of Medicine and staff physician at New York’s Bellevue Hospital .  The book is published by Beacon Press

“What patients say and what doctors hear can be two very dissimilar things. The reverse is also quite true: what doctors say and what patients hear can be radically different. ”

I am so convinced of the truth of these two statements, that I have written several blog posts about physician-patient communication. So when I learned of a book that delves into this subject in detail, I knew I needed to read it; I was not disappointed.

As a physician, this was not an easy book to read; Dr. Ofri does not hesitate to tell us physicians what we need to do better in our communication with our patients.

But she also makes it plain to patients that you have a role and a vested stake in communicating your concerns, questions, and even grievances to the physicians who care for you; that without such information, your physicians cannot provide optimal diagnosis and treatment for you.

doctor talking to a woman
photo compliments American Academy of Family Physicians

Dr. Ofri bases her conclusions on her own encounters with patients over 20+ years of practice, interviews with other doctors and patients, and published research on communication. In her book she explains

  • How the uniqueness and complexity of the physician-patient relationship impacts their communication
  • Why patients’ less satisfactory encounters with the medical system are often due to poor communication, rather than lack of caring and competence, but can lead to lawsuits
  • Why patients’ unfamiliarity of medical terms can hinder communication , and how differences in use of words between doctors and patients, and even between doctors can lead to misunderstanding

For example, Dr. Ofri relates an incident when she was still a medical student working in the hospital and came across the term “expired” to refer to a patient who had died. She had never heard the word used this way. Then years later, when she was an attending physician, she was confused when an intern from a southern state reported to her that a patient had passed during the previous night. Passed what?, she thought. In some areas of our country,  “passed” is commonly used to mean someone has died, but Dr. Ofri had never heard this.

Dr. Ofri discusses the placebo effect of medicines and treatments, and how expectations affect response to treatment. (The placebo effect means responding to  a treatment that contains no active medical substance.  Interestingly, placebo treatments “work”.)

She details the many reasons patients have difficulty adhering to doctors’ recommended treatment plans, such as cost, inconvenience, distance, and other factors unrelated to not understanding the seriousness of their condition, as one might suppose.

I was intrigued by the story of a hospital in The Netherlands which hired a woman to be the “Chief Listening Officer.” Her only duty was to listen to patients talk about their complaints or grievances  about their care, not to fix or solve problems, but just to listen. And it was successful; once patients felt they had been heard, they had no desire to pursue legal action and felt more satisfied with their care.

She also relates a program called Sorry Works!, a way to handle medical errors with mediation rather than lawsuits, also a successful program.

Dr. Aletha talking to a mother and her son
Talking to a patient through an interpreter makes communication extra challenging. (photo from a volunteer medical trip to Ecuador)

 

 

What Patients Say, What Doctors Hear  helps  patients understand the complexity of what physicians do in our encounters with patients and how that impacts our subsequent decision making and treatment decisions.

This book illustrates there are multiple detailed steps between

  • A patient’s problem and the best solution
  • The patient’s and family’s questions and the correct answers
  • The final (or sometimes current) diagnosis and the definitive,  best available ,or least toxic treatment.

 “The biggest take-home message is that both doctors and patients need to give communication its just due. Rather than the utilitarian humdrum of a visit, the conversation should be viewed as the single most important tool of medical care..a highly sophisticated technology. “

 

 

 

 

In this previous blog post I offer suggestions on physician-patient communication based on my years in practice:

Do you know the best questions to ask about your healthcare?

You know it’s important to tell us details of your symptoms, medical history, family history, habits, and other medical facts.   But besides medical information about you , we need to know

Your expectations about your care,

Your concerns about your care,

Your obstacles to getting care,

 

sharing the HEART of health and communication

 

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

 

                              Dr. Aletha 

 

 

 

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A simple way to help your doctor beat burnout

“What would you say to your doctor on your deathbed?”

 

What would you say to your doctor on your deathbed?

Would you remind them of the times you waited weeks  for an appointment or sat  in the waiting room long past your scheduled appointment time?

Would you ask them why they didn’t try harder to cure you? Would you ask why all the tests and medicines they ordered didn’t work to save your life?

Or would you ask, “How was your vacation?”

family skiing on mountain
one of many vacations with my family 

 

 

A patient named Rosemary

One woman did. In a JAMA  essay (Journal of the AMA), Dr. Wendy Stead , an internal medicine physician, described her patient, Rosemary, who “never had a bad interaction with any of her health professionals. After a clinic visit, or hospital stay, she will rave about the excellent care she received from the many teams involved.”

“This is not because we are all such exceptional caregivers.” she admitted. “It is because of the kind of patient she is..the kind who probes for the person behind the doctor.

When Rosemary was terminally ill, Dr. Stead left on a family vacation, fearing that her patient would die while she was gone. As soon as she returned, she went to Rosemary’s home to visit one last time.

Now so weak, Rosemary was confined to bed, and could barely speak. As Dr. Stead leaned over the bed straining to hear her, Rosemary asked,  “How was your vacation?”

 

Probe for the person behind the doctor

 

Dr. Aletha dancing
I actively pursue a hobby-ballroom dancing.

 

 

Do you know if your doctor has children or grandchildren?

What hobbies they pursue?

Who is their favorite sports team?

 

 

 

 

My husband and his eye doctor share an interest in  the Oklahoma City Thunder basketball team. At each visit, he and Dr. Nanda spend a few minutes discussing the team’s progress, good or bad.  It makes what otherwise would be a dry, routine visit into a special occasion. I think Dr. Nanda enjoys it as much as Raymond does.

Chesapeake Arena
Chesapeake Arena, home of our beloved Thunder Basketball team – Dr. Nanda has season tickets and follows the team closely.

 

 

 

 

 

 

 

 

 

When I was expecting my second son, William and Audrey became my patients. William had multiple serious health conditions but he was always positive and never complained.

During his frequent office visits, they never failed to inquire about the progress of my pregnancy. After I delivered they always asked about my new baby boy.

When I walked into the exam room, William’s first words were always, “How are you Doc?” And the next words were, “How’s the baby?”- even though by the time William passed away, my “baby” was in kindergarten.

woman with a toddler
Me with “the baby”

 

 

 

 

 

 

 

 

Seeing doctors and patients as people

For physicians, our patients’ “social histories” help us understand factors in your life that impact your health -where you live, your job, your family, your hobbies . Besides that, we enjoy getting to know you, especially the things that make you and your life unique and interesting. Dr. Stead points out that when our patients learn our social history we “build an even stronger bridge that goes both ways.”

Now you probably won’t have the time or interest to “probe” every doctor you see, maybe just those you see regularly . Exchanging a few social words can make the encounter more satisfying for both of you. Some of us will be more open about sharing our personal lives, and some subjects may be off limits. But I don’t think any of us will object to honest, caring interest in our lives outside of medicine.

“As healthcare professionals we like to think of compassion as a limitless resource, but some days even the deepest well can feel like it’s running dry. Patients like Rosemary refill the well. They make us better doctors for all our patients.” Dr. Stead 

 

Burnout- bad for doctors and patients

Leaders in the medical community recognize the high and increasing rate of burnout in physicians. In burnout, physicians feel exhausted,  lack enthusiasm about work, lose motivation, and feel cynical about the value of the medical profession. Some estimate as many as 50% of physicians in the United States experience burnout.

Perhaps even more common among physicians is compassion fatigue, which can affect anyone involved intensely in helping others. Compassion fatigue occurs when a helper begins to feel overwhelmed and stressed from their efforts to relieve the pain and suffering of those they help. As they give more of themselves and neglect self care, they in turn become traumatized by their own efforts.

(Photo credit-American Academy of Family Physicians)

 

Doctors on the “front lines” of medicine -family physicians, emergency physicians, internists, pediatricians, psychiatrists- are especially vulnerable to burnout and compassion fatigue as are other health care workers, police, social workers, teachers and disaster workers.

 

 

 

 

 

Why should you care about physician burnout and compassion fatigue?

Factors causing physician burnout include the technological and bureaucratic hassles in medical practice that hinder doctors from spending adequate and quality time with patients and interfere with our ability to care for patients in the way we believe is best.

Studies suggest that burnout causes physicians to spend less time providing direct care to patients, and that care may be less efficient and effective. 

 

According to observational studies of physicians at work, we spend 50% of our time doing paper/computer work about the care we provide the other 50% of the time. (photo credit- American Academy of Family Physicians)

 

 

 

 

 

March 30 is National Doctor’s Day, a day designated by Congress to honor doctors.

One way you can honor your doctor is by trying to connect personally next time you visit. By doing so, you may get a glimpse of the “person behind the doctor” ; empathy can go both ways. If you see your doctor as a person with a life not that different from yours, you may see your interaction as a partnership and  find it easier to communicate .

And better communication can lead to better care for you. See my previous post

3 keys to effective communication with your doctor

Why patients sue their doctors

Dr. Aletha examining an infant on a volunteer trip
Volunteering to serve where we are most needed is one way physicians can recover from burnout and compassion fatigue.

 

Read  here about how government regulations contribute to physician stress

And here about efforts to reverse and prevent physician burnout

 

 

 

 

 

Thanks for exploring the HEART of health with me. Please consider these affiliates which help this blog inform and inspire wellness and wholeness throughout the world.

Dr.Aletha a world globe with two crossed bandaids

 

 

 

 

Do you know the best questions to ask about your healthcare?

expectations, concerns, obstacles-medical communication #askthedoctor

I blog about healthcare communication because you need to understand your doctor better and  we doctors need to understand our patients’ expectations, concerns and obstacles.

Physicians should  use clear understandable plain language with patients. Patients should also be clear and specific when they talk to their doctor.

You may think your doctor knows exactly what you mean, but sometimes we are left trying to read between the lines of what you tell us.

Dr. Aletha talking to a mother and her son
Talking to a patient through an interpreter makes communication extra challenging.

You know it’s important to tell us details of your symptoms, medical history, family history, habits, and other medical facts.   But besides medical information about you , we need to know

Your expectations about your care,

Your concerns about your care,

Your obstacles to getting care,

You may wonder, won’t or shouldn’t my doctor ask me theses questions? Sure, we can ask and probably will, but by volunteering it , you start dialogue that gets you and your doctor communicating effectively much faster. Your doctor knows about disease, but you as the patient know the experience of the illness much better. 

Let me illustrate by giving you some examples. These are all statements patients say  to me in my daily practice. The original statements aren’t bad or wrong, but by rephrasing to add some additional detail they  give your doctor valuable information that will help provide you the best care possible.

The underlined words can be substituted for others listed in parentheses.  The exact words aren’t as important as the  message they convey. 

Hello doctor, I’m here because I want my thyroid checked.

(substitute heart, lungs, cholesterol, blood sugar, kidneys, etc.)

Instead try-

Hello doctor, I’m tired a lot, and wondered if it might be a thyroid problem or something else. What testing would help us find out what’s wrong with me?

It’s better not to limit your doctor to checking just one thing, when there are many possible explanations for your symptoms. You expect a thyroid check, but you’re open to other possibilities.

tubes used to collect blood samples in a lab

 

Doctor, I feel terrible and think I have  pneumonia. The last time I felt like this the doctor said it was pneumonia, so it must be that again.

( sub kidney infection, strep throat, sinus infection)

But if you say this

Doctor, I feel so sick. This illness is similar to when I was diagnosed with pneumonia and I’m afraid I have it again. I am concerned it’s pneumonia again so  I’m here to find out what is wrong, as I realize it may be something else.

You’ve told the doctor your concern about pneumonia but you’re not trying to diagnose yourself.

 

 

I have a family history of cancer so I want to have a mammogram.

(sub any other cancer, heart disease, stroke and other tests)

That’s good, but this is better.

Doctor, I’m concerned about breast cancer as it runs in my family. My grandmother was diagnosed at age 45 and now my sister has been, and she is 40. Do I need a mammogram or any other testing now?

Knowing who in your family had a disease and at what ages helps the doctor make an accurate recommendation. It also tells your doctor this may be an emotional issue  (concern)  for you.

Top 10 cancers in the U.S.

 

 

I need an antibiotic (anti-inflammatory, muscle relaxer, steroid, shot )  for this; I know because my previous doctor always gave me one for this.

Please try this instead:

When I had this before my doctor prescribed an antibiotic; I wonder if that would be appropriate this time?

This tells the doctor your expectation, but also that  you are open to different  advice/recommendation. (and avoid getting a medication you don’t need.) 

6 smart facts about antibiotic use

 

 

 

Will my insurance pay for this? How much will this cost me? Is this an expensive drug?

Patients may expect us to know about insurance and cost, but often we don’t. We can work with you on financial issues if we know more about your obstacle. Try asking-

I need to find out if this is covered by my insurance. Can someone in your office look that up, or help me find out?

I’ve had a lot of medical bills this year that have stretched my budget. I will need to find out what my out of pocket cost will be before scheduling this test. Can your office help me with that?

If there is a generic version of this drug that will work just as well, I would like it, to minimize my out of pocket cost. If not, is there another alternative?

 

 

Is this drug safe? (effective, good, best, dangerous, harmful)  

Few things are 100% safe. But what we can discuss with you is –

What are the risks and side effects of this drug? Is the benefit I get from the drug worth the risks? Are there alternatives that would be effective and less risky?

We always should be concerned about drug use, and safety isn’t the only issue. Don’t hesitate to ask questions.

medication capsules

 

 

 

 

 

How long will I be off work? When can I go back to work?

Here’s what your doctor needs to know –

My job requires me to stand and walk for several hours?

(sit and type; talk on the telephone; drive long distances in my car)

And here’s what you need to ask:

How soon should I expect my stamina to return so I can work part time? Full time?

When can I safely work without interfering with my recovery?

What can I do to hasten my recovery so I can return to work sooner?

Both  you and your employer, need to know when it is safe to return to work.  We have to balance health concerns with your financial concerns and what is expected and allowed by your employer and the law. 

If you are clear  with your concerns and obstacles  and flexible in your expectations it will be easier for your doctor to make the right decision.

 

 

These are just a few examples. I’m sure you can think of others.

Whenever you have a need to consult a physician, think ahead of what your

expectations, concerns and obstacles are before you make the visit so you’ll  be

prepared to share .

Here are  more tips on talking with your doctor-

How to talk to your doctor to improve your medical care

How to tell your doctor what’s wrong with you.

I invite you to follow this blog as we explore the HEART of health together.

 

Dr. Danielle Ofri’s book  What Patients Say, What Doctors Hear,

details the reasons doctors and patients don’t communicate well

and offers ways to improve our interaction.

What Patients Say, What Doctors Hear by Danielle Ofri, MD
written by Danielle Ofri, M.D.

(this is an affiliate link)