“All disease begins in the gut.” – Hippocrates

Friday, July 9, 2010

Forming a Partnership: How to Talk (and Work) With Your Doctor

***Thanks for switching over your feeds and subscriptions. I gave it a few days without posts to give folks time to switch. Now on to more topics...***

My wife often asks me to come to the doctor with her, ostensibly, because I ask good questions; she forgets or is often too intimidated to ask the doctor all of her questions. In conversation last week she suggested that my ability to form partnerships with doctors might be a good subject for a post--Thus, the title/subject of this post.

There are oodles of articles out there about "How to talk with your Doctor". I find most of them too fluffy, lacking substance. Reading them is like eating whipped cream for dinner, it might taste good going down, but there's no nutrition there. Of the articles I found, here are the two I found most helpful.

New York Times Article, republished by the Huffington Post:

And a useful little piece from knol.

That said, here are my suggestions on forming a partnership with your doctor, born from experience. I go first to the conceptual and then to the practical. Note that all of these suggestions require frequent, open, honest communication with your health care team.

1. Envision your health care as a team environment. You are the team lead, the coach. You are building a team of colleagues around you who can help care for you, who will work with you (not ON you) to manage or heal your condition. A true partnership is built on mutual respect and cooperation. You should expect this from your doctor, and he/she should be able to expect it from you. This is a change of mindset for lots of people. Growing up, my mindset was that you do what the doctor tells you; i.e., I went to be told what to do. The team mindset for digestive conditions is, I think, a much more beneficial outlook.

2. When you're first searching for a GI, view the first appointment as an interview. Make sure the two of you are a fit. It can be a bit like dating... Is the doctor respectful? Does he/she take time with you? What are his/her credentials? Why did he/she get into medicine? Does he/she listen to you? Is he/she open to naturopathic treatments? etc.

3. Research your doctor. No, I'm not suggesting you stalk him/her, but some base knowledge will help you choose someone you are likely to get along with. I look for three things:
              a. Reputable Education-- Most insurance websites will list a physician's education, and board certifications (which in some specialties are not required...but can speak highly)
              b. Kind, helpful staff-- It may seem shallow, but when looking for a doctor, if the staff on the phone aren't kind, if they won't endure 15-30 seconds of small talk ("Hey, Cheryll! How are you?...), I hang up and keep looking. Congeniality of staff speaks volumes (in my mind) about how a practice is run. The good or the bad of this will eventually trickle down to you, the patient-partner.
              c. Personality-- This gets at what I stated above. You want a doctor who is willing to work WITH you and not ON you. Why? With digestive conditions you are your primary care provider. The doctor can guide you, advise you, prescribe for you, but in the end, if you don't take ownership of your treatment, whatever it is, it will fail. So I look for a doctor who doesn't seem rushed (even though I recognize that all doctors are constrained for time--that's just the way it is today.). I make sure he/she is willing to answer my questions, looks me in the eye, hears my suggestions, exhibits flexibility, is honest with me all of the time, and treats me with collegial respect (I don't like doctors, I've experienced them, that withhold or dumb down information because they either don't have time, or think I won't understand. I say, "Try me.")

Now the practical:

4. Engage fully in your care, and build credibility with your doctor. Whether you are seeing a naturopathic or allopathic doctor, he/she should be able to expect from you that you will participate willingly and faithfully in your treatment. Here's how I build credibility with my GI:
           a. Become an expert-- Read. Read. Read (my growing book list here). Read as much as you can on anything and everything that pertains to your condition. Being practical and well researched; being an informed patient, built for me credibility with my GI that I otherwise wouldn't, couldn't have gained any other way. It allowed me to ask appropriate, probing questions about the treatments he was suggesting (I knew the side effects, and the pros and cons of Imuran, for example), and you know what? When he was stymied, when none of the allopathic treatments were working, I was able to say, "What about probiotics? I read a study from XYZ journal that demonstrated positive results..." He paused, and said, "That's a good idea. Lets try it." I couldn't have done that if I had not educated myself.
          b. Be disciplined and responsible in your care-- Demonstrate that you can stick to a treatment, and that you can adjust your lifestyle to maximize your treatment. For example, when I first was diagnosed with Colitis, my doctor told me to stay away from spicy foods. What did I do? A week later I ate mounds (I'm a hungry athlete) of spicy Pad Thai, and suffered. I lost credibility in the beginning because of incidents like that.

5. When you come for a visit, know your agenda and stick to it. You need to be as respectful of a doctor's time (they're busier these days than ever before) as they do of yours (you need their help). With that in mind here's what I do for EVERY appointment. Yes, it takes time, but I think it's worth it as it has helped increase my quality of life (by finding treatments that work), and help set expectations and build rapport with my doctor.
            a. Prepare for the meeting. Remember, you're a team. If the coach comes to the game unprepared, how can the team be expected to play well?
   I gather my symptom tracking, diet, and treatment information and write it up in a concise, 3 minute summary that I can deliver to him orally, and on paper (for my file). My wife thinks this is a lot of work, but it's gone a long way at convincing my allopathic GI of the efficacy of the naturopathic treatments I've been doing. (I think this also puts him more at ease, knowing I'm responsible, systematic, and well researched) I've even geeked out and showed him statistics. See my posts on tracking your diet, and tracking your symptoms.
   I write down my questions and bring them to the appointment. Again, this shows your GI or naturopath that you are engaged in your treatment. That said, you want a doctor who will answer your questions to your satisfaction. This is one of his/her critical roles in your care. Make sure they do this. If they are continually unwilling to do this (give them more than one shot), then find a new doctor (and let them know why you're leaving).

6. Finally, I ask my doctor small talk questions. I don't waste his time, but 1 or 2 questions that don't involve my gut, but show mutual understanding and respect go a long way towards building rapport.

Onward to Health.

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