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Team Work Makes the Dream Work: Communicating Effectively with Your Doctor


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You arrive at your scheduled appointment with a list of things you’d like to talk about. You spot your doctor dashing from room to room as you study the clock wondering how long you will be waiting this time. You glance at a sign pasted next to the administrative assignment: ‘Only one issue will be discussed per visit. Thank you in advanced.’ You sit down and begin to fiddle with your phone. 5 minutes goes by. 15 minutes. Where is this person? 20 minutes goes by. When your name finally gets called you feel frustrated, tired, and irritated. And the appointment hasn’t even started yet. Sound familiar? How will you get all your concerns addressed? How can you explain them while maintaining your sanity? Straight from the horse’s mouth, here’s some thoughts on how to make the most out of your time with your doctor:

Come prepared with an up-to-date list of medications.

I’m not a betting woman, but if I were I would place money on your doctor asking for a list or clarifying the medications they already have documented in your chart. Write them down in advanced or take a picture of them with your phone. This simple act will save you both from having to guess the names of the little blue or white pills you’re taking. Don’t forget to include any vitamins, herbal remedies, or over-the-counter medications!

Have a game plan.

Typically people don’t show up to their doctor’s purely for social enjoyment. What is it that’s been bothering you? Do you have multiple complaints? Which are the most pressing? If your doctor isn’t able to get to them all in one visit, are there any which can be followed up in the next week or month? You don’t need a medical degree to know what’s been troubling you the most. Let your gut be your guide and we’ll help you take care of the rest.

Think like a doctor.

I’ll let you in on a little secret. In medical school, we are taught a basic approach to characterizing complaints. You can improve the efficiency of your appointment by reflecting on some of these points even before seeing your physician. Let’s take knee pain for example. Things you can expect to get asked are: Onset (When did the knee pain begin?), Palliating and provoking factors (Is there anything that makes the knee pain better? Anything that makes it worse?) Quality (What type of pain is it? Throbbing? Stabbing? Burning?) Radiation (Does it spread anywhere?) Severity (How bad is the pain?) Time (When is the pain the worst? At night? When you wake up? Has the pain changed over time?). Put it altogether and here is how I might respond to my doctor when asked what brings me into the clinic today: “Well, I seem to be having this pain in my right knee which started yesterday after a bike ride. Walking on the knee makes it a lot worse, while staying off it makes it a little better. I feel like the back of my knee is throbbing and it’s only gotten worse. The pain doesn’t spread anywhere“. This format doesn’t give your doctor all the answers, but it does give them a great foundation to figure out what’s going on.

Be your own health advocate but maybe leave Dr. Google at home.

It is incredible the wealth of information online for us to learn more about different health problems and treatments available. You can plug a symptom in on Google and within seconds have a differential diagnosis of 100+ medical conditions. I think the internet can be an empowering education tool for patients and physicians alike; however, it can also be overwhelming and create trust and communication barriers between both parties. Patients can feel frustrated that physicians aren’t taking their concerns that they have X disease seriously; physicians feel irritated that patients are self-diagnosing. How can we work through this? Here’s what I think – If you want to do some of your own research – go for it. Try to avoid websites based on other individuals’ personal testimonials and instead search for resources that are based on more reports. Your doctor should be able to recommend some resources if you are having difficulty finding some. If you choose to do your own research, try to avoid using diagnoses when asking for assistance with symptoms. That being said, it is perfectly reasonable to discuss what your particular concerns are after your symptoms have been appropriately characterized. For example: Instead of telling your doctor that you have Guillain-Barre Syndrome, maybe say that you are concerned that the increasing numbness and weakness in both of your feet could be related to Guillain-Barre.

Know your learning style.

Some people can remember ever detail of a conversation just by listening to it. Some people are more visual and need things written down. Try to reflect on how you absorb information best and advocate on your behalf. If your doctor is rattling on and on about atherosclerosis and you know you are a visual person, ask if they can draw you a picture or direct you to some print resources. Depending on your physician’s learning style, they might not have considered that you might benefit from a different teaching aid.

Keep an open mind.

I can be an inpatient person. When I show up to an appointment, typically my expectation is that I will be seen around that time (or why bother scheduling appointments at all?!). I used to become really edgy and crusty while waiting for physicians – can anyone else relate? However, since starting to practice medicine, I have developed a little more empathy. Undoubtedly, there are some physicians who are better than others at managing their time. They are a conversation for another day. For the majority of physicians who are usually endeavour to keep to their schedule – the universal fact is that things happen. People are unexpectedly unwell/in crisis and as a physician you are obligated to respond. When these unexpected “bumps” happen (and boy do they happen), they typically take up a fair bit of time. Am I suggesting that you should be all “sunshine and roses” with your physician who is consistently four hours late? No. But for your own sanity, and that of your doctor, maybe pause to consider what events might have lead up to the delay. When I feel frustrated by the wait (frustrated is the politest descriptor I could think of), I try to have a gratitude moment – I am not the person in trouble.

Final thoughts: Communication is a two way street. Some doctors are better communicators than others. Following these steps doesn’t guarantee that you will have a productive and fulfilling appointment; however, they are guides to help you, as the patient, use your time as efficiently and effectively as possible. I hope they are helpful! Any other tips or strategies you have learned? I would love to hear them!

 

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7 Steps for Making the Most Out of Your Overnight Call Shift


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Happy you Friday all you (c)all stars! I am writing to you hot off an eventful shift in psych emerge. On my bike ride home from the hospital, I found myself reflecting on my “call habits” and some of the behavioural changes I have been trying to make since starting residency.  Whether you are a clerk or a senior resident, call can be a physical, emotional, and mental marathon. Does it have to be? Is it possible to not only survive while on call, but thrive?

First off – for those of you who may not be familiar – what is is “call” and what does it involve? Just like New York City, healthcare never sleeps. Being “on call” means that, as a healthcare professional, there are periods of time where you are required to be local and available to assist with providing care. Some physicians are able to complete call from home. They will be called by the hospital if there are any questions or if they need them to come in. However, as a medical student and resident, your call typically takes place in house. The expectation is that you stay at the hospital throughout the day and overnight carrying a nifty little pager so that you can be summoned to complete consults or reassess patients as needed. Call can be an incredibly valuable learning experience; however, as I mentioned before, it can also feel sometimes like a tearful, Timbit-filled marathon. Let’s look at 7 easy ways to improve your call shift experience!

Step One – Radical Acceptance

Radical Acceptance is a popular concept in Dialectical Behavioural Therapy, a form of psychotherapy, intended to help individuals regulate their emotions. As a psychiatry resident, I try to practice what I teach my patients and this technique has really resonated with me! Radical Acceptance means acknowledging your present life circumstance and accepting it exactly how it is. Let’s face it – call can be really hard. You’ve been working for 20 hours straight and your mental faculties and patience can, and often will, run low. It’s is so easy to slip into a negative mindset and ruminate on how hungry, tired, angry, overworked, etc., you are. Sound familiar? Next time, try acknowledging whatever is happening during your shift and how you are feeling. Try not to assign any judgment to what is going on. Acknowledging your circumstance does not mean that you have to approve or agree with whatever is happening. Now, this is easier said than done; however, with practice it will become easier to stay focused and problem-solve effectively.

Step Two – Pack a variety of healthy snacks and eat them

This step takes a little bit of planning but can have such a huge pay off! Almost every call shift I work, someone asks if I want to order takeout. Now don’t get me wrong – I love a good meal out just as much as the next person; however, the huge servings usually leave me feeling ready for a long nap. I won’t even start with the nutritional value of the food but I’m sure we can all agree that I am not eating the beef gyro with loaded fries “for my health”.  Try to pick snacks that you know will make you feel energized and ready to tackle the rest of your shift. As much as possible, avoid foods high on the glycemic index – these are metabolized rapidly and the energy will not be enough to sustain you for any significant period of time. Some of my favourite snacks are red delicious apples, roasted almonds, strawberries, and zucchini noodles with a light tomato sauce.

Step Three – Do a ten-second check in

While I was working in addiction psychiatry, I was introduced to the “Big Book” individuals in Alcoholic’s Anonymous use to promote and sustain recovery. As part of recovery the “Big Book” encourages its followers to take a little time every day to HALT and check-in. HALT is an acronym which stands for Hungry, Angry, Lonely, Tired. I can think of several call shifts where I checked each and every one off the HALT states and I felt terrible. Now fixing some of these feelings may not always be possible, especially when you’re on call; however, if you never practice identifying how you are feeling – how can you go about changing it? Sure – you might have been up for the last 22 hours with no chance of napping in the foreseeable future. Identify the tiredness and think of what you can do to change it right now. Can you stand outside for two minutes and breathe some cool fresh air? Can put your headphones in and listen to some music while documenting? You might be surprised by what quick changes you can make in the here and now to ward off some of those negative feelings.

Step Four – Ask for help 

In addition to training you to be an effective physician, medical school and residency can sometimes seem like extended job interview and, to be fair, it kinda is. Yes, you are trying to learn so that you can become competent and one day practice independently; however you are also trying to set yourself up for a successful residency match, fellowship, permanent position etc. and in order to reach these milestones, you need the references. As junior learners, there can be an awful lot of pressure to impress and get that “slam dunk diagnosis”. It’s easy to lose sight of what really matters – the patients and your learning. Whenever you find yourself struggling with a clinical question, check your motives for wanting to solve it independently. We learn and practice in teams for a reason.

Step Five – Be a team player

We’ve said it before and we’ll say it again – call can be tough and different people are able to cope with the demands of call in different ways. When (and if) you find a pause in your work flow, check in with your colleagues to see if they need anything before running back to your call room. Maya Angelou once said: “People will forget what you said, people will forget what you did, but people will never forget how you made them feel”. You never know when you will need support (and you will need support) – building reciprocal professional relationships early will make it easier to access this support later on.

Step Six – Wear comfortable shoes

Now this one may seem like an obvious fix and kudos to you for having that level of foresight! I learned the hard way breaking in a cute new pair of flats while on medicine call. I can get a little crusty at the best of times when I haven’t had a good nights rest. Bleeding and throbbing feet don’t make it any easier to stay focused and maintain an appropriate professional demeanour. Now, my colourful Nikes are the first thing I back before heading off to an overnight shift!

Step Seven – Be here, be now

Regardless of what service you are covering, it can be easy to get overwhelmed by all the tasks on your “to-do list”, especially during those nights when your pager doesn’t seem to stop ringing. Practice your triaging skills – What absolutely needs to happen right now? What can wait a few hours? What can be handed over to the morning team? Categorizing your pending tasks this way can free up some cognitive space to focus on what you are doing right now. Being present, especially as a junior learner, will decrease opportunities to miss important steps or nuanced clinical clues. It will also make it easier to focus on the learning opportunities present in your current task.

What are your tips for staying well on call? Do you have any post-call guilty pleasures? Did any of these steps resonate with you? Share below!