27 January 2012

A Follow-Up: Opening Dialogue with Your HealthCare Provider

Earlier today, I posted about my somewhat disappointing annual appointment with my OB/GYN. Anyone who knows me personally knows that I'm a moderate-to-highly assertive person. You could change my name to Frank because that's just what I am.

Sometimes I forget that situations I nonchalantly find myself in can be quite intimidating to others. For instance, opening dialogue with and questioning information or decisions from a health care provider can be so intimidating for some patients, their needs and concerns go unaddressed when the conversation is not prompted.

I'd like to share this with you: HealthCare Providers, whether it be your OB, Midwife, Endocrinologist, or Pediatrician, are not infallible. Ever. The primary function of any provider is to assist in the management of your health, including but not limited to answering your questions, explaining your options for treatments and procedures, and referring you to appropriate information and alternate caregivers as necessary.

So why are so many people afraid to question their providers? There's no clear answer, but I feel the two main causes are the respect (and rightfully so) we reserve for medical professionals and an uncertainty of how to approach them.

The first issue boils down to a mindset that is quickly becoming archaic. Until the last decade or so, unless you had substantial amounts of time to spend in the library researching medical conditions, information about general medical conditions was not easily or quickly accessible. With the advent of the internet as we know it now, information, and plenty of it, has become infinitesimally available. While there is a lot of wading to do with the abundance of information, reputable sites like WebMD and NIH tend to pop up first and are home to reliable and relatively complete articles regarding a myriad of health questions. Social media like Twitter and FaceBook have opened numerous communities into and from which people can share information about their experiences with various health situations.

Prior to our culture of information-availability, if a patient had a health concern, aside from asking neighbors or family members, a doctor was the guy to see (yeah, we'll take it that far back... ). Doctors were invariable encyclopaedias of information that was scarcely available elsewhere. Our parents, their parents, their parents' parents, and so forth have helped ingrain this message so permanently that we still hold it: Doctors (and all HealthCare Professionals) deserve our utmost respect, and there is little room to question their decisions and information.

The second problem I have seen firsthand. Approaching questions can be difficult. I offer two scenarios. I interned in an Internal Medicine office while an undergrad. A patient shows up for the appointment, gets asked the standard questions, vitals taken, appointment muddled through, and at the finale, the doctor asks, "Do you have any other concerns or questions?" Typically an awkward silence follows. "Well... No... I guess not..." As the doctor begins his recording of the appointment summary to be sent to the transcriptionist, the patient: "Ah!... Oh... Nevermind..." Cut off. Unsure, slightly embarrassed, shy.

A second scenario bases itself in our strive to not feel stupid - to not stutter and stumble over words, to sound like we know what we're talking about. Unless you're a master of Romance languages or a Bio major (well... even if you are a Bio major sometimes...), chances are good that those multisyllabic, Latin- or Greek-based, consonant-impossible stumbling blocks known as "Medical Terminology" are intimidating enough by themselves. Thankfully, like your grade school teachers were with spelling (except on spelling tests...), most doctors are familiar with the butchering of these terms and probably know what you're talking about. If nothing else, with all that schooling and training, they should have a firm grasp on utilizing context clues to decipher the base of the question.

So where am I going with this?

I want you to be comfortable talking to your doctor like I am. I want you to ask embarrassing questions and butcher words. I want you to assert your rights as a patient, tax-payer, and insurance-holder and get complete, thorough, and respectful information, get your money's worth. I want you to take your HealthCare provider off of their pedestal and make them human. I want you to be confident in yourself and be an educated and good patient. I want you to make them work for you. I want you to take your healthcare management into your own hands. I want you to forge a relationship with your HealthCare Providers that maximizes dialogue and leaves you satisfied and feeling taken of.

How do you do this?

Foremost, the playing field needs to be leveled. You are a person. Your provider is a person. You are not an expert. While they may be an expert in their field, they are not all-knowing. By recognizing your doctor as just that - a human, apt to err, someone with a family and life possible not unsimilar to you own - you can begin to move out the strictly sterile professional relationship you may have had up to this point. If your provider treats you like an imbecile and does not recognize you as an equally deserving person, it's time to seek out a new provider. A two-way street of respect is the most important tool to secure if you would like to have open dialogue. Talk to your doctor like you care and offer information like they do. Be personable, and you'd be surprised at how quickly the most staunch and rugged character can be broken down into someone just like you.

Secondly, while it is a provider's responsibility to thoroughly explain any procedures, treatments, or care they are administering, it is dually your responsibility to be an informed patient. If you are diagnosed with a condition, do your due diligence and research the topic. Of course, especially when first diagnosed, ask your doctor to explain the condition. What part of the body is affected immediately? What systemic effects can this condition cause? Is it permanent, or is it something you can manage or reverse without the use of medications? If you are prescribed a medication, what else is available? How is that medication derived? How long has it been on the market? Is there an equally efficacious generic? How will this affect your general quality of life? How will this affect your plans for the future? While this seems like a laundry list of questions, these are the basics. These scratch the surface generally. The answers to these questions will lead to more, especially as you investigate on your own. Chances are if you are diagnosed with a common condition (ie. hypo/hyperthyroidism, hypercholesterolemia, diabetes, hormonal imbalances), you will have multiple initial appointments within the first year of your diagnosis. Between blood tests and follow-ups, scope out WebMD. Scour Google. If you are happy with your course of treatment, tell your provider that you feel like that method is working well. If you are not happy, research alternatives. Tell your provider that you don't think the course of treatment is working well. Ask about any alternative therapies you've found. Ask if they know of any other ways to treat it. There are almost always alternatives. If your provider is unwilling to discuss any alternative, take this as a bad sign and press the subject. If there is still no headway, it's time to find a new provider.

I will, from my own experience, advise that any alternative therapies you find, you research well and specifically ask your provider about. If you don't have an appointment coming up, call and leave a message. I will lend this example: On various forums regarding breastfeeding, the question of hypothyroidism comes up an awful lot. Why? Because of a condition known as Post-Partum Thyroiditis. For varying reasons, in the "Fourth Trimester," a woman's thyroid function may decrease. It's all about the hormones. This can lead to a drop in milk supply in addition to the general symptoms of hypothyroidism - lethargy, weight gain, hair and nail problems, mood disorders. There are three typical causes for hypothyroidism in adults - Post-Partum Thyroiditis, Hashimoto's Thyroiditis, and Iodine Deficiency. While taking an often-recommended kelp-derived Iodine supplement may help in cases of Post-Partum Thyroiditis and Iodine Deficiency, the damage is can cause a patient with Hashimoto's can be great. Why? Because despite all three having nearly identical symptoms, the pathologies of each greatly differ. Hashimoto's is an immunodeficiency, an auto-immune disorder. PPT is temporal. Iodine Deficiency is environmental. This is why if you suspect a thyroid problem, it is prudent, even when only being discovered Post-Partum, to have complete blood labs drawn so the root cause of the symptoms can be ascertained and confirmed.

Third, and most difficult, lose your inhibitions about being embarrassed. Whether you are afraid you'll fumble words and become tongue-tied; worried your problem is irrelevant; embarrassed by the actual problem (especially if it involves any nether region), consider this - your provider has heard it, or something like it, before. No question is stupid. No topic too taboo. We are unfortunately terrified of sounding stupid or breaking into intimate discussions, but there's a good thing about providers - Your visit with them is private. Your friends won't hear about your inability to pronounce Staphylococcus or that leakage (unless you tell them about it). If your provider is disrespectful, firstly call them out. Tell them you don't appreciate it. Assert your interest in managing your health. Secondly, it might be time to break out the Directory and find another provider.

It is our right to understand and be active in the management of our health and the health of our family members. I hope that some of these tips and dialogue can help you open up with your healthcare provider and more effectively be a part of the decision-making and problem-solving part of your care.

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