Help Your Doctor Help You And Themselves

[Music]

now more than ever we know how important

healthcare

is to each of us and collectively to all

of us but we also know

it is more costly than it should be and

our outcomes and experience

aren’t what they should be either

typically

we look to the payers providing

institutions and policy makers

to make a difference and they certainly

can

but i believe there is another group

that is often

overlooked and who can make a

significant contribution

and that group are patients that’s right

each of you when you go to seek care

from your doctor

how simply by making some thoughtful

considerations

before during and after your encounter

that can influence the doctor to get to

yield

better outcomes and experience for you

and often

also at lower cost with one billion such

doctor-patient encounters in the united

states each year

that has real impact potential and

what’s more

these same considerations

also improve the lives of doctors

dr burnout is a

prevalent condition 80 percent report

feeling sometimes always burnt out

20 percent report feeling even depressed

to the point of worrying about making

medical errors

and they also contemplate and sometimes

even tragically

commit suicide which then means

increased

administrative burden leading to burnout

for those

still working and less access

for patients and worse outcomes and

experience

as a doctor on the front lines and a

health care consultant behind the scenes

i thought deeply about this

and i’ve put it together in a three-step

framework

of s t and i for you as a patient

to start taking initiative

here i will run through three s’s to

think about

before seeing a doctor three t’s to

think about

while seeing the doctor and three eyes

to think about in follow-up care

three esses before seeing the doctor

number one

scarcity there are two and a half

doctors for every 1 000 americans

and this low ratio is getting worse the

american medical association

anticipates a deficit of 120 000 doctors

over the next 10 years

now we doctors going to serve but we

know

that demand is greater than we can

supply and so we want to be used where

we can provide the highest value

we don’t have a problem with adding

lower value with refill requests or

routine checks but we’re conscious of

those patients where we could have

provided higher value

such as acute and complex problems

but who could not get access because of

that scarcity

and so as a shared responsibility to

think

about this because you never know when

that patient that couldn’t get access is

you

number two selection as doctors we

perform best with certain conditions in

certain settings as we’re trained

now sometimes we’re faced with patients

not in favorable circumstances but we

will always try and do our best

to not disappoint expectations but that

may not be the best

for you as a patient you have the power

to be able to guide

this yourself in advance

in thinking through does it need a

doctor at all

nurse pharmacists or other allied health

care professionals

now do more and more and are more

accessible

in the right setting because two-thirds

of emergency room visits

have been found to be better dealt with

in primary care

and save 32 billion dollars a year so

while your emergency room doctor’s

responsibility

to reassure you that there’s no

emergency your primary care doctor has

the responsibility

to go further and correctly diagnose and

manage you through

and in choosing the right doctor for

your particular

problem important metrics to look at

are their qualifications that track

record and professional interests

in your area in the area you need but

metrics that do not

make a difference are their sex

their sexual orientation their age

or their zip code

and so finding the right doctor working

in the right setting with the right

conditions will more likely

yield the right result for you number

three

supporting information

in this era of increasing technology we

capture

most of our lives and why not also

illnesses

if you have a rash take a picture if you

have a cough record a voice note

if you have pain find a way to draw out

draw and map out where

diary when and describe how and send it

ahead of time

with chronic conditions such as

hypertension and diabetes

there’s increased proliferation of home

devices

and remote monitoring so you can have

the readings that capture your real

lived experience

we get energized in dealing with this so

we because we know

we can then provide you with a more

accurate

and better management plan rather than

based

on one reading or trying to guess

your symptoms and so where you can

snap it map it and tap it

and share it with us

three t’s during your encounter

number one time doctor’s appointments

typically short

five ten maybe twenty minutes at best

and so even two minutes is a significant

delay

doctors interrupt patients on an average

of 11 seconds in

and so with delays that’s likely to be

even earlier which means less chance for

you to tell your story

but more chance for misunderstandings

when faced with a time squeeze it

creates an internal conflict

in thinking about spending that extra

time

with you and delaying the others

and that is a distracting thought that

means not being fully present and likely

to yield worse outcomes and it certainly

increases feelings of burnout

so never mind birds and worms the early

patient

certainly catches better care number two

trust 80 of doctors report

the doctor-patient relationship as being

the most satisfying

part of their job

as humans when we feel trust we’re more

likely to reciprocate trust

in fact studies have found that patients

who trust their doctors

have better outcomes and also feel

better about their experience

when we feel trust we’re much less

likely to be distracted

to worry about an impending lawsuit or

complaint

conversely when we don’t feel trust

we’re likely to resort to defensive

medicine

where we order extra tests and other

opinions

all at increased time

and money cost to you without

necessarily expecting a better outcome

and so trust us we’re doctors

number three taking part

even though you access the doctor’s

expertise the

appointment is fundamentally about you

and your personal dreams

and deadlines in this era of

democratization of medical information

you have the ability

to look online and find journals

education sites and patient forums

and with that you can research and

reflect ahead of time to bring your

ideas concerns and expectations

we love proactive patience maybe

contrary to opinion it makes us feel

that all that sacrifice

that we spent was worth it to be able to

get

that patient in front of us to live

their best life

proactive patients also are humbling

because they remind us that we

don’t know about each individual’s

possibilities as they were in

the books or taught to us by

our seniors and also inspiring

because it helps us learn and what makes

us want to be better

for the next patient and so you have the

possibility here to not only

influence better outcomes for you but

also for others

in this stance between a doctor and a

patient it really does

take two to tango three eyes

after seeing your doctor number one

investigations

it can seem that the more tests the

better but tests are not a free hit

they not only cost more money

and time but they can also sometimes

cause harm

such as with ct scans and the radiation

that they come along with

tests also have the risk of generating

false positives

when tests are done and the right

populations

where it’s more likely to be applicable

the test results are more accurate

and conversely when they are done in

populations where it’s less likely to be

true

then the test results become less and

less accurate

and sometimes even to the point of

becoming a coin toss

one study looking at women who’d had an

annual mammogram for 10 years

found that half of them had received a

false positive that had generated

increased anxiety further tests and

sometimes

unnecessary surgery

so it’s a case of buyer beware the more

you look the more you’ll find

and once a test result is known it can’t

be unknown

number two interventions

contrary to the popular maxim of do no

harm every intervention has the

possibility

of harm within it iatrogenic

causes a fancy way of saying medical

treatment related causes are estimated

to be the third

biggest killer after heart disease and

cancer

leading to up to 250 000 deaths each

year

to put that in context that is half the

number

that were victim to the opioid epidemic

over many years

now sometimes

the bad outcomes are due to malevolent

actions

or bad actors as in the opioid epidemic

but by far most of the time it is simply

inherent

in the risk of practice and so

infections from being in hospital

or from medications unexpected allergic

reactions or side effects

or complications from operations

and so even with good intentions medical

interventions can have bad outcomes

number three

interim uncertainty

if things are not getting better

afterwards it is natural to reconsider

if you had the best opinion in the first

place

or whether a second opinion with another

doctor would be better

but second opinions create conditions

with an inherent bias to action

which don’t always yield better outcomes

one study

of orthopedic surgeons found they were

much more likely to operate on an

identical

case only with the addition of being

told

that another doctor had seen it

previously

so what about giving a second chance to

the first opinion

we doctors know we don’t always get it

right

and even more we know that even the

right medication doesn’t work on all

patients

and that some conditions just take time

to get better

but we are very happy to be to

work with you and to rethink and to

update

the plan which may well include going to

see a second opinion if that’s what is

best

now whether you give a second chance to

the first opinion

or go for a second opinion that takes us

back

into the framework and the

considerations of the three

s’s before the appointment of scarcity

selection and supporting information the

three

t’s during of time trust

and taking part and the three eyes

afterwards

of investigations interventions and

interim uncertainty

and so while i wish you the best through

this pandemic

and beyond when you do

next need to see a doctor i’d encourage

you to think

about the s t

i framework and start taking initiative

and with that i will stop talking

immediately