3 Secrets to Getting the Most Out of Your Dr.’s Appointment

Do you feel like the doctor doesn’t have enough time to listen to your complaints? Is it frustrating to leave the doctor’s office and realize you didn’t get your questions answered?

Let me tell you what is going on and you aren’t going to like it. The doctor has about 12 minutes to listen to you, exam you, figure out what is wrong with you and put together a plan to help you get better.

I can hear you saying, “But 12 minutes isn’t enough.” Of course not, but that is the reality of medicine today.

You can complain but if you are smart, you can learn the three simple steps below to get the most out of your doctor’s appointment.

Here is Secret #1. You have to think like a doctor. Doctor’s think in an organized manner, so we have to give them our information in an organized way. Doctors usually play a guessing game with us as they try to figure out what is our “chief complaint”. But these questions are just wasting our precious minutes. The more organized and prepared you are for your appointment, the better.

Here is Secret #2. The doctor will make more time for you if he likes you better. And if your doctor likes you, you will get better care. I know it doesn’t seem fair but that is just the way it works.

Secret #3 is to make sure you are nice to all of the office staff. They can make it easier or more difficult for you to get in to see the doctor. They control his schedule. So, be kind to them and say, “Thank you.”

Now let’s make it easy for the doctor to help you.

Step 1. Write down all of your medications, occasional cold medicines, vitamins, herbal medicines, natural supplements, etc. And I mean everything. Even things you don’t think are important may be very important to your health. The doctor can’t protect you from things that he doesn’t know about, so write them down. If you don’t want to write them down, then bring all of them to the appointment with you.

Step 2. Write down how you are feeling. Why are you coming to see the doctor? Tell him what is hurting you, bothering you or any other physical complaints? Write down the new symptoms first and then write down the problems that are ongoing.

Step 3. Write down your questions and then circle the 2 most important questions. The doctor doesn’t have time to answer all of your questions so it is up to you to keep the doctor focused on what is most important to you.

And a Bonus Secret, if you want to make the doctor angry, keep your most important question a secret until the end of the appointment, and as the doctor is walking out the door say, “I have one more question …” If you wait until the end for this “Oh by the way” question, the doctor will only have one minute left to answer it. Please, write down this most important question so the doctor can spend time helping you.

If you would like, I have created a form for you to use each time you go to the doctor, Viki Kind’s Office Form for getting more from your doctor. Sign up for my newsletter and I will send you new support tools once a month.  Print out a couple of copies so you have them ready before your next appointment.

Have a kind and respectful day.

Having patience with a senior loved one

I understand that it isn’t easy to be patient with a loved one that is aging or has a physical or mental limitation. I know that I have tried to hurry along a loved one with little success. But it is important to understand that our loved ones aren’t doing this to annoy us. They are just at a different stage of life. As a people age, the need to be in a rush and to get a lot done changes. Older seniors have more important things to focus on, the work of aging. There are two main tasks that need to be accomplished: Keeping control over as much of their life as possible and legacy work. The need to keep a sense of control and power over one’s life is necessary as the seniors begin to experience significant losses. Seniors are losing their health, their abilities and those around them begin to die. As people come to terms with what they are losing, the need to hold on to what power they can becomes even more important.

This is why when you come in and try to take over our loved one’s life, it is not seen as being helpful, but as you trying to dominate the person. We rush our loved ones and try to make them go at the speed that we prefer. The need to rush and get things accomplished is our agenda, not theirs. It is important to remember that the senior is not in a rush. He or she is trying to enjoy and appreciate the time remaining.

Not only are seniors trying to keep control but another even more important task needs to be done. Legacy work. This is when the aging are trying to make sense of and to make peace with how their lives have gone. They want to be remembered. They want to be able to tell their story and to know that someone is listening. When seniors repeat a story, it serves many purposes. The need to make sure our families will remember our history so they can share it with future generations and the need to re-tell the story themselves so they can make sense of what has gone before. If you can, take the time to reinforce that the senior in your life matters and that he or she has made a difference.

Some day, we will all be in this stage of life and will need to accomplish these tasks as well. This is no different from a toddler needing to learn to walk or a teenager learning independence. This is just a part of life. Perhaps we could be a little more patient and understand that these life tasks do not happen in a hurry. Maybe there is something we can learn along the way if we slow down, listen and connect with the seniors in our lives in a more profound and meaningful way.

For more information about how to communicate in a way that respects the journey of the senior, read David L. Solie’s book, How To Say It To Seniors.

Have a kind and respectful day.

Are you treating your loved one like a “Third Party Patient”?

When you take your loved one to the doctor’s office, are you making sure that you are keeping the person with diminished capacity involved in the office visit? Too often, the doctor starts talking to the patient’s family or caregiver and forgets that the patient is in the room. Or sometimes we forget that our loved one is still here and begin to make all of their decisions for them. This is what is called, “Making the person a third party patient.” It is seems like the patient has become invisible.

I know this has happened in my family. Many times, my dad’s doctor would ask me in front of my dad, “How is your dad feeling today?” Then I would say, “I don’t know, ask him.” Or when I would take my aunt, who was in a wheelchair, out for lunch, people would say to me, “What would your aunt like to eat?” And once again I would say, “I don’t know, ask her.” We have to remind people that our loved one is still here. Even if the person has lost some of their ability to think and communicate, that doesn’t mean that he or she shouldn’t be included. Yes, the person with diminished capacity will not be making the final decisions about medical treatment choices, but the individual can still voice his or her opinion.

I know that it may not be easy and it may take more time, but we need to keep the person included. The person deserves our attention and our effort. Face the patient, ask the person questions and be patient when waiting for the answer. Explain to the person what will be happening to him or her in language that can be understood. It is important to include the person for as long as possible and when it is safe to have them have a voice in the decisions.

Have a kind and respectful day.

A Good Death - You Tell Me and I Will Help You Get It

A good death is what you tell me it should be. No one can define what would make a good death for you. If you tell people what would be meaningful for you, then those around you can get you what you need. I have lots of ideas for things you might want to do to create a legacy for your family but that is only if that is what you want to. Perhaps you want to record your life history on an audio or a video tape. Perhaps you want to write love letters for your family to open after you are gone. Perhaps you want to write an “ethical will” outlining what values and beliefs you would like to pass on.

Or maybe you want me to know about how to handle your physical symptoms. Maybe suffering has meaning for you. If you explain this to me, I will understand when you don’t take your pain pills. Or if you tell me that you don’t want to suffer, I will understand when you take your pills and sleep a lot. Or perhaps you want to trade a little bit of pain control for consciousness, then I will understand if you only take a little of your pain meds. You tell me. It is your death.

Or perhaps you don’t want to talk about it and just spend your days living. You get to decide but you have to tell people so they will know what is important to you. Otherwise, we won’t know what to do to support you.

There is a famous bioethics case of a lady who needed to have her leg amputated. She didn’t want to have her leg cut off even though it meant she would die. The doctor argued with her again and again. He would ask, “Don’t you want to be alive to see your grandkids grow up? Don’t you want to spend time with them?” Finally the woman said to the doctor, “I hate my grandkids.” He was shocked. But she went on to explain that the only thing that brought her joy was working in her garden. And if her leg was cut off, then she couldn’t do that anymore. The doctor had thought that what would be valuable for him would be valuable for her. He was mistaken.

You have to tell your doctor what matters to you. And if you can, write it down so people will know what to do when it comes time. When it is written down, you are more likely to get what you want. A good death on your own terms.

Have a kind and respectful day.

When you hear the words, “There is nothing more we can do.”

As a patient, there may come a time where you hear the words, “I’m sorry, there’s nothing more we can do.” I want to apologize for the doctor’s abrupt words. Many doctors have had little training in having these types of conversations and are incredibly uncomfortable. What your doctor should really be saying is, “Even though there is nothing more we can do to cure you, there’s lots more I can do. I can do plenty to keep you or your loved one comfortable, out of pain, minimize your suffering, refer them to hospice, get your religious leader in here to pray and help provide a peaceful and dignified death.” Just because you don’t hear this doesn’t mean you shouldn’t ask for this. You should advocate that the doctor makes sure you get what you need as your disease progresses and as you die. Help the doctor help you by asking for a palliative care referral if you are having problems with pain. Ask for a referral to hospice when the patient is sleeping more and eating less. You want to stay connected to the doctor even if the direction of treatment has turned to comfort and care.

As a patient or a loved one, you will have a strong grief reaction to these words. You may be in denial, in disbelief, in numbness or feel some other strong emotions. If you are in denial, you will not believe that what you were just told is true. This is okay as it is the way your brain protects you from bad news. Eventually, you will hopefully come out of denial so you can use your remaining days wisely. Or you may find yourself in disbelief. Disbelief is where you keep saying to yourself, “I know the doctor just said ______ but I can’t believe it’s true.” In this situation, you may want 2nd opinions or repeated tests. This is disbelief. Your brain knows it’s true but it is not ready to accept this news. This is also okay and normal. Or you may be numb. This can really be a problem when the doctors want you to make decisions. Ask for a few days so you can process what you have been told before you make these final decisions. You may also have many other types of emotions: anger, fear, hopelessness, helplessness, sadness, etc. These are also normal as you come to terms with your life’s expiration date.

You get to choose how you want to spend your remaining days, months or years. Choose carefully as you won’t get these days back. And if you are like someone I knew who was waiting until they got closer to death to write love letters to his children and his wife, realize that sometimes when get closer to death, you may not have the energy or strength left to finish your goals. Please use your time wisely.

Have a kind and respectful day.

Are you a victim of the 20 second problem? Does your doctor listen to your whole story or does she interrupt you before you are done?

When the doctor says, “What brought you here today?” Does the doctor listen or does she interrupt as you begin to tell your story? If the doctor interrupts you, you are the victim of the 20 second problem. This is a common problem that has been researched over the years. Now, the doctor isn’t being rude, she is only asking clarifying questions such as: what kind of pain and how much pain and how long have you had this pain? These are important questions, but asking them too soon gets in the way of the doctor hearing the whole story. Once the doctor begins asking her questions, she may forget to come back and listen to the rest of your concerns. Without hearing the whole story, she may misdiagnose or may start heading down the wrong path because she has missed some important details.

Doctors don’t realize that this behavior will lead to the thing they hate that patients do. That is when the patient says the, “Oh by the way” question or the “One more thing doctor” question. This is the last question you ask before the doctor walks out the door. This drives the doctor crazy because they’ve already spent their time with you and are ready to move onto the next patient. But many times, the reason you have the “One more thing doctor” question is, because you weren’t allowed to ask everything at the beginning of the appointment.

So what can you do? Tell the doctor that you won’t ask one more question at the end of the appointment if she’ll take the time to listen to your whole story at the beginning of the appointment. Let her know that it will only take a minute or so for you to explain why you’ve come to the doctor’s office that day. Research has shown that all it takes is one to two minutes for the patient to get their whole story out. Now this may feel like an eternity to the doctor, but it really works to decrease medical errors, improve medical outcomes and to increase patient satisfaction.

I also recommend that you bring in a prioritized list of questions so the doctor will know what you’re there to talk about. Make sure you mention the most important items first. The doctor doesn’t have forever with you so make it easier for the doctor to help you by being prepared and getting right to the point. You can also print out the sister blog piece under the healthcare professionals category to take to your doctor’s office. It is titled, “Overcoming the 20 second problem or How I learned to save time.”

Have a kind and respectful day.

When you can’t understand your doctor’s accent, you may be in trouble.

As our country becomes more and more diverse, the issue of language and communication becomes an ever growing problem in healthcare. There are 329 languages being spoken in America, and with that comes many different accents. If you can’t understand your doctor, you may be in trouble. If you can’t hear the instructions for your surgery, how to take your medications or the information they are telling you about your disease, then how will you be able to get better? This is not about bias, this is about your safety and reality. And I’m not just talking about accents from other countries; it may be accents from different parts of the country. And if you add the increasing hearing loss with our aging population, it only compounds the problem.

So what can you do? If you have a choice, pick a doctor that speaks the same language that you do. The other good thing about picking a doctor who speaks your language and is from the same culture is that when it’s time to make end-of-life decisions, you will probably be in greater agreement. If you truly can’t get a doctor that you can understand, then ask for a professional medical interpreter, even if you are both speaking English. You are entitled by law to have a professional interpreter in a hospital. There is also a medical service that that is free called the A T and T interpreter phone line. You can get an interpreter on the phone and they can help you with your conversation with the doctor.

I was talking to a professional medical interpreter at Children’s Hospital and she was telling me about the different ways one gets into trouble when using the family as the interpreter. She told me that in one language, the words a doctor might say when a patient has died, “I am so sorry your sister has died” don’t translate very well. “I’m sorry” in that language means, “I’m responsible. I killed your sister.” Oops. If you had a professional translator in that situation, the interpreter could have stopped and asked, “Is that what you meant to say?” And of course when the doctor said no, she could then help put the words into terms that would be acceptable. The translator in this instance would say that what should be said is, “I’m so sad. Your sister has died.”

This is just one reason you should be using a professional translator. There are other reasons as well. Your family may not be able to translate some of the terminology because they’re medically illiterate. The language of medicine is complicated. Or they may have an agenda and only translate some of the information to you, the patient. Or they may be following their cultural rules about what can be spoken to their elder. Or there may not be a word for what the doctor is trying to say in your language. Did you know that in one language there is not a separate word for bacteria and virus? There is only one word to describe both. How is your doctor going to explain something when they don’t even have a word for it? Good luck without a professional interpreter.

If you do use an interpreter, make sure you thank the interpreter and respect that they are professionals and are there to help us. Using an interpreter may save your life.

Lastly, your local hospital may want to consider having the interpreters visit the patients throughout the day to make sure their needs are getting met and that they feel like they have a voice in their health care. Your hospital may also think about sending interpreters into the doctor’s offices to provide interpretation services in the outpatient setting. Some hospital systems in Los Angeles have already begun doing this and it is making a difference.

Have a kind and respectful day.

When you are standing alone in the hospital waiting room and don’t know what to do next, you can call me.

I remember when my mom was dying and I was sitting vigil with her in the hospital on the last day of her life. My brother, who I was close to, said to me, “There really ought to be someone who can help people with this.” And what he meant by “this”, it was the dying process. I said to him, “This is what I do, I am a hospice volunteer.” My brother knew me very well and knew that I worked with the dying, but he couldn’t imagine what that meant. And if he couldn’t imagine what a hospice worker does, then a lot of people may be confused or unsure.

But it is not just hospice that people have questions about. There are so many new things to deal with when a loved one is sick. There are specialists who can help you make your home safer for the patient, help you with applying for disability benefits or help you make decisions about both the short and long term plans.

I get called by so many people, whether it is for help during the dying process, help with figuring out what to decide when the patient can’t speak for themselves anymore or how to deal with a conflict in the hospital. You aren’t alone. I can help you when you are standing in the hospital waiting room asking yourself, “Am I doing the right thing? What do I do next?” You can run it by me and I will walk you through it.

Have a kind and respectful day.

Are you the patient’s advocate or a bully?

This might be painful to read, but you may be making things worse for your loved one. Now I am a big believer in advocating for what you need in healthcare but there is a line which shouldn’t be crossed. And the line is when you start bullying the members of the healthcare team. Here is what this might look like. The doctor says, “What you are requesting won’t work for this condition. That treatment isn’t an option.” And you say, “You have to do it anyway or I will sue you.” You will probably get your way because doctors are afraid of the “l” word, lawsuit. But what you really just got is a medical treatment that will not work for your loved one and will only give them toxic side effects. Are you sure that’s what you meant to do?

If you truly want to know if a treatment is appropriate, ask for a second or third opinion. If you can find a doctor that will give you what you want, then change to that doctor. But if after you have asked 2 or 3 other doctors and they all tell you no, then you need to realize what you are getting is good medical advice. If everyone around you reacts negatively to you, it is not everyone being the problem, it is you. So if all the doctors and nurses are a “problem”, then perhaps the problem is you. You may be a bully.

You may think that if you become loud and demanding then you will get what you want. It doesn’t work that way in hospitals. You may get what you want but you will destroy the relationship between the patient and the doctor. And did you know that if the patient trusts the doctor, they will actually heal faster? It’s true. So when you damage the relationship, you are damaging the recovery process. And again, your good intentions will cause harm.

The doctors and nurses will start avoiding the patient’s room and spend less time interacting with you and the patient. And you and your loved one will become known as the “problem in room 321.” Every nurse that comes on shift will be warned about you. And again, that doesn’t get you what you want.

If you want to get more, be kinder and more appreciative. I always tell people that if you want to get better care, bring snacks to the nurses. Say thank you to the doctor. Make them want to spend more time thinking about your loved ones health and more time talking to you and the patient. Be a part of the healthcare solution.

Have a kind and respectful day.

Are Mixed Messages Harming Your Health?

When you are in the hospital, you are vulnerable to the problem of “Mixed Messages.” What this means is that each of the specialists come in and give you information about the part of the body they take care of. So the pulmonary doctor will say, “Your lungs are doing better.” The cardiologist will say, “Your heart is failing.” And the internist will say, “Your infection is getting under control.” But nobody is giving you the big picture. Nobody is telling you how to interpret all of these pieces of information about your health situation. So here is what happens next. The next day your internist comes in to talk to you about end of life issues. You are shocked and ask, “How can I be dying when my lungs are doing better?” You have just done what most people do. You latch onto the best news and forget to take into account the worst part of the news. Yes, your lungs might be better, but you can’t live without your heart and your heart is failing. But nobody is explaining this to you.

Nurses do the same thing. Each day, different nurses are assigned to you. And each nurse has a slightly different view of how you are doing. Or they say, “You are doing better.” What does “better” mean? It doesn’t mean better and you are going home, it means you are doing better than the worst moment you have had in the hospital. Lots of people die in hospitals that are doing “better.” Better doesn’t tell you the whole story.

So what can you do? You can ask the main doctor, called the attending, to give you an overall update about how you are doing. Not just a part by part explanation, but a “big picture” explanation. And if you are getting mixed messages, make sure you listen to the good and the bad. I know that this can be difficult but it is necessary so you can make appropriate decisions about your health. The only way you can have informed consent is if you understand all of the information, not just the news you want to hear.

Have a kind and respectful day.

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