A beautifully-dressed older woman with beautifully-coiffed hair raises one beautifully-manicured hand during the Q&A portion of my Heart-Smart Women presentation. She stands and asks aloud:
“Carolyn, my doctor told me I have a heart rhythm problem. What does that mean?”
What she wants is for me to explain to her what her doctor has not. But what I want to do is to grab her by her beautifully-clad shoulders and shake her, very hard. How is it possible, I wonder, that such an articulate, well-trotted-out woman doesn’t know what her own diagnosis means, and, worse, hasn’t gone back to her doctor to find out? How can she be capable of making decisions about her expensive wardrobe, hairstyle and nails, yet somehow still be incapable of staying on top of the most important thing she owns: her heart health?
Sadly, she is not alone. A 2008 study of women over 40 done by The Federation of Medical Women of Canada called the LIPSTICK Survey reported that women spend more time thinking about their weight than they do about their hearts. And only 10% of women surveyed knew their personal heart disease risk factors versus the 64% of women who know how much they weighed in high school!
When I ask the people in my audiences to raise their hands if they know their blood pressure numbers, it’s common to see at least half of the group who have absolutely no clue. And when I ask them if they know their cholesterol numbers, the awareness level is even worse.
Dr. Henry Ting, who conducts research on informed consent, points to a Mayo Clinic study that found 80% of hospital patients signed consent forms they had not even read, and did not actually know the benefits or risks of the treatment they were having.
Dr. Ting believes that the problem of patient understanding is common in many areas of medicine.
“We [doctors] don’t do a good job of knowledge transfer in a way that patients and family members can understand. Graphs and charts are not going to work for many of our patients.”
Dr. Richard Frankel, a Regenstrief Institute research scientist at the Indiana University School of Medicine, offers this observation on the classic doctor/patient miscommunication problem:
“We don’t assume when a pilot and an air traffic controller converse that they have understood each other until there is an affirmation of understanding. That acknowledgement is lacking in most patient-physician encounters.”
Dr. Frankel, who studies ways to improve the doctor-patient relationship, is currently investigating how behavioral changes by both doctors and patients can impact medical care. He explains:
“From previous work, including a well-regarded 1999 study from the University of Washington, we know that doctors ask patients whether they understand what was just discussed less than 2% of the time.
“Doctors should be trained to routinely check for understanding to ensure that there is neither miscommunication nor mismatch between what the patient wants and what doctors assume the patient wants.”
Until doctors are better trained to do this, and until we smarten up about being accountable for our own health, here are six helpful rules for making the most of your next doctor’s visit, courtesy of the University of Minnesota’s Center for Spirituality & Healing and the Life Science Foundation, as part of their Taking Charge of Your Health series:
1. Know how to make appointments
Explain the reason for the appointment, so the receptionist knows how much time you’ll need. Be as clear as possible. For example:
“My knee has been bothering me for several months and I would like to schedule an appointment within the next week or two to have it evaluated.”
“I’ve had a cold for a week and now I feel worse with a high fever and pain. I would like an appointment today.”
Ask for what you need on the front end, and your time with your health care provider will be more useful.
2. Bring your health care records
If you are seeing a new doctor, bring a copy of your health care records and the results of any previous tests or procedures. Remember to keep copies of these records for yourself, just in case you are asked to leave the documents you bring to your appointment. Put together a notebook or filing system to maintain all of your records in an orderly fashion. It is also important to remember that your health care records belong to you. You have a right to your own medical information and may request this from any provider or hospital.
Here are some simple things you can do to verify the accuracy of your records:
- Make sure that your name appears on all of the forms, reports, and correspondence.
- Verify that you have had the conditions and/or procedures listed, and that the diagnoses are correct.
- Read the report of each office visit and the results of each procedure.
3. Arrive prepared to tell your story
Since the average doctor’s appointment is about 15 minutes, you must prepare for your visit. Write a list of your concerns and use it to jog your memory. Include the following information.
Preparing for Your Appointment Form (print this list)
- What symptoms am I experiencing?
- When did they begin?
- What makes the condition better or worse?
- What are my questions or concerns?
- What medications am I taking, including prescriptions or over-the-counter medications, vitamins, herbs, or nutritional supplements? Be sure to note the name of the medication, the dose, and how often you take it.
Ideally, you will have the chance to discuss your health while you are comfortable in your street clothes (prior to disrobing and having an examination).
Even if you feel worried, anxious, or embarrassed about your health concern, don’t wait until the end of the visit to bring up your real reason for the appointment or your health care provider won’t have time to deal with it.
4. Honesty is the best policy
Using acupuncture for pain management? Tell your doctor. Thinking about trying valerian to help your insomnia? Tell your doctor. Health care professionals can often tell you how your therapies might complement one another, or offer you vital information about how certain treatment combinations might even be dangerous.
Whatever treatment you’re using or planning to try, always let everyone involved with your health care know about everyone and everything you are accessing to address your needs.
5. Consider bringing a friend or family member
If you are feeling particularly anxious or concerned about a medical appointment, have a language barrier, are facing a challenging diagnosis, or anticipate discussing treatment options, it may be helpful to have someone with you. Choose someone who is a good listener and who won’t interrupt, dominate the visit or ask too many of their own questions.
The person who accompanies you on your visit can be another set of ears. This will help you remember after the appointment what was said. It is often helpful to have this person write information down so that you have a written record of what was discussed or done.
6. Don’t leave until you understand what to do next
Even with routine medical examinations or check-ups, be sure you understand the results before you leave. Write them down for your own medical files.
Results of the Appointment Form (print this list)
- What was the result of the exam? Were any problems identified or diagnosis made?
- If laboratory or other tests were done, when and how will I get the results? Will I also receive an interpretation of the results – in other words, how will I know if they are normal?
- Are there screening or diagnostic tests that should be scheduled? If so, when or how often?
- If a diagnosis was made, what are my treatment options?
- What recommendations does the health care provider have for helping me maintain or improve my health?
If you have been given a prescription or other type of medication, know the following.
Medication Questions Form (print this list)
- What is being prescribed and why? What symptoms does it treat?
- How and when should the medication be taken? What is the dose and frequency? Should I take it with food or water?
- Are there side effects? For example, drowsiness, nausea, dry mouth?
- How will I know if the medication is working? When will I notice, or how long before I can expect a change?
- Will the medication interfere with any other prescriptions or substances I’m taking?
- What should I do if I forget to take a dose? Take another? Skip it?
- How much does it cost? Will my insurance cover it? Is there a generic subsitute?
- Are there alternative medications to consider? Are there other medications that might have fewer side effects, or are less expensive?
- Consider making an appointment with your local pharmacist to review your medications list.
Printable lists from the University of Minnesota
NOTE FROM CAROLYN: I wrote more about doctor-patient communication in my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 20% off the list price).
Make at least one heart-smart lifestyle change every day