Part 3: Find the Right Hospital

  • hiermedia
  • March 14, 2019

Part 3

This is Part 3 in a 5-part series of articles on 5 Tips to Be a Better Participant in Your Healthcare. In Part 3, I discuss the importance of choosing the right hospital.

5 Tips to Be a Better Participant in Your Healthcare: Introduction

Part 1: Find the Right Doctor

Part 2: Speak Up During the Visit

Part 3: Find the Right Hospital

 


Tip #3: Find the Right Hospital

Nearly all hospitals treat complications of common medical problems: high blood pressure, diabetes, falls, and seizures. They differ in the volume or extent of treating patients, the availability of tests (ex. MRI, PET scans), and the types of doctors who offer services to the patients of the hospital. Some hospitals offer beneficial services such as intense rehabilitation programs or advanced technology such as robotic surgery.

Just as doctors have a special interest, many hospitals have unique or exclusive programs. They may also have special procedures and research that may benefit you as a patient. Most of this information can be found online by searching the hospital or by asking your doctor.

Frequently, the hospital wherein you are treated is determined by your health insurance or by the preference of your treating doctor. Your treating doctor may work at several hospitals or only at one hospital. Your health insurance may only provide coverage at certain places.

But you can still play a role in finding the right hospital for you!

You should know the hospitals your doctor works. You should also know the extent of your insurance coverage for any treatments and procedures to help prevent any surprise charges. Will they pay for your colonoscopy? How much do you have to pay for your mammogram at a certain place? Is it cheaper at another facility? If your preference is a certain hospital, it may ultimately mean you may have to choose a different doctor who works there.

Remember, when you know more, you will be more engaged in your healthcare. You will also be more aware and assured in navigating through the process.

Part 2: Speak up during the visit

  • hiermedia
  • March 6, 2019

This is Part 2 in a 5-part series of articles on 5 Tips to Be a Better Participant in Your Healthcare. In Part 2, I discuss how you can speak up and become more comfortable doing so at your doctor’s visits.

5 Tips to Be a Better Participant in Your Healthcare: Introduction

Part 1: Find the Right Doctor

Part 2: Speak Up During the Visit


Tip #2: Speak up during the visit

While some physicians get frustrated with patients consulting “Dr. Google,” there are few physicians who can argue with patients striving to better understand their disease. Perhaps you are unsure about a new diagnosis or how the diagnosis will impact your life. If something does not sound right to you, speak up and ask for clarification!

Explain to your doctor how you aim to be an active participant in your care. If you have researched your illness and treatments on the internet, preface your questions by saying you are hoping to educate yourself on your condition and you are hoping they might explain some confusing information you found online. You are not expected to know as much detail about anatomy, diseases, and recommended medications as they do, so feel free to speak up.

Ask the questions that matter to you!

If you are too embarrassed to talk about a particular problem, write it down and give it to your doctor.  The job of your doctor is to help you better understand your conditions and treatments.

Finally, if helpful, bring a friend and empower them to be a second set of ears, your advocate, and permit them to speak up with questions.

What factors should you consider when choosing a hospital? I share more about this question in Part 3 of this 5-part series of articles on 5 Tips to Be a Better Participant in Your Healthcare.

Part 1: Find the Right Doctor

  • hiermedia
  • February 28, 2019

In Part 1 of this series of articles on 5 Tips to Be a Better Participant in Your Healthcare, I take a look at finding the right doctor by understanding the different types of doctors, the training and special interests of the doctor, and exploring the possibility of seeking a new doctor or a second opinion.

5 Tips to Be a Better Participant in Your Healthcare: Introduction

Part 1: Find the Right Doctor


Tip #1: Find the right doctor

Not all doctors are the same. Primary care physicians practice general medicine and include family practitioners, pediatricians, internists, obstetricians, and gynecologists. These doctors are generally the first stop for patients and are a long-term partner in healthcare. You can find a primary care physician by looking through the providers in your insurance network, word of mouth and talking to people you know, or by online searches.

When there are more particular needs or problems to address, patients are referred or sent to specialists, such as oncologists, cardiologists, endocrinologists, or surgeons who may then use other tests to further diagnose the problem and develop treatment or management plans. These relationships are generally centered on a particular problem and once that problem is solved, you may no longer need to visit that doctor. Speak with your primary or referring doctor to be sure you are going to the right specialist for the right problem.

Do you know what special training your doctor received that may be beneficial to you as a patient? Do they treat the diseases or disorders for which you need attention? There are several ways to find these answers. Ask your doctor about their experience of taking care of people with your condition. Also, doctors’ offices and hospitals often place information about their physicians’ background, education, and special training on their website where you can discover the diseases and disorders they have a special interest in treating.

But even when you have found your doctor, there are times when it is necessary to seek a second opinion or find another doctor. Please know doing so is okay. Though I enter the relationship seeking to help, I recognize there are times where I may not be the best doctor for the particular needs of a patient. Furthermore, I have had patients who requested a second opinion or have care transferred to a different provider. Sometimes, through no fault of the doctor and/or the patient, it is not a good match, leading to such changes so the patient can receive the attention and care they rightly deserve.

So there you have it. As mentioned in the introduction to this 5 part series, next week I will have another tip to keep you fully engaged in your healthcare. 

Until then, share this tip with your friends and plan to learn about tip #2 next week: speaking up during your doctor’s visit.

5 Tips to Be a Better Participant in Your Healthcare

  • hiermedia
  • February 28, 2019

This is the introduction for a 5 part series, 5 Tips to Be a Better Participant in Your Healthcare.

After finishing rounds at the hospital on a Friday afternoon several weeks ago, I got a call from my brother telling me about an upsetting doctor’s report. An x-ray of his chest raised a concern of an abnormality. He feared the possibilities: cancer, death, and the other unknowns. As his “Dr. Brother,” he asked what should his next steps be. What questions should he ask his doctor? Armed with enough knowledge to initiate and engage in a more robust discussion, he was able to leave his next doctor’s appointment not only with more answers but also with a sense of calm that continued throughout his work-up (which fortunately turned out to be ok).

My goal is that all patients can be more engaged, navigating and participating in their healthcare with awareness and assurance, even without their own “Dr. Brother.”

Going to the doctor can be overwhelming. Besides understanding strange words and complicated explanations, many patients have underlying fears about potential treatments and facing their own mortality. In my world of taking care of patients with colorectal cancer, concerns of patients include if an ostomy will be needed, will they experience hair loss from chemotherapy, or will the cancer be the immediate cause of their death.

Research shows the potential benefits of patient engagement includes increased trust and satisfaction of patients, improved quality of life, reduced patient anxiety, and perhaps better results of given treatments.

In this 5-part series, I will share 5 tips for you to be an engaged member of your treatment team and to ensure your success as the most important player in that team.

So what are these tips?

 

The full series of articles on 5 Tips to Be a Better Participant in Your Healthcare are below:

Part 1
Part 2
Part 3
Part 4
Part 5

Black Health Disparities are Real: Here’s How We Can Reduce Their Impact

  • hiermedia
  • January 8, 2019

Sitting in class in medical school and learning about various diseases often felt like a roll call of many of the people in my life. When reading about lupus, I thought of a childhood friend from my church who was diagnosed with lupus in her late teenage years and died in her mid-20’s. Having discussions about kidney disease reminded me of a family friend who spent 3-4 days a week in dialysis, requiring the remaining days of the week to rebound from the fatigue it often brought her. Discussion of the anticoagulant warfarin (Coumadin), brought back conversations with my grandmother about altering doses of the same medication for her ever prevalent heart disease. The pathology I learned in medical school reminded me too much of my familial circle.

The data is alarming: younger African Americans live with or die from many conditions usually found in white Americans when they are older. Data from the Center for the Control and Prevention of Diseases further show African Americans are more likely to die at earlier ages from all causes. African American women are more likely to have an aggressive form of uterine cancer and are more likely to die from it. Other studies have shown both women and men who are African Americans have more advanced stages of colorectal cancer at diagnosis and have lower survival rates. Prostate cancer, hypertension, Alzheimer’s disease, COPD, and diabetes are other disease processes with disparity in African Americans. Another study demonstrated that African American women have higher rates of maternal death during childbirth.

There are several explanations of these findings. Discussions often center on genetic links that connect diseases in African Americans from one generation to another. Dietary factors such as diets high in salt, sugar, fats, processed foods, and cured meats often found on the table during traditional African American “soul food” meals help explain higher incidences of high blood pressure and kidney disease. High cost and limited access to healthcare has been shown to delay diagnosis and treatment (such as with a colonoscopy to find precancerous polyps before they become cancerous). If there is no available doctor in the neighborhood, city, or town it may be extremely difficult to find one or arrange transportation. Biases (conscious and unconscious) on the part of both physicians and patients can limit care the patient receives. Even more, deeper cultural influences such as mistrust of doctors (an unfortunate result of decades of unchecked medical experimentation on Blacks and other minorities) and reliance solely on faith may additionally negatively influence seeking out medical help.

These factors can seem insurmountable. How can one effectively change the cultural thread from which they are made? Beliefs are deeply embedded and habits are hard to break, especially when some of the behavior, which leads to diseases, is so pervasive and accepted around you. At times, for both patient and the healthcare provider, sometimes it seems easier to not even try.

But we should. We must. We can all play a role in overcoming these challenges. For members of the healthcare profession, we have a responsibility to create awareness of the diseases we know disproportionately affect the patients we treat. We must advocate for early screening, and continue collaborations with government, churches, and community groups to create programs to increase access to care. In my own practice, I have learned to take extra time even at the expense of running a few minutes behind in the office to explain in plain language information about a disease and the treatment plan. I often request additional members of the family to come into the office to help ensure understanding of the plan. Patients must seek health professionals they trust and seek their advice when they first experience symptoms. While you cannot change your genetics, you can move more. Another solution is to make changes in the diet by including vegetables and whole grains as the main course in the meal with a choice of a lean cut meat as a side. Let fruit be your desert. Become an active member of your healthcare team and seek solutions as a team. Ask questions. And if your reliance is solely on faith, recognize all good gifts come from God, even your doctors and the knowledge and advice they share with you.

New Screening Recommendations

  • hiermedia
  • June 8, 2018

Every 10 minutes, a person dies from colorectal cancer. With the recent change in recommendations from the American Cancer Society to begin screening for colorectal cancer at the age of 45 instead of 50, we could see a positive change in this number.  The new guidelines published in CA: A Cancer Journal for Clinicians was sparked by research noting, despite overall decreases in the number of deaths from colorectal cancer over the past 25 years, there has a been a 50% rise in rates in those under 50. Other studies have shown those born in 1990 have twice the risk of being diagnosed with colon cancer and 4 times the risk of being diagnosed with rectal cancer. Of those diagnosed under the age of 50, nearly 50% are 45-49 years of age.  Fifty has been the recommended start age for screening in average risk patients, causing many of these patients to unsuspectingly “miss the boat” and be diagnosed too late with more advanced disease being found at the initial presentation.

Colorectal cancer is preventable. It begins as a polyp, which is a small bump formed along the inner lining of the large intestine. If left to grow, these polyps can enlarge, become cancerous, and spread through the intestine to the blood stream, nearby structures, and even distant organs. If diagnosed early, 5-year survival can be up to 95%; however, in cases where the cancer has spread to other areas of the body, survival may be less than 20%.  The goal of colorectal cancer screening is to find and remove these polyps before they reach this stage.

The recently released guidelines suggest doctors offer a choice of screening options to maximize the chance patients will actually undergo screening, While a colonoscopy every 10 years has traditionally been the most commonly recommended colon screening test, several other screening options are recommended in the guidelines: fecal immunochemical test every year; guaiac‐based fecal occult blood test every year; stool DNA test every 3 years; CT colonography every 5 years; and flexible sigmoidoscopy every 5 years. Each of these test have strengths and weaknesses. Patients should discuss these various screening options with their healthcare providers, as ultimately the best test is the test the patient will actually undertake.

This new recommendation of initiating screening at 45 instead of 50 does not change the fact that regardless of age, if symptoms of bleeding, pain, or unexplained changes in bowel habits or weight are present, a colonoscopy should be performed. Also, if a first-degree family member was diagnosed at an early age, screening should begin 10 years before the age of the affected family member. Additionally, this recommendation does not ensure automatic changes in what the various health insurers will pay.  Other national organizations still recommend screening for average risk patients at 50. Even more, the change in recommendations does not answer the “why” in the increase of colorectal cancer in younger patients. But, ultimately, this change presents opportunities to find and remove more precancerous polyps and earlier-staged cancers, thereby decreasing the numbers of patients dying from this preventable disease.

Learn more and see an interactive video here

Journey to #BlackMenInMedicine

  • hiermedia
  • November 27, 2017

There were fewer Black men enrolling in medical school in 2014 than in 1978.

In a world where the first Black president of the United States was elected nearly a decade ago with many declaring it to be a new day of progress for Blacks in America, statistics such as this one come as a surprise. Fifteen years ago only 677,000 Blacks held an advanced degree. Today that number is 1.6 million. For unclear reasons, these successes have not translated into increased representation of Black men in medicine.

The 2015 AAMC report Altering the Course: Black Males in Medicine provided interviews of premedical students, physicians, and researchers that highlighted reasons for the decline in Black men enrolled in medical school, emphasized research and data to help explain trends, and sought ways to encourage more black men to consider medicine as a career. They identified recurring themes such as unequal educational opportunities from kindergarten-12th grade, absent role models or mentors in medicine, negative societal bias and perceptions of black men, and the increasing financial burden from the cost of a medical education.

We are familiar with the AAMC report, and many of us have been working to address the issues presented.While at Duke University, Dale Okorodudu, MD created the video series “Black Men in White Coats” with the goal of inspiring and encouraging black men to pursue careers in medicine. He wrote blogs, such as Where The Brothers At?-Mentoring and Black Men Doctors, which called for strong mentorship to young men who could and would pursue medicine if they were exposed to “men of seniority…similar to our black men…who could capture their attention and gain their respect.” In September 2015 Damon Tweedy, MD released his book, Black Man In A White Coat, to document the challenges he faced and to inspire other black men to follow in his footsteps. In his New York Times Op-Ed article “The Case For Black Doctors,” he recognized that further under-representation of this group in medical school could lead to “even worse health outcomes for a population that is already the least healthy.”

So, when medical student, Vince Morgan, tweeted the statistic from the AAMC report November 16, 2017 many of the black male physicians on Twitter felt a sense of camaraderie and solidarity with Vince’s tweet. While our experiences in medical school spanned decades, we were united by our common experience of representing less than 2% of our individual graduating medical school classes. Unfortunately, for the majority of medical schools, these numbers remain unchanged today.

A robust conversation ensued on Twitter among those of us who recognized the problem and wished to do something to rectify the disparity and to find ways to lead by example and support those coming behind us. Perhaps inspired by the strength and resiliency we have seen demonstrated by women physicians and hashtag movements such as #ILookLikeASurgeon and #ThisIsWhatADoctorLooksLike and an immediate recommendation by Quinn Capers, IV, MD, we decided a social media movement and community of our own was in order. In fact, the surgeons among us had previously brainstormed with Heather Logghe, MD, founder of #ILookLikeASurgeon as to how to leverage social media and create a similar, simple to read, but influential hashtag. The goal of the hashtag would be to promote and encourage more young black men to pursue careers in medicine, especially to those who may not recognize medicine as a viable career option perhaps because they have never actually seen or met a black male physician.

Similar to #WomenInMedicine, Darrell Gray, II, MD, MPH suggested #BlackMenInMedicine. Dr. Dale Okorodudu mentioned the Facebook group with a membership of nearly 500 strong with the same name started by Dr. Henry Lewis, III. While we shared the same goal of advising, mentoring, and motivating black men to enter the medical profession with that Facebook group, our goal of re-purposing #BlackMenInMedicine is to encourage universal use of the hashtag across Twitterverse and other social media. Our hope is that the hashtag will be used not only by Black physicians and the allies similarly passionate about increasing diversity in medicine, but by anyone wanting to recognize the many accomplishments of Black men in medicine.

With use of #BlackMenInMedicine, we aim to:

  • Provide visible role models of black men in medicine, both as they practice medicine, and perhaps more importantly, how they spend their time outside of the clinic or hospital
  • Highlight achievements of black male physicians, as well as black men in medical school, and those aspiring to the premed track
  • Inspire black men to pursue careers in medicine and become motivated to care for communities of color
  • Highlight outstanding achievements of black doctors in both community and academic medicine and practice
  • Provide support, mentoring and sponsorship of black women in medicine who face additional challenges at the intersection of gender and race
  • We pledge to speak up when we witness gender-biased microaggressions, blatant sexual harassment, or harmful bias and discrimination toward other minority groups
  • Together, we aim to ensure a safe and inclusive educational, training, and working environment for all of us

Blog post written by Cedrek McFadden, MD and Heather Logghe, MD

Supported and developed by:

Cedric Bright, MD (@CedricMBrightMD)

Quinn Capers, IV, MD (@DrQuinnCapers4)

Dale Okorodudu, MD (@DoctorDaleMD)

Darrell Gray, II, MD, MPH (@DMGrayMD)

Joshua J. Joseph, MD (@joshuajosephmd)

Alden Landry MD MPH (@AMLandryMD)

Heather Logghe, MD (@LoggheMD)

Cedrek McFadden, MD (@cedrekmd)

James Moore, III, M.A.Ed, Ph.D (@DrJLMooreIII)

Brian H. Williams, MD (@BHWilliamsMD)

 

Also Supported By: Tour for Diversity in Medicine (@tour4diversity)

One Diagnosis Away

  • hiermedia
  • October 19, 2017
“How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving and tolerant of the weak and strong. Because someday in your life you will have been all of these.” —George Washington Carver

Earlier this week, I walked into the exam room and introduced myself to a 48-year-old male.  As I generally do, I sat in front of him and asked “how can I help you today?” We talked about bleeding that started one month ago, discussed his concerns about only having a bowel movement every other day and his mother’s bout with colon cancer in her 60’s. We proceeded to the physical exam. During the digital rectal exam, I felt a large, firm, and fixed rectal mass that told me his life was about to change. Now it was my job to tell him how.

I appreciate just how tough it is to be a patient. Fortunately, for most, good health has been their norm, taken for granted while going through life without ever seeing a doctor. Perhaps they suddenly begin having problems they had never experienced (seeing blood on the toilet paper, feeling abnormally tired after a daily walk, or a gnawing abdominal pain they can no longer ignore); symptoms, which eventually prompt a visit to a doctor. For others, an abnormality is discovered during a routine exam (i.e. colonoscopy, mammogram, an EKG). With diagnoses such as colorectal and breast cancer, patients must adapt to a new normal that includes frequent office visits, periods of hospitalization, and in some cases, suddenly facing life-altering treatments and even their mortality.

A friend and colleague bravely shared with me her early writings as she begins to process her experience of being diagnosed with breast cancer at the exact time she had hoped to start a family. With a single diagnosis, her future was forever altered. A surgeon who operates on patients with lung cancer, she found herself looking at the operating room lights from a different angle as she underwent bilateral mastectomies with reconstruction. Having always sported a thick mane of curls, her hair loss following chemotherapy is a powerful symbol of her new reality. She was anxious to return to work with a scrub cap thinly veiling her bald scalp. As she described her fears, “I am bald. I can’t hide it anymore and I am terrified of everyone’s reaction. I was and I am scared of the fact that my cancer can come back and kill me, that I may never be able to have children, that the future that I have carved so carefully for myself is so uncertain because my own body betrayed me.”

It is common for patients to feel this sense of betrayal: sometimes from their body. Sometimes from God. Patients have cried, become silent, or even angry when I have given results indicating a diagnosis of cancer. Unable to fix everything in that moment, I sit with their silence. Hand them a tissue and wait. Most patients want answers and a cure. While I generally enter these patient encounters with the goal of finding a cure and full recovery of whatever ailment may be present, there are times I am often forced to care for the patients in other ways, usually with the goal of alleviating suffering. With time, most patients process and reframe their future and transition to an active member of their treatment team.

We are all just one diagnosis away from a different reality. My interactions with patients, and now the diagnosis of a close friend and colleague compel me to consider my own reaction if faced with similar circumstances. How would I respond to a life-changing diagnosis? Above all else, I would want my physician to possess compassion–to listen, care, and remain empathetic. May I always strive to enter each patient encounter with sincerity, compassion, and gratitude for the opportunity to serve.

On Being ‘Dr. Dad’

  • hiermedia
  • June 5, 2017

I take my 10-year-old son to school as many school days as possible. We recap events from the prior day, and I give him early morning pep talks. It is a rarity, however, that I pick him up from school. During one of those rare occasions, he got into the car, smiling as he handed me a project he completed in class. It was an assignment in which he was asked to introduce his hero to his classmates. To my delight and surprise, he chose me as his hero. He explained that he looked up to me, in part, because I am a doctor.

This moment affirmed my belief that being a doctor compliments my role as a father. Being a doctor makes me a better father. Equally, being a father makes me a better doctor. While I’ve had a decade to establish a healthy relationship with my son, in clinic, I must establish a doctor-patient relationship in a relatively short amount of time. Many patients come into the clinical encounter with problems they would not share with their closest confidante. During these candid conversations, they trust I will listen and not only have solutions for their complaints but remain objective and unbiased in the process. I incorporate these same skills while instructing and nurturing my children.

One such opportunity arose after a recent track meet when my son came in 7th place during the 100-m dash run. I could see his disappointment in his performance. I could also see the embarrassment he felt. After listening to him share his feelings of being intimidated by his competition, we problem-solved and discussed ways to improve his performance for the next race. Our solutions included spending additional time after practice working on his technique. His effort paid off; he had a faster time and came in 2nd place during the following track meet. Years of listening, searching for, and offering methodical solutions to my patients subsequently have improved my problem solving as a father.

Just like my patients, my son does not follow all of my instructions. He has challenges getting homework done in a timely fashion and most definitely has challenges keeping his room clean. Guiding him through life’s challenges has taught me how to remain cool and level headed even when I am feeling anything but. Techniques that work in parenting translate to my professional responsibilities. For example, I rely on the ability to speak clearly in language the patient can understand to facilitate conversations about the medical and surgical management of various disease processes. Keeping cool and level headed in a wide range of clinical situations ranging from treating a noncompliant patient to proficiently and dexterously completing a tough surgical procedure is a necessity in my profession. Being a father of an energetic and active son has definitely equipped me for comparably challenging situations that require the same quiet resolve in my surgical practice.

Despite all the ways being a father and a doctor complement each other, it is a challenge to do them both well and give them both the time they require. I am intent to take full advantage of the time I have with each, whether in the car going to school or in the office and operating room. Time is fleeting and I recognize my son is growing older much too fast. My patients have many medical and surgical needs that continue even after the office has closed for the day. Clearly, I am not able to be present at all times for both. Nonetheless, when I am with family or with a patient, my goal is to be fully present. I know my son has a better father and my patients have a better doctor because of the experiences I have with each of them. Ultimately, I know the conversations with my son during our time in the car provides motivation, inspiration, and encouragement that will help mold him into a better version of himself that will benefit his future children and maybe, just maybe, his very own patients.
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