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Hi blog readers.  I know I have been remiss in the last month posting anything new.  I also owe you all a blog post on the researched and resulted benefits of coffee and that is in the works.  I just wanted to take a minute and share something recent.

It’s always amazing to me how being the patient for even a single appointment gives me much needed perspective and often prompts me to put down in writing my thoughts to remind myself about patient perspective.  Recently, I had a health issue arise that prompted further testing, biopsy, meeting with surgeon, and a plan for continued high risk monitoring moving forward.  I guess I should just be clear as to what my issue was up front… I had a bi-rads category 4 reading on a screening mammogram, with clustered micro-calcifications in one specific spot in one breast that were new and not seen, even after detailed diagnostic imaging, on last mammography.  I am not over 50, not overweight, exercise routinely, don’t smoke, and yet I have a paternal grandmother with no daughters and no sisters who died young after a 4 year battle with breast cancer. Needless to say, I was a little worried about the new finding. Luckily the biopsy was benign(ish), but all of this has brought the patient experience front and center to my practice and teaching.i

When a routine screening comes back positive
For all patients this is stressful, regardless of family history.  In my case, I watched a family member die after a long battle with the same illness.  The only thing I heard, as a single mom of three kids after the positive screening, was that my screening was positive.  No rational discussion, or ‘probably benign’ wording, resonated for me.

Don’t tell patients not to look on the internet
The internet is where everyone, including health care providers, go for data. When we tell patients ‘not to look on the internet’, we’ve created an irrational and impossible command. Not only did two separate providers give me this directive,  the surgeon asked on their intake form how much I went to the internet for information. Why not instead give patients websites with sound advice or links to research? Gone are the days when the provider knows all and is all and the patient should only get information from him or her. We have to learn to work with the internet, not against it. To a patient, such advice sounds closed minded and dismissive of their own abilities or need for information.

Attempt not to be dismissive of their questions or condescending
Patients are our partners and the reason we have jobs.  We are not a gift to them. In fact, there are many days when healthcare providers may truly be an obstructive force. Recognizing that, I am going to be more mindful of my tone in speaking with patients.  For this event, from the first moment I entered the surgeon’s office, who did not have a nurse or an advanced practice provider in the office but is another topic entirely, I felt small and belittled. There was yelling of names and insurance co-pays into the waiting room and comments like “oh you must have a high deductible”.  The MA, then chastised me for wearing a dress to an appointment on a work day when no instruction to dress a certain way was given.  The specialist then was in and out in 5 minutes, I was not allowed to ask questions about procedure, family risk, or genetic testing, but was told several times that “my staff will explain everything”.  I also was told repeatedly the same fact, “80-90% of the time this is nothing”, which I know not to be true given my risk factors, the mammogram findings, and my professional training.  The surgeon was out the door quickly, only to stick her head back in after not reading my chart thoroughly and asking about two other key issues in my history that she had not read prior to coming into the room… then she left again, mumbling a repeat of her 80-90% statistic again. The visit was 5 minutes and cost me close to $200 out of pocket.

What I will change in my own practice – Clearing time each visit to ask the patient if they have specific questions.  I will not proverbially and condescendingly p’at the patient on the head’ with my words by telling them things will be fine and that this health concern of theirs is essentially nothing. To each person, no matter how routine their situation may be to us their diagnosis is personal in ways that run deep, whether it is simple contact dermatitis or an upcoming surgical procedure. Fear of the unknown and disruption of normal life is real to every single patient.

Talk to patients who are awake during procedures
I don’t do surgical procedures, but if I did… I would want someone to tell me to acknowledge my patient during a procedure. If patients are awake constant communication is mandatory and if general anesthetic or something that may affect recall is administered, to make time to talk to the patient and support person before and after any procedure. I spent 30 minutes face down on a mammogram table, with my breast in a vice clamp while a hole was drilled into my breast and repeated images taken. The surgeon never even let me know when she entered the room or left and did not speak to me once throughout the procedure. The radiology tech (again no nurse, no vitals, no assessment before or after the procedure) is the one who did my teaching, intake, and talked me through what was happening. She was very good. Kudos to the support staff who make the providers look better. (Side note – the cash price for the biopsy was 1/3 the cost of what I was charged  out of pocket to meet my deductible as the cost billed to insurance, but if I had chosen to pay the cash price it would not have counted toward my deductible.  The catch-22 of insurance.  #UnitedHealthcare— care to reply to this issue in billing?)

Providers, remember who is on the table.  Make time for them regardless of who they are.  Give the same care you would want for yourself or your family member.

Nursing was surprisingly absent
In all of my recent encounters nursing was surprisingly absent. I have some ideas as to why that was, but I am still alarmed.  Nurses are the assessors, protectors, communicators, educators, to the patient.  They are more benefit than cost.

I am thankful for in all of this is the chance to reflect on my own practice and to be nudged once again to patient and nursing advocacy.