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 wait 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 when a patient’s
voice isn’t heard either because it’s
disregarded or the words just 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 and 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 names
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 came to
class on time turn Dennis deliverables
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 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
minute 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 kind of laughed
and said uh 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 felt
exhausted and 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
it’s a definitive sign of Lyme disease
when Peter said no his doctor said come
back if and when you do now 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 so he would
from my course 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 there Peter
repeatedly voiced his concern that he
had Lyme disease but the medical staff
said hey 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 Peters 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 yes Peter made
a full recovery
he even Rhian rolled in my class and got
a pretty 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 in that 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 now I’d like to spend
some time on your first part of your
prescription
the challenge of getting your voice
heard now 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 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’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 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 minute segue down
memory lane but what’s the cost 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 well like for
my talk here today think about your
audience 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
for those concerns have specific
questions the more specific your
question is the more detailed and
explicit your doctor’s answer will be
now you don’t have a lot of time with
your doctor anticipate their questions
and have answers ready for them also
it’s not uncommon that at the end of
your appointment you think of several
questions 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
schedule another appointment and if that
appointments not soon 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 now 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 now
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 had back problems that
necessitated two surgeries the pain and
my father’s back and legs has made his
ability to walk around the house
unassisted very difficult however he had
never know it from his doctors
appointments Colonel Boyd how’s it going
oh I’m feeling pretty good how’s the
mobility won’t be running any for minute
miles but you know I’m doing all right
and so it went year after year with
unerring consistency until finally after
watching my dad try to move around my
parents house as I watched his scope of
activities get smaller and smaller I
reached the tipping point now 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 dad and during that
conversation I asked the one question
that apparently wasn’t in his doctor
script dad what do you want and he
admitted that he wanted to be able to
walk in to my grandmother’s 98th
birthday unassisted however he was
afraid that the pain and his back and
his legs would make that impossible I
went to my dad’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 her
flowers if you can’t give voice to your
words bring someone with you who can a
loved one a friend a patient advocate
doctors need to know what’s important to
you and the presence of someone else
can raise the level of expectation and
doctors will respond in kind and I can’t
stress enough how your story doctors
need to know what’s important to you
if you rattle off a series of symptoms
hey 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