What Did The Doctor Say?

Did the doctor say isolate, or irrigate? And was that two tablets, two times a day? Misunderstanding what a doctor says can be confusing and dangerous—and it happens a lot.

A study on health literacy released by the Canadian Public Health Association last fall revealed more than half of adult Canadians have problems understanding their doctor, and the problems worsen with age.

A 2009 study by Texas A&M University in College Station of patients with osteoarthritis severe enough to warrant knee replacement showed 18 per cent of them were unclear on whether the doctor had recommended surgery. In another U.S. study about one-third of adults tested misunderstood dosage and frequency instructions on medication labels. Another study showed half of patients on anticoagulants were unaware they were not taking their medicine accurately—raising the risk for stroke if they weren’t taking enough, or life-threatening bleeding if they were taking too much.

There are steps patients can take to make sure they better understand and remember what the doctor says, reports Bill Godolphin, co-director of the University of British Columbia’s Division of Health Care Communication, which holds Talk To Your Doc workshops.

The average doctor’s appointment lasts seven minutes “or up to 15 minutes if the problem is more difficult,” says Godolphin. Yet in that time, despite being tense, in pain, feeling sick or hurried, patients need to give their doctor accurate information on their conditions and come away understanding exactly what the doctor ordered. Even when the instructions are not initially clear.

The UBC workshops use the PACE protocol—which stands for presenting, asking, checking and expressing—developed by  Dr. Donald Cegala of Ohio State University.

“Preparing yourself is very important,” says Godolphin. Begin by thinking about the purpose of your visit. Are you reporting new symptoms or side-effects from medication? Do you need a diagnosis or referral to a specialist for tests? Or do you need a prescription refilled?

Present detailed information about how you feel. It helps to write down what you want to say. Describe your symptoms, when they began, whether they’re getting worse and what you’ve done about them. Provide a list of all medications you’re taking and dosages, including vitamins, herbs and over-the-counter medications.

Ask questions. “This is difficult for some patients because it feels like they’re being pushy or disrespectful,” says Godolphin, “but it’s really important.”  You can see a list of sample questions on Dr. Cegala’s website patcom.jcomm.ohio-state.edu. Write down the ones you think might apply.

Check that you understand by summarizing and recording what the doctor said. For example, ask “Did you say I need to take two pills twice a day?”

“If I had my way, I’d equip every patient with one of those little voice recorders,” says Godolphin. Not only does a recording make sure you can remember the doctor’s instructions, but when doctors know they’re being recorded, they are reminded to be clearer. “Say ‘do you mind if I record this—my memory is not as good as it used to be,’” he suggests.  If you don’t have a recorder, take along a notebook.

Express concerns. They can be about medication or treatment. “Will this pill make me better?” “Are there side-effects?” This includes non-medical worries.  “Will I be able to attend my granddaughter’s christening?” Or “I don’t think I can afford that treatment.”  The doctor may adjust medication or suggest a different treatment to accommodate your concerns.

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Shining Light On Gum Disease

How many doctors wish for a magic wand they could wave over patients to detect a disease before any symptoms develop? Scientists at the National Research Council Institute for Biodiagnostics in Winnipeg have developed just such an instrument—though it’s based on science, not magic—to detect a disease that affects millions of Canadians and annually eats up an estimated  $9 billion of health spending.

The disease is periodontitis (gum disease)—a bacterial infection that attacks tissue around the teeth, then travels through the bloodstream to other organs, such as the heart. Gum disease increases risk of systemic diseases including heart disease and stroke, especially for people with diabetes.

“The technique is less subjective than current methods of examination,” says researcher Dr. Kan-Zhi Liu. “It is non-invasive…and uses light, not x-rays.”

The research team developed an infrared probe that ‘reads’ levels of inflammation, a telltale sign of gum disease. The probe, resembling a small flashlight, measures light reflected from patients’ gums, which varies depending on oxygen levels in the blood, and how much water is in surrounding tissue. Low oxygen levels and swelling indicate gum disease.

The device can detect the disease long before symptoms like swelling, bleeding, plaque, bone loss or receding gums become visible. At this stage, treatment is cheap and easy. Once symptoms are visible, the infection has already begun destroying attachment fibres and bone supporting teeth. As the disease progresses, it becomes harder and more expensive to treat. The gums separate from the teeth, forming pockets that fill with plaque, spreading the infection.

The probe will not only allow dentists to start treatment earlier, but will help eliminate expensive diagnostic mistakes—either treating healthy tissue after it has healed or not treating in cases with subtle symptoms. It “will be able to identify specific areas of the gum that need treatment and rule out those areas that don’t,” says Liu.

NRC anticipates the probe will be available to dentists in about three years, and should be widely available, since it’s based on low-cost technology now used in telecommunications.

Laughter Is The Best Medicine

Here are some cheery insights for these troubled times.

Positive emotions help you stay healthier—even when you’re poor. Positive emotions like love and laughter, enjoyment and enthusiasm are critical to health of the deeply poor, never mind those of us more blessed, according to researchers at the University of Kansas.

A study of 150,000 adults from more than 140 countries around the world  showed that positive emotions are linked to better health—even when people are lacking their most basic needs like food and shelter. And the reverse is also true: negative emotions reliably predict worse health.

And one good way to increase your happiness quotient is to listen to some of your favourite music (assuming your sound equipment or IPod hasn’t been repossessed).

Joyful music arouses emotions that improve blood vessel function, researchers at the University of Maryland School of Medicine have discovered. When volunteers listened to their favourite music, tissue in the lining of their blood vessels expanded by 26 per cent, increasing blood flow. When they listened to music that caused anxiety, their vessels narrowed by six per cent.

The results, reported lead researcher Michael Miller “were music to my ears because they signal another preventive strategy that we may incorporate into our daily lives to promote heart health.”

In earlier research the team discovered that watching feel-good movies increases blood flow by 22 per cent, while seeing a flick that caused mental stress decreased flow by 35 per cent.

Laughter also boosts the immune system, a research group at Loma Linda University in California discovered. Laughter reduces secretion of stress hormones and increases immune response, and these effects on the body last a whole day for some people. In fact, even thinking you’re about to have a good laugh reduces the level of stress hormones, these researchers found.

So, leave your worries on the doorstep, listen to your favourite CD, rent a comedy and share a joke. It will help you weather the recession in better health.

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