Taking Time: Good Communication with Patients Vital for Vermont’s Medical Community

March 10, 2011  
Filed under Health & Wellness

By Clara Rose Thornton

Audrey Boerum gets right to the point. “When I walk into the doctor’s office, the doctor asks me, ‘How are you feeling?’ I generally say, ‘I’m falling apart slowly, I’m always tired and my feet hurt. Now what?’ At 81 years old, the cells are slowly waning, they’re slowly checking out. That’s what happens, and that’s okay. This is life: the doctor knows I’m checking out, I know I’m checking out. So save that fake and cheery garbage. I need more specific communication.”

Boerum, a retired administrative assistant for a computer software company in New Jersey who has lived in Jericho since 1995, showed wit and pragmatism in a recent interview about her experience with the medical industry. Boerum has a primary care provider that she visits every three months and a cardiac specialist that she sees regularly. She considers herself in relatively good health for an 81-year-old woman.
“I have very few, if any, complaints. Every day I’m in my car, walking around, going to community events, and enjoying a social life, though it’s limited,” she said. She has only two major physical traumas in her life that required hospital care: In 2001, she tripped on her way to a social event in Walpole, N.H., and broke her shoulder; and in 2005, she required the removal of a brain meningioma, a benign tumor.

For the meningioma, because it was such a serious procedure that she’d previously had no experience with, she conducted thorough research and came into the doctor’s office with 52 questions prior to the operation. “He listened patiently and answered all of them. I hadn’t seen him before and haven’t since. This was a surgeon at Dartmouth Hospital (in Lebanon, N.H.) where there’s a top-notch neurology center.”

With her previous ailment, the broken shoulder in 2001, she had a very different experience. Since the accident had happened in Walpole, N.H., and she was in extreme pain, she was taken to Springfield Hospital in Springfield, Vt., a half-hour away.

“He threw me for curve,” Boerum said of her doctor there. “He was a deadpan, matter-of-fact kind of guy. He talked to me a bit and then left. I got the impression he wanted me to leave quickly and didn’t have time for me. I still deal with pain in that shoulder.”

Boerum acknowledges the difference in severity of the ailments of these two experiences, and does not feel that her experience in Springfield is particularly indicative of one hospital’s professionalism over the other. But she does feel that her experience with the surgeon in Dartmouth was unique, and that many people – even those with as serious a condition as a tumor or needing some other surgery – have an experience closer to hers at Springfield.

“Patients, and yes, particularly senior patients, should be more adamant about being talked to by their doctors so they fully understand what’s going on and get the right treatments. I don’t have any comprehensive impressions of the medical industry and I can’t say how doctors should treat each individual patient because I don’t know what the demands on their time are. But as far as my personal wishes, I would like to see more doctors raising a lot of pertinent questions that show he or she knows what he or she is looking for. I come in with symptoms, they should ask the questions to try to pinpoint what they indicate. Doctors should make an effort to field my questions and then build upon those with greater knowledge to truly come to a point of understanding of my condition. Show me you’re interested in what I have to say.”

Experiences and perceptions like Boerum’s are at the core of what has recently forced a recognition of the need for heightened communication with senior patients by medical colleges nationwide. The December 2010 issue of the Journal of the American Geriatric Society published an article called “Healthy Aging Rounds: Using Healthy-Aging Mentors to Teach Medical Students About Physical Activity and Social Support Assessment, Interviewing, and Prescription.” The article was originally published online in October 2010, and appears to be the first time a severe deficit in assessment, interviewing and social support for senior patients was directly addressed by the Society.

For senior patients who may have multiple ailments, are on multiple medications, or are not knowledgeable about the intricacies of their conditions when seeing their doctors, there’s a higher risk of side effects from drugs or drug combinations, and of being misdiagnosed. The type of exacting inquiry that Boerum mentions can help outline all particulars and possibilities.

Dr. Roger Giroux — a general physician who runs a small, patient-centered solo practice called Brookside Family Health Care in Hinesburg with his wife — agrees, but thinks that most senior patients don’t approach him with enough questions. Giroux has been practicing medicine for ten years, and treats approximately 6-10 patients per day, also making house calls regularly.

“What patients need more than anything is time for the doctor to listen, and time for the doctor to explain,” said Dr. Giroux. “When a patient can’t fully articulate what’s wrong and a doctor can’t fully explain what needs to be done, the entire system breaks down. Doctors provide less of a service if they’re rushing. Yet elderly people tend to be of a generation that doesn’t complain, doesn’t ask for help; they work hard and they don’t want to bother the doctor by bringing up topics they think will burden him or her.”
“Elderly people often put doctors on a pedestal and don’t think of them in a way where they don’t feel comfortable ‘prying’ about certain topics,” Dr. Giroux continued. “It’s part of the cultural fabric of the older generation. The key is to make them realize they are as important as everyone else.”

So what is the situation at the big hospitals, such as Fletcher Allen Health Care, the largest medical practice in Chittenden County? Is it possible to use patient-centered methods? Are these health centers recognizing the new surge in awareness?

“They certainly are,” said Jennifer Nachbur, a press representative at University of Vermont College of Medicine, who forwarded course notes and a synopsis for a new program called, “Medical Student Leadership Groups: A Professionalism and Leadership Skills Curriculum,” taught by Lee Rosen, PhD.

The synopsis, which outlines activities and programs for the first and second years of medical training, is based on the idea that “the medical community is recognizing that leadership and professionalism require knowledge of and skills for collaboration, cultural awareness, decision-making, life-long learning, and self-assessment.” The curriculum includes small-group focus sessions in the first year that stress “communication skills integral to professional development” and discussion of “family systems.” The second year applies these sessions to a public health project.

Only time will tell how effectively this program and others like it will infiltrate the medical system through a new crop of doctors, or how it could affect hospital time-management structure. In the meantime, it’s important to approach physicians with well-researched questions and concerns about ailments, and know that your time and your health concerns are just important as others’.

 

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