How To Get The Most Out Of Any Medical Appointment
Kara Wada, MD: Hey everyone, I am so excited to talk with you this morning about how to make the most out of any medical appointment. Insider tips from a doctor to an autoimmune patient, that would be me. For those of us that haven't met quite yet, my name is Dr.
Kara Wada. I am Board Certified in Internal Medicine, Pediatrics, Allergy Immunology, Lifestyle Medicine, have some additional training in medical education and as a life coach. And it was about two years into the job that I had dreamed of working, when I was diagnosed with systemic Sjogren's, within about two weeks of my daughter being diagnosed with a life-threatening egg allergy. And that really was our wake up call that we needed to make some changes.
It also was my trial by fire in regards to really experiencing life truly as a chronic illness patient, and understanding how frustrating it is. And also realizing the immense privilege I had as a physician. And once the dust settled and I was feeling a little bit better, I really realized it was my mission to help others navigate healthcare and wellness with a little more ease.
The systems are incredibly complicated and they're only getting more complicated. And so if I could help others have a little bit easier go at things that might allow me to have some reason for the suffering and the situations that I went through.
All right. So my disclaimer for all of my talks, although I am a doctor, I am not your doctor, especially in this context, and this information is for educational purposes only.
And over this next 30 minutes or so, our objectives are really to connect. To see the common commonalities in the humanity we share both as patients and as physicians, to walk in each other's shoes for a few moments, to identify and use the three principles that I really lean into for optimizing your next medical appointment. And then to learn a few practical strategies, some red flags to watch out for when you're navigating healthcare and wellness industries. Just some things to really open your eyes and think about things as a conscientious consumer.
How does one become a physician
Kara Wada, MD: Alright, so I wanted to just share a little bit about how does one become a physician. And so this was my path. I went to undergraduate college for four years and then four years for medical school. Occasionally there are some streamlined programs where it's six years to get your undergraduate in medical school education together, but most often, this is an eight year process.
Medical school consists both of classroom and clinical work. And increasingly over the last, 10, 15 years, that clinical work really starts from the get go within weeks of starting medical school. After you graduate medical school, the training is not over. You have continuation of training called postgraduate training, it's residency and sometimes fellowship. So residency spans three to seven years depending on the specialty. Family medicine, internal medicine, pediatrics are all three years. Neurosurgery, seven years. I did internal medicine and pediatrics, which is a combined program, which is four years long. And then fellowship is when you are able to specialize even further.
So for me, that was allergy immunology. My program was an additional two years. During this postgraduate education, we're typically working about 80 hours per week. Those are the work limits which were imposed within the last 15 years or so. And there are multiple examinations along the way from that MCAT you may have heard of, which is how you get into medical school.
There are multiple sets of board examinations that occur along the way. And the learning doesn't end when you've graduated and you've finished your postgraduate training. There are ongoing continuing education requirements that are a part of staying board-certified in those various specialties.
So I like to look back at this picture. It's picture from when Grey's Anatomy, debuted around 2006. I remember this and know this because this was my first year of medical school. And so my medical school in trainee story coincided with that of Meredith Grey and her colleagues and friends on Grey's Anatomy.
We think that it looks very exciting and sexy and all these things. But practicing medicine is a little bit of a different story, and I've used the dumpster fire analogy on occasion and it's one way that I use a little bit of humor and exaggeration to explain some of the issues that we're having within the healthcare system.
And unfortunately the reality is that about 62% of physicians, when they survey physicians within the last year or so, are burned out. And that really affects our quality of care that we receive on the patient side. And so this is a meme that is used often within physician circles of, ' What do you want? More wellness lectures or mindfulness or some antidepressants or do you wanna pay more for some of these multiple exams?' And really all that we want is reasonable work hours, a civil workplace, some understanding of our humanity as physicians. And yet that seems to be really hard for sometimes the powers that be to understand that.
Okay, so that's the physician's plate. But let's think about our experiences as patients, right? We are in pain, we're exhausted, we're confused because we don't know what the heck is going on with our body. We're being passed from specialist to specialist, playing the game of hot potato, getting referred. You know you have eyeballs, so go see the eye doctor. You have a nose, go see the nose doctor. You know this organ, that organ. Countless tubes of blood. X-rays, CT scans, MRIs, all the bills that go along with that. And you may get that result of, 'Hey, your labs look great. I don't know what to say.' or 'Have you thought maybe it's related to your anxiety or your depression?' 'Do you think it's maybe related to your weight or your hormones?'
Some of that, either Frank dismissal or symptoms being brushed off and not maybe taken as seriously as they are affecting our quality of life. And that is no easy place to be in. So as we think about the physician-patient relationship really, when this relationship is functioning well, we are able to communicate what's going on, how our symptoms are affecting us. We feel that we can trust that our healthcare professional is going to care for us and do the best that they can for us.
It's really hard to do that though in many circumstances. We have seen a real shift in power dynamics and medicine. I think we're headed in the right direction, but for so often doctors we're seen as these god-like figures or superhero figures. And really I am excited and anticipate a time when we are really recognized in our humanness because I think that, One helps us as the healers to heal, to understand that we have our own limitations, that we need to take care of ourselves in order to take the best care we can of our patients.
We've also seen this is reflected in social movements, right? So you can think about how the evolution of social movements has come along too, and really seeing more of a push for for patient rights along with similar things to the 'Me Too' movement and and LGBTQ+ communities and so on and so forth.
Unfortunately, what we've seen though, we take this very human relationship between someone who is called to help ease someone's suffering, healthcare professional, and the person who is suffering, the patient. There are a lot of forces that wanna get in between, right? They wanna get like their piece of the pie.
They wanna make some profit off of things, they want to have their say. And so you see the role of insurance companies, government related and law changes, pharmacy benefit managers, hospital administrators, all these different outside forces are really putting so much pressure between the physician and the patient or the healthcare professional and the patient.
And we don't get as much face time with our healthcare professionals. And the unfortunate reality is we spend and see, more time, are able to build more trust sometimes with these other folks that we see more often on TikTok, on Instagram so on and so forth and that's a whole nother area that can come into play.
3 principles for preparing for medical appointments
Kara Wada, MD: Okay, so let's dive into the three principles that really can help you in this next encounter that you have with your physician or another healthcare professional. The first is owning your story. Second is taking the pressure off with some preparation. And then getting comfortable with the uncomfortable.
All right. So owning your story, you need to know your history, your medical history specifically. And you need to own it to understand it, to get an education and what's going on in your body. And one tool that can be really helpful is preparing a health summary to bring with you, especially when you are going to see someone who is new to your team.
Yes, we have electronic medical records. They're pretty great, but they have huge flaws and huge limitations. So the average patient, average, I am guessing many of us are above average here. The average patient creates 40,000 pages worth of data each and every year within the medical record system.
There also are multiple systems that different healthcare systems will use. There are some quite common ones. For instance, Epic is one that our hospital system uses along with several other hospital systems in my area. The problem is each hospital system has a different version of Epic. Although I can see some lab results, I can see notes from the hospital across the highway, I cannot see, for instance, the actual pictures from your CT scan or from your x-ray. So there are some limitations there in regards to how we can find that information. And I have to go into a separate area to look for it. As we're thinking about going through all this data, sometimes it's like looking for a needle in a haystack.
So having all of your diagnoses, medications you're on, dosages, perhaps even a list of medications you've tried and had problems with or maybe weren't effective. Some, your significant procedures, like if you've had colonoscopies, endoscopies, surgeries, the dates or outcomes of those also can be helpful.
And so what I would suggest to you is from this day forward, When you go to see a healthcare professional asking for a copy of the note, you should be able to get a copy of that now. Almost all healthcare systems are making those generally available to their patients but you also can ask for copies of your results as well.
I will say, so when you are reading through notes from your healthcare professional, give us a little bit of grace. We're trying to not only take care of you, but also document that at the same time. That was not always the case. We also will tend to use quite a bit of hospital speak, or sometimes we will need to use particular diagnoses that we are considering in order to get particular studies or labs covered by insurance. So keep that in mind as you are reading through these records. These records are a reflection of you, but also understand that they are professional records as well. And so there may be some aspects that are a little bit confusing. Feel free to ask questions and to inquire.
But also I think it's just important to understand that the notes in particular for many decades have been used to communicate between other healthcare professionals, and we as healthcare professionals are just getting used to having to write these, not only for communicating with one another, but also with our patients as well.
So give us a little grace with that as well. It's also important as we think about owning our story to think like a doctor and to start tracking your symptoms. So what are some things I'm gonna think about or ask about when you come in to talk to me about a particular symptom. If you're having pain or if you're having fatigue, it can be really helpful to tell me what makes it better, what makes it worse? Does anything make it go away completely? How bad is it at its worst, and how bad is it at its best? What are some activities that may cause problems with? Paint me a picture of what that looks and feels like. It also makes you more human, so it might help a doctor who's a little bit burnt out snap back in and, ' Oh, she can't sit and play with her kids because she's so stiff with her back pain. Man, she's only 35. That's not, that doesn't seem normal.' Like it's those little elements instead of, ' Oh, my back's stiff. My back is so stiff, I can't sit and play with my kiddos on the floor without crying. You know, like that. It's not an exaggeration that's what I was feeling, but that is doing maybe a little bit better job of explaining my symptoms. And I could say, 'Yes, my symptoms got better when I was pregnant.' 'They got worse after I had the baby.' ' They got worse when I was sitting for too long or not active.' ' They're worse in the morning and that lasts for X number of hours.' Those sorts of things can be really helpful because what's the doctor's going to do is they're gonna put their Sherlock Holmes detective hat on and they're going to try to piece together your history along with your physical exam to decide what labs are gonna be most helpful, what imaging might be most helpful, and how can then we get to the root of things and help move the dial so you're feeling better.,
Take the Pressure off (Understanding Your Nervous System)
Kara Wada, MD: Alright. Taking the pressure off. So we need to respect our nervous system. Hazard to say, nearly all of us, myself included gets activated when we go in to see a healthcare professional. And so activated. It's triggered or the sympathetic nervous system response, all describing the same thing. It is kicking off that fight, flight, freeze, or fawn response. I mention all of those because for some of us it may be our blood pressure goes off, white coat hypertension. Have you heard of that? It may be that you shut down and have trouble sharing your story. That's what I tend to do. Or I'll try to paint everything as this rosy picture, 'Oh yeah, I'm doing great. No problem.' That fawning response because I always like to people please. That's my baseline and something I have to push against. So what can we do to counteract this? One, Sit down before your visit, maybe a day or two before your visit. What do you need to communicate to your physician or your healthcare professional?
Do you need to say, 'Hey, my pain has been on the rise,' or, 'Hey, this medication I don't think I'm tolerating it too well.' Think about some of those, who, what, when, where, why, and when and how. Those different questions we had to learn in schooling. Also, think about what might make you more comfortable in that environment.
Do you need to have an advocate with you? Do you wanna ask your healthcare professional if you are able to schedule a longer appointment? Do you want to ask if it's okay if you record things? Can they provide a copy of their notes afterwards? All of these are ways that you can consider accommodating and respecting your nervous system as you're going into a visit.
All right. The last of our three steps is getting comfortable with the uncomfortable. The reality is vast majority of us, especially those of us with invisible illnesses, have had experiences within the healthcare system that have not always been positive. Whether it was something that was painful, but like from physical pain, emotionally painful or traumatic.
But the reality is, if we are having symptoms occurring, it behooves us to get those figured out and to try to reverse course in one way, shape, or form. So learning how to practice pushing back. Generally, you wanna stay respectful as best as possible, trying to give folks a little bit of grace, but also realizing we work within a system that has many imperfections, there are many layers. It can be frustrating and hard to communicate sometimes between visits. And we have to grapple with all of that. And I'll say that's on both sides of the coin.
Think about what your values are. That can be helpful as you are thinking about building your care team as well. Some folks will decide, 'Hey, I'm gonna continue getting some care within the university system for X, Y, Z, but for my primary care, I'm gonna elect to step out of the insurance system. I need someone who's gonna be on call. I'm gonna have access to them a little more directly. I'm willing to maybe think about paying a little bit for that service and for having those longer visits.
And so that would be something like a direct care type practice. I think, one of the ways that I have pushed back on my side of the coin is With very rare exceptions, refusing to double book patients.
And to ensure that I have enough time with my more complicated patients. And I think as a group, what I would love for us to do and to think about moving forward from this summit is thinking bigger. How can we push back? How can we be the change that we want to see and the cure we receive and the cure we give.
And so that is always going to require us to be pushing up against our limits of what we feel comfortable and safe in.
Health of Healthcare Professionals
Kara Wada, MD: So as I mentioned a little bit before, even before the pandemic, the health of our healthcare professionals was a big issue. And we know that the saying holds true. Hurt people, hurt people. And so what does burnout look like? And I think this is important to share here because this is one of the things you're gonna want to look for as a red flag potentially in your healthcare professionals that are helping take care of you and on your team. So depersonalization, feeling like you are being put in the role of a diagnosis or a number rather than a human.
Does this person not really have any empathy? Does it seem like that empathy chip was not installed in? Are they really cynical? I will have my moments of cynicism. I will say it's one of the ways that I deal with all of the dumpster fire that is there. But trying to really lean into that empathy is hard when your cup is empty, emotionally exhausted.
We also see, and this is why it's so important, those who are burned out have increased mistakes. They also resort to cognitive biases more often. So what is a cognitive bias? It is a shortcut our brains use in order to get from point A to point B in a little more streamlined fashion. And many times these biases work pretty well.
But if you are someone who doesn't read the textbook or you have something going on that is a little bit more confusing, cognitive biases aren't something that are likely to help your situation. You need someone who's going to be able to think creatively, to be curious, and those are things that take a lot more energy and brain power to sort through.
You'll see substandard work and poor teamwork too. And this will occur especially within like trauma teams or surgical teams. Think about in the OR, you need nurses, residents, surgeons, anesthesia, scrub techs, all these people working in concert together. And if you have poor teamwork that's when mistakes are more likely to happen.
And we see that in the rates of infection or rates of other mistakes that can happen. And actually that's some of the work that I help out with in some of my administrative roles at the university, is really helping those who are on the path to burnout or in the early stages of burnout, try to reverse course to help connect them with resources knowing that in the end is going to help improve the care of our patients along with our own health as well.
So you wanna look for, and we'll talk about this at the end, but you wanna look for someone who generally looks pretty happy and content in their work. That is a green flag. That's great to look for. So I just wanna add this little blip in here because I think this kind of comes into a similar overarching idea of navigating healthcare and wellness as well.
The reality is healthcare and wellness are big business, like trillions of dollars are spent on our health every year. And yet here we are in the US with worsening health. So all that money being put in.
Caution before using supplements
Kara Wada, MD: But you know what I like to say, and this is from my own lived experience, is if you are thinking about starting in particular a supplement or another complimentary treatment, hit the pause button just for a few minutes and remind yourself that natural does not always equal safer.
So arsenic. It's natural. It's also a poison that will kill you, right? Or even too much water. Too much water. You can get water intoxication and cause electrolyte problems too. So natural, not always safer. And nearly 20% of liver injury is caused by vitamins and supplements.
And I am one of those who experienced this. And in this picture, it's a little hard to see, but my eyes are yellow, itching all over, my liver enzymes were through the roof, and I was getting ready to have a little piece of my liver taken with a big needle, under kinda ultrasound guidance because my liver enzymes were through the roof.
And at the time we weren't sure if it was related to my Sjogren's. Or to one of the supplements I was taking. And once the pathology was reviewed both by the folks at Ohio State and by the National Institutes of Health, they were pretty convinced that this was related to a supplement I'd been taking.
We don't have the ability to narrow it down to specifically which one but I know which ones I stopped and so most likely from one of those. And the reality is when I reported this back to the company, they have no real like requirement to track this data. In part because they're not as highly regulated by the FDA as pharmaceutical medications. They have some oversight, but not as that.
I think it's just an important reminder that we need to be conscientious consumers. In general when we're thinking about our skincare or our vitamins and supplements, the pharmaceuticals we're using, let's take that pause button and then follow the science.
How suggestive does the science look? Do the studies, are they like pretty good studies? Are they placebo controlled and blinded? Are they animal studies, the human studies? Looking through that, follow the money too. Who's suggesting that you take it and do they have a stake in recommending that?
Something that I don't think is commonly known is that folks promoting supplements and some lab testing make 30-50% commission on these recommendations. Just like I do when I maybe suggest like for instance, someone use Beautycounter or some of the other products that I have some affiliate relationships with.
So I think it's important, as my big push and call is for increased transparency, I think that really just helps us at least know who has a stake in what we are promoting. Are they citing data from humans? Also important because some things, do occur in culture or in mice.
But maybe don't really pan out in the human studies. And then do the humans that they study, do they look like you? I think that's also important. That's important when we're thinking about pharmaceutical research as well. I will say, one of the other things, when I say this or have some critique or criticism for supplements, one of the things will come up with, 'Oh, you're a shill for Big Pharma, or you're in Big Pharma's pocket.'
You actually can look up your physicians and healthcare professionals through a database. It's All documented. So if I've received some funding as a fellow that was untagged funding for me to be able to present my research at the national meetings, and that was initially provided by some of the pharmaceutical companies.
So you can see that recorded when you look up my name in the CMS database. So all of that is required to be reported and you can look it up. So if you Google the Sunshine Act, you'll be able to look up and see do your docs get money for pharma and what is it for? Is it funding research? Are they speaking on behalf of them? And again, this is all a call for transparency and not to say that working with pharma is necessarily bad, right? It's just providing some insight so that we can all then decide and make decisions that feel aligned with where we are.
And then, maybe proceed with caution with some guidance from your healthcare team. Get your doctors and your healthcare professionals on board. Ideally it's folks that aren't necessarily selling you of the stuff in their front office. But proceed with caution. Do you think it's been helpful? Have you noticed any potential for harm? Do we need to monitor blood work? All these things are really important.
Medical Matchmaker Quick Tips
Kara Wada, MD: All right. So here are my take home messages for this talk, my Medical Matchmaker Quick Tips. You're trying to assemble a team to help you out, educate yourself on the experts in the field or the condition that you have.
Who are the players? Who are the ones that are writing the guidelines? Who are the ones that are publishing reports? Who are the movers and shakers? Also ask for word of mouth recommendations from your favorite physicians and/or if there's a disease specific support group, who better to know who has a really good bedside manner, or who is thinking creatively than those who have a similar condition such as yourself.
I think that can be really helpful. Look at the reviews, but also realize who may be writing them. So the reviews do tend to have a bias on the really good side and sometimes the unsavory side, right? There are some folks who are generally hard to please. So keep that in mind. I think it's also important to note that those of us who have the best patient satisfaction don't always have the best quality of care. So that is also just a little food for thought. And I say that as someone who generally has pretty good patient satisfaction scores. And so I'm always like, 'Oh, should I be ticking people off a little bit more? I don't know.' And then look for someone who is happy in their work, who doesn't look burned out, who looks engaged, who is like curious, who is compassionate.
This is important. And when you're thinking about forging a really trusting therapeutic, successful and hopefully long-term relationship with your healthcare professionals and on your team. And last but not least, I love this quote. 'The oak fought the wind and was broken. The willow bent when it must and survived.'
So just realize like it is rough out there. It is stormy, but if we can bend and sway, if we can give folks some grace, we can give ourselves some grace, we can make it through on the other side. But we also need to stand up like the tree and advocate for ourselves as well.
if we're not connected already I'd love to connect with you on Instagram or Facebook. And every week we have a new episode of the Becoming Immune Confident Podcast that comes out. Thank you so much for joining me this morning, and I cannot wait until we get to meet and work together again.
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