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Are You On The Case When It Comes To Your Healthcare?
Patients often fail to remember what their doctors say to them, a physician reminded me this week. Research supports his observation. Yet only rarely do doctors actually write down their recommendations. End-of-visit reviews of diagnoses and treatments are scarce. As a result, too many patients leave their doctors’ offices unsure of what was decided and what they should do next.
Part of the problem is dysfunctional “framing” or the perceptual schemata we use to guide our decisions and actions. Word choice, length of discussion, eye contact, facial expressions and hand gestures are among the ways doctors create frames that influence patient experiences. Vocal tone alone may cause a doctor’s well-intentioned advice to seem condescending, resulting in a patient becoming upset or defensive.
The endeavor to create a constructive doctor-patient frame for interaction is made more difficult by the constraints on time doctors can provide to patients. For this reason alone, patients should become aware of how their doctors see them and how they themselves participate in building a doctor-patient interaction frame.
Gender, for example, can lead to problems in the treatment of heart disease. If you are a female cardiac patient or at risk for cardiac disease, it’s particularly important to know how your gender may affect your physician’s choices. Similar gender issues exist for the treatment of stroke.
For a good start in influencing how your doctor relates to you, look at some entrenched frames into which doctors can easily slip unless you guide them to do otherwise.
Lecturing doctors tend to go off on soliloquies. They may intend to provide helpful answers, but they fail to remember that the best answers only emerge from asking the right questions. Many of these doctors are Patronizing – although often inadvertently so. They don’t sense that in their tone and wording they’re talking down to patients. By so doing, they stifle many patients and thus damage the relationship that can be crucial to obtaining a good medical outcome.
Defensive doctors don’t like being second-guessed. They reveal this in vocal tone, terse answers or nonverbal expressions of annoyance at any kind of challenge. As with styles that become routine over time, doctors may not realize that they’re being defensive. Some have been listening to other doctors for years. They only hear that they sound like some of them.
Other doctors act as Partners right from the get-go. While this doesn’t mean they are friends to their patients, they truly want to hear what those patients have to say. The most responsive often have spent time as patients themselves, and thus can empathize with the challenges of dealing with illness. They spend at least as much time asking questions as they do giving advice and prescribing treatment. In short, they’re both curious and concerned.
If you have a lecturing, patronizing, defensive, or closed-minded doctor, consider making a change. However, be sure to examine your own contribution to the relationship, so you can avoid creating a similar dysfunctional frame with your next doctor.
Here are some comments that can help your doctor understand that you plan to take an active part in your healthcare:
“I find it useful to take notes on what we discuss here and what I should do when I get home.”
“I did some research before coming today and I have a few questions.”
“There’s something you said earlier that needs some clarification.”
“I have some additional information that could make an important difference.”
“Before I leave, let’s quickly go over what you’ve recommended.”
Involved patients tend to be more satisfied with their care. They gain a better understanding of their condition and treatment options, and are more committed to therapeutic regimens. Thus, your doctor is also likely to benefit from your interest in your own care. No, you’re not looking for the nicest doctor in town, but rather one who is a good communicator.
When it comes to your health, you’re the expert in charge. You know your body better than anyone else. The best doctors will participate with you in this frame. Find yourself one of those doctors. It can be an important step on the path to wellness.
photo: Alexander Raths/Shutterstock.com
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A laboratory technician at Queen Elizabeth University Hospital, Glasgow, holds a container of test-tube samples from people tested for novel coronavirus.
Further research required<div class="rm-shortcode" data-media_id="z9vH49bb" data-player_id="FvQKszTI" data-rm-shortcode-id="7ef1ab8ca2f90b28543d580c408ed25f"> <div id="botr_z9vH49bb_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/z9vH49bb-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/z9vH49bb-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/z9vH49bb-FvQKszTI.js"></script> </div> <p>The Montefiore-Einstein study is currently preliminary, and further research will be required before researchers can determine what, if anything, its results illuminate.</p><p>The study is currently published on <em>Medrxiv</em>, a <a href="https://www.aje.com/arc/benefits-of-preprints-for-researchers/" target="_blank">preprint</a> distributor. This means the study has been shared publicly before undergoing the <a href="https://undsci.berkeley.edu/article/howscienceworks_16" target="_blank">peer-review process</a>.</p><p>Preprints allow researchers to communicate their findings before official publication, which can take months if not a year or longer. This pre-publication can lead to early feedback, increased visibility, and new collaborations. It's especially helpful for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400415/" target="_blank">early-career researchers</a> trying to establish themselves.</p><p>However, given the speed at which coronavirus is spreading, researchers have leaned on preprints as a means of disseminating data to other experts faster than the peer review allows. As a result, <em>Medrixiv</em> has seen a <a href="https://www.nytimes.com/2020/04/14/science/coronavirus-disinformation.html" target="_blank">surge of preprint studies</a>, but they must be read within the context of their preliminary status.</p><p>The Montefiore-Einstein also has its limitations. The study had an initial sample size of only 68 subjects (48 males, 20 females) and a further examination of three families. And the connection of coronavirus to ACE2 enzymes in the testes came from database research, not direct observation.</p><p>The researchers acknowledge the need for further investigation. In particular, Shastri stresses the need to confirm the coronavirus's ability to infect and multiply in testicular tissue. If other researchers find their data promising, they could move forward with new research to build upon the study and see if this clue fits into the mystery.</p>
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Coronavirus protesters in Los Angeles. Men are more likely than women to disregard health warnings from officials.
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- Gregg Behr, founder and co-chair of Remake Learning, believes that this small word shift opens up the possibilities in terms of how and where learning can happen. It also becomes a more inclusive practice, welcoming in a larger, more diverse group of thinkers.
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