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.

HEALING PEOPLE, NOT PATIENTS

In HEALING PEOPLE,NOT PATIENTS Dr. Weinkle describes ways he believes the current healthcare system in our country fails to meet the needs of both patients and physicians. Dr. Weinkle wants to see medical care return to being
meetings between two human beings, together forming a covenant to achieve healing

Creating Authentic Relationships in Modern Healthcare.

In HEALING PEOPLE,NOT PATIENTS Dr. Weinkle describes ways he believes the current healthcare system in our country  fails to meet the needs of both patients and physicians. Reading it, I thought of a new television medical drama in which a determined, idealistic young doctor fights a bureaucratic system to care for  disenfranchised patients. Critics call the show unrealistic, but if they read Dr. Weinkle’s book, they may decide it’s not so far fetched.

The author,  Jonathan Weinkle, M.D. , FAAP

Dr. Weinkle practices primary care medicine at Squirrel Hill Health Center, a federally qualified health clinic in Pittsburgh Pennsylvania. He  serves as Clinical Assistant Professor of Pediatrics and Family Medicine at the University of Pittsburgh, where he also attended medical school. He lives with his wife and three sons.

Dr. Weinkle contacted me after reading  my review of a book by Dr. Danielle Ofri. He asked if I would consider reading and reviewing his book also.  I agreed, and he provided a complimentary PDF copy.

Pitchwerks podcast - #115:Dr. Jonathan Weinkle
Dr. Weinkle’s podcast


Why our healthcare system is broken

One problem, he says,  is the EHR -electronic health record, which doesn’t allow him to express himself the way he would like. He prefers to


open a patient’s (paper) chart,(so it) tells me a story about the patient much like he might tell himself, almost as if I am reading a medical memoir

Although he calls this book  a “how to”- how to restore the sacredness of the doctor-patient relationship– it also  reads like the “medical memoir” he prefers for a patient. It’s his memoir, a telling of his journey from a  medical student entering the “adventure” of medicine to a graduate physician who believes


“Practicing medicine is a privilege, a gift- a sacred trust.

He illustrates several issues plaguing modern medicine using anecdotes about patients from his practice (with details changed to preserve privacy and confidentiality). Our current medical system sabotages   healing by

  • Fractured communication
  • Muddled priorities, where paper work takes precedence over patients
  • Procedures valued over counselling
  • Volume incentivized over value
  • Turning humans in pain into consumers, “as if they were buying televisions”

A turning point and lesson learned

A couple of months into medical school, Dr. Weinkle interviewed a distressed patient in acute alcohol withdrawal. He tried to develop empathy for the man as he unraveled  his long history of alcohol abuse and explored his reasons for trying to quit.

However,as he proceeded to examine the patient, his empathy evaporated when the man rolled up his sleeve for a blood pressure check- revealing a huge tattoo of a Nazi swastika.

Dr. Weinkle is Jewish.


“I am not a vindictive person, but all I could think was, “Well, it serves him right. This is poetic justice.”

He excused himself, never telling his preceptor how ill it (the tattoo)  made him feel, or the malicious thoughts it triggered in his mind.

In HEALING PEOPLE, NOT PATIENTS, Dr. Weinkle explains how he learned to change those kinds of encounters into ones with


Open, honest communication, mutual respect, and shared purpose, even when systemic problems push them into adversarial positions.

But it’s not easy.


even when everyone has the best of intentions,
building a covenantal relationship in the current healthcare system is about as easy as
building a house on the Carolina coast and not having it destroyed by a hurricane.

a male doctor talking to a middle aged woman
Photo by Dr. Weinkle’s son, used by permission

How to fix our healthcare system

One way he makes it happen is by working in a Federally Qualified Health Center, FQHC.

A FQHC is the closest thing we in the U.S. have to “socialized medicine.” Dr. Weinkle has worked in one for 10 years. As he describes it, in a FQHC

Anyone who is a stranger to the healthcare system, who has to clear high barriers in order to access care, should be welcomed in and have help knocking down those barriers.

Most doctors  concentrate on helping patients manage acute and chronic disease and try to address the major causes of disease and death -smoking, poor eating, lack of exercise, stress, sleep deprivation, substance use, and obesity. But doctors like Dr. Weinkle tackle other challenges , the “social determinants” of health. These include

  • Inadequate houses or homelessness
  • Lack of reliable transportatin
  • Unsafe neighborhoods
  • Food Deserts, where healthy food is unavailable
  • Language, ethnic, or cultural differences
  • Discrimination and/or exclusion
  • Unemployment, low wages, and/or poverty
  • Limited education and/or education opportunity

His patient panel consists of people who are

  • Refugees, who often speak little or no English
  • Members of ethnic minorities, including African Americans and Hispanics
  • LGBTQ persons
  • People who are mentally ill and/or developmentally challenged
  • People with stigmatizing illnesses, such as HIV/AIDS
  • People with substance abuse
  • People who have been incarcerated


Dr. Weinkle feels at home taking care of them because

“I come from a long line of people who have been strangers in a long line of places. We are supposed to understand how it feels to be shut out, demonized, misunderstood, or simply ignored.”

Since I finished residency many years ago,  I have had limited experience treating these types of patients, but enough that I understand the challenge, frustration, and sometimes satisfaction of doing so. Non medical professionals may be surprised by Dr. Weinkle’s descriptions of dealing with patients who are often unable or unwilling to cooperate with even basic healthcare steps.  

American medical care has transformed in the past 50 years but most of us wish it still worked like in the “good old days. As Dr. Weinkle describes it


most doctors were solo practitioners who did everything, and a patient, especially in a smaller town, could expect care that felt like home.
Continuity throughout their life… and accompanying them through
old age.
Presence wherever and whenever it was needed, in the middle of the night,

Unfortunately, medicine in the 21st century doesn’t look like that because


There are too many different kinds of care,… and too many demands on a doctor’s time to enable this kind of practice ..


Hospital privileges, insurance credentialing,

and the simple fact that doctors have belatedly learned that we can’t work 168-hour weeks and maintain our own health and family relationships

prevent us from being like our favorite docs of yesteryear.

Dr. Weinkle’s practice uses the concept of a “medical home”, often called the patient centered medical home, PCMH, which many medical offices are adopting, not just FQHC. But it is especially important with patient groups like the ones he and his colleagues care for.

(The concept of PCMH is explained here Defining the PCMH )

He takes it one step further, writing we need more than medical homes, we need medical communities, where doctors work closely with their local hospitals, ERs, pharmacies, and schools to address patients’ needs.

a male doctor examining a smiling baby girl
Dr. Weinkle’s baby girl patient seems to be enjoying her visit. Photo by the girl’s father, used here by permission. When posted on Facebook, this photo received 4000 likes in one week.

The solution- covenant health care

In HEALING PEOPLE, NOT PATIENTS Dr. Wrinkle argues for creating authentic relationships in modern healthcare by  

Promoting health behavior change without insulting or scaring patients, by learning what obstacles they face and helping to resolve them

Honesty about disease outcomes, especially at the end of life; avoiding futile care, and recognizing that sometimes death is not a complication but is the ultimate outcome of some illnesses

“Activated patients”  determined to get better,  to do something about their illnesses, becoming experts on their diagnoses

Doctors and patients valuing and respecting each other’s time and knowledge

Cutting waste- eliminating those things we do in healthcare that don’t add value to care, making it safer or more effective; bureaucratic policies, procedures, and rules that waste both time and money, like prior authorizations, “utilization review”, and 15 minute appointments

Medical education that includes teaching interpersonal skills, with learning objectives given as much importance and time as other medical skills,

Ultimately, Dr. Weinkle wants to see medical care return to being


meetings between two human beings, together forming a covenant to achieve healing

That concept is partially born out of Dr. Weinkle’s Jewish roots discussed in the Appendix- Being a Nice Jewish Doctor

“God forms a covenant—many covenants, actually, sealing the promises with symbols like rainbows (Genesis 9:13), circumcision (Genesis 17:10), and stone tablets engraved with the law (Exodus 24:12).

Image from Lightstock.com, stock photo site, affiliate link

The essence of the Jewish faith, the place where a Jew’s worth as a person is tested most thoroughly, is in the relationship with God—and the parallel relationship with other human beings made in God’s image. ”  


Why you should read HEALING PEOPLE

Health care professionals will find Dr. Weinkle’s concepts an attractive alternative to “burnout”, an encouragement to remember why we entered the profession in the first place, and a challenge to restore the personal touch that makes medicine truly an art.

Patients will find explanations about why medical care is at times fragmented, uncoordinated, and unproductive, will understand the challenge that their own physicians face in providing effective care, and understand how they can be part of the solution.


The book concludes with  an extensive list of Notes listing the references used in each chapter and an exhaustive list of References and Suggested Readings, a few of which I will include below.

Here is a link to Dr. Weinkle’s website where you can read excerpts from the book.

Healers Who Listen

An unexpected connection

You may recognize Dr. Weinkle’s practice location as one that was recently in the news.

a building with sign-Squirrel Hill Health Center

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.

This is also the Pittsburgh  neighborhood where a gunman walked into the Tree of Life Synagogue and opened fire, killing 11 people on October 27, 2018.

I had only exchanged one email with Dr. Weinkle so it wasn’t until a few days later that I made the connection. 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. Some of the victims were friends and colleagues.

I will tell you more about that in an upcoming post.

Suggested resources

Here are a few of Dr. Weinkle’s recommendations; please note these are affiliate links which help me fund this blog.

Thanks for joining me to meet Dr. Weinkle and review his book. Please follow Watercress Words to learn more about him and his work, as we explore and share the HEART of health.

                              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.

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                              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

 

 

 

 

 

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Dr.Aletha a world globe with two crossed bandaids