Description: This is a TED talk about healthcarefirst-login. Stacy Lee understands the miscommunication between doctor and patient. She has outlined a way to enhance this exchange to improve your treatment plan. Lee demonstrates through stories of misdiagnosis, treatment as usual and not getting results. Each of us possess the single most powerful tool to get the care we need.
Suppose I told you that you possess the single most powerful medical diagnostic tool to get and stay healthy. What’s more suppose I told you that use of this tool doesn’t depend on whether your doctor is in network or out of network. You don’t have to reach some deductible before you can use it.
In fact use of this tool isn’t tied to your health insurance at all. But it gets even better. Suppose I told you that you can increase the effectiveness of this tool at any time. So what is it? What is this powerful diagnostic tool that you already possess? It’s your voice. Your ability to effectively communicate with your doctor is the single most powerful diagnostic tool you have to get and stay healthy.
But what happens when that voice isn’t effectively used and when a patient’s voice isn’t heard either because it’s disregarded or the words don’t come out. When that happens, it causes tens of millions of Americans to suffer unnecessarily every year. It causes emergency room visits and misdiagnosis that cost our health care system over 300 billion dollars each year.
When that happens, it creates a silent dissonance over treatment decisions that place a tremendous emotional and physical strain on patients. Because they feel their voices aren’t being heard. I’d like to share with you one of those stories, one of those voices. This name is Peter and Peter’s in my health law class.
I saw Peter on Wednesday nights from 6 p.m. to 9 p.m. Peter was a very good student who came to class on time and was actively engaged in class discussions. Afterwards we talked about his marathon training over the course of the term.
I watched Peter go from that engaged prepared student to someone who missed the class and when he was there, he was so exhausted. He could barely keep his eyes open. So I asked Peter what’s going on and he said I don’t know. I went on a training run and I found a tick on my thigh knowing that ticks can carry Lyme disease people. Peter saved the tick, made an appointment with this doctor and wanted to discuss it.
During his 15 minutes appointment with his doctor, he explained what happened and showed him the tick and asked him to have it tested. The doctor looked at him laughing and said we don’t do that, come back when you develop symptoms a couple weeks after the bite.
Peter started to feel achy, developed reoccurring fevers and felt exhausted. Generally rundown he made another appointment. This time his doctor came into the exam room carrying his laptop and proceeded to run through a series of Lyme disease indicator questions.
After checking a series of appropriate boxes, he asked Peter have you developed a bullseye rash which according to his laptop is a definitive sign of Lyme disease. When Peter said no, his doctor said come back if and when you do.
At this point I have to interject myself into the story. By now Peter had withdrawn from my course with the demands of work in battling extreme exhaustion. He couldn’t keep up with the course deliverables. We kept in contact with email. So I can tell you what happens next several weeks later.
Peter developed 105 degree fever and couldn’t walk in a straight line. His friends took him to the emergency room and the medical staff started running tests while Peter repeatedly voiced his concern that he had Lyme disease.
But the medical staff said for that to be the case you would have the rash. Fortunately for Peter before he was to be discharged the rash appeared. It was only then that Peter’s voice was heard. The medical staff treated him for his Lyme disease and Peter was discharged with a three-week supply of antibiotics.
In case you’re wondering, Peter made a full recovery. He even rolled in my class and got a good grade. The effectiveness of your voice rests in your ability to get your doctor to listen and hear you. But as we saw with the case of Peter, sometimes that can be difficult.
For instance the research shows that a doctor spends on average 15 minutes with each patient in some cases only 11 minutes. It’s not a lot of time however in that same amount of time of a doctor’s appointment today, you will leave with the three part prescription on how to effectively use your voice to get and stay healthy.
It requires you to acknowledge the challenges in getting your voice heard, anticipate your experiences, prepare for those doctor’s appointments and finally amplify your voice with story. I’d like to spend some time on your first part of your prescription, the challenge of getting your voice heard.
Going back to the 15 minutes that your doctor spends with you, that’s not a lot of time. Studies show that during that time with your doctor one of the things that’s most important to patients is to explain why they’re there and what hurts.
The research shows that it takes the average person about three minutes to explain the nature of their visit. That same research shows that a doctor interrupts you 12 seconds in it. It’s hard to get your voice heard if you’re being interrupted and cut off.
In addition it’s not uncommon for doctors to walk into exam rooms with their laptop. Your electronic health records have become permanent third parties for the conversation you’re trying to have with your doctor.
As they scroll through their computer screen checking appropriate boxes, try to maintain eye contact. While staying engaged with you requires a set of multitasking skills that can drown out your voice.
Short doctor’s visits, doctor’s interrupting you and the presence of Technology these challenges may make it easier for your doctor to hand you a prescription than to have a 10-minute conversation with you about lifestyle changes.
To promote better health or to ask an unscripted question that they fear could lead you down a journey of a 20 minutes segue down memory lane. But what’s the cost of those unasked questions of those unspoken conversations, if you’re not talking, if your doctor isn’t listening, if those conversations aren’t being had.
The research shows that increases the possibility of your doctor coming up with a wrong diagnosis or during a test you don’t need of you leaving your doctor’s appointment without a complete understanding of what your diagnosis is or without full buy-in into your treatment plan.
So that brings us to the second part of your prescription, how do you use your voice effectively to maximize the 15 minutes you have with your doctor? Your agenda may not be the same as your doctor’s. His goal is to zero in on your primary concern. Yours may be to go through your laundry list of ailments in no particular order and no matter how small.
A more effective approach might be to identify your top one or two concerns. If you have more, write them down and bring them with you to your appointment and ask your doctor to help you prioritize what makes sense to deal with at this appointment and what might better. Wait until your next appointment.
Those concerns have specific questions. The more specific your question is, the more detailed and explicit your doctor’s answer will be. You don’t have a lot of time with your doctor. Anticipate their questions and have answers ready for them.
It’s not uncommon that at the end of your appointment you think of several questions and you’d like to ask at that point. Your doctor has a choice, answer your questions briefly now perhaps at the expense of good clinical care or schedule another appointment.
Use your voice and make the choice for them to schedule another appointment. If that appointment is not enough, ask about email communication through a patient portal. Your voice can take many forms. An email communication is an effective way to deal with after appointment and in between appointment questions.
I’d like to go to our third part of your prescription what happens when your voice isn’t heard. Not because your question has been disregarded but because the words aren’t coming out. This can happen for a number of reasons.
It could be because of the magnitude of the appointment. It could be because of embarrassment or cultural factors or as in the case of my father, a chronic non complainer, who has never asked the right question.
My father was a career army officer and since retiring he’s experienced a host of medical issues. He was diagnosed with chronic myeloid leukemia and had back problems that necessitated two surgeries.
The pain on my father’s back and legs has made his ability to walk around the house unassisted and difficult. However he had never know it from his doctors appointments. Colonel Boyd how’s it going? I’m feeling good. How’s the mobility? I won’t be running any for minute miles but you know I’m doing all right.
It went year after year with unerring consistency until finally after watching my father try to move around my parents’ house. As I watched his scope of activities get smaller and smaller. I reached the tipping point. I got to tell you I’m sure there’s a great TED talk in here for when an adult child figures out that they need to take the caregiver reins from their parents.
But seeing the note cards that they’re holding up in the back. Today’s probably not the time for suffice to say that. Tipping point finally forced me to have that frank conversation with my father and during that conversation I asked the one question that apparently wasn’t in his doctor script.
Father, what do you want? He admitted that he wanted to be able to walk in to my grandmother’s 98th birthday. However he was afraid that the pain on his back and his legs would make that impossible. I went to my father’s next doctor’s appointment with him and several more after that to give voice to what he wanted to tell the doctor his story instead of getting another prescription for tramadol for his pain.
We got a walking and swimming training program. Now all of this didn’t unfold in one appointment but over several appointments we put a plan in place that was eight months ago On February 12th.
My grandmother turned 98. My father walked in unassisted to bring her flowers. If you can’t give voice to your words, bring someone with you who can be a loved one, a friend. A patient advocates that doctors need to know what’s important to you and the presence of someone else can raise the level of expectation.
Doctors will respond in kind and I can’t stress enough how your story is. Doctors need to know what’s important to you. If you rattle off a series of symptoms like my shoulder hurts doctor, I need an MRI not memorable, not riveting, not informative instead try the story my brother had cancer that spread to his bone and shoulder, I’m worried about the pain in my shoulder or in the case of my father I want to be able to walk in unassisted and hand my mother flowers on her 98th birthday. Your voice is your single most powerful medical diagnostic tool to get and stay healthy. Use it.