It has been quite some time since I last posted, and I do apologize. Without going into too much detail, there were some unexpected issues that came up, both PD related and not PD related, that I had to deal with. I am hoping that most of these issues have been laid to rest permanently, so that I may refocus my energies on the “important” things in my life, one of which is this blog.
As I have previously written in other posts, aside from Parkinson’s Disease, I also have multiple spinal problems. I have had a herniated C5-6 disc for about four years, but up until recently was able to control the associated symptoms conservatively. In May I decided that the pain and weakness caused by this problem were becoming no longer tolerable.
On June 10, 2008 I had a cervical fusion done in the hope that some of the issues could be resolved. It was important to find just the right surgeon because of the Parkinson’s Disease. I wanted to insure that the surgeon was familiar with Parkinson’s Disease, so that any risks or issues could be addressed prior to the surgery. My experience with not only the surgeon, but also with the local hospital, turned out to be one of the most pleasant I have ever had.
Prior to surgery, I created a list of all of my Parkinson’s Disease medications, both prescription and over the counter, and provided both the surgeon and the hospital with this list. I also took all of my medications with me on the day of the surgery. This worked very well, because one of the medication that I needed to re-start after the surgery was Azilect. I had to come off the Azilect prior to surgery, because it could have conflicted with some of the drugs used during anesthesia. I found that the hospital and surgeon made certain that I received my medications exactly as needed. In addition, because I had brought my medications with me, I was able to take the Azilect, even though the hospital pharmacy did not carry that medication.
In addition to providing information about my medications, I also made sure that the hospital and surgeon knew exactly how my body reacts after surgery. One of my main concerns is that it appears that my digestive system seems to have a difficult time functioning properly after anesthesia. Because of this, I requested that the hospital not serve me any “solid” food after the surgery and would allow me to get up and walk around which encourages the body’s functions to return to normal more quickly. Again, the hospital and surgeon took this information into consideration, and my digestive system had little opportunity to “shut down” completely. It was still more sluggish than I believe most non-PD patients experience, but it did resume to its “normal” pre-surgery function without any real problems within about a week’s time.
I cannot emphasize enough the importance of making sure that everyone who will be involved in your medical care during and after a surgical procedure, has as much information in their hands prior to that surgery. Because I provided this information in writing, there was little room for misinterpretation with respect to my medical condition and needs.
Again, I do apologize for being away for so long. In the next few days I will do my best to answer any comments that have been left and give additional update on other issue that have kept me away for this period of time. My thoughts are always with my fellow bloggers and everyone else out there who is just looking for answers. God Bless to all.
Showing posts with label Communication. Show all posts
Showing posts with label Communication. Show all posts
Saturday, July 26, 2008
Monday, March 31, 2008
The Importance of Having an Advocate
There were many times along the road to diagnosis when just the thought of seeing a new specialist would bring thoughts of fear and dread. On one hand, the desire to find answers would give me hope; on the other hand, the thought of being brushed off would bring intense anxiety, dread, fear, etc. Going through any diagnosis process can create an emotional yo-yo effect that is often worse than the symptoms being seen for.
For many years I went to my appointments with my doctors alone, armed with my list of questions and previous records. My ex-husband accompanied me to two appointments, because I was hoping for back-up when describing my symptoms. During the first appointment, he lost his temper and stormed out of my doctor’s office. This surprised me, because this was my General Practitioner who later retired, and I always felt he had my best interests in mind. The second visit he attended was when I saw a neurologist who stated that my symptoms were most likely due to depression, but that I did not realize that I was depressed. Although my second husband did not lose his temper this time, neither did he question or outright state that the neurologist’s opinion was out of line. I left that appointment in tears. My ex-husband just stated that I should see a different neurologist, and that he was not interested in going to any future appointments.
As time moved on, unfortunately my marriage did end. As I have written in previous posts, I am remarried to a man who has played an important role in finally receiving a diagnosis. Not only did my husband insist on being at every doctor’s appointment, but he did hours of research, so that he could competently talk with the many doctors we saw. It was my husband who was able to connect the dots of my symptoms. He had to ability to explain to the doctors how my symptoms resembled the symptoms that his mother experienced with Parkinson’s Disease. He has often been my voice when I have had difficulties explaining my perspectives, and his keen observations of my health changes and his ability to verbalize his observations, were the catalyst that increased the momentum in getting to a diagnosis. I truly believe that had he not taken the initiative to support me in this manner, I may have not received a diagnosis for at least two more years.
An advocate can serve many purposes when visiting with a doctor. This person can serve as a second set of ears, offer observations that may not be evident during the actual exam, and can be a second voice when asking questions during the visit. Most importantly, an advocate can be a great comfort to the patient during these very stressful visits. An advocate should be someone who sees you often enough and can fully describe the symptoms or changes that he or she has observed. In addition, it does help if this person is not easily intimidated, especially if the patient is dealing with a doctor who does not like to be challenged or questioned.
A spouse or significant other can obviously be a great choice as an advocate. Unfortunately, there are those times when a spouse or significant other may not be the best choice due to various circumstances. Other candidates can include a close relative or friend who sees you on a regular basis, and who has known you for many years. This person will have the ability to describe you and your lifestyle prior to and after the onset of symptoms. Additionally, this person should be someone who has a deep desire and level of concern that is sufficient enough to compel them to become a partner in your search for a diagnosis. This requires that they be willing to educate themselves along side you, so that they may be an efficient source of support in the doctor’s office environment. Here are some examples of how my husband acted as an advocate:
1. Researched my symptoms and possible causes
2. Made the association between my symptoms and Parkinson’s Disease based on personal
experience, as well as follow-up internet research; outlined this observation in a manner to my General Practitioner which enabled me to try a trial prescription of Sinemet
3. Created a list to submit to the doctors that included his observations of my symptoms, abilities, etc. that outlined a comparison between what he observed prior to symptoms and after the symptoms began.
4. Readily spoke up, based on facts known through research, when a doctor stated something contrary to those known facts.
5.Often spoke on my behalf if I became too “emotional” during the visit, in order to insure that the doctor did not arbitrarily throw out a mental health diagnosis, based upon the fact that I had become emotional.
6. Often asked questions that I either forgot to ask, or that he felt were important enough to ask; often these were questions I had not thought about asking.
7. Never wavered in his opinion or responses, especially if a doctor was going down a trail that had already been covered or appeared to go down the mental health road.
8. Never allowed me to personally throw in the towel after an especially emotional or disappointing visit; continually reminded me that the answers were already there, and that the only missing factor was the appropriate specialist.
I have found that having an advocate with me changed the dynamics of a visit with the doctor in many positive ways. Because the diagnosis process is so very stressful, just having the comfort of knowing that someone who cares about you is by your side, lessens the tension and fear factor. I also notice that a doctor will often pay more attention to what the advocate has to say than the patient, especially when a doctor wants to lean toward a mental health related diagnosis. A strong advocate can actually sway the opinion of the doctor in a more appropriate direction, especially if the advocate is well spoken and speaks purely in factual terms. I remember once when I had to see a specialist alone, because my husband had a business meeting and was unable to attend. That particular specialist seemed genuinely disappointed that my husband was not with me, because they had shared in depth discussions on PD related illnesses on previous visits. My husband had a better relationship with my specialist than I did, because he seemed to be able to talk the doctor’s talk, but this was a situation that was to my benefit. Although this doctor was unable to provide me with a confirming diagnosis, I believe that the interactions with my husband helped to motivate him more and to take a greater interest in trying to help me with finding a diagnosis.
Now that I have a confirmed diagnosis and a core group of medical doctors that I completely trust and feel comfortable with, my husband no longer has to go with me for my visits. He seemed hesitant to release his role as advocate at first, but he now understands that his role as advocate is no longer necessary at this time. He now plays the role of advocate, but only behind the scenes. Whenever I have an appointment, we usually talk about and make a list of issues that I need to discuss with the doctor. Thus far, this change has proven to be beneficial. I have enough confidence to deal with my doctors alone, and he no longer has to miss time from work to attend every appointment. Of course, he is always ready to reactivate his role as advocate if any future issues arise that require this action.
He still continues to be my main source of comfort, support and encouragement when I am having a bad day. In many ways, he is not just my life partner, but he is my partner in Parkinson’s Disease. His only sadness is that he cannot “fix” for me what is broken. Just knowing he walks beside me during this journey, is more than I could ever ask for. Yes, a cure would be wonderful. Since that is not yet an option, I have the second best option. I have someone in my life who loves me enough to take on my disease with the same intensity that he would if he were the one who had it. I am very lucky to have that in my life, and I thank the Lord daily for providing me with my partner.
For many years I went to my appointments with my doctors alone, armed with my list of questions and previous records. My ex-husband accompanied me to two appointments, because I was hoping for back-up when describing my symptoms. During the first appointment, he lost his temper and stormed out of my doctor’s office. This surprised me, because this was my General Practitioner who later retired, and I always felt he had my best interests in mind. The second visit he attended was when I saw a neurologist who stated that my symptoms were most likely due to depression, but that I did not realize that I was depressed. Although my second husband did not lose his temper this time, neither did he question or outright state that the neurologist’s opinion was out of line. I left that appointment in tears. My ex-husband just stated that I should see a different neurologist, and that he was not interested in going to any future appointments.
As time moved on, unfortunately my marriage did end. As I have written in previous posts, I am remarried to a man who has played an important role in finally receiving a diagnosis. Not only did my husband insist on being at every doctor’s appointment, but he did hours of research, so that he could competently talk with the many doctors we saw. It was my husband who was able to connect the dots of my symptoms. He had to ability to explain to the doctors how my symptoms resembled the symptoms that his mother experienced with Parkinson’s Disease. He has often been my voice when I have had difficulties explaining my perspectives, and his keen observations of my health changes and his ability to verbalize his observations, were the catalyst that increased the momentum in getting to a diagnosis. I truly believe that had he not taken the initiative to support me in this manner, I may have not received a diagnosis for at least two more years.
An advocate can serve many purposes when visiting with a doctor. This person can serve as a second set of ears, offer observations that may not be evident during the actual exam, and can be a second voice when asking questions during the visit. Most importantly, an advocate can be a great comfort to the patient during these very stressful visits. An advocate should be someone who sees you often enough and can fully describe the symptoms or changes that he or she has observed. In addition, it does help if this person is not easily intimidated, especially if the patient is dealing with a doctor who does not like to be challenged or questioned.
A spouse or significant other can obviously be a great choice as an advocate. Unfortunately, there are those times when a spouse or significant other may not be the best choice due to various circumstances. Other candidates can include a close relative or friend who sees you on a regular basis, and who has known you for many years. This person will have the ability to describe you and your lifestyle prior to and after the onset of symptoms. Additionally, this person should be someone who has a deep desire and level of concern that is sufficient enough to compel them to become a partner in your search for a diagnosis. This requires that they be willing to educate themselves along side you, so that they may be an efficient source of support in the doctor’s office environment. Here are some examples of how my husband acted as an advocate:
1. Researched my symptoms and possible causes
2. Made the association between my symptoms and Parkinson’s Disease based on personal
experience, as well as follow-up internet research; outlined this observation in a manner to my General Practitioner which enabled me to try a trial prescription of Sinemet
3. Created a list to submit to the doctors that included his observations of my symptoms, abilities, etc. that outlined a comparison between what he observed prior to symptoms and after the symptoms began.
4. Readily spoke up, based on facts known through research, when a doctor stated something contrary to those known facts.
5.Often spoke on my behalf if I became too “emotional” during the visit, in order to insure that the doctor did not arbitrarily throw out a mental health diagnosis, based upon the fact that I had become emotional.
6. Often asked questions that I either forgot to ask, or that he felt were important enough to ask; often these were questions I had not thought about asking.
7. Never wavered in his opinion or responses, especially if a doctor was going down a trail that had already been covered or appeared to go down the mental health road.
8. Never allowed me to personally throw in the towel after an especially emotional or disappointing visit; continually reminded me that the answers were already there, and that the only missing factor was the appropriate specialist.
I have found that having an advocate with me changed the dynamics of a visit with the doctor in many positive ways. Because the diagnosis process is so very stressful, just having the comfort of knowing that someone who cares about you is by your side, lessens the tension and fear factor. I also notice that a doctor will often pay more attention to what the advocate has to say than the patient, especially when a doctor wants to lean toward a mental health related diagnosis. A strong advocate can actually sway the opinion of the doctor in a more appropriate direction, especially if the advocate is well spoken and speaks purely in factual terms. I remember once when I had to see a specialist alone, because my husband had a business meeting and was unable to attend. That particular specialist seemed genuinely disappointed that my husband was not with me, because they had shared in depth discussions on PD related illnesses on previous visits. My husband had a better relationship with my specialist than I did, because he seemed to be able to talk the doctor’s talk, but this was a situation that was to my benefit. Although this doctor was unable to provide me with a confirming diagnosis, I believe that the interactions with my husband helped to motivate him more and to take a greater interest in trying to help me with finding a diagnosis.
Now that I have a confirmed diagnosis and a core group of medical doctors that I completely trust and feel comfortable with, my husband no longer has to go with me for my visits. He seemed hesitant to release his role as advocate at first, but he now understands that his role as advocate is no longer necessary at this time. He now plays the role of advocate, but only behind the scenes. Whenever I have an appointment, we usually talk about and make a list of issues that I need to discuss with the doctor. Thus far, this change has proven to be beneficial. I have enough confidence to deal with my doctors alone, and he no longer has to miss time from work to attend every appointment. Of course, he is always ready to reactivate his role as advocate if any future issues arise that require this action.
He still continues to be my main source of comfort, support and encouragement when I am having a bad day. In many ways, he is not just my life partner, but he is my partner in Parkinson’s Disease. His only sadness is that he cannot “fix” for me what is broken. Just knowing he walks beside me during this journey, is more than I could ever ask for. Yes, a cure would be wonderful. Since that is not yet an option, I have the second best option. I have someone in my life who loves me enough to take on my disease with the same intensity that he would if he were the one who had it. I am very lucky to have that in my life, and I thank the Lord daily for providing me with my partner.
Wednesday, March 12, 2008
An Update On My Letter Writing Campaign
Hi Everyone,
I just wanted to make sure that everyone knows that I am still here. I have finally completed all of the letters to the doctors. I wrote a total of nine doctors. Rather than sending them out one by one, I wanted to make sure that I sent them all at the same time. So, I will be making a trip to the Post Office today.
More than anything, I hope that by writing these letters, doctors may take a step back before presuming that a patient must have mental health problems, because he / she does not fall into a neat little category. Each person is different, and it is well known that Parkinson's Disease appears differently in each individual. No two people with PD will have the same symptoms. Some patients will exhibit slow progression, while others may progress more rapidly than expected. Just as each of us is unique, so is our Parkinson's Disease.
On an additional note, I hope to add a few new posts that may be useful to those who are still trying to find a diagnosis. I did get a bit sidetracked due to some extreme fatigue, as well as trying to get our taxes done. So, although I still fight daily fatigue, I do hope to get back to writing posts that relate back to my original intent for starting this blog.
This blog has opened up many doors for me personally. Through the contacts I have made because of this blog, I have learned so much from each new person I correspond with. Each person seems to touch my life in such a positive manner. These contacts help drive my desire to continue to write and share my experiences.
I will definitely offer an update if I receive any responses from the letters. For now, I am going to attempt to get some sleep, since insomnia has had me up for most of the night.
Blessings to you all.
I just wanted to make sure that everyone knows that I am still here. I have finally completed all of the letters to the doctors. I wrote a total of nine doctors. Rather than sending them out one by one, I wanted to make sure that I sent them all at the same time. So, I will be making a trip to the Post Office today.
More than anything, I hope that by writing these letters, doctors may take a step back before presuming that a patient must have mental health problems, because he / she does not fall into a neat little category. Each person is different, and it is well known that Parkinson's Disease appears differently in each individual. No two people with PD will have the same symptoms. Some patients will exhibit slow progression, while others may progress more rapidly than expected. Just as each of us is unique, so is our Parkinson's Disease.
On an additional note, I hope to add a few new posts that may be useful to those who are still trying to find a diagnosis. I did get a bit sidetracked due to some extreme fatigue, as well as trying to get our taxes done. So, although I still fight daily fatigue, I do hope to get back to writing posts that relate back to my original intent for starting this blog.
This blog has opened up many doors for me personally. Through the contacts I have made because of this blog, I have learned so much from each new person I correspond with. Each person seems to touch my life in such a positive manner. These contacts help drive my desire to continue to write and share my experiences.
I will definitely offer an update if I receive any responses from the letters. For now, I am going to attempt to get some sleep, since insomnia has had me up for most of the night.
Blessings to you all.
Tuesday, September 25, 2007
Communicating With Your Physicians - Part 2
In part one, I addressed the importance of effective written and verbal communication when communicating with a Primary Care Physician or Specialist. I gave examples of various situations that often arise and the type(s) of communication I normally choose to utilize for those situations. Additionally, I outlined some of the benefits and protections that the patient gains through effective verbal communication, and to a greater degree through written communication.
In part two I am going to offer suggestions on how a patient can be more effective in both verbal and written communication. Keep in mind that effective communication is only beneficial if the patient has a patient friendly physician.
Verbal Communication
I will outline below the key elements of verbal communication that are particularly important when communicating with physicians, and I will include examples.
1. Prior to any visit with a physician, the patient should make a list of all issues that he / she wants to address during the visit. Example: new symptoms, changes in existing symptoms, medication changes, alternative treatment options, etc. This will insure that the patient does not leave anything out due to faulty memory. Obviously, there will not be effective communication at all, if the patient cannot remember what he / she wanted to discuss.
2. Listen to what the physician is communicating, more than how he / she is communicating. Example: A physician may speak in a tone that may give the impression that the physician is skeptical of or not interested in a patient’s medical situation. That may be the case, or it may be just the way that the physician speaks, and is not a reflection on his / her actual opinion. If a patient moves into a defensive mode because of the manner of speaking, he / she may miss the information that the physician is trying to provide. Rather than concentrating on “how the words” are spoken, the patient needs to maintain his / her focus “on the words” that are being spoken.
3. The patient needs to make sure that he / she fully understands what the physician is communicating. Example: If the patient is unclear of something the physician just said, the patient can repeat back to the physician (paraphrase) what the physician just said. The patient should then ask, “Is that correct?” Once the physician confirms that the words the patient repeated back to him / her are correct, the patient can ask additional questions if further clarification is necessary.
4. The patient must be willing to state his / her position or opinion in a polite but firm manner, even if it is not in agreement with the physician’s position or opinion. Example: The physician tells the patient that it is not necessary to order an MRI of the lower back, although the patient has had radiating back pain for over a year. An X-ray two months prior did not produce the cause. This patient has done research and now understands that the type of pain he / she has been experiencing could be caused by a herniated disc or some other soft tissue injury, which will can not be seen on standard X-rays. The patient should communicate to the physician the information he / she believes to be relevent, remind the physician of the duration of time the pain has been present, and firmly state that it is his / her understanding that an MRI of the lower back is the best way to determine the source of the symptoms. By making a firm, educated statement, the physician is now obligated to provide specific reasons for his / her position. On the other hand, the physician may now concur with the patient’s educated statements and request the MRI. (I have had both scenarios occur.)
5. The patient must communicate in a clear, descriptive, and detailed manner. Example: A patient is seeing his / her Primary Care Physician for an abdominal problem and says, “My stomach hurts when I eat, but it does not hurt every time I eat”. Although a physician should ask multiple questions in response to this vague statement, this may not happen. This vague statement leaves the option open for a physician, especially one who is running behind schedule, to make a quick diagnosis of convenience, rather than take the time to extract more information from the patient.
The patient with the abdominal problems must clearly communicate the following information:
1. Type of pain (burning, stabbing, constant, intermittent, etc.)
2. The specific portion of the abdominal area affected by this pain
3. When the pain occurs (after meals, before meals, before bed, etc.)
4. How often the pain occurs (after every meal, daily, weekly, etc.)
5. Conditions that contribute to the pain (types of food, time of day, exercise after a meal, exercise prior to a meal, etc.)
By providing clear, descriptive, and detailed information, the patient enables the
physician to offer a more accurate initial differential diagnosis. It also provides enough information for the physician to quickly determine what type of diagnostic tests should be done, as well as a possible initial treatment plan to ease symptoms. Communicating in this manner saves time during the visit by limiting the number of back and forth questions and answers. This is especially important when dealing with a physician who is running behind schedule and is trying to limit the time spent with each patient in order to catch up.
6. A patient should communicate with emotion and feeling, but should not react emotionally. (This is easier said than done.) Example: If the patient is told something by a physician that he / she disagrees with, the patient can verbally respond in a passionate manner in order to get a point across or for emphasis on that topic. However, if the patient becomes visibly angry or bursts into tears, this can be very detrimental, especially if the patient is being told that his / her physical symptoms are being caused by a mental health disorder. These types of emotional reactions or outbursts will only serve to strengthen the physician’s opinion that the symptoms are mental health related rather than being caused by a physical medical condition. Even if mental health is not in question, a physician may be less inclined to want to work with the patient, if the patient is unable to keep emotional outbursts under control.
7. Before allowing a visit to end, the patient needs to inquire and understand the follow-up protocol, as well as a date for the follow-up. Example: A patient is trying a new treatment for a chronic condition. Any new treatment should include a follow-up appointment, especially if associated with a chronic condition. The patient should not allow for an open-ended statement such as, “Try this and call me if there are any problems”. Because the patient has a chronic condition, there should already be regularly scheduled follow-up visits in place. If this is not the case, the patient should insist on a follow-up visit, including the date the follow-up would take place. Depending on circumstances, at the bare minimum, a telephone follow-up should at least be scheduled.
8. Prior to any appointment, a patient should research medical terminologies associated with the chronic condition, as well as the medical terminologies often associated with the field of medicine that the chronic condition falls under – Example: A patient has been given a differential diagnosis of Parkinson’s Disease and is seeing a Movement Disorder Specialist. During the visit the patient should use the most accurate medical terminologies when discussing
symptoms, previous diagnostic testing, medications, etc. This will allow the physician to get a more accurate picture of what the patient has been or is currently experiencing. The greatest benefit of using and understanding the correct medical terminologies is that it demonstrates to the physician that you have a firm understanding of not only the differential diagnosis, but of other associated conditions. Because the patient has educated himself, it makes it more difficult for a physician to offer a diagnosis of convenience or statements contrary to known facts about the condition.
Written Communication
I will outline below the key elements of written communication that are particularly important when communicating with physicians, and I will include a sample written correspondence.
1. If the written correspondence is in letterform, which is my preference, always include the date, name of physician, physician’s address, subject of correspondence, and correspondence delivery method.
2. In the opening paragraph, provide a short, detailed summary that includes the purpose for the correspondence. If it is a summary being sent to the patient’s Primary Care Physician, in reference to a visit with a specialist, include the specialist’s name, location, and the date of the visit. Likewise, if it is in reference to concerns with or changes in a patient’s medical condition, the date of the patient’s previous visit and the specific concerns or changes since that visit should be included.
3. In the body of the correspondence, provide the details clearly. It is particularly important to use appropriate medical terminologies when corresponding in writing. Each paragraph should be limited to one subject, concern, symptom change, etc. Too many subject matters in one paragraph can cause confusion and may promote a less clear picture of the patient’s purpose for addressing the subjects.
4. Once all individual subjects have been addressed, the next paragraph should include either a summarization, if known, of future visits with a specialist, treatments, goals, or a question on how the physician would like to proceed based on the information in the correspondence.
5. The final paragraph should include a statement of thanks to the physician. A sentence that states that the patient looks forward to hearing from the physician should be included. This type of statement lets the physician know that you expect some form of response to the correspondence.
Sample: Written Correspondence to Primary Care Physician
September 24, 2007
Dr. Physician’s Name
1111 Any Street. Suite 1
Any City, Any State, Zip
Re: Patient’s Name – New Symptoms and Medication Concerns
Via Facsimile: xxx-xxx-xxxx
Dear Dr. Physician’s Name
Since my last visit with you on July 1, 2007, I have had two new symptoms develop, that I believe relate to my condition. I am now experiencing insomnia and multiple awakenings during the night. Additionally, the medications I am taking for this condition are not controlling my symptoms as well as they were. As you may recall, I am taking medication A and medication B for the last six months with positive results up until two weeks ago.
Within the last two weeks, I have had multiple episodes of insomnia. Most evenings I got to bed at 10:00 P.M. It usually takes no longer than twenty minutes to fall asleep. I have had difficulty falling asleep on ten of the last fourteen nights. On those evenings it has taken anywhere from two to four hours to fall asleep. I have had no recent lifestyle changes or stressors that could be contributing to this problem.
The multiple awakenings during the night began to occur at the same time as the insomnia. This now appears a nightly occurrence. On most nights, I wake up approximately six times per night. Of those awakenings, only one can be attributed to needing to use the bathroom. The rest appear to have no known cause. Again, I have no recent lifestyle changes or stressors that could be contributing to this problem.
For the last six months, medication A and medication B have been sufficiently controlling most of my symptoms. I have been taking both medications every four hours as directed. Two weeks ago, I noticed that my symptoms would return three hours after taking the previous dose. As a result, I now have one hour per every four-hour period that I must deal with the symptoms at their maximum levels. This has caused a great deal of hardship for my family and me. This change in effectiveness has been consistent throughout the entire two-week period.
At this time, I think it may be necessary to return to the specialist in order to address the new symptoms and medication issues. The onset of new symptoms appears to correspond with the onset of medication issues. Historically, it normally takes four to six weeks before an appointment is available with the specialist. If this is the case currently, should I make an appointment to see you in the interim? If you do not believe that an appointment with you is necessary at this time, then I would like to request that a prescription sleep aid be called in to my pharmacy. If it enables me to get a few more hours of sleep each night, I will be better able to handle the four to six week wait to see the specialist. I also believe I can handle dealing with my symptoms returning every four hours. Additionally, if it is possible, I would appreciate if your office could expedite the referral to the specialist.
Please let me know how you would like to proceed. I look forward to hearing from you. As always, thank you in advance for your assistance.
Sincerely,
Patient With A Plan
This correspondence provides clear and accurate information to the Primary Care Physician with respect to the patient’s immediate concerns. Additionally, it provides a potential temporary solution for those concerns, until they can be addressed appropriately. In the manner written, this correspondence reflects the patient’s comfort level with the physician. The patient does not hesitate to state the need for a referral to a specialist, nor does the patient hesitate to offer input for an immediate course of action. A good doctor / patient relationship is evident, as well as the patient’s previous experience in dealing with the changes that can occur with a chronic condition.
Although personal information was not included, this correspondence represents my personal experience with this scenario. More often than not, my Primary Care Physician will call me, rather than have me come in for an appointment. This of course depends on the severity of the situation. Additionally, he has often been willing to call in prescriptions when situations warrant, as long as it does not pose a risk to my health. Again, because I have a good relationship with my Primary Care Physician, which was built through effective communication, there is a mutual understanding that my healthcare is a team effort.
The willingness to correspond directly with me outside of an office visit is something that is not common in the medical world today. In fact, this is the first Primary Care Physician that I have met, who goes above and beyond with respect to communication. There is no guarantee that a patient who communicates effectively will have the same exact results. However, the patient who communicates in an effective manner, both verbally and in writing, has a better chance of building a good relationship with his / her physician. That relationship, along with effective communication, provides the patient with the security that is essential when dealing with any chronic condition.
In part two I am going to offer suggestions on how a patient can be more effective in both verbal and written communication. Keep in mind that effective communication is only beneficial if the patient has a patient friendly physician.
Verbal Communication
I will outline below the key elements of verbal communication that are particularly important when communicating with physicians, and I will include examples.
1. Prior to any visit with a physician, the patient should make a list of all issues that he / she wants to address during the visit. Example: new symptoms, changes in existing symptoms, medication changes, alternative treatment options, etc. This will insure that the patient does not leave anything out due to faulty memory. Obviously, there will not be effective communication at all, if the patient cannot remember what he / she wanted to discuss.
2. Listen to what the physician is communicating, more than how he / she is communicating. Example: A physician may speak in a tone that may give the impression that the physician is skeptical of or not interested in a patient’s medical situation. That may be the case, or it may be just the way that the physician speaks, and is not a reflection on his / her actual opinion. If a patient moves into a defensive mode because of the manner of speaking, he / she may miss the information that the physician is trying to provide. Rather than concentrating on “how the words” are spoken, the patient needs to maintain his / her focus “on the words” that are being spoken.
3. The patient needs to make sure that he / she fully understands what the physician is communicating. Example: If the patient is unclear of something the physician just said, the patient can repeat back to the physician (paraphrase) what the physician just said. The patient should then ask, “Is that correct?” Once the physician confirms that the words the patient repeated back to him / her are correct, the patient can ask additional questions if further clarification is necessary.
4. The patient must be willing to state his / her position or opinion in a polite but firm manner, even if it is not in agreement with the physician’s position or opinion. Example: The physician tells the patient that it is not necessary to order an MRI of the lower back, although the patient has had radiating back pain for over a year. An X-ray two months prior did not produce the cause. This patient has done research and now understands that the type of pain he / she has been experiencing could be caused by a herniated disc or some other soft tissue injury, which will can not be seen on standard X-rays. The patient should communicate to the physician the information he / she believes to be relevent, remind the physician of the duration of time the pain has been present, and firmly state that it is his / her understanding that an MRI of the lower back is the best way to determine the source of the symptoms. By making a firm, educated statement, the physician is now obligated to provide specific reasons for his / her position. On the other hand, the physician may now concur with the patient’s educated statements and request the MRI. (I have had both scenarios occur.)
5. The patient must communicate in a clear, descriptive, and detailed manner. Example: A patient is seeing his / her Primary Care Physician for an abdominal problem and says, “My stomach hurts when I eat, but it does not hurt every time I eat”. Although a physician should ask multiple questions in response to this vague statement, this may not happen. This vague statement leaves the option open for a physician, especially one who is running behind schedule, to make a quick diagnosis of convenience, rather than take the time to extract more information from the patient.
The patient with the abdominal problems must clearly communicate the following information:
1. Type of pain (burning, stabbing, constant, intermittent, etc.)
2. The specific portion of the abdominal area affected by this pain
3. When the pain occurs (after meals, before meals, before bed, etc.)
4. How often the pain occurs (after every meal, daily, weekly, etc.)
5. Conditions that contribute to the pain (types of food, time of day, exercise after a meal, exercise prior to a meal, etc.)
By providing clear, descriptive, and detailed information, the patient enables the
physician to offer a more accurate initial differential diagnosis. It also provides enough information for the physician to quickly determine what type of diagnostic tests should be done, as well as a possible initial treatment plan to ease symptoms. Communicating in this manner saves time during the visit by limiting the number of back and forth questions and answers. This is especially important when dealing with a physician who is running behind schedule and is trying to limit the time spent with each patient in order to catch up.
6. A patient should communicate with emotion and feeling, but should not react emotionally. (This is easier said than done.) Example: If the patient is told something by a physician that he / she disagrees with, the patient can verbally respond in a passionate manner in order to get a point across or for emphasis on that topic. However, if the patient becomes visibly angry or bursts into tears, this can be very detrimental, especially if the patient is being told that his / her physical symptoms are being caused by a mental health disorder. These types of emotional reactions or outbursts will only serve to strengthen the physician’s opinion that the symptoms are mental health related rather than being caused by a physical medical condition. Even if mental health is not in question, a physician may be less inclined to want to work with the patient, if the patient is unable to keep emotional outbursts under control.
7. Before allowing a visit to end, the patient needs to inquire and understand the follow-up protocol, as well as a date for the follow-up. Example: A patient is trying a new treatment for a chronic condition. Any new treatment should include a follow-up appointment, especially if associated with a chronic condition. The patient should not allow for an open-ended statement such as, “Try this and call me if there are any problems”. Because the patient has a chronic condition, there should already be regularly scheduled follow-up visits in place. If this is not the case, the patient should insist on a follow-up visit, including the date the follow-up would take place. Depending on circumstances, at the bare minimum, a telephone follow-up should at least be scheduled.
8. Prior to any appointment, a patient should research medical terminologies associated with the chronic condition, as well as the medical terminologies often associated with the field of medicine that the chronic condition falls under – Example: A patient has been given a differential diagnosis of Parkinson’s Disease and is seeing a Movement Disorder Specialist. During the visit the patient should use the most accurate medical terminologies when discussing
symptoms, previous diagnostic testing, medications, etc. This will allow the physician to get a more accurate picture of what the patient has been or is currently experiencing. The greatest benefit of using and understanding the correct medical terminologies is that it demonstrates to the physician that you have a firm understanding of not only the differential diagnosis, but of other associated conditions. Because the patient has educated himself, it makes it more difficult for a physician to offer a diagnosis of convenience or statements contrary to known facts about the condition.
Written Communication
I will outline below the key elements of written communication that are particularly important when communicating with physicians, and I will include a sample written correspondence.
1. If the written correspondence is in letterform, which is my preference, always include the date, name of physician, physician’s address, subject of correspondence, and correspondence delivery method.
2. In the opening paragraph, provide a short, detailed summary that includes the purpose for the correspondence. If it is a summary being sent to the patient’s Primary Care Physician, in reference to a visit with a specialist, include the specialist’s name, location, and the date of the visit. Likewise, if it is in reference to concerns with or changes in a patient’s medical condition, the date of the patient’s previous visit and the specific concerns or changes since that visit should be included.
3. In the body of the correspondence, provide the details clearly. It is particularly important to use appropriate medical terminologies when corresponding in writing. Each paragraph should be limited to one subject, concern, symptom change, etc. Too many subject matters in one paragraph can cause confusion and may promote a less clear picture of the patient’s purpose for addressing the subjects.
4. Once all individual subjects have been addressed, the next paragraph should include either a summarization, if known, of future visits with a specialist, treatments, goals, or a question on how the physician would like to proceed based on the information in the correspondence.
5. The final paragraph should include a statement of thanks to the physician. A sentence that states that the patient looks forward to hearing from the physician should be included. This type of statement lets the physician know that you expect some form of response to the correspondence.
Sample: Written Correspondence to Primary Care Physician
September 24, 2007
Dr. Physician’s Name
1111 Any Street. Suite 1
Any City, Any State, Zip
Re: Patient’s Name – New Symptoms and Medication Concerns
Via Facsimile: xxx-xxx-xxxx
Dear Dr. Physician’s Name
Since my last visit with you on July 1, 2007, I have had two new symptoms develop, that I believe relate to my condition. I am now experiencing insomnia and multiple awakenings during the night. Additionally, the medications I am taking for this condition are not controlling my symptoms as well as they were. As you may recall, I am taking medication A and medication B for the last six months with positive results up until two weeks ago.
Within the last two weeks, I have had multiple episodes of insomnia. Most evenings I got to bed at 10:00 P.M. It usually takes no longer than twenty minutes to fall asleep. I have had difficulty falling asleep on ten of the last fourteen nights. On those evenings it has taken anywhere from two to four hours to fall asleep. I have had no recent lifestyle changes or stressors that could be contributing to this problem.
The multiple awakenings during the night began to occur at the same time as the insomnia. This now appears a nightly occurrence. On most nights, I wake up approximately six times per night. Of those awakenings, only one can be attributed to needing to use the bathroom. The rest appear to have no known cause. Again, I have no recent lifestyle changes or stressors that could be contributing to this problem.
For the last six months, medication A and medication B have been sufficiently controlling most of my symptoms. I have been taking both medications every four hours as directed. Two weeks ago, I noticed that my symptoms would return three hours after taking the previous dose. As a result, I now have one hour per every four-hour period that I must deal with the symptoms at their maximum levels. This has caused a great deal of hardship for my family and me. This change in effectiveness has been consistent throughout the entire two-week period.
At this time, I think it may be necessary to return to the specialist in order to address the new symptoms and medication issues. The onset of new symptoms appears to correspond with the onset of medication issues. Historically, it normally takes four to six weeks before an appointment is available with the specialist. If this is the case currently, should I make an appointment to see you in the interim? If you do not believe that an appointment with you is necessary at this time, then I would like to request that a prescription sleep aid be called in to my pharmacy. If it enables me to get a few more hours of sleep each night, I will be better able to handle the four to six week wait to see the specialist. I also believe I can handle dealing with my symptoms returning every four hours. Additionally, if it is possible, I would appreciate if your office could expedite the referral to the specialist.
Please let me know how you would like to proceed. I look forward to hearing from you. As always, thank you in advance for your assistance.
Sincerely,
Patient With A Plan
This correspondence provides clear and accurate information to the Primary Care Physician with respect to the patient’s immediate concerns. Additionally, it provides a potential temporary solution for those concerns, until they can be addressed appropriately. In the manner written, this correspondence reflects the patient’s comfort level with the physician. The patient does not hesitate to state the need for a referral to a specialist, nor does the patient hesitate to offer input for an immediate course of action. A good doctor / patient relationship is evident, as well as the patient’s previous experience in dealing with the changes that can occur with a chronic condition.
Although personal information was not included, this correspondence represents my personal experience with this scenario. More often than not, my Primary Care Physician will call me, rather than have me come in for an appointment. This of course depends on the severity of the situation. Additionally, he has often been willing to call in prescriptions when situations warrant, as long as it does not pose a risk to my health. Again, because I have a good relationship with my Primary Care Physician, which was built through effective communication, there is a mutual understanding that my healthcare is a team effort.
The willingness to correspond directly with me outside of an office visit is something that is not common in the medical world today. In fact, this is the first Primary Care Physician that I have met, who goes above and beyond with respect to communication. There is no guarantee that a patient who communicates effectively will have the same exact results. However, the patient who communicates in an effective manner, both verbally and in writing, has a better chance of building a good relationship with his / her physician. That relationship, along with effective communication, provides the patient with the security that is essential when dealing with any chronic condition.
Tuesday, September 18, 2007
Communicating With Your Physicians - Part 1
Communication between patient and physician is an important factor in the diagnosis process. At one time, I thought that verbal communication was the only form of communication necessary, when communicating with my physicians. I have since changed my opinion.
There was a time when I only saw my Primary Care Provider for an annual exam. I was normally a healthy person, and I was not prone to automatically seeing a physician for minor illness. Therefore, a quality doctor / patient relationship was not established with my primary care physicians during my healthy years.
Once I began having medical problems, I went through two Primary Care Physicians, prior to finding a patient friendly physician who was willing to work with me. Since I had become a frequent visitor to my Primary Care Physician’s office, the development of a good doctor / patient relationship was able to take root. Familiarity, as well as communication during appointments, helped to solidify a good working relationship between us. Unfortunately, he retired prior to my symptoms progressing enough for him to render a differential diagnosis.
My current Primary Care Physician inherited me because of my previous physician’s retirement. In the beginning, I was not sure that he and I would be a good match for an acceptable doctor / patient relationship. However, I did not throw in the towel. One afternoon we engaged in an intense verbal discussion by phone, which turned the potentially disastrous doctor / patient relationship into probably the best doctor / patient relationship I have had to this date. Clear communication and some human emotion had turned this relationship around.
While I was a patient of the now retired Primary Care Physician, I incorporated written communication into my doctor / patient relationship. As it became clear that I was potentially dealing with a chronic illness, I wanted to insure that every symptom I experienced was communicated and documented. My previous Primary Care Physician was very thorough at taking notes, but for my own peace of mind, I wanted my symptoms and other health related concerns, documented in writing from my perspective as the patient. Additionally, not all physicians are thorough when taking notes, and there are often key pieces of information that are left out. Therefore, when a patient brings up a previously discussed symptom at a future date, and if that symptom never made it into the notes, the physician is very likely not to recall ever discussing the symptom. Physicians see so many patients, that it is impossible for them to remember every word of every verbal communication with every patient.
It is now my standard practice to communicate with physicians verbally, as well as in writing. The type of circumstance dictates whether I utilize verbal communication, written communication, or both forms of communication. The following is a list of various scenarios, and the type of communication I will normally use:
1. Office visit with Primary Care Physician for minor illness or basic follow-up appointment – verbal communication
2. Initial visit with a Movement Disorder Specialist or other specialist – verbal and written communication. If time permits, I send a letter of introduction and copies of my medical records, prior to the appointment. I also make sure to bring backup copies with me to the appointment, in the event that my letter and medical record copies somehow did not make it into the physician’s hands.
3. Follow-up visit with a Movement Disorder Specialist or other specialist – verbal and written communication. Prior to the appointment, I write a brief summary including symptoms, changes in symptoms, medication problems, etc., to give to the specialist during the appointment. This summary not only helps me to remember the topics I want to verbally discuss during the appointment, but also serves as a permanent record that the information was provided to the physician on that date.
4. Non-office visit follow-up with Primary Care Physician after seeing a specialist – verbal and written communication. Following a visit with a specialist, I write an informational short report detailing the visit. This includes information pertaining to symptoms, treatment, topics discussed with the specialist, and future visits. Additionally, I include a copy of any written communication I had given to the specialist. I then fax these items to my Primary Care Physician’s office, and call to make sure they were received.
5. New concerns, which may or may not be related to my spinal condition or Parkinsonism, that I want my Primary Care Physician to be aware of – verbal and written communication. I call my Primary Care Physician’s office and provide a brief description of my concerns to his office assistant. I then write a more detailed summary of my concerns and fax it to my Primary Care Physician’s office. Again, I then place a call to his office to confirm that my fax was received.
Why do I now communicate with physicians both verbally and in writing?
Verbal Communication
Verbal communication is obviously the primary form of communication used during a visit with a physician. During a visit with a specialist, a patient verbally describes his / her symptoms, duration of symptoms, differential diagnosis, diagnostic tests performed, and current treatment(s) to date. Likewise, a physician may verbally ask questions for clarification, explain his / her findings after examining the patient, present a need for further diagnostic testing / evaluation, and render a preliminary diagnosis with a treatment plan. A patient will normally be able to ask questions, in order to make sure he or she fully understands what the physician has said. Even if the specialist does not render a diagnosis during the visit, if the verbal communication is adequate, the patient will understand the physician’s course of action necessary to assist with the diagnosis process.
Written Communication
I have found that written communication is an important tool, especially for the patient who has an undiagnosed chronic condition. Additionally, for patients who do have a diagnosis, written communication is a great way to keep your Primary Care Physician, as well as your entire team of physicians, informed on any changes in your condition, in between appointments. Aside from and including some of the situations that I have previously listed, here are a few examples of the benefits of establishing written communication with your physicians:
1. Patient provided written documentation of symptoms gives an exact description and complete information that leaves little room for misinterpretation. Verbal communications have the potential to allow incorrect interpretation and potentially incorrect note documentation with respect to the patient’s symptoms. Patient provided written documentation eliminates these issues, because it is the patient’s accurate, first hand account that can be added to the patient’s chart for future reference by the physician.
2. Patient provided written documentation of changes in the chronic illness helps in two manners. First, if it is provided to a physician during a visit, it gives an accurate, first hand account of those changes. Again, a patient can request that the documentation be added to the patient’s records / chart. If the patient is in-between visits, he / she can fax the written account of the changes to the physician’s office. This allows the physician to determine whether or not the issues need to be addressed immediately, or if the issues can be addressed at the patient’s next appointment. I have found that my Primary Care Physician will often call me to discuss my correspondence, and then he will determine the necessity for an earlier visit.
3. Patient provided written documentation provides security for the patient. In my experience, there are times when a physician may not recall a specific issue of a verbal conversation with a patient, and may not have taken detailed notes of that conversation. For example, a patient may be at an appointment and wants to talk about a symptom that had been discussed six months ago. The patient goes on to describe changes involving that symptom. The physician states he / she does not recall discussing this particular symptom and it is not noted in your patient file. In this scenario, a patient may then remind the physician of the previous verbal conversation and can offer to provide him / her with another copy of the written documentation. Providing written documentation to your physician and having it added to your patient file provides the patient the security of knowing that there is an accurate record of any concern, new symptom, medication issues, etc. in the physician’s possession.
Another aspect of security provided to the patient who provides written documentation, is that it tells the story of your “history” with respect to the diagnosed or undiagnosed medical condition. This history becomes a great asset if the patient applies for permanent disability through Social Security. When the Social Security Administration sends out a request for your medical records, your written documentation / correspondence with your physician, can assist in establishing degree of disability, progression, length of chronic illness, etc. It also provides evidence that the medical condition causing the disability has existed for an extended period of time, and it is likely to continue.
Here is my personal example of how written documentation saved me from an incorrect differential diagnosis that could have potentially caused an enormous delay is my search for a diagnosis. I have written of this previously, but it deserves additional attention at this point.
When my symptoms progressed to a point where every aspect of my daily life was affected, I made an appointment with my Primary Care Physician. My physician had previously not observed most of my symptoms, due to their intermittent frequency in the beginning. Being the master procrastinator that I am, by the time I finally went to see my physician, my symptoms were not only constant, but also profound. The most prominent features were my extremely slow walking pace and the quality of my speech, which was low in volume and slow. By this time, I had virtually no facial expressions or bodily animations when speaking.
When my physician saw me in this condition, he was shocked. After speaking to my husband and me and performing an exam, he stated that I was possibly bi-polar. He also did not recall ever hearing about these symptoms before this particular visit. My husband was with me for this appointment, and he began to explain to my physician that my symptoms reminded him of his mother, who had been diagnosed with Parkinson’s Disease prior to her death. He also let my physician know that he had never observed any signs of depression, bi-polar disorder, or any other mental health related condition in the six years that he has known me. My physician agreed to prescribe Sinemet, which I still take today. He also believed an appointment with a Psychiatrist was needed.
That afternoon someone from my physician’s office called me to give me the name of a Psychiatrist that my physician wanted me to see. I was annoyed that he was still going down this trail, but I wrote the name of the Psychiatrist down. At this point, the biggest thing that was bothering me was that I was certain I had previously told my physician about all of the symptoms.
That evening I began going through all of my copies of written correspondence that I had given to my physician on previous occasions. I not only found written correspondence from two years prior that had detailed many of the symptoms to that date, but also written correspondence to my previous physician that noted a few of the symptoms that had emerged during that time period. Both correspondences should have been in my patient records file at my physician’s office. So, at this point I became even more upset about the initial bi-polar opinion. I composed a new written correspondence, detailing the beneficial effect of Sinemet on my symptoms, as well as referencing my previous correspondences. I faxed this new correspondence along with the previous correspondences to my physician’s office. Within an hour of that fax, my physician called to apologize and let me know that I would receive a referral to a Movement Disorder Specialist, and that there was not a need to see the Psychiatrist at this time.
Had I not implemented written communication into my relationship with my physicians, I believe that valuable time might have been wasted while chasing after a mental health disorder that did not exist. Of course, a few months later I took the steps necessary, as I noted in a previous post, to insure that in the future, mental health conditions could not be offered as the source of my condition. Additionally, had I not retained copies of my previous written communications, I would not have been able to offer proof that I had already shared that information with my physician. I also would not have had the ability to prove that the symptoms even existed prior to the most recent appointment.
In the second part of communicating with your physicians, I will better define some key elements that can assist a patient on how to be more effective in communicating both verbally and in writing. I will also post a “sample” written correspondence.
There was a time when I only saw my Primary Care Provider for an annual exam. I was normally a healthy person, and I was not prone to automatically seeing a physician for minor illness. Therefore, a quality doctor / patient relationship was not established with my primary care physicians during my healthy years.
Once I began having medical problems, I went through two Primary Care Physicians, prior to finding a patient friendly physician who was willing to work with me. Since I had become a frequent visitor to my Primary Care Physician’s office, the development of a good doctor / patient relationship was able to take root. Familiarity, as well as communication during appointments, helped to solidify a good working relationship between us. Unfortunately, he retired prior to my symptoms progressing enough for him to render a differential diagnosis.
My current Primary Care Physician inherited me because of my previous physician’s retirement. In the beginning, I was not sure that he and I would be a good match for an acceptable doctor / patient relationship. However, I did not throw in the towel. One afternoon we engaged in an intense verbal discussion by phone, which turned the potentially disastrous doctor / patient relationship into probably the best doctor / patient relationship I have had to this date. Clear communication and some human emotion had turned this relationship around.
While I was a patient of the now retired Primary Care Physician, I incorporated written communication into my doctor / patient relationship. As it became clear that I was potentially dealing with a chronic illness, I wanted to insure that every symptom I experienced was communicated and documented. My previous Primary Care Physician was very thorough at taking notes, but for my own peace of mind, I wanted my symptoms and other health related concerns, documented in writing from my perspective as the patient. Additionally, not all physicians are thorough when taking notes, and there are often key pieces of information that are left out. Therefore, when a patient brings up a previously discussed symptom at a future date, and if that symptom never made it into the notes, the physician is very likely not to recall ever discussing the symptom. Physicians see so many patients, that it is impossible for them to remember every word of every verbal communication with every patient.
It is now my standard practice to communicate with physicians verbally, as well as in writing. The type of circumstance dictates whether I utilize verbal communication, written communication, or both forms of communication. The following is a list of various scenarios, and the type of communication I will normally use:
1. Office visit with Primary Care Physician for minor illness or basic follow-up appointment – verbal communication
2. Initial visit with a Movement Disorder Specialist or other specialist – verbal and written communication. If time permits, I send a letter of introduction and copies of my medical records, prior to the appointment. I also make sure to bring backup copies with me to the appointment, in the event that my letter and medical record copies somehow did not make it into the physician’s hands.
3. Follow-up visit with a Movement Disorder Specialist or other specialist – verbal and written communication. Prior to the appointment, I write a brief summary including symptoms, changes in symptoms, medication problems, etc., to give to the specialist during the appointment. This summary not only helps me to remember the topics I want to verbally discuss during the appointment, but also serves as a permanent record that the information was provided to the physician on that date.
4. Non-office visit follow-up with Primary Care Physician after seeing a specialist – verbal and written communication. Following a visit with a specialist, I write an informational short report detailing the visit. This includes information pertaining to symptoms, treatment, topics discussed with the specialist, and future visits. Additionally, I include a copy of any written communication I had given to the specialist. I then fax these items to my Primary Care Physician’s office, and call to make sure they were received.
5. New concerns, which may or may not be related to my spinal condition or Parkinsonism, that I want my Primary Care Physician to be aware of – verbal and written communication. I call my Primary Care Physician’s office and provide a brief description of my concerns to his office assistant. I then write a more detailed summary of my concerns and fax it to my Primary Care Physician’s office. Again, I then place a call to his office to confirm that my fax was received.
Why do I now communicate with physicians both verbally and in writing?
Verbal Communication
Verbal communication is obviously the primary form of communication used during a visit with a physician. During a visit with a specialist, a patient verbally describes his / her symptoms, duration of symptoms, differential diagnosis, diagnostic tests performed, and current treatment(s) to date. Likewise, a physician may verbally ask questions for clarification, explain his / her findings after examining the patient, present a need for further diagnostic testing / evaluation, and render a preliminary diagnosis with a treatment plan. A patient will normally be able to ask questions, in order to make sure he or she fully understands what the physician has said. Even if the specialist does not render a diagnosis during the visit, if the verbal communication is adequate, the patient will understand the physician’s course of action necessary to assist with the diagnosis process.
Written Communication
I have found that written communication is an important tool, especially for the patient who has an undiagnosed chronic condition. Additionally, for patients who do have a diagnosis, written communication is a great way to keep your Primary Care Physician, as well as your entire team of physicians, informed on any changes in your condition, in between appointments. Aside from and including some of the situations that I have previously listed, here are a few examples of the benefits of establishing written communication with your physicians:
1. Patient provided written documentation of symptoms gives an exact description and complete information that leaves little room for misinterpretation. Verbal communications have the potential to allow incorrect interpretation and potentially incorrect note documentation with respect to the patient’s symptoms. Patient provided written documentation eliminates these issues, because it is the patient’s accurate, first hand account that can be added to the patient’s chart for future reference by the physician.
2. Patient provided written documentation of changes in the chronic illness helps in two manners. First, if it is provided to a physician during a visit, it gives an accurate, first hand account of those changes. Again, a patient can request that the documentation be added to the patient’s records / chart. If the patient is in-between visits, he / she can fax the written account of the changes to the physician’s office. This allows the physician to determine whether or not the issues need to be addressed immediately, or if the issues can be addressed at the patient’s next appointment. I have found that my Primary Care Physician will often call me to discuss my correspondence, and then he will determine the necessity for an earlier visit.
3. Patient provided written documentation provides security for the patient. In my experience, there are times when a physician may not recall a specific issue of a verbal conversation with a patient, and may not have taken detailed notes of that conversation. For example, a patient may be at an appointment and wants to talk about a symptom that had been discussed six months ago. The patient goes on to describe changes involving that symptom. The physician states he / she does not recall discussing this particular symptom and it is not noted in your patient file. In this scenario, a patient may then remind the physician of the previous verbal conversation and can offer to provide him / her with another copy of the written documentation. Providing written documentation to your physician and having it added to your patient file provides the patient the security of knowing that there is an accurate record of any concern, new symptom, medication issues, etc. in the physician’s possession.
Another aspect of security provided to the patient who provides written documentation, is that it tells the story of your “history” with respect to the diagnosed or undiagnosed medical condition. This history becomes a great asset if the patient applies for permanent disability through Social Security. When the Social Security Administration sends out a request for your medical records, your written documentation / correspondence with your physician, can assist in establishing degree of disability, progression, length of chronic illness, etc. It also provides evidence that the medical condition causing the disability has existed for an extended period of time, and it is likely to continue.
Here is my personal example of how written documentation saved me from an incorrect differential diagnosis that could have potentially caused an enormous delay is my search for a diagnosis. I have written of this previously, but it deserves additional attention at this point.
When my symptoms progressed to a point where every aspect of my daily life was affected, I made an appointment with my Primary Care Physician. My physician had previously not observed most of my symptoms, due to their intermittent frequency in the beginning. Being the master procrastinator that I am, by the time I finally went to see my physician, my symptoms were not only constant, but also profound. The most prominent features were my extremely slow walking pace and the quality of my speech, which was low in volume and slow. By this time, I had virtually no facial expressions or bodily animations when speaking.
When my physician saw me in this condition, he was shocked. After speaking to my husband and me and performing an exam, he stated that I was possibly bi-polar. He also did not recall ever hearing about these symptoms before this particular visit. My husband was with me for this appointment, and he began to explain to my physician that my symptoms reminded him of his mother, who had been diagnosed with Parkinson’s Disease prior to her death. He also let my physician know that he had never observed any signs of depression, bi-polar disorder, or any other mental health related condition in the six years that he has known me. My physician agreed to prescribe Sinemet, which I still take today. He also believed an appointment with a Psychiatrist was needed.
That afternoon someone from my physician’s office called me to give me the name of a Psychiatrist that my physician wanted me to see. I was annoyed that he was still going down this trail, but I wrote the name of the Psychiatrist down. At this point, the biggest thing that was bothering me was that I was certain I had previously told my physician about all of the symptoms.
That evening I began going through all of my copies of written correspondence that I had given to my physician on previous occasions. I not only found written correspondence from two years prior that had detailed many of the symptoms to that date, but also written correspondence to my previous physician that noted a few of the symptoms that had emerged during that time period. Both correspondences should have been in my patient records file at my physician’s office. So, at this point I became even more upset about the initial bi-polar opinion. I composed a new written correspondence, detailing the beneficial effect of Sinemet on my symptoms, as well as referencing my previous correspondences. I faxed this new correspondence along with the previous correspondences to my physician’s office. Within an hour of that fax, my physician called to apologize and let me know that I would receive a referral to a Movement Disorder Specialist, and that there was not a need to see the Psychiatrist at this time.
Had I not implemented written communication into my relationship with my physicians, I believe that valuable time might have been wasted while chasing after a mental health disorder that did not exist. Of course, a few months later I took the steps necessary, as I noted in a previous post, to insure that in the future, mental health conditions could not be offered as the source of my condition. Additionally, had I not retained copies of my previous written communications, I would not have been able to offer proof that I had already shared that information with my physician. I also would not have had the ability to prove that the symptoms even existed prior to the most recent appointment.
In the second part of communicating with your physicians, I will better define some key elements that can assist a patient on how to be more effective in communicating both verbally and in writing. I will also post a “sample” written correspondence.
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