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CNN Sunday Morning
Weekend House Call
Aired September 14, 2003 - 08:29 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: All right. Good morning and welcome to CNN's WEEKEND HOUSE CALL. I'm Dr. Sanjay Gupta. Well, taking control of your own health care and becoming a power patient. We want to help you meet those goals, today. A very important topic. The first step, learning to communicate effectively with your doctor.
(BEGIN VIDEOTAPE)
GUPTA (voice-over): Going to see a doctor can be a stressful event to begin with. Not really knowing what's going on after the appointment can be even more stressful. Experts say poor communication between the patient and the physician is the real culprit. Over the past decade, medical schools have been trying to teach new doctors thou better communicate. Step No. 1, listen.
Emory University's Dr. William Branch says many physicians blame poor doctor-patient communications on the ever-present lack of time. But, he says when researchers videotaped experienced physicians with real patients, what they found was not encouraging.
DR. WILLIAM BRANCH, EMORY UNIVERSITY: They discovered that the average patient was interrupted within 11 seconds of starting to talk.
GUPTA: He has this advice for all physicians.
BRANCH: What I will tell them is, if you listen for just a minute you've already done five times the average doctor.
GUPTA: Listening to what patients say, how they say it, what words they use, observing their body language can all help the doctors find out what's really bothering the patient and it only takes a few minutes. But, how patients communicate with the doctor also plays a large role. Given that physicians have a limited time to spend with each patient; it can be frustrating when patients haven't organized their thoughts about what's bothering them. Patients can help their doctors help them by doing simple things like collecting their thoughts and writing down questions in advance, and writing down all medications that they are taking.
(END VIDEOTAPE)
GUPTA: All right, so if you take a lot of medications and have trouble remembering all the dosage amounts you might want to consider bringing your medications to your appointment, that could be an easy way to take care of that. Make sure to include vitamins as well, over-the-counter drugs, and herbal supplements, they are often important. And, there are other things you can also do to prepare before you even get to the doctor's office.
Make sure you have a piece of paper and pencil with you; you might even consider getting a special notebook or folder that you use just for keeping your medical information. Gather up your pertinent records, keep a hold of those things -- letters from other doctors and x-rays, also keep a reminder of what your drug allergies are and write those down, as well.
Now, you may want to ask a relative or friend to accompany you to the appointment and that gives you another set of ears. Sometimes two sets of ears are better than one in terms of hearing your doctor's advice.
We're going to have lots of tips today, more than two dozen other tips for you throughout the show. We know you have lots of questions from us, so we want to hear from you. Call us, 1-800-807-2620. International charges may apply for our overseas callers. Or e-mail us, if you're an e-mailer that's at housecall@CNN.com.
There's lots of information to get through today, so joining us for your HOUSE CALL, this morning is Dr. William Branch. He is from the Emory University School of Medicine, he's an expert in doctor- patient relationships, also an internationally recognized leader in medical education.
Thank you so much for joining us, appreciate it.
BRANCH: Thank you, Sanjay.
GUPTA: Lots of questions here and we're not going to rush through these because you -- you've already told us that it's important for doctors to sometimes take their time. We're going to talk about all those issues, but there is a lot of people curious about this topic. So, let's get to one of our e-mailers.
First one, Jim in Massachusetts writes, "My doctor is always in a rush when we meet. He allows 15 minutes for each visit. What can I say to get him to slow down and listen to me?
And, Dr. Batch, I mean, you've talked a lot about this. I think this sort of gets to the issue. How do you get the doctors to slow down?
BRANCH: I mean, it's a tremendous issue for the doctors. I mean, if you meet with doctors nowadays you'll hear more about this 15-minute limit on visits than almost anything else. Which is -- it's very disturbing for them because they would like to spend more time. I think, first of all, the patient should organize their thoughts when they go in. They know that the doctor will have some time pressures, and the doctor should ask them a question that allows them to talk, and -- so that the first thing would be organizing your thoughts into a coherent, minute or two, where you can really convey what is that's most important to you, that you want them to care for.
GUPTA: Is it the insurance companies you think that are putting these time limits on doctors or why is that happening?
BRANCH: Well, in the managed care setting, the doctors economically, it boils down to they really need to increase their productivity.
GUPTA: Is it the insurance companies, you think, that are putting these time limits on doctors or why is that happening?
BRANCH: Well, in the managed care setting, the doctors, economically, it boils down to they really need to increase their productivity.
GUPTA: Yeah, because you mentioned that the doctors actually would like to spend more time with patients, but sometimes they can't.
Let's get to another e-mail question. We'll get to more of this in a little bit. Our next e-mail coming to us from Stanley in Texas, who writes, "Doctors rush to get through a long list of patients. Short of standing on your head, how do you get their attention and detailed questions about your condition? Sometimes, the doctor is more worried about the next patient than about me!
And, let me just say, because this is sort of, obviously, talking about the same thing as well, there are a couple tips here, Stanley, if you sort of think about. Try starting your visit by simply talk -- telling your doctor that due to the seriousness or complications that are -- you think are involved this visit may take a little longer than usual. That's sort of important, have that conversation off the top. Also have a short list of questions. Keep the list of questions short but focused, that you prepare at home, and then you may want to go to the library or on to the Internet, or something else to do some research so that you're familiar with the medical terms related to your condition and possible common treatments for that sort of stuff, that may help facilitate. Anything else to add to that, Dr. Branch?
BRANCH: Well, I was going to say that when we teach doctors, I mean, our first -- our very first principle is: ask a an open question to the patient and let the patient talk for a few minutes and listen to them. And even at -- we usually tell the students, ask several open questions before you stop, and then ask your own questions. The patient could use some of the same -- could use some of the same advice in terms of preparing for that. The other thing is, in terms of trying to help the doctor to structure the interview, little comments like "I need to explain this to you" or "this is important to me, can you spend a little time -- can I spend a little time explaining this?" I think those kind of things would actually help the doctor to focus on what you think is important.
GUPTA: And, I should point out, this is something you do, I mean, you spend time training not only student and residents, but also doctors. They seem pretty amenable to that, when they hear this sort of advice? If they get an open-ended questions, most doctors are going to respond well to that, you think?
BRANCH: Well, let's just say that in the last 10 years there's been a tremendous increase in the amount of teaching on patient-doctor communication in medical schools around country.
GUPTA: OK.
BRANCH: And, we with very really stressed some of these basic principles to the students. Now, I think the practicing doctors that graduated, you know, furthered in the past did not get this training, but a lot of them have learned on the job.
GUPTA: All right, and hopefully some of them are watching today, as well.
We got a phone caller coming in now, as well. Debbie from Missouri.
Welcome to house call, Debbie.
DEBBIE, MISSOURI: Good morning. My question was: Why do doctors or the staff sign up so many people for the same time?
GUPTA: And, did you hear the question OK, there?
BRANCH: Yes.
GUPTA: Talking about signing up so many people. I think you already, sort of, touched on that a little bit with the managed care. But, how do you -- what do you say to Debbie?
BRANCH: Well, the doctor is trying to manage their schedule, and they might be -- I'll just have to speculate. I think they might be trying to -- what we call frontload the schedule in order to be sure that there are enough patients there at the beginning of the session to get started efficiently. That should not -- I mean there should be a limit to the number of patients that are brought in, and they usually -- we don't bring them in at the same time. We would bring them in -- in staggered intervals. It may seem like the same time, by the time you get signed and ready to go.
GUPTA: So, if you want a 12:00 appointment your doctor says I have four patients scheduled for 12:00, that could be a problem, right?
BRANCH: Well, of course -- you know, there's so many different varieties of practices, and, I meant, there are some great doctors out there who do primary care that have large patient volumes they take care of and you have to respect them, and I mean, they will -- you know, they will go the extra mile sometimes to see their patients when the patients call, they'll sometimes just say come on in...
GUPTA: All right.
BRANCH: I'll see you.
GUPTA: Lot more tips coming up. One of the most difficult things for patients to describe and for doctors to really fully -- understand is pain. When we come back: How to explain your pain. We're going to take more of your calls and your e-mails. We want to hear from you. Our number 1-800-807-2620 or e-mail us, we'll try and get your question on the show, as well, housecall@CNN.com. Stay with us.
(COMMERCIAL BREAK)
GUPTA: All right. I'm Dr. Sanjay Gupta and we're turning you into a power patient, this morning, with tips on how to talk to your doctor. You can give us a call, that's at 1-800-807-2620 or send us an e-mail at housecall@CNN.com.
Right now it's time to check our "Daily Dose Health Quiz." See if you know the answer to this question: More than age, race, income, employment status, or education level, what one skill is a better predictor of someone's health status?
We're going to have the answer to that in 30 seconds. Stay with us.
(COMMERCIAL BREAK)
GUPTA: Checking the "Daily Dose Quiz," now we asked: "More than age, race, income, employment status, or education level, what one skill is a better predictor of someone's health status?"
The answer is: health literacy, which is the ability to read, understand, and act on health information is one of the strongest predictors of health status.
That information, incidentally, came from askme3.org where you can get more information on patient-doctor communication.
At askme3.org they recommended three simple questions to get the most out your doctor's visit. The questions are: What is my main problem? What do I need to do? And, why is it important for me to do this?
Sounds like pretty basic stuff, but sometimes keeping it simple can be the key to good communication. I'm here again, with Dr. William Branch, he's from Emory University. He's a recognized leader in medical education and in also training doctors and residents to actually be better listeners and communicators. Sort of helped me out quite a bit this morning.
We got a lot of e-mails and phone calls coming in, no surprise, there. Let's take our next one which comes from Dave in Illinois, who writes, "I found it interesting that my current doctor was much more responsive to my pain when I had an ankle sprain than previous doctors have been. I'm not sure if it was because he had broken his ankle, as well, a few months earlier.
Is there a link between doctors having experience with pain and recognizing the pain isn't always a positive thing for the patient? Previous doctors, on a different situation, scratched their heads and wrote down "Neuropathy" and simply said to deal with it."
You know, it's sort of interesting, right? I mean if a doctor's, I guess, is like anybody else, if a doctor has been through it, they're probably more likely to be sympathetic to the situation?
BRANCH: Well, there's no question. I mean I would hate to have to recommend that every doctor experience the illnesses of their patients. Pain, in particular, is hard to appreciate, unless you've experienced it.
GUPTA: Right.
BRANCH: I mean I had a cervical disk, myself.
GUPTA: Yeah, right.
BRANCH: And I'll tell you, once I've been through that pain, I know what it's like for these patients. And prior to that, I did not. I have to confess. I did not quite -- I did not grasp what it was like to be in constant, severe pain for a period of time.
GUPTA: I'm going to second that. I just had a herniated disk in my lower back, as well. And, I take care of that particular problem as a neurosurgeon. But, after I've been through it myself, I have a pretty good idea of what it is these patients are talking about, probably a lot more sympathetic to that.
BRANCH: Right.
GUPTA: Let's stay on this theme, here. I'm going to get more of your thoughts, but let's stay on this theme because Lisa from Florida also wants to ask a question about pain, I believe.
Lisa, good morning and welcome to HOUSE CALL.
LISA, FLORIDA: Hi. How are you?
GUPTA: Good morning. Do you have a question?
LISA: Yes. I'm sorry. My problem is, I have several major medical problems, and I have -- my main one is I have costochondritis and I also have heart stints in both main arteries and I can't tell the difference between, is it my heart or is it my costochondritis and the pain management doctor takes care of that, but my primary care doctor just has a fit over my pain medication.
GUPTA: So, trying to distinguish between treat -- costochondritis, we should just say, is an inflammation of the muscles in the chest wall and sometimes that can be confused with heart pain or chest pain, due to the heart. What do you tell someone like Lisa?
BRANCH: Well, she's asking two questions. One is about pain management. I mean, doctors today are being trained -- a lot more emphasis is being placed on managing pain, and on the consent that we should be able to diminish pain in most patients. We're using this scale, for example. We're calling it the "Fifth Vital Sign."
GUPTA: Right.
BRANCH: That is, a scale of one to 10 where one is barely perceptible, 10 is unbearable -- where is your pain? And, we're training doctors to really ask about pain in every patient and really to try to treat pain a lot more aggressively than we did in the past. As an internist, I mean I'm constantly am dealing with people whose problem is they might have costochondritis, coronary artery disease. You know, it's a very difficult problem. I think you to see the patient three or four times and sort through this before you begin to get a really good feel as to what is the costochondritis, they might have coronary artery disease. It's -- you know, it's a very difficult problem. I think you have to see the patient three or four times and sort through this before you begin to get a really good feel as to what is the costochondritis and with is the coronary disease.
GUPTA: Right.
BRANCH: And usually what I say to patients is, now, once we know that this is costochondritis, you can relax when you have this. But when it changes, in some significant way, that's when I want you to call me or come in and be reevaluated.
GUPTA: Now, talk about that pain scale for a second. You were mentioning that earlier, as well. What -- most people don't know what that is. How would you describe what a pain scale is?
BRANCH: Well, it's an effort to quantify pain, and it's also, frankly, a way to get doctors to pay more attention to the pain their patients are in. And, it would help the doctor if you can give me a scale, if you can say, my pain is a 6, where a 10 is unbearable. Now, that's still subjective, but if I treat you and you come back and say it's a 3, I know I've done some good.
GUPTA: So, you can put it all in relative terms.
BRANCH: Right.
GUPTA: Very important topic. Yet, let's run through some other tips, as well, that may help Dave and some of the other viewers communicate pain because this is a tough one for doctors and for patients. We spent a lot of time on this particular topic.
If you have ongoing pain, try to keep a pain journal. Write down when the pain occurs, how long it lasts, note exactly where the pain is occurring and be as specific as you can. Sometimes a doc. will ask you to point to it with one finger. Jot down what you were doing when the pain occurred, write down a description of the pain, try using the words like dull, throbbing, burning, stabbing, shooting, and cramping, some sort of descriptive word to help the doctor understand more about your condition. It can also be helpful gauge or rate the pain, as Dr. Branch was saying, on a scale of one to five, or a scale of one to 10. You'll rate it as a one if it's mild; three if it's distressing, but not horrible; and up to five if you consider it unbearable. We're going to have all sorts of tips like this.
Sure.
This pain scale I find fascinating. It's simple, but can really solve a lot of problems for patients and doctors. Lots of tips coming up. Stay with us on WEEKEND HOUSE CALL.
(COMMERCIAL BREAK)
(NEWSBREAK)
(COMMERCIAL BREAK)
GUPTA: All right. Welcome back. We're talking about talking to your doctor. Before we get to our next e-mail, you want to make another point about pain, really quickly here.
BRANCH: Well, actually I wanted to make a point about what you just said about pain.
GUPTA: OK.
BRANCH: A lot of people don't realize that the physician makes the diagnosis, 90 percent of the time, from the patient's history. All the tests and all the exams we do, contribute only 10 percent of the diagnoses. And when I said earlier on, if you were a patient, if you could think about how to structure what you're going to say and what you want to say. I mean the history that you just gave of pain is an absolute role model for what you'd like a patient to tell you. I mean, you're going to make the diagnosis from those things the patient says about where the pain is, where it radiates, how did it -- when did it start, is it getting worse. All of those simple factors.
GUPTA: Sure. It's an interesting point, you know. So many doctors now, relying on tests and fancy tests, sometimes, but sometimes a history being so important, something doctors and patients need to remember, as well.
BRANCH: Yes.
GUPTA: Let's try and get to another e-mail, here. I believe Eileen in Maryland has a question.
"How do you get your doctor to listen to your when you are in pain or ill and he says he cannot find anything wrong?"
So here's an interesting thing -- you, Dr. Branch, we've talked a lot about communicating pain. When a doctor can't find out what's wrong, what should a patient do? And also, as part of that, when you look for a second opinion or another doctor -- that's another important topic -- how do you talk to your primary care doctor about getting that second opinion?
So, here's a scenario: A patient comes into the doctor's office with lots of pain. They can barely communicate what's wrong with them because their any so much pain and the doctor says, "You know what? Sorry, I can't find anything wrong with you." What does a patient do in that sort of situation?
BRANCH: Well, first of all, I think doctors know, now, that people can be in pretty severe pain and we may not be able to find anything wrong. I mean, we may not be able to find what we would call "objective evidence" and there still could be severe pain. And I have to say, this problem is a bit overwhelming for a lot of doctors. There are a lot of doctors that will feel kind of a knot in the stomach when they have a patient like that, because it's tough, and the patient is suffering -- they don't know what's wrong, it's very hard to assess. The first thing the doctor may thinking is, actually can I send the patient to someone -- a pain specialist? I actually would suggest to the patient -- making -- asking the doctor that question. There is pain, I would say if I were a patient, "I am in pain, I know this pain is real, I'm experiencing it. I know that pain sometimes can't be found. Is there a pain specialist I can go to?" I think that often takes the heat off the doctor.
GUPTA: A second opinion is into the bad idea sometimes, right?
BRANCH: It's a superb idea.
GUPTA: Yeah, OK. We're getting a lot of tips so far, this morning and there's going to be a couple final thoughts when we get back.
How to communicate better with your doctor and how doctors communicate better with your patients. Dr. William Branch and I will be back, right after this break. Stay with us.
(COMMERCIAL BREAK)
GUPTA: All right. Power patients and power doctors that's been the theme of today's show. A final thought there, from Dr. William Branch.
BRANCH: Sure. Let me reflect a moment on some of the meaning of what I've said. There is a lot of concern, nowadays, about the patient-doctor relationship, about the need for trust, which is always been the bedrock, and the need for us to maintain professionalism, which basically means, the patient comes first before everything. So what I would say that patients should understand is that's what we're striving for. And what we're striving for is a partnership.
GUPTA: Collaborative effort between doctors and patients, no question about it. Well, really important topic and that's all the time have for -- time for, today. So, thank you so much for joining us. I really appreciate that.
Remember, this is the place for the answers to all of your medical questions. Thanks for watching this morning. I'm Dr. Sanjay Gupta. "CNN Sunday morning" continues, now.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
Aired September 14, 2003 - 08:29 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: All right. Good morning and welcome to CNN's WEEKEND HOUSE CALL. I'm Dr. Sanjay Gupta. Well, taking control of your own health care and becoming a power patient. We want to help you meet those goals, today. A very important topic. The first step, learning to communicate effectively with your doctor.
(BEGIN VIDEOTAPE)
GUPTA (voice-over): Going to see a doctor can be a stressful event to begin with. Not really knowing what's going on after the appointment can be even more stressful. Experts say poor communication between the patient and the physician is the real culprit. Over the past decade, medical schools have been trying to teach new doctors thou better communicate. Step No. 1, listen.
Emory University's Dr. William Branch says many physicians blame poor doctor-patient communications on the ever-present lack of time. But, he says when researchers videotaped experienced physicians with real patients, what they found was not encouraging.
DR. WILLIAM BRANCH, EMORY UNIVERSITY: They discovered that the average patient was interrupted within 11 seconds of starting to talk.
GUPTA: He has this advice for all physicians.
BRANCH: What I will tell them is, if you listen for just a minute you've already done five times the average doctor.
GUPTA: Listening to what patients say, how they say it, what words they use, observing their body language can all help the doctors find out what's really bothering the patient and it only takes a few minutes. But, how patients communicate with the doctor also plays a large role. Given that physicians have a limited time to spend with each patient; it can be frustrating when patients haven't organized their thoughts about what's bothering them. Patients can help their doctors help them by doing simple things like collecting their thoughts and writing down questions in advance, and writing down all medications that they are taking.
(END VIDEOTAPE)
GUPTA: All right, so if you take a lot of medications and have trouble remembering all the dosage amounts you might want to consider bringing your medications to your appointment, that could be an easy way to take care of that. Make sure to include vitamins as well, over-the-counter drugs, and herbal supplements, they are often important. And, there are other things you can also do to prepare before you even get to the doctor's office.
Make sure you have a piece of paper and pencil with you; you might even consider getting a special notebook or folder that you use just for keeping your medical information. Gather up your pertinent records, keep a hold of those things -- letters from other doctors and x-rays, also keep a reminder of what your drug allergies are and write those down, as well.
Now, you may want to ask a relative or friend to accompany you to the appointment and that gives you another set of ears. Sometimes two sets of ears are better than one in terms of hearing your doctor's advice.
We're going to have lots of tips today, more than two dozen other tips for you throughout the show. We know you have lots of questions from us, so we want to hear from you. Call us, 1-800-807-2620. International charges may apply for our overseas callers. Or e-mail us, if you're an e-mailer that's at housecall@CNN.com.
There's lots of information to get through today, so joining us for your HOUSE CALL, this morning is Dr. William Branch. He is from the Emory University School of Medicine, he's an expert in doctor- patient relationships, also an internationally recognized leader in medical education.
Thank you so much for joining us, appreciate it.
BRANCH: Thank you, Sanjay.
GUPTA: Lots of questions here and we're not going to rush through these because you -- you've already told us that it's important for doctors to sometimes take their time. We're going to talk about all those issues, but there is a lot of people curious about this topic. So, let's get to one of our e-mailers.
First one, Jim in Massachusetts writes, "My doctor is always in a rush when we meet. He allows 15 minutes for each visit. What can I say to get him to slow down and listen to me?
And, Dr. Batch, I mean, you've talked a lot about this. I think this sort of gets to the issue. How do you get the doctors to slow down?
BRANCH: I mean, it's a tremendous issue for the doctors. I mean, if you meet with doctors nowadays you'll hear more about this 15-minute limit on visits than almost anything else. Which is -- it's very disturbing for them because they would like to spend more time. I think, first of all, the patient should organize their thoughts when they go in. They know that the doctor will have some time pressures, and the doctor should ask them a question that allows them to talk, and -- so that the first thing would be organizing your thoughts into a coherent, minute or two, where you can really convey what is that's most important to you, that you want them to care for.
GUPTA: Is it the insurance companies you think that are putting these time limits on doctors or why is that happening?
BRANCH: Well, in the managed care setting, the doctors economically, it boils down to they really need to increase their productivity.
GUPTA: Is it the insurance companies, you think, that are putting these time limits on doctors or why is that happening?
BRANCH: Well, in the managed care setting, the doctors, economically, it boils down to they really need to increase their productivity.
GUPTA: Yeah, because you mentioned that the doctors actually would like to spend more time with patients, but sometimes they can't.
Let's get to another e-mail question. We'll get to more of this in a little bit. Our next e-mail coming to us from Stanley in Texas, who writes, "Doctors rush to get through a long list of patients. Short of standing on your head, how do you get their attention and detailed questions about your condition? Sometimes, the doctor is more worried about the next patient than about me!
And, let me just say, because this is sort of, obviously, talking about the same thing as well, there are a couple tips here, Stanley, if you sort of think about. Try starting your visit by simply talk -- telling your doctor that due to the seriousness or complications that are -- you think are involved this visit may take a little longer than usual. That's sort of important, have that conversation off the top. Also have a short list of questions. Keep the list of questions short but focused, that you prepare at home, and then you may want to go to the library or on to the Internet, or something else to do some research so that you're familiar with the medical terms related to your condition and possible common treatments for that sort of stuff, that may help facilitate. Anything else to add to that, Dr. Branch?
BRANCH: Well, I was going to say that when we teach doctors, I mean, our first -- our very first principle is: ask a an open question to the patient and let the patient talk for a few minutes and listen to them. And even at -- we usually tell the students, ask several open questions before you stop, and then ask your own questions. The patient could use some of the same -- could use some of the same advice in terms of preparing for that. The other thing is, in terms of trying to help the doctor to structure the interview, little comments like "I need to explain this to you" or "this is important to me, can you spend a little time -- can I spend a little time explaining this?" I think those kind of things would actually help the doctor to focus on what you think is important.
GUPTA: And, I should point out, this is something you do, I mean, you spend time training not only student and residents, but also doctors. They seem pretty amenable to that, when they hear this sort of advice? If they get an open-ended questions, most doctors are going to respond well to that, you think?
BRANCH: Well, let's just say that in the last 10 years there's been a tremendous increase in the amount of teaching on patient-doctor communication in medical schools around country.
GUPTA: OK.
BRANCH: And, we with very really stressed some of these basic principles to the students. Now, I think the practicing doctors that graduated, you know, furthered in the past did not get this training, but a lot of them have learned on the job.
GUPTA: All right, and hopefully some of them are watching today, as well.
We got a phone caller coming in now, as well. Debbie from Missouri.
Welcome to house call, Debbie.
DEBBIE, MISSOURI: Good morning. My question was: Why do doctors or the staff sign up so many people for the same time?
GUPTA: And, did you hear the question OK, there?
BRANCH: Yes.
GUPTA: Talking about signing up so many people. I think you already, sort of, touched on that a little bit with the managed care. But, how do you -- what do you say to Debbie?
BRANCH: Well, the doctor is trying to manage their schedule, and they might be -- I'll just have to speculate. I think they might be trying to -- what we call frontload the schedule in order to be sure that there are enough patients there at the beginning of the session to get started efficiently. That should not -- I mean there should be a limit to the number of patients that are brought in, and they usually -- we don't bring them in at the same time. We would bring them in -- in staggered intervals. It may seem like the same time, by the time you get signed and ready to go.
GUPTA: So, if you want a 12:00 appointment your doctor says I have four patients scheduled for 12:00, that could be a problem, right?
BRANCH: Well, of course -- you know, there's so many different varieties of practices, and, I meant, there are some great doctors out there who do primary care that have large patient volumes they take care of and you have to respect them, and I mean, they will -- you know, they will go the extra mile sometimes to see their patients when the patients call, they'll sometimes just say come on in...
GUPTA: All right.
BRANCH: I'll see you.
GUPTA: Lot more tips coming up. One of the most difficult things for patients to describe and for doctors to really fully -- understand is pain. When we come back: How to explain your pain. We're going to take more of your calls and your e-mails. We want to hear from you. Our number 1-800-807-2620 or e-mail us, we'll try and get your question on the show, as well, housecall@CNN.com. Stay with us.
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GUPTA: All right. I'm Dr. Sanjay Gupta and we're turning you into a power patient, this morning, with tips on how to talk to your doctor. You can give us a call, that's at 1-800-807-2620 or send us an e-mail at housecall@CNN.com.
Right now it's time to check our "Daily Dose Health Quiz." See if you know the answer to this question: More than age, race, income, employment status, or education level, what one skill is a better predictor of someone's health status?
We're going to have the answer to that in 30 seconds. Stay with us.
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GUPTA: Checking the "Daily Dose Quiz," now we asked: "More than age, race, income, employment status, or education level, what one skill is a better predictor of someone's health status?"
The answer is: health literacy, which is the ability to read, understand, and act on health information is one of the strongest predictors of health status.
That information, incidentally, came from askme3.org where you can get more information on patient-doctor communication.
At askme3.org they recommended three simple questions to get the most out your doctor's visit. The questions are: What is my main problem? What do I need to do? And, why is it important for me to do this?
Sounds like pretty basic stuff, but sometimes keeping it simple can be the key to good communication. I'm here again, with Dr. William Branch, he's from Emory University. He's a recognized leader in medical education and in also training doctors and residents to actually be better listeners and communicators. Sort of helped me out quite a bit this morning.
We got a lot of e-mails and phone calls coming in, no surprise, there. Let's take our next one which comes from Dave in Illinois, who writes, "I found it interesting that my current doctor was much more responsive to my pain when I had an ankle sprain than previous doctors have been. I'm not sure if it was because he had broken his ankle, as well, a few months earlier.
Is there a link between doctors having experience with pain and recognizing the pain isn't always a positive thing for the patient? Previous doctors, on a different situation, scratched their heads and wrote down "Neuropathy" and simply said to deal with it."
You know, it's sort of interesting, right? I mean if a doctor's, I guess, is like anybody else, if a doctor has been through it, they're probably more likely to be sympathetic to the situation?
BRANCH: Well, there's no question. I mean I would hate to have to recommend that every doctor experience the illnesses of their patients. Pain, in particular, is hard to appreciate, unless you've experienced it.
GUPTA: Right.
BRANCH: I mean I had a cervical disk, myself.
GUPTA: Yeah, right.
BRANCH: And I'll tell you, once I've been through that pain, I know what it's like for these patients. And prior to that, I did not. I have to confess. I did not quite -- I did not grasp what it was like to be in constant, severe pain for a period of time.
GUPTA: I'm going to second that. I just had a herniated disk in my lower back, as well. And, I take care of that particular problem as a neurosurgeon. But, after I've been through it myself, I have a pretty good idea of what it is these patients are talking about, probably a lot more sympathetic to that.
BRANCH: Right.
GUPTA: Let's stay on this theme, here. I'm going to get more of your thoughts, but let's stay on this theme because Lisa from Florida also wants to ask a question about pain, I believe.
Lisa, good morning and welcome to HOUSE CALL.
LISA, FLORIDA: Hi. How are you?
GUPTA: Good morning. Do you have a question?
LISA: Yes. I'm sorry. My problem is, I have several major medical problems, and I have -- my main one is I have costochondritis and I also have heart stints in both main arteries and I can't tell the difference between, is it my heart or is it my costochondritis and the pain management doctor takes care of that, but my primary care doctor just has a fit over my pain medication.
GUPTA: So, trying to distinguish between treat -- costochondritis, we should just say, is an inflammation of the muscles in the chest wall and sometimes that can be confused with heart pain or chest pain, due to the heart. What do you tell someone like Lisa?
BRANCH: Well, she's asking two questions. One is about pain management. I mean, doctors today are being trained -- a lot more emphasis is being placed on managing pain, and on the consent that we should be able to diminish pain in most patients. We're using this scale, for example. We're calling it the "Fifth Vital Sign."
GUPTA: Right.
BRANCH: That is, a scale of one to 10 where one is barely perceptible, 10 is unbearable -- where is your pain? And, we're training doctors to really ask about pain in every patient and really to try to treat pain a lot more aggressively than we did in the past. As an internist, I mean I'm constantly am dealing with people whose problem is they might have costochondritis, coronary artery disease. You know, it's a very difficult problem. I think you to see the patient three or four times and sort through this before you begin to get a really good feel as to what is the costochondritis, they might have coronary artery disease. It's -- you know, it's a very difficult problem. I think you have to see the patient three or four times and sort through this before you begin to get a really good feel as to what is the costochondritis and with is the coronary disease.
GUPTA: Right.
BRANCH: And usually what I say to patients is, now, once we know that this is costochondritis, you can relax when you have this. But when it changes, in some significant way, that's when I want you to call me or come in and be reevaluated.
GUPTA: Now, talk about that pain scale for a second. You were mentioning that earlier, as well. What -- most people don't know what that is. How would you describe what a pain scale is?
BRANCH: Well, it's an effort to quantify pain, and it's also, frankly, a way to get doctors to pay more attention to the pain their patients are in. And, it would help the doctor if you can give me a scale, if you can say, my pain is a 6, where a 10 is unbearable. Now, that's still subjective, but if I treat you and you come back and say it's a 3, I know I've done some good.
GUPTA: So, you can put it all in relative terms.
BRANCH: Right.
GUPTA: Very important topic. Yet, let's run through some other tips, as well, that may help Dave and some of the other viewers communicate pain because this is a tough one for doctors and for patients. We spent a lot of time on this particular topic.
If you have ongoing pain, try to keep a pain journal. Write down when the pain occurs, how long it lasts, note exactly where the pain is occurring and be as specific as you can. Sometimes a doc. will ask you to point to it with one finger. Jot down what you were doing when the pain occurred, write down a description of the pain, try using the words like dull, throbbing, burning, stabbing, shooting, and cramping, some sort of descriptive word to help the doctor understand more about your condition. It can also be helpful gauge or rate the pain, as Dr. Branch was saying, on a scale of one to five, or a scale of one to 10. You'll rate it as a one if it's mild; three if it's distressing, but not horrible; and up to five if you consider it unbearable. We're going to have all sorts of tips like this.
Sure.
This pain scale I find fascinating. It's simple, but can really solve a lot of problems for patients and doctors. Lots of tips coming up. Stay with us on WEEKEND HOUSE CALL.
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GUPTA: All right. Welcome back. We're talking about talking to your doctor. Before we get to our next e-mail, you want to make another point about pain, really quickly here.
BRANCH: Well, actually I wanted to make a point about what you just said about pain.
GUPTA: OK.
BRANCH: A lot of people don't realize that the physician makes the diagnosis, 90 percent of the time, from the patient's history. All the tests and all the exams we do, contribute only 10 percent of the diagnoses. And when I said earlier on, if you were a patient, if you could think about how to structure what you're going to say and what you want to say. I mean the history that you just gave of pain is an absolute role model for what you'd like a patient to tell you. I mean, you're going to make the diagnosis from those things the patient says about where the pain is, where it radiates, how did it -- when did it start, is it getting worse. All of those simple factors.
GUPTA: Sure. It's an interesting point, you know. So many doctors now, relying on tests and fancy tests, sometimes, but sometimes a history being so important, something doctors and patients need to remember, as well.
BRANCH: Yes.
GUPTA: Let's try and get to another e-mail, here. I believe Eileen in Maryland has a question.
"How do you get your doctor to listen to your when you are in pain or ill and he says he cannot find anything wrong?"
So here's an interesting thing -- you, Dr. Branch, we've talked a lot about communicating pain. When a doctor can't find out what's wrong, what should a patient do? And also, as part of that, when you look for a second opinion or another doctor -- that's another important topic -- how do you talk to your primary care doctor about getting that second opinion?
So, here's a scenario: A patient comes into the doctor's office with lots of pain. They can barely communicate what's wrong with them because their any so much pain and the doctor says, "You know what? Sorry, I can't find anything wrong with you." What does a patient do in that sort of situation?
BRANCH: Well, first of all, I think doctors know, now, that people can be in pretty severe pain and we may not be able to find anything wrong. I mean, we may not be able to find what we would call "objective evidence" and there still could be severe pain. And I have to say, this problem is a bit overwhelming for a lot of doctors. There are a lot of doctors that will feel kind of a knot in the stomach when they have a patient like that, because it's tough, and the patient is suffering -- they don't know what's wrong, it's very hard to assess. The first thing the doctor may thinking is, actually can I send the patient to someone -- a pain specialist? I actually would suggest to the patient -- making -- asking the doctor that question. There is pain, I would say if I were a patient, "I am in pain, I know this pain is real, I'm experiencing it. I know that pain sometimes can't be found. Is there a pain specialist I can go to?" I think that often takes the heat off the doctor.
GUPTA: A second opinion is into the bad idea sometimes, right?
BRANCH: It's a superb idea.
GUPTA: Yeah, OK. We're getting a lot of tips so far, this morning and there's going to be a couple final thoughts when we get back.
How to communicate better with your doctor and how doctors communicate better with your patients. Dr. William Branch and I will be back, right after this break. Stay with us.
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GUPTA: All right. Power patients and power doctors that's been the theme of today's show. A final thought there, from Dr. William Branch.
BRANCH: Sure. Let me reflect a moment on some of the meaning of what I've said. There is a lot of concern, nowadays, about the patient-doctor relationship, about the need for trust, which is always been the bedrock, and the need for us to maintain professionalism, which basically means, the patient comes first before everything. So what I would say that patients should understand is that's what we're striving for. And what we're striving for is a partnership.
GUPTA: Collaborative effort between doctors and patients, no question about it. Well, really important topic and that's all the time have for -- time for, today. So, thank you so much for joining us. I really appreciate that.
Remember, this is the place for the answers to all of your medical questions. Thanks for watching this morning. I'm Dr. Sanjay Gupta. "CNN Sunday morning" continues, now.
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