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

I would love for you 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 

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.

I would love for you 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 

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

RoboForm Password Manager. What I use to manage passwords.

You’re reading this post on a computer, tablet, or mobile phone, so you visit sites that require a password. How do you remember them all? You don’t have to if you use RoboForm Password Manager.
My husband introduced me to RoboForm years ago and I am glad he did. I have used it continually to remember my passwords so I don’t have to. It syncs to both my computer and my phone so my passwords are always available. It will even generate passwords for me.

Go to this link to try RoboForm Free; if you like it you can upgrade to RoboForm Everywhere version with all the features I mentioned above. With Roboform, you will have one less thing to feel stressed about.

And for fitness I use Aaptiv

Spring/Summer Banners

What women doctors want you to know about healthcare

September is Women in Medicine Month, so in this post I’m introducing you to some women physicians who promote health in creative ways-writing, speaking, coaching, and advocating.

September is Women in Medicine Month, so in this post I’m introducing you to some women physicians who promote health in creative ways-writing, speaking, coaching, and advocating.

At Dr. Momma Says, Dr. Deborah Burton, pediatric ENT surgeon reviews her reasons for recommending vaccination.

“The growing antivaccination (anti-vax) movement has me confused.  I think it is a developed world thing to celebrate where we are, but we forget where we came from.

As an ENT surgeon who has studied and worked in the healthcare field for about 30 years, I have borne witness to the miracles that vaccines have done. There is no question in my mind that vaccines work.” She goes on to describe

MY AUTHENTIC 30 YEAR JOURNEY REVEALING SPECTACULAR WAYS THAT VACCINES WORK

Recommended Child and Adolescent Immunization Schedule
2019 Recommended Vaccinations for children and adolescents

Psychiatrist Dr. Melissa Welby writes

“Anxiety is a treatable condition. Depending on the intensity, some people can get better on their own and others need therapy and/or medications to help with anxiety. Either way, recovering from anxiety is possible! There are great self-help options available to assist with the treatment of anxiety which includes websites, apps, and books on overcoming anxiety.” Find her list at this post-

48 Resources to Overcome Anxiety for Adults and Children

From Charmaine Gregory, M.D., an ER doctor and fitness coach blogs at Fervently Fit with Charmaine with nutrition and fitness tips.

“Trips to the grocery store are almost as crucial as trips to work. We all need to eat. Some people have stress when they try and go in without a plan. Creating a routine is a good step. Following a few helpful hints can make your shopping easier on you.” Read her tips at

Quick Tips for Easier Grocery Shopping

a basket filled with fruits and vegetables
Will you commit to buying, preparing, and eating more fruits and vegetables? image from LIGHTSTOCK.COM, stock photo site, an affiliate

Dr. Aletha Maybank , a pediatrician, served as deputy commissioner for the New York City health department and now is the first chief health equity officer for the American Medical Association. She believes

Good Health Goes Beyond Having a Doctor and Insurance

“Health is created outside of the walls of the doctor’s office and at the hospital. What are patients’ jobs and employment like? The kind of education they have. Income. Their ability to build wealth. All of these are conditions that impact health. “

(And I’m thrilled that Dr. Maybank and I share our first name.)

The Frugal Physician, Dr. D. writes about finances, specifically how to live debt free. Her main audience is other physicians but she offers advice to patients too.

“Take note of the deductible for your plan and whether your employer chips in. High deductible plans can be alluring because of their low cost and the option to enroll in a Health Savings Account (HSA).  But, if you sign up for one of those, make sure you have the cash to spend the deductible during the year. ” Read the other 9 tips at this link-

10 Ways to Maximize your Doctor’s Visit

a woman in white coat with mask over mouth
Know your health history and medications.

Dr. Eileen Sprys is a family physician who wants you to know

When you have a cold, why I’m not giving you an antibiotic

“I want you to know that as a physician, I feel a pang of insecurity, guilt, and sadness when a patient tells me they’re upset because I won’t write an antibiotic.  I don’t want you to be sick or miserable.

I understand how inconvenient and sometimes life altering a cold can be. I desperately, desperately wish that I had a cure for your cold, but none of us do.

I also want you to know that for every antibiotic I over-prescribe, that I run the unnecessary risk of making someone even more sick, even to the point of hospitalization or death. I went into medicine to help you and to relieve your suffering with integrity — and that by giving you antibiotics without indication, I am betraying my own purpose.”

six-facts-graphic

Emergency medicine physician K. Kay Moody, M.D. wants you to know she is not a “provider” (and neither am I).

“Hi, my name is Dr Moody and I’m NOT a “provider.”

.

Here’s why your doctor isn’t your “provider”.

“The term “provider” levels distinctions and implies a uniformity of expertise and knowledge among health care professionals. The term diminishes those distinctions worthy of differentiation such as education, scope and range of ability.

Generic terminology implies an interchangeability of skills that is inappropriate and erroneous, as well as conferring legitimacy on the provision of health services by non-physician providers that are best performed by, or under the supervision of, physicians.”

position of the American Academy of Family Physicians

a nametag reading ALETHA OGLESBY, M.D.

Women physicians are sharing the HEART of health

I appreciate my female colleagues who share their knowledge and experience through writing in addition to caring for patients. I am honored to share their insights here.

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.

I would love for you 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 

HEALING PEOPLE, NOT PATIENTS- a book review

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.

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.

More of that story is at this link.

Squirrel Hill Mourns

Suggested resources

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

sharing the HEART of Healing People, Not Patients

Thanks for joining me to meet Dr. Weinkle and review his book.

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.

I would love for you 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 

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.


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Weekend Words-

sharing words of faith, hope, and love

(1Corinthians 13:13)

What doctors want you to know about healthcare

To address a female physician as “Mrs.,” even if she is married, is to imply that despite all her professional accomplishments, her worth is reduced to her marital status. It ignores all the hard work that went into earning the title of “Doctor,” and denotes, whether intentional or not, that a female physician is somehow less deserving of the title than a male physician.”

Read KevinMD

If you want to know what doctors think, and more importantly, how they feel about their jobs, read KevinMD.

(This post has affiliate links.)

Founded by Dr. Kevin Pho in 2004, this blog features articles by thousands of doctors, representing multiple specialties, ages, genders, ethnicity and practice setting. They write on multiple topics related to health, the science, practice, business, and politics of medicine, the doctor-patient relationship, and anything else even remotely related to medicine and health care.

On KevinMD  you will not find detailed infographics, slick images, or cute printables.

You will find stories filled with raw emotion as physicians  candidly share the horrific struggles, the occasional remarkable successes, and the everyday grind  of providing healthcare to hurting, needy, sometimes demanding, occasionally grateful patients.

And you will hear from patients whose experiences with physicians and the healthcare system range from sublime to horrendous.

You may not like or agree with some of the things you read there-I often don’t and I’m a doctor myself.  That’s part of the point of this blog. We physicians are not homogeneous. We are individuals with different stories to tell from differing points of view, based on background, training,  and experience.

The blog is divided into sections based on broad categories of topics –

  • physician,
  • practice
  • policy,
  • finance
  • tech,
  • edu,
  • meds,
  • conditions.
  • patient
  • social

Some of the articles are directed to patients while others are physician oriented. I encourage you to read some of both, in addition to the ones I am sharing here.

Many of the physician authors write their own blogs, so it is a good place to explore and discover other health bloggers that you may enjoy.

How doctors feel about relationships with patients-

Dr. Jennifer Lycette , an oncologist who blogs at The Hopeful Cancer Doc, offered her take on a situation that I have encountered more than once myself.

Don’t call me “Mrs.” Call me “Doctor.”

“To address a female physician as “Mrs.,” even if she is married, is to imply that despite all her professional accomplishments, her worth is reduced to her marital status. It ignores all the hard work that went into earning the title of “Doctor,” and denotes, whether intentional or not, that a female physician is somehow less deserving of the title than a male physician.”

Dr. Oglesby nametag

How patients feel about communicating with doctors

Martine Ehrenclou is a patient advocate.

She is the author of Critical Conditions: The Essential Hospital Guide to Get Your Loved One Out Alive and The Take-Charge Patient.

She submitted an interesting piece on a controversial topic, that of patients recording their visits with doctors, either with or without permission.

“patients are in fact secretly recording conversations with their doctors without asking permission first.

Talk about a blow to the doctor-patient relationship.

I understand the hesitation to ask permission to record an office or hospital visit with a medical provider as I experienced it myself. But secretly recording is a violation of trust. Why would any patient surreptitiously tamper with the relationship with their doctor, something that is considered the cornerstone of quality care?’

Documenting information your doctor gives you is essential because it’s just too easy to misunderstand or forget the medical information conveyed. “

She offers these

Tips to remember what the doctor tells you.

How doctors think about treating illness

Dr. Eileen Sprys is a family physician who wants you to know

When you have a cold, why I’m not giving you an antibiotic

“I want you to know that as a physician, I feel a pang of insecurity, guilt, and sadness when a patient tells me they’re upset because I won’t write an antibiotic.  I don’t want you to be sick or miserable.

I understand how inconvenient and sometimes life altering a cold can be. I desperately, desperately wish that I had a cure for your cold, but none of us do.

I also want you to know that for every antibiotic I over-prescribe, that I run the unnecessary risk of making someone even more sick, even to the point of hospitalization or death. I went into medicine to help you and to relieve your suffering with integrity — and that by giving you antibiotics without indication, I am betraying my own purpose.”

six-facts-graphic

What doctors want you to know but don’t have time to tell you

a vision refractor
An ophthalmologist is a physician (doctor of medicine, MD, or doctor of osteopathy, DO) who specializes in the medical and surgical care of the eyes and visual system and in the prevention of eye disease and injury.

Dr. Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor. This article originally in the HealthZette reveals

8 things doctors secretly want to tell their patients

Number 8 is “I’m only human.”

 “We have our good days and bad days just like anyone else. We try to always have a smile on our faces, be upbeat and cheerful. But we, too, are affected by life’s challenges — work, family, finances, health, and so on. Don’t be too quick to judge and criticize!”

What doctors do away from their practice

KevinMD does have a few photos, and even some videos. I enjoyed this one by physician-comedian Brad Nieder, MD who blogs  at the The Healthy Humorist.

In this clip he explains how he learned to eat less.

sharing the HEART of health

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.

I would love for you 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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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.

I would love for you 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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