SEE, DOCTOR? This is Where It Hurts

Once, I was referred to a doctor who just did not like me.  He did send me to Pth, but at the end of our awkward hour, he informed me that:

"You're not good at saying what's wrong with you."

I thought he was supposed to tell me what's wrong with me.  But I think I know what he meant; Describe some pain, something that will tell me where to start, something you want to do but can't.

When I was tutoring, I remembered a girl I knew in college who drew muscles and whatever on her own skin as a study skill.  I suggested at a tutor training that there might be a place for that when the tutor and the client didn't speak the same language,

 Now I found this article  thru Twitter. 

Show, don’t tell: how visuals improve healthcare visits

By Katie McCurdy and Chethan Sarabu, MD,    (BYLINED Katie McCurdy.)

The banner of the article was just very simple line drawing, like a smart kid could draw (of a doctor's office.  BINGO.  I wanted to draw too-tall waiting room chairs and how they cut off my circulation.  But the bylined author, Katie McCurdy is not about furniture, she's sharing how pictures can give a trainload of our information to the doctor - and in a picture of how one symptom, one day, one weather change may cross-affect other ills, other tests.

 McCurdy has drawn an elaborate time line chart; symptoms, felt or diagnosed, overlaid on each other day by day   I see this as valuable for so many reasons - each day shows a relationship of symptoms, so if there's an effect between two symptoms, it shows.   I hope you can find the article to see how this looks: with one major problem in pale color, the others can be line drawn on top of it.  Tests and other affecting factors can be written in the margin.

     If I could learn to do this with my colored pencils - 

 it might take the place of even an hour of talking to the doctor. 

 He could see for himself what aggravated a pain, affected a  test.

    

A help for people like me - a lumbar fusion that affects arthritis and circulation and more...   a dermatitis affects my eye infection; and do my sinuses also affect my eyes. 

Dr. Sarabu, the other author,  is a pediatrician.  He understands dealing with a kid's vocabulary, including scared vocabulary.  We might be surprised how kids can draw the hurt times and place -  just what  doctor needs to know.  

And Yes, adults have scared vocabulary days.  I sometimes do,  and did when that voice on the phone said "cancer."

He also mentions how visuals can help the doctor.  (So we don't feel funny bringing in these charts and pictures.)

 There is so much more covered here.  Including a reference to " a long history of surgeons adding paper drawings to the chart to better describe the details of the surgery they performed."

Even if we don't chart (I don't,) McCurdy shows us her very simple "paper doll views" that we can do.  One front view sketch can show where it hurt Monday, one for Friday. a different one for Wednesday.  Could show ailments like Arthritis that stab  Tuesday morning, then disappear for days.

She has a photo of how she arranged those paper doll  "day" sketches in order before the doctor even got into the office.    Did this work for Katie and the doctor?

"I felt that she heard me, 

and she ordered a bunch of tests

 based on the symptoms I was having."   

 There is even a worksheet you can copy to start your own "record."

   I see this as a way to "engage" our doctors and to show that we are and have been engaged.


(Medium) @Medium  https://medium.com/@katiemccurdy/show-dont-tell-how-visuals-improve-healthcare-visits-1b994f7fd90e

HOW DOES YOUR DOCTOR TALK TO YOU? What your doctor should ask... What to say to your doctor.

On April 5, in their e-mail MedicineMatters, Mt Sinai mentioned that medical students toured the hospital "Learning to Give Compassionate Care."

The key word in the mention was ' "tell me more"  messages." '

By a happy coincidence, I had just had a first visit with my new doctor.  I said I wondered if it was time for my blood sugar test...(I was really there to see if I would like him at all).  He said it wasn't quite time for the test.  Then he won my heart!

He asked:  What else is going on?

The perfect words.  In all the current patter about patient engagement, there is no better key a doctor can use than those.  I unloaded my current tormenting problem that I think is the eyelid disease (horrid Demodex mites.)

He asked me to describe the symptoms - I was so amazed that I had trouble putting the just plain icky symptoms into words.

Then he said he would refer me to an ophthalmologist in their group.

He asked some other questions, like why does my oncologist monitor some meds and tests, and I gave him a bit of info on that.

No judging, no contradicting what's been done so far.  Just kind questions.

Does your doctor do that?  If not, what to do?  Long ago my California doctor told me firmly:

 "It is important to be heard."

And I had gotten up the nerve to tell a certain surgeon in mid-rambling: 

"I need to speak."  

 Those four words spoken without anger did wonders. 

You can practice them in front of the mirror if you like.  If they don't work, you can do what we sometimes have to do.  Say goodbye.

I wish you health.

HELP THE DOC DO HIS JOB . . . all you need is a pencil

It really is important that we ask the right questions in the doctor's office.   And the right questions are complete:  not why does it hurt, but why does it hurt after I eat?  Why does it hurt at work?  

After all, if he doesn't ask the right questions, then what?  There's a reason so many hospitals are teaching doctors to communicate.  What we need in that office is not a speech, but a conversation.  And any conversation is partly our job.

To do our part of the job, besides a pencil we also need a clock!  And a calendar.  Why?

Let's go back to that chart I never could keep, in The Immune Power Personality. *  What the chart is really for is paying attention to our symptoms.  Dreher reminds us, that unfortunately, it's harder to pay attention to symptoms if we just pop a pill to quiet them so we can get on with our daily business of doing too much, criticizing ourselves, endlessly rushing forth unprepared.  

He's right, I know.  So I've abandoned the charts and started using my too-small purse calendar.  That way, even if I'm unprepared for a doctor visit, the records are with me.

In the calendar, I write on that tiny page that the waves of fatigue I associate with Tamoxifen often occur at about 9 a.m., when I've already had a good breakfast.  I write down a word about what my acid reflux is doing right then.

I write down whether I've had coffee, or chocolate, or milk.  (Sometimes it feel like the doctor should have a confessional with a curtain so I can't confess what I ate, and the exercise I didn't do.)

And a record would have helped to remind him that although there was big anxiety right before the backaches started, there was also too much of the depression (another thing I blame on Tamoxifen) for me to take the anxiety pills he wanted me to take.  

I can even tell the doc I have exhaustion just before computer lab.  Or I have stomach trouble getting ready for my appointment with client Susabella B.)

You can tell doctor Jones you have more stomach trouble after a do/everything day, a rush-too-much day. .
Or your feet hurt when you woke up every morning for two weeks.
And with a calendar, you can be sure to let Dr. Sally know if the symptom hurts for three days, goes away for a week, then comes back every week.  (That's important, or they wouldn't mention it on medicine bottle labels.)
In short:

A clock for: What time does it hurt.  
A pencil to write down: What happened just before it hurt.   
And a calendar so I can tell the doc how many days it hurts, and which days of the week.   (There was a study once that showed the big heart attack hours are Monday morning.  Guess why.)  


Then, it's up to us to take the calendar out, and tell the doctor what's going on.  We deserve a turn to talk.  We don't wait for him to ask.


*Henry Dreher, Plume/Penguin, 1996