Value – #AtoZChallenge2018

The topic for today’s discussion is value. Not the kind of value one may think of in the terms of monetary value, but rather today we will touch on the surface of how we value ourselves as it pertains to both a patient and provider. First, I wish to address how we value ourselves from a patient perspective. It is not uncommon for a patient who has experienced a seemingly devastating illness or injury to feel that they are now less of a person or somehow less valuable than they were prior to the diagnosis. Continue reading “Value – #AtoZChallenge2018”

Understanding – #AtoZChallenge2018

\Understanding each other is a skill most if not many of us could use to spend a little more time practicing. It is far easier to make snap judgments and not give others the benefit of doubt or the energy required to attempt to put ourselves in the other person’s position, or shoes, as the old cliché goes. This applies to both life and healthcare equally. It also applies equally to both providers as well as patients in the healthcare setting. Continue reading “Understanding – #AtoZChallenge2018”

Time to Talk – #AtoZChallenge2018

Time is a finite thing when it comes to our lives regardless of whether we are healthy or ill. None of us know how long we will have on this planet before our time is up. This is a fact. Also a fact is that while many of us do not wish to talk about it we really need to be having the difficult discussions with our family about what we )and they) may desire should either become unable to make or communicate decisions regarding their medical care on their own. Continue reading “Time to Talk – #AtoZChallenge2018”

Stress – #AtoZChallenge2018

Stress is undoubtedly a part of all of our lives to some degree or another. It doesn’t discriminate between healthy or ill, and it also doesn’t discriminate between patient or provider. Each can experience their own kinds of stress. Regardless of your occupation, position in life, status or nearly any other quantifier you may wish to place on stress, you are not immune to it. Continue reading “Stress – #AtoZChallenge2018”

Responsibilities – #AtoZChallenge2018

The topic for today’s post is responsibilities and there are various aspects, which can pertain to this for both practitioners and patients alike. While many things are important I do believe that honesty and communication are either near or at the very top of the list, quite possibly accompanied by trust. Without trust, communication, and honestly there is little chance you will achieve what you set out to accomplish regardless what you may attempt to accomplish in life. While these should typically be implied let’s explore them a little bit to clarify precisely what I am referring to. Continue reading “Responsibilities – #AtoZChallenge2018”

Questions – #AtoZChallenge2018

The topic of today’s post is questioning. Questioning what you might ask? Well, questioning your physician about what to expect with your new or worsening chronic illness is an obvious example. How about having your physician doubt or question your symptoms or the amount of pain that you may be in. Having a friend, spouse, significant other question if you’re really that sick or if you may be simply trying to avoid that particular family function, or worse yet that maybe you’re simply exaggerating and things aren’t as bad as you say they are. Continue reading “Questions – #AtoZChallenge2018”

Pharmacies & Pharmacists – #AtoZChallenge2018

The topic of today’s discussion is how to get the most out of your pharmacy and the pharmacist. It is my experience that many people simply fill a medication and begin to take it as ordered without ever consulting with the pharmacist regarding potential side effects or interactions with other medications they may be on. This is a dangerous and potentially even deadly practice that should be avoided at all costs. Continue reading “Pharmacies & Pharmacists – #AtoZChallenge2018”

Office Visits – #AtoZChallenge2018

 

O is for Office Visits – #AtoZ Challenge 2018

 

Today’s topic for the letter O shall be office visits. This will include such things as how to adequately prepare for, participate in, and get the most out of the limited face time you may get with your physician or other advanced practitioners. How hard can this be, you may be thinking. Well, in reality, it isn’t hard per se but many people have never learned how to do it effectively.

In today’s healthcare system where providers are expected to see more and more patients in an ever decreasing amount of time, this is an essential part of you being your own best advocate. Even if you are among the lucky ones to have adequate time with your provider, it is still your responsibility to make the most effective use of that time. By following a few simple suggestions you can achieve this while increasing the efficiency of your interactions with your provider and by extension the level of your own care.

I made a form a few years ago that I will share here for you to print out and use as a template for your office visits. It may look complicated at first, and as with anything new, it may take some time to get used to. However, I can tell you from speaking with many physicians and advanced practitioners that it makes their side of the appointment much easier and improves the quality of the time they get to spend with the patient addressing other needs or concerns.

Whether you use my form or not is entirely up to you. You can handwrite the same information, legibly of course, on a sheet of paper if you so desire. Or you can simply print mine and fill it in, or if you have access to PDF editing software you can even complete it on your computer prior to printing.

There are some simple things to include in a list when you are preparing for your office visit, some of which can be started as early as when you finish your previous office visit. For example, let’s say you just saw your doctor and as you’re getting in your car you remember something that you wanted to ask but slipped your mind. You know you will be returning in a month to review lab work. Start a new sheet for that office visit and go ahead and start adding things to it now so you don’t forget a month from now. You could add the item that slipped your mind. You could even add an item to review the lab work lest you forget.

Looking at the provided form you on the very top left, in the header, you put your name. On the right side of the same header, you put the date of your appointment. Immediately below that, you will see in big, bold, red letters a spot for medication allergies. If you are allergic to any medications or have severe life-threatening allergies to something you would put that here. For example, if you are allergic to latex, or penicillin that information should go here for the provider to plainly see.

Then following down the left side of the page you then list your medications one at a time starting with the medication name in the first column. Let’s say, for example, that you take the medication Lisinopril 10mg once daily every morning for hypertension (high blood pressure). The name Lisinopril would go in the name field. Then the strength of the medication in the next column typically indicated on your pill bottle as mg or mgs, which refers to milligrams and in the above example would be 10mg. The next column is frequency, which refers to how often you take it. You could put once daily here and you would be correct.

However, some medications are more effective or even better tolerated at different times of the day. So let’s be as specific as we can to give our physician the most complete information to work with so you could write once daily at breakfast, or once daily in a.m. to show when you take it. This detail can be especially useful with some medications that may cause drowsiness as a side effect so it is important to be as specific as you can. Moving on to the next two columns, these are simply checkboxes in which first you indicate if you take the medication daily, or on strictly an as needed basis (PRN). In some more unusual circumstances you may need to check both these boxes for the same medication, but typically it will be one or the other.

An important note in completing the medication side of the form is that it is highly recommended that you include everything you take. By this, I mean that you should include vitamins, supplements, over the counter medications etcetera as this will give your doctor a complete picture of your medications and any potential interactions with anything you are either already taking that could be hazardous to you, or something new that they may wish to prescribe.

While this particular item does not apply to me personally, I would suggest that you also consider listing medical marijuana if you have been legally prescribed to take it and it is legal where you live. I am neither a pharmacist nor a physiologist so I can’t even begin to speculate as to how different forms of medical marijuana may alter or interact with other medications.

Lastly on the medication side of the form I also like to list any treatments I may currently be on that would need to be continued should I be admitted to the hospital so that in the chaos of admission paperwork things to not get overlooked. For example, I use BiPap to treat my obstructive sleep apnea and cannot sleep without it. Therefore I list it under the medication side of the list with the appropriate information so that the admitting physician can see that an order will need to be written to include that therapy while in the hospital as well.

The right side of the list is rather self-explanatory, but starting on the top right you would list any medications you need refills on either now or before your next appointment. A little bit of planning goes a long way here. Check your bottles before your appointment and if you know that you see this doctor every three months but you still have one refill left, some simple math will tell you that you will need more before you see the doctor again. List that medication here so there is no interruption in your medication regimen, and you don’t have to play phone tag with the office to get a refill when you do need it.

Below the section for refills is a section where you can list any items that need to be addressed during this visit. Some things to think about when completing this section include such things as have you had any labs or imaging studies since your last appointment that you wish to get the results on? Add this to your list of topics to address. If they order follow up tests you can even start the list for your next appointment now, during or after the current appointment, so that neither of you forgets to review the results next time.

Has your condition changed whether improved or worsened since your last visit? If so detail how so that you and your doctor can discuss the changes and modify treatment as necessary. Are you experiencing a new problem? List it here so that you don’t forget to bring it up. Anything that you feel either the doctor should address or that you wish to inquire about should be put here, no matter how small or inconsequential you feel the item may be. Sometimes the little details make all the difference.

Lastly, in this section, you should also include a brief synopsis of any visits you may have had with other practitioners since your last appointment. In this manner, you can be sure to address things that other professionals may have done since you last saw this particular doctor to ensure that nothing gets overlooked or interacts with what another provider has done.

I’ve had numerous occasions where one doctor would order a medication and when I next saw another specialist they informed me that while that medication may normally be appropriate for most people it was not appropriate for me because it would interact with one of my other medications or exacerbate any underlying condition that the other physician may not have thought of particularly if it was outside their area of expertise.

If completing the form on your computer I suggest you print two copies, but if you are completing it by hand simply ask the office staff to make a copy for you once you get there. Then when the medical assistant wants to review your medications, you can hand them the list. When they are done with it they can leave it in the exam room with you on the computer, for the doctor to see.

Once the doctor comes in you can simply ask him to follow along. Refills needed are clearly indicated for them to complete in the computer as you start to address your list of items to discuss. Many physicians have told me that it has made our brief encounters much more organized and efficient as we can easily address the items in short order as opposed to having to sit there trying to remember what it was you wanted to ask the doctor about. The purpose of the copy is so that you can both follow along and on the bottom of your copy you can take notes as to answers to your questions, new treatments ordered, medication changes, etcetera.

When you get home from your appointment is a perfect time to go ahead and start a new form for the next appointment and add anything that you may have forgotten to include on this visit’s form, or that you and your doctor have agreed needs to be revisited at a later time. By doing this you can make your visits much more productive as well as get the answers and information you need to be a more productive member of your own healthcare team.

Do you have suggestions for what should be added to this form? Do you have another way of doing it that works for you? Let us know in the comments as we are working on various adaptations of this form for the future to suit various situations. We’d love to hear from you!

PS – You can find the form by clicking on the link here: Blank MedList from Tupeak Hope.

N is for Nuance – AtoZChallenge2018

N is for Nuance – #AtoZChallenge

For the letter N in today’s post, the topic is going to be nuances and how they can appear where you least expect them. According to Merriam-Webster, nuance is defined “as a subtle distinction or variation” and it goes on to explain that it can also refer to a “sensibility to, awareness of, or ability to express delicate shadings (as of meaning, feeling, or value)”.

When you are ill you and your provider may need to have some very serious discussions and this can apply to a one-time relatively minor illness as well as to someone who is chronically ill who may have an entire team of specialists or even some sub-specialists.Even if you have what may seem a simple bacterial infection that would likely be treated very well with an antibiotic you and your provider should be having a discussion about the potential side effects or interactions of the medication on either your body or any other medications you may be on. While this may seem that it should be commonplace, there are still plenty of people who are content to simply have the doctor tell them what to do and they do it.

The time for patients to sit idly by and simply follow directions is long gone. In medicine today it is absolutely imperative that proper communication takes place. This is especially true for those who may be chronically ill with multiple illnesses or those who see multiple providers in order to ensure continuity of care and the best possible outcomes. Nuances occur every day in our lives, both in our speech and in terms of how our bodies may react to treatment regimens.

If we simply follow directions and don’t communicate well it could be easy for a practitioner to potentially miss a symptom that may important that you had no clue was important but have noticed for quite some time though you simply dismissed it as inconsequential. I’ve both seen and heard of patients dismissing symptoms as “just getting older” when in fact they were indicative of other underlying problems or conditions.

A well-trained provider should know the proper questions to ask to elicit the proper responses during an examination or a patient history. However, it would be unfair of patients to put this burden strictly on the practitioners. Physicians are being expected to accomplish more items, be more accurate in their patient-centered activities, and to do so in less and less time than ever before.

As a responsible partner in your own healthcare team, the burden not only falls on you to take a more active role in your healthcare, but this is a challenge you should be eager to undertake as it leads to better overall care for you, the patient. By participating in your care directly and doing even a little bit of efficient preparation you can ensure that you receive more accurate diagnoses and treatments, in a shorter time frame as you will know the basics of what needs to be discussed.

Each and every patient should prepare a list prior to an appointment, which can be as simple or as elaborate as you so desire. A list of items scribbled (legibly) on a piece of notebook paper is sufficient. I recommend starting with your name at the top, followed immediately by any allergies to medications as a reminder for the doctor. Below that you can list whatever prescriptions you may need refills on. Then you can individually list items that need to be addressed or questions that you may have. In this area, you should also include any symptoms you may be feeling despite whether you think they are pertinent or not.

You aren’t expected to be able to discern what is or is not diagnostically pertinent. However, if you don’t mention it then the physician cannot evaluate the information in its entirety to even attempt to make a proper diagnosis, nor should they be expected to treat you appropriately with less than complete information. While some topics may be sensitive or difficult to talk about, you can’t be shy. You have to have the ability to speak up and directly address something for the provider to ascertain its importance in the diagnostic and therapeutic decisions regarding your care.

In a similar vein when someone in the healthcare field asks you how you are doing, you are doing yourself a general disservice if you downplay how much pain you are in, how bad a symptom is, or how it may be otherwise affecting you and your immediate family. Subtle hints may often be missed and if you’re not explicit and honest you cannot expect your provider to see through the mask you put on to appear strong and capable of handling a situation when, in fact, you may feel as if the matter is overwhelming and that you can’t even keep your head above water.

If I were to sum up the point of this I would say take control of your own healthcare, do your proper research, and prepare to be an active member of your own personal healthcare team while practicing open, honest, and effective communication. You must also expect these traits from your providers and you can start things off quite well by exhibiting these things yourself and leading by example. Don’t rely on nuance or jargon to convey your meaning. Speak in clear and concise terms to convey your meaning.

Do you have a story to share? How do you participate in your own healthcare?

M is for Money (and Mindfulness) – #AtoZChallenge2018

 

M is for Money (and Mindfulness) – #AtoZ Challenge 2018

 

There are two separate for the letter M today for I couldn’t decide between the two. First, we are going to address money and it’s relevance in health matters. Secondly, we are going to address mindfulness as a way of coping with your life regardless of whether you are a patient or a caregiver.

They say that money can’t buy happiness and to many, that is a trite, pointless and inaccurate statement. At times it may seem insensitive or even judgmental when money judgments are made about patients by providers. I’ve had many providers look at me and make statements about my lack of ability to afford very expensive medications without prescription insurance.

Some prescription medications are quite expensive regardless of their availability as generics. Inhalers are typically several hundred dollars per month and that estimate is being conservative. I once had a medication ordered that was 400 dollars per month. When I inquired about the generic version of the medication the pharmacist informed me that the generic was actually 600 dollars per month. I have yet to be able to figure out how this made any sense whatsoever given that generics typically are cheaper than the original brand specific medication.

The point is that when a provider tells a patient that they simply aren’t making enough of an effort to properly acquire and use the medications provided it can result in the patient feeling insulted. Worse yet providers often document that a patient is being non-compliant with their medication regimen. I offer an alternative explanation that is quite succinct. Being poor does not mean you are non-compliant. Actually having the medication or the means with which to get it and making a choice not to do so makes you non-compliant.

Further, when a provider labels a patient as non-compliant the ramifications of such a statement are great. They can range from the patient feeling as if they have done something wrong, or otherwise failed to take proper care of themselves, which can lead to a potentially dangerous downward spiraling emotional state for the patient to an outright refusal of the provider to continue treating the patient for not doing what had been ordered. This can result in the patient feeling as if it were a punitive approach and therefore obviously should be avoided unless it was meant to be.

Switching topics slightly let’s explore mindfulness. By the provider practicing mindfulness, they can avoid treating the patient in such a punitive manner, instead of discussing potential alternatives that may be more within the patient’s available means. Doing this reinforces the concept of a team-based approach to medical care that includes both provider and patient as equal members of the team.

The patient can practice mindfulness in a totally different manner as a tool to help manage pain, stress, physical, or emotional trauma. By doing so the patient may be able to successfully manage such things as severe anxiety without the regular intervention of frequent anti-anxiety medications unless the symptoms being experienced are unusually severe. This can apply to pain management as well. This is not to say that medications are neither necessary nor appropriate at times. The point is that by learning techniques of mindfulness one can use these techniques as an adjunct whether in place of or in conjunction with appropriate prescription medications.

Providers and patients alike should learn to practice even one of the simplest forms of mindfulness by attempting to understand the other person’s point of view or position. By doing so we may be more able to effectively communicate with each other and accomplish whatever goals we are trying to reach.

Do you have a story to share? Please share with us in the comments below. We’d love to hear your point of view.