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

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 . 

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

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha 

The electronic medical record-asset or annoyance?

The increase in physician burnout has been directly linked to the introduction of electronic medical records.

You’re probably used to your doctor’s office using an EMR, electronic medical record (also called EHR, electronic health record) . By now most clinics, private medical offices, hospitals, labs, imaging centers, and other healthcare settings use computers exclusively for everything from scheduling, communication, to documentation and billing. If you are a young adult, you may not even remember a time when medical offices and hospitals used paper records.

Medical Record
Do you remember the stacks of charts in doctor’s offices and hospitals?

Dr. Danielle Ofri, author of several books about healthcare delivery, wrote an astute opinion piece about EMRs for STAT which I encourage you to read. I’m going to review her post adding my own ideas, , with the goal of helping you understand why we doctors, and maybe you, have a love/hate relationship with computers in healthcare; as Dr. Ofri says about electronic health records,

they all have their breathtaking assets and snarling annoyances

Dr. Danielle Ofri

In her piece, Dr. Ofri refers specifically to the use of electronic records in hospitals, but the issues are similar in clinics and other settings.

Breathtaking assets

  • more efficient storage of records than paper (taking up less physical space and time for sorting and filing)
  • ability to generate reports
  • improved hospital efficiency and financial margins (possibly by the ability to analyze data and generate reports)
  • able to analyze the health needs of large numbers of patients, called population health, so health systems can plan for and offer needed services more efficiently
  • communication- the ability to contact doctors by email, get test results through a portal, schedule appointments online, order med refills, etc.
  • legibility and standardization in documentation

Snarling annoyances

  • changes the way doctors work and make decisions; current software often does not reflect the way doctors are taught to approach patient diagnosis and treatment
  • less efficient retrieval of data than paper (due to larger amounts of data, which may be redundant)
  • little evidence yet that use decreases complication rates, or improves patient care in general
  • less personal interaction with healthcare professionals when communicating through a portal
  • increased time spent documenting on a computer , much of it simple data entry, compared to writing on paper

But the greatest disadvantages attributed to the use of computers in the medical setting, ones far more than “snarling annoyances” are

  • interference with doctor patient interaction and communication in the office or bedside; both doctor and patient may pay more attention to the computer than to each other
  • erosion of staff morale, often due to more time spent on the computer than with the patient, boredom with data entry, and stress of having to learn new systems and updates
  • contributing to physician burnout, which can have a negative impact on patient care

Doctors like me, who did not grow up in the computer age, went through the entire medical education experience without touching a computer. For us , the transition to computerization while maintaining a busy schedule of patient visits, was difficult and stressful. The increase in physician burnout has been directly linked to the introduction of electronic medical records.

Boldly going…

As Dr. Ofri points out, the EMR is not going away, and few if any of us want to go back to the old system, as annoying as the new system can be. The annoyances are slowly being worked through and resolved, and the assets are becoming truly helpful.

The younger generation of doctors who have never known a world without computers embrace their use readily. As we senior doctors wind down and eventually retire, we can pat ourselves on the back for being the generation that led the way into this strange new world.

a graphic showing various mobile computing devices
a graphic from the LIGHTSTOCK.COM collection, an affiliate

Where you, the patient, fit in

You as a patient have a stake in this endeavor too. As already mentioned, being able to access your records, make appointments, manage payments, and send messages on your computer or mobile device brings efficiency and convenience to a process that formerly was time consuming and cumbersome. I now routinely use my doctor’s office portal for my own medical needs and my patients use my office’s online services . Here’s what you can do to help make EMR use better.

  • Use whatever online healthcare resources available to you. The more we all use them, the easier they will be to use, and feedback will help developers make them even more helpful.
  • Be patient with your doctors and other healthcare providers as they transition to EMRs, from one to another, or when problems occur. Like any piece of technology, they don’t always work perfectly, and occasionally they don’t work at all.
  • Give constructive feedback. A thoughtful critique will help more than irate criticism.

Here is the link to Dr. Ofri’s article-

The EMR has changed the doctor patient relationship into a menage-a-trois

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.

from my review of Dr. Ofri’s book -at this link

What Patients Say, What Doctors Hear

Danielle Ofri, M.D., is a physician at Bellevue Hospital, a clinical professor of medicine at the New York University School of Medicine, editor-in-chief of the Bellevue Literary Review, and author of the forthcoming book

When We Do Harm: A Doctor Confronts Medical Error

Another physician explores the EMR

MAN’S 4TH BEST HO$PITAL By Samuel Shem

Samuel Shem (pen name of Stephen Bergman, M.D.) is a novelist, playwright, and, for three decades, a member of the Harvard Medical School faculty. His other novels include The House of God, Fine, and Mount Misery .

In this novel about a hospital dominated by computer screens and corrupted by money, an idealistic doctor has one goal: to make medicine humane again. Here is an excerpt-

“Cynical? me? I feed on ideals, on ideal care. I’m so idealistic, to you I sound cynical! And I do not call ’em Electronic Health Records, ’cause they don’t help with health, and may well harm it. With a screen between you and your patient, you get distracted, right? It’s like texting while driving.

So, to remind us of the danger let’s call ’em EMRs, the ‘M’ for “Medical’. “

After a student asks why the computer systems at the VA (Veterans) and the Indian Health Service hospitals, both government agencies, are more user friendly, he goes on to explain,

“Nobody’s makin’ money offa it. So we all gotta get together and unhook care from billing. So nobody makes an obscene profit offa the sick.”

available on Kindle (affiliate link)

exploring the HEART of the health record

I hope you found this discussion enlightening; maybe it answered some questions you had about electronic health records and maybe raised some issues you’d like to know more about. Please contact me with questions and I’ll answer them in a follow up post.

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.

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha 

These are affiliate links you may find helpful and which help fund this blog with a commission when a purchase is made using them.

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