10 October 2013

Can You Deal With the Elephants in the Exam Room?

First, it is necessary to identify the elephants that a discussion is hard for providers and patients to talk about with ease.

#1. Sex
#2. Costs of care
#3. Alternative treatments
#4. Advanced directives
#5. Digital technologies

I find I have no trouble in discussing any of the above or more, but studies show that they are often difficult for providers and patients to talk about and many just won't consider talking about them.

The first item above is important for both men and women with diabetes for a variety of reasons. Men often have sexual dysfunction or erection dysfunction quite often and this can affect how they feel about diabetes. In looking for studies, there are a few, but not worth the time because most are less than 10 men. Women have other problems and often dislike having sex because of yeast infections and often dryness making sex painful.

The second item above is very difficult to get providers to talk about because often they are not totally aware of what the actual costs are when providers are employed by the hospital. Hospitals have so many extras that are tacked on to a charge to get more from the insurance companies and/or Medicare/Medicaid. There are at least three free apps, which address health care costs.

The third item above is more difficult for patients because they are afraid of the reactions they will receive from their provider. Once the diagnosis is received by the patient, some will consider having the treatment prescribed by their provider, but others would like to consider complimentary treatment, which may include holistic, neuropathic, or homeopathic regimens. Often they won't discuss these with the doctor because they know from past experience that the doctor will ridicule them and dismiss the treatment. Often they just take the prescription or prescribed treatment and go to another doctor that will provide these.

The fourth item above is probably one of the more contentious topics as many providers just hand out papers to have the patient check the boxes for the advance directives for end of life care to meet federal mandates. In these situations, many patients just ignore these. If they are like me, I have seen physicians, hospitals, and families ignore the wishes of the patient and do what they want done, even with the advance directives on file. I have even seen family ushered out of a parent's room so they can follow their own policies against the directives.

The fifth and final item above is about mobile technologies. These can improve the doctor-patient relationship, but even then, doctors do not want them around and will ignore their use. Many patients use the internet and this often causes physicians to see this as a threat to them and upsetting the balance of their relationship with the patients. Fortunately, times are changing and with both shared decision making and digital health technology in present popularity, physicians are often forced to deal with this or lose patients.

Now it becomes necessary to state that both providers and patients need standards that medical app developers can follow. If they are reliable and effective digital tools, they can help prevent the elephants from being in the exam room discussion instead of making the elephants presence larger.

While the above discussion may not include all the elephants, often once they are recognized and the provider brings them up with the patient, they disappear and the tension is relieved. Often a partner or a caregiver can be the one to start the conversation and they can be the ones to carry these discussions. Read a doctors interpretation and thoughts about this topic here.

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