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