physician-patient communication – watercress words by Dr Aletha

Questions you must ask your doctor before and after care

You can master medical terminology . How many new things have you learned in the past 5 years? Each of those had a vocabulary and instructions that you learned and now use regularly. Think of your first computer, smartphone, tablet, digital camera, or even a coffee maker . You make the effort to learn what is important to you .

In another post I discussed the importance of establishing a connection between doctors and patients before trying to communicate. The goal is to establish effective patient engagement. You might want to read it now, but this post will make sense even if you don’t; you can always read it later. (The current post was previously published as part 2)

3 keys to effective communication with your doctor

Now we’re going to look at some practical aspects of exchanging information with doctors- remember, exchange means give something and receive something in return.

Doctors want to give patients the information they need and most of the time believe they have done so. We are surprised when patients come back and say we didn’t explain their problem and its treatment, or they didn’t understand what we told them about it. I think this happens for 2 reasons.

We doctors tell patients what we think is important, but it may not be what you the patient or family considers most important.
After patients hear part of what we say, they get saturated and don’t hear the rest, especially when it is emotionally charged.

That’s why it is so important for patients and families to ask questions; don’t just rely on what the doctors volunteer. What is important to them may not be what is most important to you. And the more specific questions you ask, the more detailed the information you receive will be.

one question you should always ask at each visit

“What is the most important problem today, and what is the next step in treating it?”

The most important problem that the doctor finds may not be the one you were admitted for or came to the office for. Or if you came with multiple problems, the most important may not be the one that seemed most urgent to you.

and the answer you need to know at each doctor visit

For example, you may go to an emergency facility for an injury that caused a large gash on your leg, one that needs stitches. This is an urgent problem that needs to be treated. But the doctor finds that you have high blood pressure that you didn’t know about.

High blood pressure can lead to heart failure and stroke if left untreated. So the doctor is going to instruct you to see your primary care doctor to have this problem addressed. In terms of your long term health, the high blood pressure is your most important problem today.

Sometimes these unexpected problems can get lost if you and the doctor only communicate about the urgent problem and what happens next with it.

It is important to control blood pressure — High blood pressure can cause a heart attack.

questions, questions, questions

You will get more helpful information from your doctor if your questions are as specific as you can ask; always inquire about how tests and procedures this will affect your treatment and recovery. Here are some examples-

What did the xray show and what does mean for my problem?
What was blood test result and will it change my treatment?
How will this procedure change my condition?
What needs to happen before we move to the next step?

Write important things down. Questions that you want to ask. Information that the doctors need. Answers to the questions. Refer to it each time you speak with the doctors.

It doesn’t end when you are discharged

When you or a loved one is in the hospital, your main concern is going home. When the time comes to be discharged, it is just as important to ask questions and understand the plan as during the illness. Too many times I have had patients return to my office after a hospital stay unable to give me any information about their illness and care . Important information to know include

What problems were treated during this admission and how did they change?
What will we need to do at home to continue the recovery?
When do we need to see a doctor and which doctor do we see?
What medications will I need to be on when I go home?

Understanding your doctor– medical jargon may not be the problem

Doctors are being encouraged and taught to use “plain language” when talking to patients, meaning limiting the use of medical jargon. I agree that a string of highly technical terms of any kind makes communication harder. But I’m not sure that simply using plain words solves the problem either. Whatever terms you use to exchange information must be understood by both persons. And that is not always the case.

Here’s an example.

If a doctor says that you or a relative has had a Myocardial infarction , do you know that that means a Heart attack?

But, do you know exactly what heart attack means? Probably not.

What causes heart disease? — A heart attack means the heart muscle is injured from too little oxygen reaching it, usually due to blockage in the arteries.

So, if the doctor says “heart attack” without adding any additional information, you should ask

“I understand a heart attack to mean ________. Is this correct?”
“I do not understand what a heart attack is. Please explain.”

Learning the language

Make an attempt to learn about your and your family’s medical issues; even if you don’t understand it completely, your doctor will appreciate that you are trying.

In addition to doctors you have nurses, pharmacists, dieticians, physical therapists, social workers who can answer questions. Ask for referrals to community resources.

There are helpful resources on the Internet so anyone with a laptop, tablet, or smartphone has access to medical information anywhere anytime.

Learn the basics of medical terminology here-

Understanding Medical Words: A Tutorial from the National Library of Medicine

Find the meaning of medical words and terms here

A.D.A.M. Medical Encyclopedia

rhinoceros — It’s easy to remember that “rhino” refers to the nose, as in rhinosinusitis.

Also on this topic, my previous post

How to tell your doctor what’s wrong with you

exploring the HEART of communication

Dr Aletha

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 27^th 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 30^th. 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.