Sunday, June 26, 2011

Questions are the Answer

I have posted the second installment of my column on the MPD Chat listserve below. Though this column is written for members of the myeloproliferative disorders community, my suggestions apply across all conditions. A previoius post on this blog contains similarPlease leave a comment or offer your ideas for questions that patients might ask to enhance their participation in care.
June 23, 2011 – Number 2

The National Patient Safety Foundation's Ask Me 3 campaign (see: encourages patients to ask 3 questions of their health card team to increase their understanding of their health conditions and what to do about them. The 3 questions are:
  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

Though these questions are good ones, I view the The Ask Me 3 questions as a minimalist approach for promoting clinician-patient communication, patient understanding and enhanced patient capacity to manage their conditions. These questions will help you get your clinicians' view of what you need to know, including their impression of what ails you (e.g., a diagnosis) and the options for managing your condition. Hopefully, if you ask the second question, you will learn not just about treatments, but also self-management options (i.e., what you can do to manage your condition). These questions hopefully will lead to a discussion and not just a lecture.

However, many clinicians do not have the inclination or skill to respond to these basic questions well. So, you may want to bring some additional questions. Here are a few others you might want to consider asking:

  • "What else might be going on to explain my symptoms, examination and test results?" Ask "what else?" at least twice. Dr. Jerome Groopman, the noted oncologist and writer thinks "what else?" is one of THE most important questions you can ask. Asking "what else" actually helps clinicians to reflect and consider possibilities they might have prematurely rejected in their efforts to "make" a diagnoses.
  • "What aspects of my presentation are not well explained by your diagnosis?" "Presentation"" is a word that clinicians use to convey the combination of symptoms, physical examination findings, and lab tests. They will be impressed if you use this word! Again, you are helping them to reflect and consider what doesn't fit their conceptualization.
  • "How sure are you that this is my main problem?"
  • "What tests would help you to be more sure?" For those of us with MPNs, you can get more specific and ask about JAK2 testing, bone marrow biopsies, imaging tests, etc.
  • "How useful would it be to see another doctor who has more experience treating patient with my condition?" This is especially important question for us, since MPNs are relatively uncommon and only those who treat many MPN patients are aware of new and emerging treatments.
  • "What are other treatment options?" This is similar to the "what else could it be?" question in helping the clinician expand his/her thinking about possible treatments.
  • "What are the pros and cons of the treatment options?" Many clinicians minimize the down side - but it is important that you make fully informed choices that include an understanding of the risks and benefits.
  • "What things can I do, (besides taking medication or undergoing other treatments) that will help me to manage my condition and have the best chance of maintaining my function?" Hopefully, this will lead to a discussion of strategies that may enhance your capacity to monitor you condition, maximize your well-being and function (e.g. eating well, being physically active, paciing oneself, etc.)

I realize that it may be challenging to ask ALL of these questions in a single visit...and some clinicians my bristle or balk if you pull out a list or ask too many questions. That kind of reaction is regrettable. After all, this is your life, your health, your condition! The doc may be the expert on the condition and treatment, but you are the expert about you!. Clinicians have the knowledge about what to prescribe. Yet, to effectively manage a condition, especially a MPN, you need to learn how to monitor, manage, cope and adapt.

I hope you will share your own favorite questions here....

Asking is the first step. As the US Agency for Healthcare Research and Qualtiy has said in their ads, "Questions are the Answer!" see:

Next column, I'll discuss what patients and caregivers can do if their clinician is reluctant to answer questions or hesitant to consider alternative diagnoses, treatments, referrals or self-management education.

Best wishes,

Saturday, June 11, 2011

New Column on Communicating with Your Health Care Team

At the request of the moderator of an online support group for people with Myeloproliferative Neoplasms (MPNs) and their caregivers, I will be writing a regular column, "Communicating and Connecting", that focuses on helping patients and caregives communicate with members of the health care team. (As noted in my previious posts, I have a MPN, Polycythemia Vera, that is currently is being controlled with medication.)
"This is my first installment of this column, which I am very excited to humbly offer to the readers of MPD Chat. Thanks to Beverly for inviting me to share my thoughts about communicating with your health care team, a topic that has been a central focus of my entire 30+ professional career as a physician educator and part-time researcher.

I must start by apologizing for being tardy with this first offering, as I had promised Beverly I would send it to the group on Tuesday, and it is now past midnight on Thursday. I fell asleep at the computer on Tues eve. I am not the night owl I used to be, which I attribute to a combination of aging, my PV and the interferon I have been taking for more than 18 months.

In this first column, I thought it would be useful to share a little bit about me, so you have some context by which to judge my viewpoints, and associated bias. I am the grandson and son of physicians and grew up feeling awe and admiration for both my grandfather and dad. I actually began hanging out in my father's office, which was in my house, at the age of 4. (The office staff were convenient babysitters). When I became old enough to help out (by filing charts or stamping them with dates), my father would often invite me in to his consultation room to introduce me to grateful patients who were more than happy to share their stories or allow me to view their healing eye conditions (my dad was an ophthalmologist, an eye surgeon). My dad loved his work, and enjoyed his daily interaction with his patients. Sometimes, he would call me in just to have a patient retell the joke that she had just shared, or to introduce me to a valued member of our local community: the town librarian of 50 years; the former fire chief; or the nurse supervisor of the local hospital's operating room. He loved hearing their stories and it was clear they loved the extra attention and interest he showed in them. To him, they were more than just eye conditions, they were "whole people" who just happened to have an eye condition... and he loved caring for them. My grandfather, a family doctor for more than 60 years, was most proud of his opportunity to care for several generations of family members. I will never forget him telling me on the cusp of starting medical school that he knew I would become a good doctor because I had "a good mind....and even more importantly, a good heart".

So, I followed my grandfather's footsteps into primary care medicine, then pursued additional training in psychosomatic and behavioral medicine, and subsequently psychiatry. I embarked on an academic career, inspired by my mentors at the University of Rochester, which is known for it's focus on the "biopsychosocial model" and the importance of strong training in interpersonal and communication skills. I have been very fortunate during my career to have had many opportunities to teach communication skills to medical students, residents and practicing clinicians and my current job includes a heavy emphasis on developing and implementing training and other strategies to improve clinician-patient communication.

And, despite some progress in recent years, there is great need for improvement in clinicians' communication skills. The evidence for this comes from not only a large body of research in clinician-patient communication, but also from my personal experience as a patient, from your stories on this list, and from the stories of many, many other patients and caregivers.

The good news is that we, as patients, can take steps to improve the communication process, steps that will increase our participation in care, help us to make good health care decisions, and ultimately improve the quality of our lives. This will be the focus of subsequent posts to this column, which will include links to resources, tools and other useful information on this topic. I also hope you will contribute your thoughts, ideas and experiences. Tell us what has worked for you and your family members and where you see opportunities for improvement. We will all benefit if we share "best practices".

With best wishes,


People with Higher Levels of Empathy Enjoy Sex More

Researchers have identified another benefit to working on enhancing empathy skills.

A recent study, published in the June 3rd issue of the Journal of Adolescent Health, found that empathy, self-esteem and autonomy are associated with sexual pleasure among students, aged 18 - 26 though, for men, only empathy was significantly associated with sexual pleasure.

"Sexual health includes sexual well-being, and sexual enjoyment is an important part [of that]," said study researcher Adena Galinsky, of Johns Hopkins Bloomberg School of Public Health. "How people interact and their ability to listen to each other and take each other's perspective can really influence the sex that they have."

The study analyzed data from about 3,200 students, ages 18 to 26, who were surveyed between 2001 and 2002 as part of the third wave of the National Longitudinal Study of Adolescent Health.

The study citation is: Galinsky AM, Sonenstein FL. The association between developmental assets and sexual enjoyment among emerging adults. J Adolescent Health. Jun;48(6):610-5, 2011. Epub 2010 Dec 30.