Soothing Trauma

This is probably breaking all kinda HIPAA rules, but here goes anyway...

A few weeks ago, my wife and I were out of town on a biz trip. While heading into Target to grab a couple road items, Marvelyne suddenly started experiencing abdominal pain. Now, my wife is tough as nails and does not complain. So, when the first words out of her mouth were, "I need to get to a doctor", I knew there was no messing around.

Off to urgent care, but urgent care suggested a CT scan. Off to the E.R. where we spent the next four hours. Seriously, E.R.s of the world, run a tighter ship. But, I digress...

After her CT scan showed up clear, her pain subsided and the docs couldn't find the cause of the earlier pain, she was released to go to our temporary Doubletree home.

If you've never been in an emergency room, consider yourself lucky. VERY lucky. No matter what your ailment, these days, it seems like three hour minimums are the norm in the E.R.Yet, with all the hustle and bustle and trauma and weirdness of the E.R., there was a single oasis: Marvelyne's doc.

He came in, sat down next to her gurney and leaned in to converse. His tone was never much more than a low breath, his words came slow and compassion just oozed from the man. Even in the craziness that is the E.R., his tone and demeanor neutralized everything except the patient, the doc and the ailment.

Is this helpful? Absolutely. Is it even MORE helpful when the patients the doc usually treats are in traumatic situations? Double absolutely.

His tone did so much to calm our fears; just by speaking quietly and slowly and sitting down. We weren't just a couple of yahoos who were in for no reason. We'd endured some terrible and unexpected and immediate pains. Well, SHE had, at least.Yet, the scary fears associated with the E.R. were negated by one person's ability to communicate effectively.

The Whitest Of White Coats

Are you a little nerdy? I am! Got no probs admitting it, either!

One of my nerdy things is some lighter exploration of science, the brain, really anything. I don't want to get a Ph.D. in astrophysics or anything, but I like learning a little about a lot of different topics. One way I do this is through Radio Lab.

What's Radio Lab? A NPR program featuring two highly intelligent scientifically minded individuals. For one hour per week, they explore everything from the evolution of ancient practices in medicine, to the effects of love on the brain, to whether or not animals can reason like humans, just a wide variety of interesting topics. If you check out RadioLab.org, you'll also find a program on the placebo effect.

One of the hosts' father is a M.D. at a major university hospital. In observing his father, the host watched his father prepare to see patients in his office. One of his rituals was to open his closet, choose the whitest of a half dozen white coats hanging there and don it for the day. As the host said, there was a perceiveable change when his father put on his white medical coat. That change? Confidence and competence.

As they stepped into the hall, his first patient of the day, a woman, ran to the doc and hugged him. "I'm just so glad to see you," she murmured over and over. Her life had gotten out of control; family stuff, her health, etc. Just the sight of the doc in his lab coat was enough to cause her feelings of comfrt, that all was well now that her doc was in control.

This is exactly what the white coat SHOULD communicate. A physician who is compassionate, comforting, competent and confident. After all, a patient is giving up his/her control of their health as soon as the doc walks in.

But what about if the doc does NOT communicate compassion and competence? Could the reverse happen? Absolutely...and this is why, I feel, docs owe it to their colleagues to practice compassionate care. Is it unfair to think a physician's moment of frustration or weakness could tarnish the entire field of medical docs, at least in the mind of a single patient? Sure it is...and that doesn't change the reality.

Yet another reason docs should take a moment to put on a coat of compassionate, not just the identifier of their position.

Got Any Good Book Reccos?

In a few days, yours truly will be sitting in an office at an Ivy League university, chatting with faculty of a grad school about continuing my education. I'm looking into a highly specialized form of health care that'll help me do an even better job on the platform, in my writing, anything you associate with your ol' pal, Marcus.

If I'm accepted into the program, and if all the cosmos align properly, I'll start the year long master's work in about a year. In the meantime...I need your help.

First, since I haven't been a student for, oh, 10 years, I need to get back in the swing o' things. So, do you have any health care book reccomendations you'd like to share? Anything from the patient/caregiver element to systems and institutional/organizational psychology? Anything?

Second, If you know of funding sources for grad schools, I'd love to hear of them! Scholarships, grants, work for hire by Marcus Engel-I'm all about the creative ways we can make this happen! Thanks, friends!

Spells and Some Awesome Ideas From Snyderman

I've just finished reading Dr. Nancy Snyderman's "Medical Myths." If you're not familiar, Dr. Snyderman is the health correspondent for one of the major television networks. Truth be told, I did not know this before starting her book; probably b/c I usually watch cable news. Anyway, I digress...

Dr. Snyderman told a story I think we should all heed. As a young med student in Omaha, Nebraska, a woman came into the emergency room at the teaching hospital where Snyderman was working. The female patient was middle aged and appeared healthy, for the most part. The patient filled out her paperwork, waited in the ER waiting room until she finally got her turn with the ER doc.

When the female patient spoke with the doc as the students looked on, she complained of the feel of ice in her back as she inhaled. A few other symptoms were discussed, but none were the classic symptoms of heart attack, stroke, diabetes and the woman had suffered no trauma. The physician asked the students what a possible diagnosis may be. Students called out several possibilities, but the doc dismissed all of them and said quietly, "She could just be hysterical."

Simply put, this doc thought the woman was a hypochondriac, or crazy, or attention seeking. The catch all phrase of "hysterical" was primarily used for women, further reinforcing the stereotype of women as unreasonable and afraid of everything (aren't you glad we've come a little further than that in society?) The ER doc gave the woman some Rolaids and the name of a gastro specialist then released her from the ER. The woman walked out of the hospital and dropped dead of a heart attack in the hospital parking lot.

What a fantastic teacher! And no, I'm not kidding! Is this a horrible tragedy? Most certainly it was. But, what a fabulous time for students to always know to be cognisant of symptoms...and not to disregard patient complaints as nothing IF those complaints don't fit a pattern.

Have you ever known someone like this ER doc? While there's a sick part of me that takes pleasure in knowing this doc had to eat a whole flock of crows, and while it wasn't his intention, he taught a fabulous, FABULOUS lesson. I'm sure many of us can think back to someone we disliked or disagreed with. I sure can think of a few! If you're like me, you may have even made a vow to do everything NOT to be like that person. I've gotta bet that Dr. Snyderman made that vow, too. It's certainly not worth the death of a medical mistake, but the lesson changed Dr. Snyderman. And she's hopefully inspired and influenced docs along the way...I know that reading "Medical Myths" certainly gave me a lot to think about.

I mean, Voice Mail Has Only Been Around For , What? 15 Years?

I just finished reading an interesting article in Men's Health about something totally NOT health related: E mail etiquette. Good article talking about how certain E mail techniques can be perceived as insulting, improper or just a time waster.

So, why don't health care offices understand this concept?

Here's the thing: Very few people E mail with their doc. I'm not referring to that, but to that other "mail" that's a tecnological improvement over the Pony Express, a.k.a. Snail Mail. That is, for you novices, voice mail.

I called a physician's office at 11:50 a.m. today. I get a recording that says the office is closed every M-F from noon until 1 for lunch.

What time did I call? Oh yeah, 10 minutes BEFORE the lunch break. Did I have the option to have my call returned? Nope. Just a message saying call back during business hours.

I don't think I'm that much different than other people here. I don't like my time wasted. By taking an earlier than stated lunch break, my time was wasted by the office staff. Now, I have to call back after 1 instead of someone calling me back. A little thing? Yes, but having that option to leave a msg would have made a big (and positive) impresion on me.

And what happened when I called back at 1:23 p.m.? I press 1 to schedule an appointment...and, without ever speaking a word to a human being, stay on hold until after 1:35. Again, had I been able to leave a voice mail, an extra 10 plus minutes of my time would not have been wasted. Now that my time has been wasted on two separate occassions in one day...well, I'm thinking there needs to be an article like the E mail etiquette article in Men's Health. And who shall write it? Me. And I'll be on that soon.

In the meantime, though, if you're office staff can't get it together, please understand that it's making a bad impression on your patients.

15 Seconds

I've become a big fan of Boston Med. Granted, I'm just kinda nerdy about medical stuff, anyway, but it also gives me fodder for this blog and for my patient care keynotes.

The last episode I caught showed a surgeon in pre-op with his patient. He spoke to the patient, explained what he'd be doing and what the patient could expect. When the camera cut away to a quick interview segment, he said something really profound (I'm paraphrasing here):

"Before a patient goes into surgery, you have about 15 seconds to make them comfortable. Because we (surgeons) do this kind of thing every day, we get accustomed to it. What we forget is that it's traumatic for a patient to know they're going to be cut on. Especially if they've never had surgery before and don't know what to expect, we only have about 15 seconds to help them understand and feel comfortable before they go under."

Maybe this is the whole scenario of "walk a mile in his moccasins", but I think it's important for health care professionals to keep in mind that, while appointments, surgery or hospitalization is common for them, for patients, it brings about feelings of vulnerability and fear.

If you're a health care pro, I encourage you to take 15 seconds, just like the doc said. But not 15 seconds with the patient...take your 15 seconds on one of your breaks. Think about what a patient might be feeling, thinking or feeling. It doesn't take long to understand what the patient feels...and then to help them because, now, you have some extra empathy.

Habla Doctor?

25% of physicians practicing in America went to medical school outside the United States.

Does this matter to you?

Okay, story time! Back in my single days, I dated a young lady who was an aspiring physician. By aspiring I mean she started college going into pre-med, but dropped that and went with nursing in hopes she'd return to medicine. While we were dating, she discussed a medical school in the Caribbean where a friend was a student. This friend had trouble passing the standardized test for med school, so looked outside the country. As a patient, this was kinda concerning. After all, if he's not smart enough to get into an American med school, why should he be able to come back to the states, do his residency and be recognized as a board certified physician? Well, this was nearly 10 years ago...and my tune has changed.

I have had several foreign born docs who also attended med school outside the states. Off the top of my head, there are some who I didn't care for their bedside manner, but their practice of medicine was professional and competent. Turns out, my experiences align with the data.

The Journal of Health Matters recently looked at the data on cardiac mortality rates with docs who graduated from an American med school vs. those who graduated from a foreign school. Their findings? No discernable difference. Good to know...and I, for one, believe in the economical data. Therefore, I no longer have any sort of prejudice against a doc who graduated from a med school in another country. In fact, in the last several months, I've switched our family doc to a gent who's degree was handed out by Mexico. Still, I was kinda surprised when I found out that one in four American docs didn't go to American med schools.

Here's a question (no idea if this data has ever been tabulated. If not? Someone should...) Take a survey of a wide group of patients. How many patients have even checked on where their physician went to med school? Or where he/she did his/her training? Fellowships? Unless you see the diploma hanging on their wall and recognize the name of the institution, I'd bet a shiney new nickle most patients can't discern undergrad from med school from residency from fellowship.

I find this a little sad; that patients are so uninformed. But, what does a patient think when they find out their doc's med school sheepskin comes from a university across the pond? What if it's the really big pond called the Pacific? I would love to see these opinions taken, the data analyzed, etc. Mainly, just because I'm a big nerd like that. Also, though, I'm fully in favor of patients arming themselves with knowledge. The more active a patient is in his/her own care, the better of they are.

So, faithful reader, how much do you know about your doc? And, if and when you do find out where he/she got their degree...does it matter?