Beth Brown 00:10
Welcome to Q and A with Dr. K, a podcast by Mountain Pacific Quality Health, where we sit down with Dr Doug Kuntzweiler and get your health questions answered, because on Q and A with Dr. K, the doctor is always in. Hi everybody, this is your host, Beth Brown, and we're back. It's been a little while, but we're here with Dr. Kuntzweiler to dive into something a little bit differently, but it's good to see you. Dr. K, thanks for being on
Dr. Doug Kuntzweiler 00:48 it's good to be seen. Thank you.
Beth Brown 00:51 So we're getting back to in the studio with a new series. This is going to be all about patients empowering themselves and really taking an active role in their health care and being part of their health care team in a way where they can be confident. And so for the next few episodes, that's sort of the overlying theme that we're going to tackle. And today, specifically, we want to talk about the power of asking questions. But before we dive into that, let's first talk about what it means when we say patient empowerment, or we're trying to empower patients. That's a phrase that's sort of a buzzword type thing in the health care industry right now. But what would you say that means?
Dr. Doug Kuntzweiler 01:33 Well, I agree it is a buzzword and and what that implies is that people have their own definition, and it gets used in various ways. But to me, what it really means is patients, first of all, take an interest, an active interest, in their health care, and most specifically, they take responsibility in joint decision making. That is, they they get educated about their health. They get educated about options for dealing with their health problems, and then they are actively helping make the decision about it, as opposed to the old system where the doctor was sort of like God and said, "Here's what you've got, here's what we're going to do about it, and if you don't like it, you can go elsewhere." It implies responsibility on both the provider and the patient. The provider's responsibility is to educate the patient about their health and treatment options, and to do that in language that they are certain that the patient understands. The patient's obligation is to get themselves educated and to get active. Ask questions of their provider. Maybe look at the internet that reliable sources like Cleveland Clinic and Mayo Clinic and Johns Hopkins, those sorts of things, find out and educate themselves about their their health care, and then take some responsibility and help make decisions about what they want to do about it.
Beth Brown 03:07 So much more of a partnership.
Dr. Doug Kuntzweiler 03:09 Exactly, exactly.
Beth Brown 03:11 And so do we know, is this better for health, or how does that help improve our health? Maybe that's an obvious question. But do we know it helps to have that partnership?
Dr. Doug Kuntzweiler 03:23 Intuitively, it's better. But this is something that doesn't lend itself very well to a scientific sort of investigation, because how do you how do you gauge how empowered or how involved a patient is? It's tricky. There have been studies, especially in Europe, where people have been compared those who are more involved in their decision making versus those who just do exactly what the doctor tells them. And certainly, people are more satisfied with their care, and they have more realistic expectations of what is doable or what they can expect. They have reduced anxiety and just in general, feel better about their hell. But in terms of outcomes, I don't think there is at this point a lot of hard science on that. Intuitively, it's better. The more active you are in your own health care, the better you're going to do. But difficult to prove that.
Beth Brown 04:23 Sure that makes sense, and it sounds like too. It probably depends on the person a little bit of maybe they do want the doctor just take a leader role, or maybe somebody does want to have a little more control. So I think a balance in that relationship too is what is going to make somebody feel more comfortable with what's going on.
Dr. Doug Kuntzweiler 04:40 Exactly. And I think again, the responsibility is on the patient to let their provider know how active they want to be. Some people want to be very active in confirming a diagnosis, but then they really don't want to take responsibility for deciding what's the best treatment, and they'd really like their provider to make that decision. And that's fine. The provider's responsibility is to figure out where the patient's at.
Beth Brown 05:04 And so you talked earlier about doctors explaining things, or your providers explaining things in a way that makes sense, but sometimes we get caught up in our jargon. We know what the terms that we're talking about, we don't always think about the person that we're talking to and whether they know the terms we're talking about. And so that brings us to what I mentioned when we got started here is the power of asking questions and how important that is. But if you go to that old school mentality that you talked about where the doctor is God, and they say, what's going to happen, and that's it, there are people who are still a little intimidated in that moment and feel like they're challenging the doctor, or they're uncomfortable, or they don't want to show that they don't understand, because that can feel embarrassing. So what was your experience with patients asking you questions? Did you have varied experiences there?
Dr. Doug Kuntzweiler 06:01 Certainly. And I'll tell you, my favorite was a patient that I saw repetitively in the emergency department. But she asked me, What on one visit. She said, Are you, in fact, a real doctor? Oh, my. Well, that was right. How did you answer that? And I thought, well, that's a legitimate question. You know, for sure I could be an imposter who's hanging out with a stethoscope. No, I will. I will tell you that I always felt like patients who asked questions, who were more interested in being involved in their health care. They were more fun to take care of because you just knew you were going to have a better outcome. And the people who just sat there and didn't say anything were not as rewarding for me to take care of. I always felt like I needed all the help I could get anyway, and if I have the patient working to better their own health, rather than sometimes it felt like patients were, you know, cheering for the wrong side, like cheering for the disease process, because they were so uninvolved. So my my advice to people would be is don't be intimidated it's your health, it's your body, be be happy to ask questions.
Beth Brown 06:22 There are no-
Dr. Doug Kuntzweiler 07:20 And, you know, the provider didn't understand medical terminology out of the womb, and they had to go to school and learn it, and if they learned it, they ought to be able to explain it to other people. So I always tried to take particular attention to explain things in simple, layman's terms and not use medical jargon, and it's not that hard to do. It's a lot more fun.
Beth Brown 07:46 Yeah. So everyone is different, for sure, as far as how they interact with their provider, and who knows that silence could be they were sort of in shock of what was going on, or again, that intimidation factor, but it sounds like you definitely did not feel challenged or offended in any way when patients ask you questions.
Dr. Doug Kuntzweiler 08:06 No, no. In my estimation, it helped me, and I needed all the help I could get anyway, so I was, I was happy to have them get more involved in a discussion. I think your responsibility on the provider is to be honest, and if you really aren't sure, you really don't know for sure what's going on, I always felt like I was obliged to say that.
Beth Brown 08:29 Wow, that's brave. That's good, because lots of times patients want the doctors to be the expert, and you should know what's going on, but our bodies are so complicated with some of that.
Dr. Doug Kuntzweiler 08:37 Exactly and and the alternative is to be certain and be wrong. So-
Beth Brown 08:44 Right.
Dr. Doug Kuntzweiler 08:45 That's that's not a very comfortable place to be, so it's much better to be honest and and tell them exactly where things stand.
Beth Brown 08:54 Sure. And from the doctor perspective, you only know what you can see and test or what the patient tells you. So that's why that communication is so important.
Dr. Doug Kuntzweiler 09:02 Right. That's what I mean when I say I needed all the help I could get them.
Beth Brown 09:06 Exactly.
Dr. Doug Kuntzweiler 09:07 Better you understand the patient, and by that I also mean their social situation and their history, maybe their family, whether or not to have support, all those things, the better you understand that, the better you are able to help them.
Beth Brown 09:21 Yep, that all plays a part, and so that's becoming more and more part of the conversation, to the point where the health care industry, at a higher level, is trying to figure out ways to help patients be more engaged and ask those questions. And the Institute for Healthcare Improvement actually has this educational program. I'm sure you've heard of it, Dr. K, called Ask Me Three, and I can certainly share the link there for folks so that they can learn more about this. But basically, it was their attempt to say, what are the three biggest questions that patients should be asking their doctor anytime, any time they're with a provider. What is those? What are those three main questions? So do you know what I'm talking about here, do you know those three questions?
Dr. Doug Kuntzweiler 10:01 Yeah, I do, yeah. So the Institute for Healthcare Improvement is a nonprofit that's, you know, like many nonprofits trying to help improve the quality of health care, and so they came up with this program Ask Me Three and the three questions are, this is pretty intuitive. What is my main problem? Is the first question. Second one is, what do I need to do about it? And then the third one is, why is it important that I do what you're recommending? So those three questions, and I think that really is a good place to start, easy to remember, and really gets to the heart of the matter.
Beth Brown 10:39 Okay, and so you said a good place to start. And so those are big, strong questions, but they're pretty high level. So are there other suggestions that you would have that? Okay, let's start with those three. What is my main problem? What do I need to do? And why is inform you for to do that. Then, then what would you encourage more questions beyond that?
Dr. Doug Kuntzweiler 10:59 Yeah, absolutely on the diagnostic side. I think, as we talked about you should ask, How sure are you? Is there some doubt? Are there other things that we should consider, are there other things testing and so forth that we should do? And then, what can I expect, if this is the diagnosis, what is the natural history of this, what? What can I expect on the treatment side? I think you should absolutely ask about cost. Is this going to be very expensive? Is there a cheaper route to go, if there are treatment options, what are the potential side effects, and what are my treatment alternatives? What? What sorts of choices do I have I think it's legitimate to ask about, does this impact my family in any way? You know, if it's an infectious disease process, are they at risk? If it's maybe some genetic thing, should they be tested? Are they also, you know, at risk of having trouble? I think it's legitimate to ask, Do I need a second opinion? Would a second opinion be be helpful? And getting back to what I said before, my approach to that was absolutely, if you want to talk to somebody else about this, I am happy to refer you to get a second opinion. As I said, I always felt like things are complicated enough that I was glad to have help so the provider should not feel, you know, insulted somehow, or, you know, take offense at that. I think that's absolutely legitimate. And you know, we all become patients sooner or later, and you want to know these kinds of things. So I think you know, it's fine to speak up and ask.
Beth Brown 12:41 Great. So you ask the questions, and those are great, really well rounded, to flesh out so many different things that people might not think about cost being such a big one, but then you have to remember what the doctor says. And so that's a tricky part, because especially in the moment, if you're learning things about your health, you might be nervous or stressed out or sad, depending on you know what the diagnosis is and what's going on. So what tips do you have, Dr. K, and not only asking those questions, but then making sure that you remember all the answers, so that if you're not processing in the moment, you can think about that and maybe make a decision later, or talk with family, or whatever you need to do to get to where you want to be?
Dr. Doug Kuntzweiler 13:23 Yeah, absolutely. There are studies, interesting studies that have been done where patients are asked as they step out of the exam room, what did the doctor say? The most common response is, I'm not sure, and to some extent that's usually because the doctor was using jargon, medical terminology, and it all over your head. Or, for instance, you say, Well, you have cancer. That's all the patient hears. They you can talk for an hour afterwards, and all they heard was, I have cancer. So my advice was, bring a pen and bring a couple of index cards and write down the diagnosis, write down the prognosis, write down the treatment plan, or better yet, make the doctor write it down in language that you can understand. Another good thing is bringing an advocate along with you, a family member or a friend, and especially if you know, you know somebody that has a little bit of medical background and and you should not feel like you know that's out of bounds. Again, the provider is there to help make you well and whatever moves things in that direction that the provider should be comfortable with. So I was always happy, especially with older patients, if they brought along a family member or somebody who could also be listening and help interpret what the physician was saying. But I'm old school, and I think writing it down, of course, today with technology, you could put a note on your iPhone or, you know, you could probably even record that and be okay with me. But, I think some way recording it so that you can then go look it up on the internet, you know, at a reliable source, or you can ask other family and friends about what they think about the situation. I used to write on sticky notes the diagnosis and the treatment plan, and give that to patients to carry. I was taught by a very old and very smart, wise professor, nobody leaves your office without something in their hand. Might be a prescription or it might be a note that you jot down on what the diagnosis is and what the next step is. But I think our memories are fallible enough that it's it's best to record it in some fashion.
Beth Brown 15:45 And you talked about it being in digital age. And I know when I'm sitting in a doctor's office, everything is going into a laptop anyway, so I imagine you could also ask for a printout on whatever the notes were that were taken.
Dr. Doug Kuntzweiler 15:56 I never liked that. It always it felt like an intrusion between me and the patient. So I did not use a laptop, but I did often take notes, especially if it was the first time I was meeting the patient, I was asking about their family history or their past history. I would have pen and paper, again, I'm old school, pen and paper, and I would jot things down to refresh my own memory when I went to make the record of the visit. What I hate, and I've had this experience in my own health care, is you go see your provider and they are looking at their computer screen the whole time. They don't look at you. And so my solution was just jot down a note and then look the patient in the face and ask a question and listen and then make a quick little note,
Beth Brown 16:44 Yeah, no, that's nice. That probably helps the patient feel more at ease, too, in initiating that conversation. And then another method that we've talked about to just check for that understanding and make sure the patient understands what's going on when they walk out, is the Teach Back or the Show Me method. And while that's something that might be intuitive and in the moment when you're having the conversation, that's a term that a lot of people probably don't necessarily hear all the time. So can you talk about what that teach back or show me method is, and how patients can engage in in that method.
Dr. Doug Kuntzweiler 17:20 Sure. So, you've had your visit, and you've blathered on to the patient about what their diagnosis is and what you propose to do about it, and you've gotten them to agreed, and they have had their input, yada yada yada. You don't really know if they heard accurately what you said. And we know from studies, if you ask them as they exit the doctor's office, what did the doctor say? I have no idea what he said. So you don't really know at the end of that encounter if they actually did understand you or not. You may think that, oh yeah, they were nodding their head and they got it all. But if you simply ask them, okay, I want you now to tell me, what did I tell you your diagnosis was? What did I tell you your treatment options were? What did I tell you your responsibility is? That's the Teach Back, tell me in your own words what I told you about this, and then you will know. Yeah, they got it. You said, I have pneumonia, and we're going to treat it with some antibiotics. And here's the possible side effects and etc, etc. Then you then the provider can say, well, they understood what I told them, and if they didn't, that will become apparent too. And then that's your time when then you can go into further detail, or perhaps put it in different terms that they can understand, but it's just simply checking to see if they really got what you were talking about.
Beth Brown 18:16 And we as patients shouldn't feel like we're being quizzed or, you know, the doctor is testing us in some way. It really is just that checking.
Dr. Doug Kuntzweiler 18:57 No, and you, as the provider, you do it with an air of concern, I want to make sure that you understand, because that's what I'm here for, is to help you. And if, if you didn't understand a word I said, then I have failed, and I need to go back and correct. That- that would be my attitude. So no, you shouldn't. The patient shouldn't feel like this was the Spanish Inquisition. This is making sure that I understood what they said, that I got it. It should be fun, really.
Beth Brown 19:28 So if the provider doesn't start that conversation and use that teach back method, what can the patient do to sort of initiate that check, checking for understanding?
Dr. Doug Kuntzweiler 19:39 Yeah, I think that's that's tough, but I have a solution, my free advice here, and I want you to write this down in quotes. Here's what you say. I am very concerned about my health. Help me to understand whatever it is. Help me to understand. And what you're saying, The diagnosis is, help me to understand what the treatment is. Help me to understand what are the potential side effects and the costs, yada, yada, yada. But you just say it like that, I'm very concerned about my health. Help me to understand what you just said. Then you have to find a different provider, because that's their job.
Beth Brown 20:21 Yeah, fair enough. That's not- it's not a big expectation to have the doctor explain it to you in ways you understand what is going on with your health. Yeah. So in addition to just the jargon and not being able to understand that, or getting caught up in- in the language of medicine, there's also just getting caught up in the language of English for a lot of people. And so for those folks who English is their second language, they have options to make sure they understand too, and they may not know that. But can you talk about what can a doctor provide somebody who maybe would like some help with just not only understanding the jargon, but also understanding English.
Dr. Doug Kuntzweiler 21:04 Yeah, so in in the ER, we were mandated to have an interpreter if English was not their first language, if, if they were fluent in English, that was fine, but we were mandated to provide translation services. And one good thing about today's age is that, via Zoom, you can get an interpreter in any language that's spoken on the earth, and you can get them on call. There's a fee for that, but providers should, should be able to accommodate that. And if you're receiving federal dollars, it's mandated that you do that, and that includes American Sign Language for the deaf. Now, sometimes having a family member there who's fluent in both languages, you can do that as well, although that sometimes gets tricky, because family relations can be entwined, and you can sometimes wish you had somebody who was more neutral. But there are interpretive services available. If you go on the web, you can, you can find services that, for a small fee, will provide a any language you can think of, they will provide an interpreter. And I use that a lot in the ER, and it actually, it worked out really well.
Beth Brown 22:28 That's great with telehealth and Zoom. That's huge too, because you don't have to wait for somebody to actually join you in the room. So I'm sure that's faster. And again, with technology, there are all kinds of translation apps that you can use too. So that's something to think about as well.
Dr. Doug Kuntzweiler 22:45 Yeah, and there's, there's a lot of, I mean, you have to be careful, but there, there's a lot of good advice on the internet, YouTube, and just make sure you're using a reputable source.
Beth Brown 22:58 Always, yep, for sure. Okay. Dr, K, I think that's all the questions that I have for you today. Anything else that you want to make sure we leave with today when it comes to asking questions or just making sure you understand what's going on with your health?
Dr. Doug Kuntzweiler 23:14 Yeah, the thing I want to really stress in about empowerment and asking questions and understanding and being involved being a decision maker in your health is that it is your body, it is your mind. I don't want Elon Musk's engineers driving my car for me. I want to drive my car myself, and that's how you should feel about your own health care.
Beth Brown 23:40 Yeah, amen. All right, that's it for today. Thank you so much for listening. We'll post some resources to help you ask questions and some tips for understanding whatever comes out of your health care visit, so that you have that information anytime you go and talk to your doctor. If you have any questions for Dr. K, please email us at QandAwithDrK@MPQHF.org, and that email address will be with this episode as well. Thanks, everybody. Bye.