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Building a Bridge – and You Are Invited

When I first began this blog aimed at doctors, nurses and other healthcare professionals, I realize it was presumptuous. In my defense, I didn’t start it because I was trying to impose anything. I started it because a number of providers had suggested I do so.

Life got in the way – and it’s been a very long time since I last posted here. But once again, I’ve kick started it as the result of an invitation to share my point of view as a patient – but even more so as a patient who has spent a lifetime bridging communications gaps. It turns out I have something to say about improving relationships between healthcare providers and their patients that may improve outcomes for all.

This time the suggestion came a bit more formally – from Physician’s Practice Magazine.

And so I am working on building this bridge — some different twists on the concept of problem patients and what you, a provider, can do to improve your relationship with them. Or even better, how to de-problem them.

The first post appeared just a few days ago in Physician’s Practice: Problem Patients: Dealing With the Waiting Game

Additional posts will cover what to do about “Googlers”, how to deal with (lack of) honesty and modesty, and eventually, how to diffuse an angry patient.

As each of the rest are posted, I’ll add links here.

Most exciting, perhaps, is the upcoming live online chat – and you are invited to attend!  Friday, May 13 at 12 noon eastern time and it’s free. Be there or be square.  Physician’s Practice requests that you register if you plan to attend.

Hope to hear you then!

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Learn more about Trisha and her work.

Learn more about Trisha’s book
You Bet Your Life! The 10 Mistakes Every Patient Makes

(How to Fix Them to Get the Healthcare You Deserve)

Friend’s Doctor Dad Shares Wisdom with His Colleagues

September 18, 2009 Leave a comment

PhysiciansLast July I attended my XXth high school reunion (you didn’t think I’d really tell you how many years it’s been, did you?) and got reacquainted with Bobbie Gonder Moore – a friend I had lost track of, but had always remembered fondly.

Bobbie (Roberta!) and I have shared many conversations since then, one of them about her dad, a well respected urologist and medical pioneer (cryosurgery of the prostate), Maurice Gonder, M.D., founder and first Chair of the Department of Urology at the State University of New York (SUNY) Stonybrook.

Before he died, he wrote down his advice for his associates and students. I asked Bobbie for permission to share them with you, as follows:

  • Take care of sick folks
  • Don’t be greedy
  • Love one another
  • Listen to what your patients tell you
  • Don’t be stupid

Simple, right? Perhaps a reframing of a combination of the Golden Rule and your mother’s best advice?

But suppose that was how you conducted your day, every day? Don’t you think your job satisfaction would soar?

I do believe your patients’ satisfaction with their medical experience would.

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Learn more about Trisha and her work.

Learn more about Trisha’s book
You Bet Your Life! The 10 Mistakes Every Patient Makes

(How to Fix Them to Get the Healthcare You Deserve)

Photo: © Chagin / iStockPhoto.com

What a Difference a Preposition Can Make!

with

As if talk of healthcare reform wasn’t enough, there are other quakes taking place in healthcare today that may create a seismic shift in how patients and providers relate to each other.

Called “participatory medicine,” it puts patient and provider on a level playing field when it comes to decision-making about treatment options or how the patient will manage her care.  The patient brings her 50 percent to the relationship based on her knowledge of her body and her medical and behavioral history.  The provider brings her 50 percent in the form of education and experience.  Both take an even share of responsibility for outcomes. Together they work toward management or healing.

As a patient, perhaps even a “professional patient” (is there such a thing?) I frequently ask providers what they think of this approach.  The responses are bell-curvy, leaning toward “I’ll believe it when I see it.”  Most can’t help it — that paternalistic, benevolent, “But I still know best” just oozes…

…Followed by some kind of further explanation, intended to show me just how inclusive they are of patients in their processes.  “We give these brochures TO patients” or “We send them TO specific websites” or “We make referrals FOR them.” While those activities may be useful to both patient and provider, they are more like customer service, and not truly participatory at all.

I suggest a new preposition is required.  Let’s try WITH.

If you are a provider, begin thinking about your patients who wish to participate in their healing or management processes as partners instead of targets.  No more of this TO or FOR stuff!  Try these instead:  “Mr. Patient and I reviewed the test results WITH each other,” or “Ms. Patient negotiated a treatment regimen WITH me.”

We patients don’t expect you’ll get it all right away.  But if you would adjust your vocabulary a wee bit, you’ll see that we want to work WITH you so we can find the best outcomes together. Because you can’t really give them TO us or accomplish them FOR us anyway.

And that’s participatory medicine.

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Learn more about Trisha and her work.

Learn more about Trisha’s book
You Bet Your Life! The 10 Mistakes Every Patient Makes

(How to Fix Them to Get the Healthcare You Deserve)

Photo: © LattaPictures / iStockPhoto.com

Patient Love Means Saying You’re Sorry

July 24, 2009 1 comment

explanation

Stop and think about the last time you made a mistake in your practice of medicine.

Did you apologize?

This is a sore spot, a topic better swept under the practice rug as far as most physicians are concerned. When you, as a healthcare professional, make a mistake, it can be life-threatening or life ending. That’s not the same as the mistakes I make which may be as easy to fix as using the delete key.

And when you make a mistake, I can only imagine the heartache and conscience-tugging it must cost for you. If you have an ounce of human decency, I have no doubt it takes a toll on your psyche.

And yes, I know for many of you, you are taught/told/ordered NOT to apologize. Gawd-forbid you should own up because the legal vultures will descend on you like flies-on-pooky.

Along comes the University of Michigan to the rescue. They have spent the last several years working on the right way to apologize — early — including compensation to the damaged patients. The results?

Malpractice claims against his health system fell from 121 in 2001 to 61 in 2006, while the backlog of open claims went from 262 in 2001 to 106 in 2006 and 83 in 2007. Between 2001 and 2007, the average time to process a claim fell from about 20 months to about eight months, costs per claim were halved and insurance reserves dropped by two-thirds.

Other health systems are paying attention, too, from Boston Medical Center to the University of Illinois to California’s Stanford University Hospital.

The only nay-sayer in the article?  Happens to be an attorney.  Go figure.

I have personal experience with this. After suffering my misdiagnosis, I was so VERY angry — angry at the pathology labs that misread my biopsy, and even angrier at the oncologist who insisted I begin chemo, even though there was so much evidence to the contrary. After it was confirmed by the NIH that I did not have cancer after all, I fully expected apologies from the doctors who were wrong. Not only did the oncologist not apologize, he wrote me a three page letter telling me why he was right to insist I begin chemo! Eventually, one of the pathologists did apologize to me. It was an overwhelming experience.

If you aren’t familiar, a group called SorryWorks! can help you move yourself or your organization toward apologies that work. They work for the patient, against lawsuits and perhaps, for you, toward far more peace of mind.

Appropriate apologies can be win-win-win. Which of your patients should hear one?


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Learn more about Trisha and her work.

Learn more about Trisha’s book
You Bet Your Life! The 10 Mistakes Every Patient Makes

(How to Fix Them to Get the Healthcare You Deserve)

Advocate Is Not a Dirty Word

advocate
Last week’s blog-versation about whether doctors could truly understand and represent a patient’s point of view brought out a very different point — one that could use some exploration.

As a medical professional, what is your first thought when you hear the term “patient advocate?”

Do you roll your eyes?  Recoil at the thought of how much time an appointment might take with an advocate present?  Put up your mental defensive “I know what’s best for this patient and you don’t” dukes?

In short, do you automatically go to the negative side of your reaction meter?

Or do you (please say yes!) welcome the advocate who accompanies your next patient and show him or her a chair in the exam room?

Patient advocates want exactly the same thing you want for your patient: successful outcomes.  This will come as no surprise to the more enlightened of you, and as a major surprise to those who gird their attitudes when they hear or see that an advocate may be involved in a patient’s care.

An advocate’s intention is not to come between you and your patient; rather, it’s to make sure that your patient understands the challenges in front of him and then follows through with whatever course the two (or three) of you have determined will work the best.  The result is a more informed patient, one that has a better chance of regaining or maintaining improved health.

Facilitation — not interference.

Think of it this way:  If your spouse or your child were sick, wouldn’t you want someone you trusted (like yourself?) to accompany her/him to the doctor to facilitate the conversation and the next steps?  Would you send him/her alone and expect the outcomes to be nearly so good?

A good advocate is a great ally for you.  Knowing you have the same goals, and being respectful, can only create more adherence/compliance and better outcomes.

If you are inclined to think anti-advocate thoughts, then I ask you to try a different approach.  See if a handshake, a smile, and a more inclusive attitude won’t make your day a little brighter — and your patient a little healthier.

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Learn more about Trisha and her work.

Learn more about Trisha’s book
You Bet Your Life! The 10 Mistakes Every Patient Makes

(How to Fix Them to Get the Healthcare You Deserve)

Patients Are Crazy

July 13, 2009 8 comments

.. or at least one of the people I follow on Twitter says we patients are crazy.  You can see his post here:

peoplearecrazy

My reply to him was that he shouldn’t be so surprised that a patient wants to review a second opinion.  Let’s look at point of view:

Suppose your car is making a horrible noise.  You take it to the mechanic who tells you your engine needs to be replaced.  Knowing what that will cost, not to mention that fact that it means your car will be out of commission for — oh — three weeks — while the engine is replaced, you take it to a second mechanic.

The second mechanic tells you that you don’t need a new engine.  You really only need to replace the belts.  That will cost you (money, time, grief) only a fraction of what replacing the engine will cost.

Now what? What if Mechanic #1 is right?  But, what if Mechanic #2 is right?  How are you supposed to know?  Do you need a third opinion?

If you trust Mechanic #1 (because, remember, trust and the expectation that he is 100% right 100% of the time are two different things) then it requires a further conversation with Mechanic #1. You need to know why he’s recommending the engine be replaced and why he doesn’t  think simple replacement of the belts is enough. You have additional questions, and you are confident Mechanic #1 can answer them.

And that is what your patients want to know.  They need a way to compare the two opinions they have received.  They need to know how you arrived at your recommendation. If they return to you, they do so because they trust you.  They just need to understand it better.

Put another way — what if it was you or your child? What if you had a difficult decision to make that would affect your child’s health and two people had told you two different things.  How are you supposed to figure out all the important details?

Patients aren’t crazy — they just don’t know the protocol.  They don’t understand reimbursements.  They don’t understand that you can only bill them if they show up in the office for the conversation.  They don’t get that you aren’t interested in donating your time to them.

But if you treat them as if they are crazy, they will never get it.

How to get beyond that hump?  Invite them in to discuss — through a billable appointment.

Your patient needs only a simple explanation.  “Mrs. Jones.  Dr. FirstOpinion would be happy to discuss this with you, but we’ll need to make an appointment to do that. Can you come in Thursday at 2 PM?”  Then, when Mrs. Jones arrives, explain to her that her payer requires an appointment be made to discuss options.  If she is puzzled, explain how reimbursement works.

We patients need all the information we can get.  And we need your respect for our information gathering efforts.  We want to collaborate with you, looking to you as our #1 resource for the information that will help us make difficult medical decisions.

Patients aren’t crazy.  We just need to learn. And we want to learn from people we trust.  Like you.

*Note:  Please see PediatricInc’s response to this post

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Learn more about Trisha and her work.

Learn more about Trisha’s book
You Bet Your Life! The 10 Mistakes Every Patient Makes

(How to Fix Them to Get the Healthcare You Deserve)

"Putting Patients First" = No Patients (Time to go clean my room now.)

July 12, 2009 10 comments

I’ve just returned after being away for the weekend and logged into Twitter, where I find my favorite Tweeps discussing a Blogger-Politician-Healthcare Reform discussion being promoted by Dr. Val of Better Health, and some real dissention in the ranks regarding whether patients should be included in the discussion.

The doctors say “No, we can discuss what is good for patients.  Patients don’t need to be at the table.”

The patients, feeling very excluded, say, “How can you discuss what is best for us without asking us?  We are supposedly the focus of your conversation. Isn’t our contribution important?”

And the doctors reply, “We know what is best for you.  After all, we are all patients.  You are, therefore, represented.”

And Trisha says, “Not so fast!”

And here’s why.  In my attempt to help frame a conversation, to collaborate, to help you understand a patient’s point of view, please bear with me for a moment.

In the midst of healthcare reform, the word “collaboration” gets tossed around by those who think they want to collaborate. But the moment they must truly step up to the collaboration table, they opt out.  Why?  Not because they don’t want to, but because they don’t know how.  This seems to be a perfect example.

When you became a doctor, or a nurse, or whatever other medical profession you are part of, you studied medicine. But you also had mentors – attendings or higher level residents or nurse supervisors — someone who had been around longer than you — who taught you how to behave with patients.  Not treat them.  Behave with them.

You learned that you are in charge.  You call the shots.  You determine what is best.  You have the knowledge, education and experience, after all.

You behave with your patients not so differently from the way you behave with your children. Because you are in charge of them, and know what is best for them, too, right?

Think of it this way.  In your experience, and the reason you learned to behave with patients the way you do, is because you know that patients have not traditionally been good about taking responsibility for their health or healthcare.  (Your children have not been good about it either.) Therefore, for many, their health could not improve or be managed unless you DID care for them in that paternalistic, benevolent manner.  (Unless you insist your children clean their rooms, their rooms will never be clean!)

Not only that, it’s what your patients have expected.  (Kids know you’ll be upset if they don’t get their rooms cleaned.)

The problem is, that the healthcare world has changed.  I don’t have to tell you that.  You know that in many ways better than most patients do.

Included in that change has been a major shift in how patients see their care.  Many of us — those of us who have learned to take responsibility, and unfortunately, those of us who have learned that responsibility is necessary because of MAJOR hiccups with our healthcare — no longer want you to be or ask you to be so paternalistic.

We don’t want mommy or daddy doctor determining our care or “raising” us through our care.  We need you to help us be responsible patients.  We want to collaborate with you. Less parenting and more insistence on patient responsibility is what’s in order here.

And so we say to you — please stop telling us what is best for us.  Teach us to learn about our options and let us help decide what is best for us. Help us learn to be responsible.

We are not your children.  We are your colleagues, friends, customers, clients…. we are your patients.  We have opinions.  We have knowledge.  We are smart. We can understand. We can make decisions. We can become responsible.

But not if we are consistently excluded from the conversation.  Not if you only ever talk ABOUT us and not WITH us.  Not if you continue approaching your jobs as if you are parents, and not collaborators, even though — yes — I understand that you mostly can’t help that.  It’s how you were taught.

You are not a (pure) patient, too.  You are one half of a team. Professional and patient, together, will improve outcomes and attitudes for all.

I’m pretty good at keeping my room clean.  I can be a good collaborator, too.

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Learn more about Trisha and her work.

Learn more about Trisha’s book
You Bet Your Life! The 10 Mistakes Every Patient Makes

(How to Fix Them to Get the Healthcare You Deserve)