Under my skin

By Michaela Gibson Morris
Daily Journal

Getting well can sometimes be an exercise in frustration on both sides of the stethoscope.

The Daily Journal asked for reader input and conducted an informal poll of regular folks and medical professionals to find out what gets under their skin. Then we asked four physicians to help us diagnose the problems and prescribe some solutions.

Most are annoyances, not life-threatening problems. For most patients and doctors, these annoyances don't happen with every visit. But it's important to address them, so they don't create big problems down the line.

“We're trying to make people healthy, not unhappy,” said Dr. Mike O'Dell, director of the NMMC Family Medicine Residency Center in Tupelo, which trains new doctors.

The overall antidote is both simple and complex: better communication.

Patient peeves

- Long waits – more than 1 hour in the lobby. “My time is as valuable as theirs.”

Why?: In some cases, doctors can be called out of the office to attend patients in the hospital. But most of the time, they get off schedule because they're trying to take time with their patients in the office and address the concerns of those who call in.

“They think we're back here having a party, but we're working our tails off to try and keep up with the schedule,” said Dr. Kevin Asa, a Tupelo rheumatologist.

By the way, doctors have the same problem with patients who show up hours late or not at all.

Rx: Show up 10 to15 minutes early to get paperwork out of the way. Any earlier than that probably won't save time. If you're going to be late or have to cancel, call ahead.

Schedule smart: Leave yourself enough time before your next commitment – probably at least 2 hours, more for involved visits. If you've got a conflict, let someone know.

Forewarned is forearmed: When you schedule a visit ask how much time you should allow. When you arrive, ask politely how long to expect to wait. Inquire again if it has gone longer, checking with receptionist to see why there's a delay.

Expedite lab work: If you know you will need specific lab tests done, inquire about having it done a day or two early.

- Can you explain that in English? Too much medical jargon, not enough information about test results, diseases, prescriptions and instructions.

Why?: Doctors often use medical language because it let's them speak very precisely, Asa said. “It's like speaking two languages.”

Rx: Ask them to explain when you don't understand, O'Dell said. Ask for hand-outs and reliable Web sites. Nurses can be great resources for information. If it's in-depth, ask if you need to schedule a follow-up appointment for more questions.

- It's so expensive. What do they think we are – made of money?

Why?: There have been tremendous advances in technology, knowledge and expectations in medicine. It all costs more money.

“We could go back in time 50 years,” Asa said. “Wards where one nurse took care of eight patients were very efficient. Patients didn't like it much, but it sure cut costs that way.”

Rx: Have a medical home. A primary care doctor or nurse practitioner can help coordinate care, avoid duplicate tests, manage medications and make recommendations if a specialist is needed, O'Dell said.

Educate yourself on your chronic conditions, said Dr. James Hubbard, a longtime Verona physician who now serves as editor of My Family Doctor magazine.

Be upfront about your financial situation and what your insurance can cover with the doctor, Hubbard said.

Be as compliant as possible with your doctor's recommendations. Medications may be expensive, Hubbard said, but “it's a lot cheaper not to have a heart attack.”

Do the homework on your insurance plan. What's covered and what isn't. Doctors' offices can't possible know the fine details of your insurance plan.

“Every company has a different benefit plan,” said Dr. Homer Horton, medical director for the HealthLink network.

- The health insurance company and health care providers never seem to be on the same page.

One reader has chronic problems, not with his health care, but getting bills for lab work and other services sent to the right place.

“It takes forever to get it straightened out.”

Why?: When you're dealing with so many different companies, it's easy for things to get off track.

Rx: Bring your insurance card and check every time possible to make sure the insurance information is correct, Horton said. Destroy old cards to make sure you don't accidentally give out old information.

Watch for explanation of benefit forms or bills that should have been paid. If you call, keep clear records of name, date and time and how to get back to that person.

If it's a repeat problem, let the doctor know there's trouble.

- The doctor doesn't seem to want to consider alternative approaches when the patient is worried about drug side effects.

After one statin – a cholesterol-lowering drug – landed a reader in the emergency room, she balked at taking another one. Six months later, her cholesterol is down, but the doctor is still pushing the statins.

“No one said good job' or you're headed in the right direction.' The message was that I still needed to get the LDL level below 100.”

Why?: Communication breakdown. The patient and the doctor may have different goals.

Rx: Non-confrontational discussion about health goals for the patient and the patient's concerns about side effects.

Establish goals together, even if there's some difference of opinion on getting there. In the end, it's the patient's body, O'Dell said. The doctor is an adviser.

“It's OK for adults to disagree,” said O'Dell, who has patients with whom he has cordial disagreements about statins.

Avoid being accusatory, but voice your concerns. “I'm afraid of taking any more meds” is a valid position, Asa said.

- Locked in for Life

“Once I go to a specialist, I am locked in to at least four visits a year for what could be the rest of my life? É All these trips to the doctor are wearing me out while I try to hold down a 40-hour a week job,” a Daily Journal reader told us

Why?: A lot of medications need blood work on a specific schedule to monitor for problems. Specific conditions may need a trained eye to spot problems early enough to do something about them.

Rx: Talk to the doctor about the guidelines for your condition and the time crunch you're feeling. Find out exactly the doctor is concerned about. He or she may be able to better schedule appointments.

“You may be able to do blood work and see the doctor less frequently,” Asa said.

- That gives me hives: Doctors/nurses miss my allergies even though they're in the chart or they're always asking about my allergies.

Why?: It's a significant safety issue, but the system is not foolproof.

Rx: It never hurts to ask and double check. Computers at the doctor's office and pharmacy help check for interactions. Whenever possible, use one pharmacy.

The cross check for drug interactions and allergies should be done, but it's always wise for patients to ask again.

“It's your body, your health,” Hubbard said.

- Multiple visits to the doctor to find out what's wrong.

Why?: Some things are obvious; other things aren't. There's no magic box in the lab that automatically spits out a diagnosis. In some cases, it's a process of elimination.

“Some things have to be ruled out to get to the bottom line,” Hubbard said.

Rx: “Ask When should I check back if I'm not feeling better,'” Hubbard said. Or it might be, “If I'm feeling better do I need to come back?”

Doctor peeves

- Yakety-yak – patients on cell phones during office visits.

Why?: This seems to be a universal annoyance for docs. High quality medical care requires step by step procedures, O'Dell said. A buzzing cell phone can distract from that.

Further, time spent waiting for someone to get off a cell phone pushes back that packed schedule even more.

Rx: Be thoughtful. Watch for signs on cell phone use in doctors office. Get off the phone immediately when the doctor or nurse comes in. Let them know if you're expecting an emergency call.

- Gimme freebies: People who pay $3 a pack for cigarettes or drive a new Lexus, and want free medicine.

Why?: Cigarettes are expensive, destructive to the individual and their family's health, and they add to the cost of health care for everybody in the system.

“They're mistaken in their priorities if they gripe about the cost of medicine, but spend hundreds of dollars each month on (luxury) car and cigarettes.”

Rx: Meet your doctor halfway to control the high cost of medicine. If you're well off financially, leave the freebies for the patients who are scraping by.

- Oh by the way' syndrome

Patients mention the most important problem – like chest pain – as the doctor is walking out the door. Or, patients make an appointment for one thing, but really want to talk about something else.

Why?: It delays everybody waiting to see the doctor.

“It's always something new, separate problem and I've got to start over from the beginning” which means more waiting time for everybody else, Asa said.

Rx: Write down the issues you want to discuss. If it's something that's bothering them, they should bring it up. If the list is long – prioritize, Hubbard said.

- Ring a ding: People who call in that should not have had to: those who said they didn't need refills during their office visit, but call back the next day to get refills called to the pharmacy

Why?: The problem with the call-ins is two-fold: It increases the opportunity for errors or missed connections, and it can add to delays in office schedule, O'Dell said.

Rx: The best thing is to deal with it at the time of the visit.

“It saves us a whole lot of time,” Asa said.

“Don't run out of medicine, but try to take care of it at regularly scheduled visits,” O'Dell said.

- Sounds of Silence: People who should call in but don't. They don't take the medicine prescribed by the doctor, but come back and complain that they haven't gotten better.

Why?: Sometimes they find the medicine is too expensive and don't fill it. Other times they start taking it and don't like the side effects and just stop taking it.

“There's a lot of time lost, ” O'Dell said.

Rx: If there's a problem, call back. There may be other medicines to try. Ask about costs, side effects and how long it will take the meds to work at the office visit.

- Too much help

Family members who want to speak for patient (unless small child or adult who can't speak for themselves). Or too many family members squeezed into exam room.

Why?: One family member to help listen can be very helpful, especially for complicated issues. More than that is a crowd.

Rx: A fully competent adult should be able to answer for himself or herself.

“Be an observer unless there's a specific concern,” Hubbard said.

- Romper room during adult's doctors visits

Why?: Kids and private exams, like pap smears, are not a good mix.

Rx: People owe it to themselves and their health to be able to focus fully on the doctor during a visit. Whenever possible, and especially for routinely scheduled visits, parents should arrange for childcare, Asa said.

- Magic stethoscope syndrome: Patients who expect to be immediately cured of the common cold or a nagging condition that has plagued them for months

Why?: “Almost no medicine works right away,” Hubbard said. “Some take a few days, some take a few weeks.”

Rx: Ask the doctor what to expect.