elf cosmetics uk

Archive for July, 2007

The Hell of the Angry Patient

Greetings from Knoxville, TN. I’ve returned to a former “home” — lived in Farragut, a suburb, for many years, but left in the early 1990s. I’d forgotten how beautiful it is, and how lovely the people are. Feel like I’m home again….

But I digress.

I wanted to share a theme that has run through a half dozen conversations in the past week or so. As I think about it, I realize that patients who understand the concept, and doctors who acknowledge and address it, will all find better outcomes.

It’s the concept of the angry patient; patients who have suffered at the hands of the healthcare system in some way, or perhaps love someone who has suffered. They have been misdiagnosed, or have gone undiagnosed, or perhaps have experienced a medical error. A loved one may have needlessly died.

The angry patient becomes distrustful and generalizes his/her anger toward all healthcare providers; not just the one who perpetrated the crime against his/her health.

The angry patient puts up tall, strong barriers because of that distrust.

The angry patient, when presented with new symptoms, or when returning to see his doctor, or when seeking another opinion or follow up care, cops an attitude and instantly puts everyone on the defensive. S/he expects substandard decision-making and care. And too often, that’s exactly what s/he gets.

How do I know this? How can I so completely describe the scenario? Because one result of my own misdiagnosis was my descent into the hell of the angry patient.

It’s easy to see how it happens. We are raised to trust and respect healthcare providers. And when that trust is broken in any way, we feel violated. Since healthcare can’t be avoided — we will always have some type of medical or health challenge — that forces us to return to the abuser(s) for our care, despite the fact that we don’t trust them.

A woman who has been violated, raped or in some way abused by her partner is counseled to walk away and never return to that person because that partner will likely abuse her again. But the violated patient must return to someone who represents a SYSTEM that has violated him or her. S/he has no choice but to return to the system that violated him/her.

As a result, s/he uses anger as a shield, as a way to protect him/herself from getting hurt again.

Are you an angry patient, too? If so, let me share with you some of the wisdom that’s been shared with me, and the thoughts I force through my mind each time I must return to a doctor….

We’ll start with the fact that NO doctor ever intends to cause a bigger problem than we arrive at her office with. Doctors all want to fix us, make us well, get us back on our feet. They aren’t always capable of it; but that’s most definitely their goal.

From there we need to understand that we patients need to be fully engaged in the process — from being completely honest to complying with the doctor’s orders, we can’t expect any healthcare provider to overcome a problem that we, the patients, aren’t 100% open to, and invested in fixing, too.

Doctors don’t want to hear complaints about other doctors. That doesn’t mean you can’t or shouldn’t share those complaints; in fact, I think it’s important that providers get feedback about their colleagues, especially if a referral has been made. I’ve even blogged about that before. But there are ways of delivering feedback about your experiences with others that don’t put all parties on the defensive… “Doctor, I’d like to share an experience I had and ask for your advice on how to deal with it….” is a whole lot better than, “Let me tell you what a quack Dr. So-and-So is!” You get the picture.

The more you partner with a provider, and the more little successes you find together, the better will be your ability to separate from that anger. It’s an opportunity — or maybe a requirement — that you both work through the differences and move on. This is true whether you are returning to the scene of the previous error/crime — or — whether you are starting all over again.

Don’t hang on to your anger for no other reason than to hang on. If the system or the provider continue to violate you, then by all means, hang on to your anger! It may be protecting you to some extent.

But more often whatever happened to you or your loved one is past, and it’s time to move on to acceptance. Elizabeth Kubler Ross described the five stages of grief as they relate to death and dying. Anger is the second, and possibly the one that wounds the process of getting beyond the violation. Don’t grieve the violation forever. You need to let go eventually in order to move on.

Learn to forgive. I was the angriest at the two pathology lab directors and the first oncologist I saw who were involved in my odyssey. I’ve had conversations with the two lab directors and based on those conversations, I was able to forgive them. I’ve never had a conversation with the oncologist — he was far too arrogant and far too self-righteous to make that happen. However, I’ve forgiven him many times over. After all, if he hadn’t been such an arrogant b*st*rd about the whole thing, I would never have changed careers to this advocacy work. And nothing in my life has ever been so rewarding as this work.

Don’t forget: everything happens for a reason.

Tomorrow I’ll write about the doctor’s side of this trust equation, and how they and other providers can actually acknowledge and help heal the angry patient’s trust wounds.

For now it’s time to step outside to enjoy a bit of Knoxville again.

………………
Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate once-a-week or so email tips
Or link here to empower yourself at
EveryPatientsAdvocate.com
………………

Second Opinions That Don’t Count – or Do

I heard from a friend (I’ll call her Nancy) this morning about symptoms she’s been battling for a few months and was unwilling to share with anyone before now. It seems she has been back and forth with several doctors, has two sets of symptoms that could — or might not — be related. And the bottom line is that both problems will either continue or be recurring. In other words, she’s needing some time now to get on her feet and deal with her new reality.

Her email reminded me of some words of advice from many moons ago — all of which bear repeating. So here you go:

From Nancy, “What I learned is that bad/mediocre doctors are associated with other bad/mediocre doctors who they refer patients to see and good/great doctors are associated with other good/great doctors. It took me time to find the right “group” of doctors that I knew where well informed and were giving me the right answers.”

And my reply, “NEVER ask a doctor to refer you for a second opinion. They have little reason to provide a good referral and every reason for the referral to be unsuccessful. They don’t want to lose you as a patient, so they’ll never send you a competitor who possibly knows more or better than they do. And they are buddies with the people they do refer you to — and a buddy will never contradict a buddy. Those are human attributes, not limited to doctors, for sure.

(Would you ask your auto mechanic to refer you to another auto mechanic? Of course not! He would never send you to his competition because he doesn’t want to lose you as a customer!)

The best referrals are those from other patients who have already been successfully treated. They aren’t easy to find — but you can go to any of the online support groups for your diagnosis and at least chat with others who have your diagnosis and perhaps get good referrals. Support groups are listed here: www.DiagKNOWsis.org/support.htm

…………………………….

From Nancy, “After second opinions, I finally found an excellent surgeon and he gave me the final word, I did not need any surgery. I had two doctors tell me they thought I would have to have brain surgery and I was preparing to go to either Philadelphia, Boston or Baltimore for second opinions. So it was a long process but I feel very comfortable with the final diagnosis.”

And my reply, “Once you have a second (or third) opinion that differs from the first one, you still need to assess who is right. Just because you like one opinion more than the other doesn’t mean it’s the right one. Just because they recommend an easier treatment, or a less invasive treatment doesn’t mean it’s the right one. And the second opinion isn’t always better than the first — if it was, why would we even seek a first one? ;-)

If you receive differing opinions, then you need to get yet another opinion from someone completely disconnected from the first ones (like in another city) – taking your medical records but NOT a diagnosis with you. It’s up to them to objectively arrive at a diagnosis based on the evidence collected.

One very hopeful sign from your email — you went to a surgeon who told you that you don’t need surgery…. Which is probably correct because a surgeon only makes money when he cuts — so if one tells you that you don’t need surgery, then he must sincerely think you don’t need it.

And then, of course, there is always the possibility of a misdiagnosis – been there, done that. Started a career.”

Sharp patients understand that objectivity is extremely important when it comes to second and more opinions. Doctors are human, and doctors run businesses. When they send you for a second opinion to a friend or partner, it’s because they want the second opinion to agree with theirs — not contradict it. But as patients we want the real story. It’s not about WHO is right or wrong. It’s about WHAT is the right answer, and the best way to take care of it.

………………
Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate once-a-week or so email tips
Or link here to empower yourself at
EveryPatientsAdvocate.com
………………

Second Opinions That Don’t Count – or Do

I heard from a friend (I’ll call her Nancy) this morning about symptoms she’s been battling for a few months and was unwilling to share with anyone before now. It seems she has been back and forth with several doctors, has two sets of symptoms that could — or might not — be related. And the bottom line is that both problems will either continue or be recurring. In other words, she’s needing some time now to get on her feet and deal with her new reality.

Her email reminded me of some words of advice from many moons ago — all of which bear repeating. So here you go:

From Nancy, “What I learned is that bad/mediocre doctors are associated with other bad/mediocre doctors who they refer patients to see and good/great doctors are associated with other good/great doctors. It took me time to find the right “group” of doctors that I knew where well informed and were giving me the right answers.”

And my reply, “NEVER ask a doctor to refer you for a second opinion. They have little reason to provide a good referral and every reason for the referral to be unsuccessful. They don’t want to lose you as a patient, so they’ll never send you a competitor who possibly knows more or better than they do. And they are buddies with the people they do refer you to — and a buddy will never contradict a buddy. Those are human attributes, not limited to doctors, for sure.

(Would you ask your auto mechanic to refer you to another auto mechanic? Of course not! He would never send you to his competition because he doesn’t want to lose you as a customer!)

The best referrals are those from other patients who have already been successfully treated. They aren’t easy to find — but you can go to any of the online support groups for your diagnosis and at least chat with others who have your diagnosis and perhaps get good referrals. Support groups are listed here: www.DiagKNOWsis.org/support.htm

…………………………….

From Nancy, “After second opinions, I finally found an excellent surgeon and he gave me the final word, I did not need any surgery. I had two doctors tell me they thought I would have to have brain surgery and I was preparing to go to either Philadelphia, Boston or Baltimore for second opinions. So it was a long process but I feel very comfortable with the final diagnosis.”

And my reply, “Once you have a second (or third) opinion that differs from the first one, you still need to assess who is right. Just because you like one opinion more than the other doesn’t mean it’s the right one. Just because they recommend an easier treatment, or a less invasive treatment doesn’t mean it’s the right one. And the second opinion isn’t always better than the first — if it was, why would we even seek a first one? ;-)

If you receive differing opinions, then you need to get yet another opinion from someone completely disconnected from the first ones (like in another city) – taking your medical records but NOT a diagnosis with you. It’s up to them to objectively arrive at a diagnosis based on the evidence collected.

One very hopeful sign from your email — you went to a surgeon who told you that you don’t need surgery…. Which is probably correct because a surgeon only makes money when he cuts — so if one tells you that you don’t need surgery, then he must sincerely think you don’t need it.

And then, of course, there is always the possibility of a misdiagnosis – been there, done that. Started a career.”

Sharp patients understand that objectivity is extremely important when it comes to second and more opinions. Doctors are human, and doctors run businesses. When they send you for a second opinion to a friend or partner, it’s because they want the second opinion to agree with theirs — not contradict it. But as patients we want the real story. It’s not about WHO is right or wrong. It’s about WHAT is the right answer, and the best way to take care of it.

………………
Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate once-a-week or so email tips
Or link here to empower yourself at
EveryPatientsAdvocate.com
………………

Patient as Customer?

Part of my work is what I call health or medical “consumerism” — recognizing, talking about, and creating guidelines for patients as they regard cost of their healthcare. From nuances in purchasing health insurance, to understanding how those dollars get allocated, to ideas for saving money and even appealing health insurance payment rejections — that’s what I call health or medical consumerism. I’ve defined it in a previous blog post.

So I was interested in this week’s article by Dr. Scott Haig, printed in TIME Magazine called My Patients are Not Customers. He describes his frustration with hospital administrators, labor unions, and the “incursion of business practices into our profession” where patients are defined as customers the concepts of customer satisfaction and patient well-being become confused.

His conclusion: “The answer is simple: we’ve lost sight of that boring and corny moral imperative to do what’s right for those in need, to love your patient as yourself. That approach has always driven good medicine. Not customer satisfaction.”

What’s refreshing to me is that Dr. Haig does not seem to have lost that idealism that probably sent him to medical school to begin with; the idea that as a doctor he would help people, make them better and save their lives.

What’s fascinating to me is that Dr. Haig seems to have missed that point that, as a doctor in private practice, his Job #1 is to be a business man. If he can’t be a good business man, then he won’t stay in practice. If he doesn’t understand the basics of business, such as making payroll or paying the rent, then he won’t be able to keep on doctoring.

What’s sad to me is that the world of health and medical care has changed in the past 20+ years, and while many of us long for the Marcus Welby-esque past, we’d like that paired with the advances medicine has made in the interim.

But my bottom line is that Dr. Haig had better wake up and smell the reality of today’s medicine. No matter how much we long for how things used to be, healthcare is not about health or care; it’s about sickness and money.

That’s what’s paying his mortgage — and frustrating us all.

………………
Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate once-a-week or so email tips
Or link here to empower yourself at
EveryPatientsAdvocate.com
………………

New Blog Section: Looking for….

My other advocate colleagues and I often get networking-type requests:

Sometimes journalists, authors, reporters, or other media reps are looking for patients who fit a certain profile and might be willing to be interviewed.

Sometimes patients want to connect with others who may be sharing experiences with similar symptoms or diagnoses.

I’ve started a page on this blog to help people connect with those they are seeking. You can find the page here, or simply click on the navigation at the top or side of this page called: Looking for…

………………
Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate once-a-week or so email tips
Or link here to empower yourself at
EveryPatientsAdvocate.com
………………