Tag: communicate

So, why did you come in to see me?

Just remember. This is supposed to be funny, but with a side of truth.

You know, my life is full and interesting. I get to help people every day and do what I love. That makes me one of the luckiest people I know. I will never forget that. I used to think, before I actually went into medicine, that every patient that would walk in that door wanted to be there and would be ready to be a part of their own healthcare team. Weirdly, that is not the case. This is true for a large portion of my patients, but for some, I am not so sure.

As I reflect over the last 20 plus years, I realize that there are several types of patients in my practice. Let’s review.

There is the patient that you inadvertently become friends with and become attached to. To some extent, this happens to me all the time. I always try to bond with my patients in attempt to care for them better. I try to get insight into their lives to help them through whatever issues they are trying to solve. They always tell you in medical school never to get attached, but sometimes I can’t help it. In my mind, it is a reflection of the depth of my caring. I am always careful to respect doctor patient boundaries though. It’s not like I go party at their houses or anything.

There is the patient that doubts literally everything you say. I mean everything. For every plan you come up with, they have a counter plan or they doubt that it will work. They question your every move. They constantly re ask the same questions to see if they can trap you into giving a different answer. I realize that most of the time, this has nothing to do with me. Often, these are patients that have been bounced from office to office without actually getting the help that they need. Or, worse yet, they have had a bad experience or suffered malpractice and this makes it very difficult for them to trust any doctor. I try to take that into consideration when working with them.

There is the patient who thinks THEY are the doctor. You know the one. They grew up with family members or friends that are physicians and they know just enough to be dangerous….to themselves and your 16 plus years of schooling are not going to change their mind.

There is the entitled patient, who thinks only of themselves and becomes indignant when attention is not focused on them. These are the patients that become irate when their pap smear is interrupted because I have to run to the hospital to save someone who is hemorrhaging. The “big picture” is somewhat lost on them. They want special treatment and have tantrums when things do not go their way, regardless of the reason. I try to set very clear communication and expectations with these folks, but sometimes they get upset nonetheless.

There is the patient that “never goes to the doctor.” This is the patient that hasn’t been to the doctor in years because they haven’t had any symptoms. This is the patient that doesn’t trust doctors and has to make sure you know it by repeating the first two statements multiple times during their visit. However, if this same patient suddenly has an issue that they determine to be urgent, you had better drop everything and address it right away. Never mind that they have neglected their health for years. It is up to you to fix it….and quickly……so they can go back to never coming in for check-ups.

Let’s not forget the self-diagnosing patient. We all know that with the help of Google, our friends, our family and the chiropractor, we can figure anything out on our own, even before reporting to the doctor’s office. Those are the folks that come in convinced they have a rare tropical disease because Doctor Google said so after they typed in their symptoms. It is often very difficult to talk them out of it, but I try. Half the time, they are apologizing for looking stuff up in Google, as they are insisting that it has to be correct!

There is also the patient with overbearing family members. In my case, this most often presents and the teenage patient with the anxious parent. The parent is often on a covert fact-finding mission to discover if the teen is sexually active or not. They talk over the patient, and try to fill in all the details to show how concerned they are, but then don’t really seem to want to hear what the teen has to say. I get that they want to make sure the patient gets what she needs, but this behavior only shuts down any potential successful communication that I was hoping to have the patient.

There is a final category. This is the one we spend our whole careers hoping to encounter: the patient that reminds you why you went into medicine in the first place. This is the patient that appreciates what you do for them and how you care for them. This is the patient that is nice to your hardworking staff. This is the patient that follows through with what you recommend. This is the patient that talks with you not at you at the office.

The bottom line is that my job offers infinite variety. All of these patient types keep me on my toes and my mind fresh and ready for anything. They each have their own advantages and challenges. It’s not exactly how I thought it would be, but I wouldn’t change a thing.

Dr. Katz

I have been really struggling with how to be a good parent lately.

Parents tired of noisy children who are running and shouting Tired mother and father sitting on couch feels annoyed exhausted while noisy little daughter and son shouting run around sofa where parents resting. Too active hyperactive kids, need repose concept parenting stock pictures, royalty-free photos & images

Wow! I have been really struggling in the parent department lately. There have been so many unforeseen and unpredictable changes in the last two and a half years that have really affected my relationship with my kids and none of them are in my control.

The ongoing pandemic has ripped us all away from our usual social environments and has taken away many traditional milestones and events. As adults, we have missed out in person interactions with work colleagues, family gatherings, and the ability to be at loved one’s side during illness or hospitalization. This has been difficult but our capacity to recover is greater because, for the most part, we have plentiful stored memories to fall back on. For our kids, they are missing once in a lifetime experiences like prom, last sports games, and in person graduations. It has been argued that they should “get over it” because these events are nothing compared to high schoolers of the past who had to leave school to go off to war, etc. Last time I checked, no one is comparing prom to Nam and they shouldn’t start now. Missing these key social interactions has caused some long-lasting psychological damage for these kids. They will never get these moments back. The level of depression that I have seen is tremendous and it affects everything.

On top of the pandemic, I got cancer and my husband had a heart attack, one right after the other. My kids almost lost both parents in one year. As much as they put up an outside facade, I know this affected them tremendously. How could it not? They don’t treat us the same way. I get the feeling that, even though we survived, a part of them didn’t. A part of them walks around every day waiting for the next shoe to drop and they can’t seem to stop. There is just a little air of underlying depression and doom almost every day. It kind of breaks my heart.

There has also been a sense of life is too short no matter what is going on for them. This sounds like it should be a healthy realization, encouraging them to live life to the fullest, but instead I worry that it has become an excuse for unhealthy choices and directions. I am just at a loss as to how to handle it.

As a parent, I feel like I should be jumping on or punishing these poor choices or at least trying to redirect them. I worry that I am not doing my job if I don’t. I am concerned that it will seem like I don’t care if I don’t react. But really, it’s not true. I talked to my therapist about this. She explained to me that punishments don’t really work in this situation. Most punishments that I could think of would really only punish me and the other people relying on my kids in the long run. Taking away phones, jobs, privileges, and cars just mean that I will have to do a lot more driving, spending, and won’t be able to communicate remotely with my kids. She assured me that I am not being a bad parent by not reacting to every single thing and leaving some things up to my kids to figure out. It doesn’t mean that I don’t care. It doesn’t erase my validity as a parent. Ultimately, the consequences of their actions need to be theirs. Making myself overly upset about it does not help anything and is counterproductive. She advised me to take a step back and I think she is right. Overly obsessing and punishing and trying to address every little thing only increases my stress, increases the negative attention impact on my relationship with my kids and gets me no where. It can only end badly. I need to put a stop to the distracting inner struggle and keep growing and moving forward. I need to refocus. I need to no longer punish myself for not being there when I was sick or my husband was sick. I need to be patient. I can help them more by living my best life by example than fighting every day. I am not saying that I plan to let them run me over. There are limits. I am just saying that I need to pace myself and realize what is really important. Everything I have been through, my kids have been going through too and it’s not over yet. This is going to be a marathon, not a sprint.

Dr. Katz

Some Patients are More Fragile Than Others or, the Importance of the Healthcare Team

Doctors and health care teams listen up! I have something to say! Some patients are more fragile than others. What the hell does this mean? It means that you have to be extra careful what you say to them. It means that you have to be extra thoughtful before you speak to them. It means that you need to do your research before you open your mouth and accidentally freak them out. You as the physician are part of a team and the whole team has to communicate with each other so that everyone has the same information. The patient does not need to hear different and/or conflicting information from each source. This only leads to potential panic and confusion and makes it difficult for the patient to follow through and get the care that they need. To you it may seem like a simple oversight. To the patient, it can seem like the end of the world.

This really applies to all patients, but the group I have in mind at the moment are cancer patients. This group of patients literally has their lives in your hands. They hang on your every word. They are depending on you to help them get to the other side of their illness with an intensity that is greater than patients with other diseases. You have a direct impact on their physical AND mental health, both of which are key to their survival. Think about it for a second. Anything you say to them is regarding a disease that could kill them. You tell them if they qualify for clinical trials. You tell them what chemo or radiation they will get. You talk about costs. You have to talk to them if their cancer is not responding like you hoped. Sometimes you have to tell them they are going to die. Every word out of your mouth carries the weight of their future. One bit of discouraging news may not just mean a bad day for them. It may affect the rest of their lives. No. I am not exaggerating. It is really that important.

The bottom line is that the healthcare team has to be a cohesive, thoughtful, compassionate, comprehensive unit. Patient’s lives, mental health, and physical health depend on it.

Dr. Katz