Computers are everywhere. Naturally, they’re used widely by doctors and hospitals. Without doubt, these technologies are improving care and communication among doctors and patients. But there are new challenges too. Do digital tools interfere with a doctor’s ability to treat patients effectively? There are pros and cons, but one thing is certain: they are here to stay.
What can you do to optimize your relationship with your doctor and his/her computer? Before I present my four tips for being a patient in the digital world, it is important to understand some of the pros and cons of computers in medicine.
Electronic Health Records (EHR) systems can improve data accuracy and sharing, but currently, most EHRs don’t communicate with each other, making it difficult for doctors to easily access comprehensive patient information.
How doctors use EHRs can significantly impact appointment quality. Doctors must listen to patients, respond appropriately, and engage with patients. A doctor typing or dictating may not be able to listen intently to the patient and may have diminished face-to-face connections.
Additionally, doctors can make mistakes when entering information, including mistakes regarding diagnosis, tests, and medications. This misinformation will travel with you if corrections aren’t made.
So What Can You Do?
- Make Sure Your Doctor Is Paying Attention to You
It is crucial that your doctor listens to your complete story, as this is a major part of getting a correct diagnosis and treatment plan. If your doctor is distracted by the computer, speak up. If needed pause while your doctor types. Realize that doctors are people too and it’s a challenge for anyone to do two important things simultaneously.
- Take Charge of Your Medical Information
Make sure your EHR is accurate by asking your doctor to print a copy of each appointment’s notes. Notify your doctor if you see inaccuracies.
Don’t rely on your EHR – keep your important medical records together and organized, including test results, medications prescribed and clinical trial information, and bring them with you to all medical appointments, including visits to the ER.
Don’t assume your doctors are communicating with each other, or reading each other’s reports. Doctors are not communicating with each other as much as 70% of the time.
- Take Detailed Notes at all Appointments
Your doctor’s notes may be inaccurate or incomplete, and are often not shared between doctors. It is critical that you take detailed notes, while still with the doctor, at every medical appointment – don’t even wait until you get in the car! A landmark study found that 40-80% of medical information provided by healthcare professionals is forgotten immediately; the more information presented, the lower the proportion remembered. Of the information that was remembered, almost 50% was remembered incorrectly.
Take notes by hand, not on your phone, tablet or laptop. Importantly, writing (versus typing) helps you remember and understand information. A recent study on note taking by college students found those who took handwritten notes remembered the material better, and were able to synthesize the information better, than students who used a laptop. It’s hard to say if this translates into note-taking in a doctor’s office, but these findings could apply.
Writing helps you maintain eye contact with the doctor which can improve the quality of the appointment. Lastly, if you use a tablet or phone, auto-correct may dramatically change important words, leaving you guessing. If you want to keep digital notes, type your handwritten notes at home.
- Be Vigilant About Medications
To minimize your risk of dangerous medication errors caused by ordering systems:
- Don’t assume ordering systems will eliminate the risk of being given medications that dangerously interact. If you are taking multiple medications, discuss the potential for adverse drug interactions with your doctor and/or pharmacist. Fill all your prescriptions at one pharmacy; their computer may detect potential adverse drug interactions.
- When given a new prescription, write down the name, dosage and instructions. Before you pay, double check to make sure you are given the right medication.
- If a medication doesn’t look familiar, ask your pharmacist (outpatients) or your nurse (inpatients) before taking it!
Technology in healthcare is here to stay. Ideally, we’ll each have a master digital file that fully captures our health history which can be accessed, shared and updated by all of our doctors, offering a more comprehensive view of our overall health and improved care coordination between specialists. However, even when EHRs reach their full potential, it will remain critical for patients to be fully involved in their care by actively advocating for themselves. It will always be important for patients and providers to ensure that EHRs and other technologies don’t get in the way of basic care and critical patient-physician communication. By being engaged in the process and speaking up if something doesn’t feel right, you can help ensure that your doctor’s computer is a help, not a hindrance.
Of course your doctors have a direct effect on your health, particularly the diagnosis and treatment of your ailments. It is also true that the type of relationship you have with your doctors can directly impact the care you receive. Like any relationship, a strained one can lead to frustrations and misunderstandings, and when this occurs with your doctor, the results can mean less than optimal care, misdiagnosis and/or delayed healing.
We‘ve all experienced the frustration that comes with long waits at the doctor’s office. And many of us feel rushed during appointments, perhaps even pressured to minimize the number of questions we ask. Other times we might feel frustrated and/or disappointed when we feel like our doctor is not truly listening to us, or taking our concerns seriously. The relationship we have with each of our doctors can be complicated and ripe for conflict.
In order to have the best possible relationship with your doctor, and ultimately the best possible care, it’s important to understand what it’s like to be a doctor today. If we better understand their day-to-day pressures, we’re more likely come to appointments better prepared and in a better state of mind.
Due to billing policies and overhead expenses, doctors may see 24-25 patients/day. The 15-20 minutes allowed for each patient is generally not enough time for patients with complicated medical histories, those who are very ill, or those who present with tricky symptoms. In addition to seeing patients in the office, doctors must handle a wide range of other time consuming responsibilities each day, including phone calls, emails, reviewing lab reports and imaging results, consulting with other doctors, refilling prescriptions, and dealing with insurance companies.
Your overworked doctor and its impact on your care
Doctors are impacted by job stress. One study found that 50% of Primary Care Physicians (PCPs) describe themselves as burned out. Many factors are responsible for these feelings, including an increased demand for productivity, a decrease in the amount of face time with patients, and an increase in administrative burdens (including filling out electronic forms) that don’t directly benefit their patients, and too many difficult patients.
Research has found that “burnout can be associated with a deterioration in the physician-patient relationship and a decrease in both the quantity and quality of care.” By many accounts, burned out physicians can negatively impact patient outcomes and recovery times, diminish patient satisfaction and reduce adherence to treatment plans.
The increasing demands on their time can also lead to errors. Almost 30% of PCPs report they personally missed test results that led to care delays. There have been various studies that show the negative impact of burnout on patient care. So how can we help alleviate some of these pressures.
Studies have shown that kindness, compassion and empathy actually have a significant effect on healing. When patients are stressed and anxious, their immune function and wound healing capabilities are negatively impacted. Conversely, studies have found that when nurses and doctors show empathy for a patient, by listening, connecting and validating their feelings, patients are likely to be less anxious, which leads to quicker recoveries from a wide range of conditions, including surgery.
Of course, this is a two-way street – kindness towards medical staff by patients can positively impact doctors and nurses. If you want to help your doctor avoid burnout, treat him/her with respect and have empathy regarding the burden of their work.
Be Prepared, Pleasant and Persistent
So what can you do to maximize your time and strengthen your relationship with your doctors? Here are some suggestions:
- Be compassionate and patient – realize that doctors are often overloaded, overworked and stressed. A little compassion from you goes a long way!
- Come to appointments prepared with questions, symptoms, concerns, etc. Prioritize your health issues/complaints in order of severity and/or concern.
- If you don’t understand what your doctor is telling you, politely ask for the doctor to repeat or rephrase his/her comments. Don’t leave the appointment confused about what you’ve been told.
- Don’t wait until the end of the appointment to bring up a serious concern or issue.
- Don’t leave the appointment without a plan for next steps.
- If you bring information you found on the Internet to an appointment be open to a conversation, and don’t insist that your information is more relevant than what your doctor has.
- Listen carefully and evaluate what your doctor is recommending. You have a right to refuse testing, treatments and/or medications, but don’t make rash decisions.
- Take detailed notes at all doctor appointments, and share the information with all members of your medical team at future appointments.
- Keep copies of all important documents (test results, etc.) together and organized, and bring them with you to all appointments.
- If something doesn’t seem right, speak up!
- Contact your doctor’s office to learn test results if you have not heard back within the expected time frame. Do not assume that “no news is good news”.
- Don’t wait until the last minute to contact your doctor for prescription refills, referrals, and other requests.
- If you hate waiting, try to schedule the first appointment of the day or the first appointment after the doctor’s lunch break.
Doctors today are facing increased pressures – an increase in the number of patients and related reporting and less time available per patient – and it’s not going to get any easier any time soon. A little kindness and understanding, and appointment preparedness, will go a long way in alleviating the pressure your doctor feels during your visits and may contribute to better care. We know that taking a more proactive role in our own healthcare is not just the right thing to do; it can positively impact the kind of care we receive.
June 29, 2005. A day I will never forget. Our 17 year old son Zachary was diagnosed with a DIPG, an inoperable, malignant brain tumor, carrying a survival rate of less than 2%. Our world crumbled before us as we were told Zach had 4-6 weeks to live. To say we were devastated does not even begin to cover the despair we felt. How could this be happening? What do we do now?
Because of the severity of Zach’s case, there was no time to research, get second opinions, or even stop to think for a second. We learned the exact diagnosis and prognosis late in the afternoon on a Thursday. Friday morning at 8:00 am he was being fitted for his radiation mask for treatments which started later that day. Chemo started that evening.
Beyond the emotional trauma our new reality looked nothing like the one we knew before.
Keeping yourself organized, while seemingly insignificant to some, during a difficult medical journey is not as easy as it might seem. Most days, just keeping yourself emotionally okay and somewhat together is more than enough. The list of daily (and often hourly) considerations and to-dos is long. There is so much critical information of which to keep track. Are the medications being taken at the correct time? Am I asking the doctors the right questions? How should I decide the best course of treatment? It is important for your mental health to stay connected to your friends and family, but even that can be overwhelming. How do I keep everyone updated on progress without repeating the story 20+ times each day? How do I organize my friends to bring us dinner and help with other chores? How can I find other people going through similar situations? It was our family’s medical journey that led me to develop a product to help people stay organized and connected through their own medical journey.
During our own journey, my husband and I tried to remain as upbeat as possible, holding on to a glimmer of hope, for Zach’s sake and our own. As the weeks progressed and his symptoms lessened, we were encouraged to learn that the tumor had started to shrink. As excited as we were by this news, it was tempered by the knowledge that these tumors generally shrink with radiation treatment, but sooner or later they regrow and cannot be stopped. We tried to bury our anxiety and carry on as happily as possible. We were planning for his life and planning for his death simultaneously.
We were lucky that Zach’s tumor shrunk to 40% of its original size and his chemo seemed to be holding it at bay. Zach finished high school and only had to deal with mild side effects. The honeymoon ended 15 months after diagnosis when the tumor started to regrow and he was ejected from his clinical trial. After four anxious weeks, a new clinical trial was able to enroll him and he started treatment again. Sadly, this treatment caused swelling in his brain, which dictated the long-term use of a powerful steroid that caused a build up of fatty tissue in his spinal column. With his spinal cord compressed, he soon became paralyzed, unable to move, swallow or speak. This paralysis led to a deep vein thrombosis, part of which broke of and traveled to his lungs, causing a pulmonary embolism. He died four weeks later.
After Zach’s death, I started a non-profit organization to help patients and families. I created the ZaggoCare System®, a how-to guide with organizational tools to help patients and their caregivers take control of and better manage illness or injury. Topics covered in the 120 page ZaggoGuide include how to manage medications, improve communication with doctors, become your own best advocate, and developing a support system.
100% of profits from sales of ZaggoCare Systems are donated to Zach’s Fund for DIPG research.
Why is this so important?
Studies have shown that effective patient-doctor communication leads to better adherence of treatment plans, better medical decisions, and better health outcomes. Yet, this is easier said than done. Doctors struggle to see patients in time-limited slots. Patients and families are so overwhelmed they can barely understand, never mind process, the information presented. Additionally, more patients recover at home for medical conditions previously treated in hospitals, forcing families to manage complex care.
The statistics are staggering. Preventable medical errors are the third leading cause of death in the United States. 40-80% of what patients hear in doctors’ offices is forgotten immediately — and even when information is remembered, almost 50% is remembered incorrectly. Without clear understanding of medical information, patients are more likely to skip medical tests, go to the ER more often, and have difficulty managing chronic illness. A recent report found that family caregivers feel unprepared for medical responsibilities, including medication management and coping with the lack of care coordination.
The ZaggoCare System provides guidance and tools needed for all patients and families to be engaged, empowered, effective members of their medical teams. Whether dealing with acute illness such as cancer, chronic illness such as diabetes, or serious injury such as traumatic brain injury, the ZaggoCare System can help you get the best care possible.