Streams

How to Get Better Health Care from Your Doctor

Tuesday, July 01, 2014

The Medicare patch is a bramble of thorny political issues. (Shutterstock)

Diagnosis, once the cornerstone of medicine, is fast becoming a lost art, with grave consequences, argues Dr. Leana Wen. She talks about the doctor-patient relationship, uses real-life stories of diagnoses-gone-bad, and explains how active patient participation can prevent these mistakes. Her book When Doctors Don’t Listen: How to Avoid Misdiagnosis and Unnecessary Tests offers follow-up questions patients can incorporate into every doctor’s visit to get better care and to avoid counterproductive and potentially harmful tests.

 

Guests:

Dr. Leana Wen

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Comments [23]

jon f edelbaum from NYC

It is always the case of finding the right doctor. I found the wrong one who looked at a sore and non-functioning shoulder and who diagnosed the problem as "you are getting old ha ha" 6 months later i damned near drowned when the "old shoulder" froze up when i was on a swim in the ocean. My son-in-law who is a banker diagnosed it as a rotator cuff, and sure enough when i went to the right doctor at HSS he shoved me through an MRI and that is what the problem was. How do you find the "right" doctor is the problem and my only thought is to talk to everyone you know before you see a doc for a diagnosis. I do not trust the websites - they are easily rigged - and random choice is just that. You have friends. Use them.

Jul. 02 2014 11:40 AM
Doc Chip from NY

Dr. WEN HAS HIT ON THE EXACT issues that are problematic in the rollout of ACA as it is currently conceived. It leverages insurance data and procedural practice while de-emphasizing the actual practice of medicine itself which involves careful exploration of the history of the complaint and the complete history as much as is possible form the patient to get at a well defined
listing of diagnostic possibilities and then define a treatment program with built in re-evaluation of the response to treatment so as to secure a return toward improved health.

the system is founded on population disease studies (textbook) and not individual health and individualized prevention models of thinking.
these have ben shown to be superior in cost analysis and in quality of care outcomes measures many times over.

Please thank her for her efforts in writing her book and I would ask that the show cover more details on the “war against physicians and patient care“ in this country that ACA may actually represent. The decisions that are made now will have serious and profound effete and cost on our [populations health and our individual health nationwide. Our expenses have already climbed astronomically with zero additional benefit of improving healthcare deliver to the individual. The profits have gone to the insurance companies, the Electronic health record companies and the bureaucracy that had to be built to manifest and monitor all the operations that have been added that have no real influence on delivery but do reduce access to treatment.

Jul. 02 2014 09:42 AM
j276

A tip: find out who medical field friends see and go to them. There is often a large difference in who the public likes to see and those that are the most capable...

As usual, this conversation yields black and white thinking when the reality is gray. Yes, docs are hamstrung by time constraints and a thorough history is best. It is still true that care is better now than when these were fewer diagnostic options. Also in the example if the appendix rupture, the same client that loved the doc that explored the child based on clinical signs would probably have tried to sue if the result was a nonsurgical abdomen...

Also love the anti-science thinking on this board. If you actually know what homeopathy is and still choose it over science, you deserve the results you get.

Jul. 02 2014 03:28 AM
LB from NYC

When I was a 24 year old graduate student, I went to the student health service of the university with terrible abdominal pain. Pain unlike anything I'd ever felt before that came in discrete "attacks." After an exam and some tests, the doctor determined that it sounded like gall bladder disease but I wasn't fair, fat or forty (the cookbook indicator for gall bladder disease) so they dismissed it as psychosomatic and sent me to the psychiatry department. Believing that was the answer, I engaged in several months of "therapy" to straighten out my life and heal my abdomen. Six months later there was no improvement in the intensity of the attacks although with self-imposed dietary restrictions I succeeded in reducing the number of attacks. I mentioned this to my mother who immediately guessed that it was gall bladder disease and sent me to the surgeon who had removed her gall bladder, several years earlier. He reviewed the X-ray images taken by the university hospital and saw 6 gall stones. They were removed a month later, putting an end to the painful attacks and teaching me the perils of cookbook medicine.

Jul. 01 2014 11:17 PM
ellen from Upper Manhattan

I once said to a doctor:"Repeat what I just said."I kept it very light but the doc definitely listened better after. I have no problem helping a doctor be as good as she/he can be with me. The anger we feel at doctors comes directly from our fear of helplessness in a vital aspect of our lives. We can't control how much the doctor cares and it can make us feel powerless. For me, the antidote is empowering and caring about myself. When I read up, come prepared, question a doctor in a polite, firm way,etc., I feel much better and I know I've gotten better care. I've seen the flicker of respect and gratitude on a doctor's face. When I can both realize and accept how very human my doctors are, my visits become a whole different ballgame.

Jul. 01 2014 09:42 PM
peter mcclean from Norwalk Ct

With all due respect Dr Wen's comments were very generous to MDs. Once again the absence of personal skills on the part of MDs and the lack of diagnostic expertise lays the blame for poor dialogue on the patient. From time to time I have met and dealt with MDS whose interpersonal skills were highly attuned to listening to the patient.I would suspect they are superior doctors. Too often it would appear to the layman that MDS are more concerned with productions numbers, i.e. processing patients, after all the more patients seen listening or not the more the financial reward.
The real solution to many of the issues mentioned is "physician heal thyself." MDs often seem imbued with the notion that they are gifted with superior intelligence. They need to prove it through outcomes.
Listening is a skill that can be acquired even though it not taught in school.

Jul. 01 2014 06:31 PM
Kate Hoekstra from Putnam VAlley, NY

People...and doctors....are joining concierge practices in ever increasing numbers because they know that the essential problem with "getting good care" is that doctors are taking too many patients on in order to make up for the decreasing payments they are receiving. With ACA, that is only going to worsen. Concierge doctors, who are retainer based, limit their practices to a TENTH of the number of patients seen in traditional practices. If you do the math, it's easy to see that this is a sure way to get the doctor's attention!

Jul. 01 2014 06:10 PM
Gail Enid Zimmer from Fair Lawn, NJ

I read this book last year but didn't find it helpful because doctors will not listen no matter what! I disagreed with our primary care physician's diagnosis of depression in my husband and didn't want him to take the medication that he prescribed. He had been suffering from Parkinsonian symptoms for several years, and his neurologist said he never gave his patients this medication, which had potentially serious side effects in the elderly and debilitated. The result of my protest? We were sent a registered letter terminating us as patients with ALL doctors in that group! My husband suffered a stroke as a result, which I attribute to this medication and one other prescribed for hypertension, when my husband's medical condition caused fluctuations in blood pressure, and having to start over with new doctors led to my husband's death a year later. A postmortem autopsy disclosed Lewy bodies, which no doubt contributed to behaviors that were misinterpreted as depression.

Jul. 01 2014 01:42 PM
Paul

Symptoms in human beings are generally symptoms of some kind of spiritual imbalance in some way, even while they show up as physical symptoms in physical bodies. The spiritual background to what is considered "human" is what is largely missing in Western medicine, which treats the body as if it's a machine that isn't working right, and it's just a matter of figuring out what the correct fix is. Instead of having a sense of approaching patients as individual holistic living entities, our study of anatomy has produced a fragmented view of different body parts and functions, which has led to an overly complex as well as complicated view of the body. In considering scientific medical history, including its pursuit of such a direction and such knowledge, how it could it fail over time to produce a view of the body as an ultimately mechanical form, and treating it as such? This is the unspoken horror permeating Western medicine today, and hearing a conversation about how doctors can listen better is totally off-point.

Jul. 01 2014 12:59 PM
Bob

My daughter went to Phillips Ambulatory Care Center in Union Square (part of Mount Sinai Beth Israel) to get some travel innoculations for a semester abroad, having already received a physical and all other needed tests from her regular doctor and the college clinic. The Phillips doctor insisted on running various hepatitis tests even though my daughter had already received the tests and vaccinations at her regular physical (and offered to call her regular doctor to confirm),with the Phillips doctor assuring her there would be no cost. Phillips then submitted bills totaling more than $1,000 to our insurance carrier. Seems like there is a financial incentive for performing unnecessary tests (especially when the provider also owns the lab).

Jul. 01 2014 12:43 PM
Lisa from Washington Heights

On a positive note, my mother, who has been homebound and ill for the past four years, has been getting visits from a doctor who makes house calls. It was difficult at first to find a doctor who does this, it took me nine months to find him, however, well worth it. She can get bloodwork done at home and not have to deal with the stress of going to his office. He's Harvard trained and is actually the director of a nursing home so he's well equipped to deal with the elderly.
The future of elder care will be more doctors who do house visits.

Jul. 01 2014 12:39 PM
Maria from Morristown, NJ

I gave my girlfriend the advise to get checked for ovarian cancer because she was blaoted and experiencing indigestion. I know those are early signs of it. Told her not to take no for an answer when she asked her gyno to test her for it. Her gyno told her that she was going thru menopause being about 53 and never checked her... a year later on her yearly gyno physical she was diagnosed with full blown ovarian cancer on both ovaries and that it went further into her body.

I am so disgusted with how many women are treated this way. Because I have had fibroids removed, I went to my gyno and asked to be tested for ovarian cancer. Again my gyno did not want to test me and said that she did not want me to go through life thinking I have ovarian cancer! She did not know the stats of NJ women and asked me to send her the information I had and where I got it. Needless to say I dumped her and later found out that this is the office that misdiganosed another girlfriend's fibroids... she had ovarian cancer and has been suffering from it for 12 years now. Considering we are in NJ, number 1 state for Ovarian cancer deaths, one would think our gynos would be more compassionate and considerate. It makes me sick that I have diagnosed 6 of my friends already, with various very serious problems, long before their doctors did. I am an artist who reads about medicine. I go to two doctors who both say "be your own doctor"... and who listen to their patients and give their patients credit for being intelligent enough to help them.

I totally agree with Dr. Lena Wen that people need to understand how to help their doctors. People have their heads in the sand... eat terrible, live unhealthy lives and then expect their doctor in a 15 minute appointment to figure their problem out.

Jul. 01 2014 12:38 PM
Amy from Manhattan

Nurses actually have separate "nursing diagnoses" that take cultural & emotional factors into account.

Jul. 01 2014 12:36 PM
Gary Book from Port Washington

In recent weeks, Apple and Google and others have announced new tools and technology for monitoring people and medical monitoring. With AI, (artificial intelligence) what is the possibility for using computers and "big data" for analyzing a patience's condition with all the data points?

Jul. 01 2014 12:34 PM
Steven from Bklyn

I think it's okay and even helpful to say to the doctor that you have a pain which you believe can be described as epigastric pain. That's assuming you have a pain in the upper abdomen right below the ribs.

Jul. 01 2014 12:30 PM
suzinne from bronx

Really, we should LEARN how to talk to our doctors? Now, this is the height of condescension if I ever heard it! WE, the patient are paying the doctor, so maybe, just maybe, the doctor should be learning how to talk to the PATIENT?

This doctor on the radio is getting on my nerves, especially when she says when a patient comes to a doctor with a suspected diagnosis, and she responds something like doctors discredit these comments because "the patient is pretending that they are something they are not." Just say it: doctors think they're patients are morons.

Hey lady, hope nobody buys your book, and I certainly WON'T. And by the way, my father died as a result of malpractice.

Jul. 01 2014 12:24 PM
Paul

This episode is just another which continue to erode confidence in the Western medical establishment. Just hearing how little sensibility is on display (about anything - where does one even begin?) confirms my decision to stick with visiting traditional Chinese, Tibetan, Indian Ayurvedic, homeopathic, or any other "alternative" practitioners. For emergencies, yes, I'll go to the emergency room at the hospital, as Western medicine is very good for that kind of intervention. But for anything else - including cancer, as well as chronic illness - I'll see anybody else but a Western doctor.

Jul. 01 2014 12:24 PM
Uri from New York

When the malpractice lawsuit is filed - they don't care how long you spent with the patient. They care what tests you did to the patient. Also if you as internal medicine doc for example do not see 30-40 patients per day - you cannot meet ends meet.

Jul. 01 2014 12:23 PM
Beth

After he went to two dentists and three MDs for his jaw pain, I took my father-in-law to a wonderful NYU physician who diagnosed angina on the basis of listening and asking one question, "Does the pain ever spread down your arm or to your chest?" When my father-in-law said, "Yes," I asked him, "Why didn't you tell anyone before?" His answer, "No one ever asked me." (We still see this perceptive, concerned physician, 25 years later.)

As a medical writer whose doctor knows my background, we both find using technical terminology enhances communication.

BTW, a great book is Lisa Sanders: Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis

Jul. 01 2014 12:19 PM
Barbara from New York & Freehold NJ

My mother died because the hospital would simply not listen to me, the daughter who knew her well and knew something was clearly wrong. They did their checklist...they did not listen. Lawyers told me I had a case but because she was 79 no one would take it due to contingency. I was not interested in money but interested in getting the word out about their inaction and lack of response. It took contact to a Senator to get them just to respond to me which basically was not much other than, "your mother was an ill woman." They never apologized, they never really cared about her or the fact that I have lost my mother.

Jul. 01 2014 12:18 PM
Amy from Manhattan

My mother died of breast cancer, but they never found a primary tumor. Her main symptom was back pain, & for a while her dr's. thought she might have Paget's disease. The cancer was advanced by the time it was found. I'm sorry Dr. Wen & her mother had a similar experience, & that so many other people do. I appreciate what she's telling us, although I don't know if it would have helped my mother get a diagnosis sooner.

Jul. 01 2014 12:17 PM
pina78 from So.Plainfield

Every time I go to the doctor I get very frustrated. Doctors are required to put data straight to the computer. So, instead of listening and talking to the patient they operate computer.
I wish all doctors be like your guest!

Jul. 01 2014 12:16 PM
anon

Thank you for such a helpful discussion. I actually only go to female doctors because over the years, I have found they listen far better. I wonder if there is anything in medical school or the culture of medicine that contributes to such a marked difference between the listening capabilities of female and male doctors.

Jul. 01 2014 12:15 PM

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