And So It Begins
From the January, 2017 issue of DelFamDoc #EducateAdvocateRespect
Do Docs hate Google?
Recently a friend sent me a link to an article from Forbes “Your Doctor vs Dr. Google and the winner is…” and asked me whether doctors really hated if patients came in to the visit having searched out their symptoms first.
Now, I’m no genius, but I sensed myself getting drawn into a trap so I asked her, “Why? What happened?” Long story short she had recently seen her doctor for a pain she was having in her chest. Worried about what it could be she googled chest pain and started making list of the tests she wanted to make sure she got “just to be sure” because from her quick search chest pain could could equally mean death and a little heartburn so she was taking no chances. When she arrived at the office with her list her doctor mumbled something about “Dr. Google” and proceeded to seem exasperated as he told her she didn’t need any of those tests. She was of course upset and wanted to know if all doctors felt that way and so she reached out to me.
Now I LOVE these #LifeofAFamilyDoc moments. I didn’t go to medical and public health school to hide my knowledge under a bushel. Anytime I can help facilitate a doctor-patient conversation, I’m down for the cause.
Here are 5 thoughts about the“Patient, Dr. Google, Family Doc” love triangle:
- Family doctors LOVE patients to be informed consumers of healthcare who understand things like what their medical history includes, what the actual name and dose of the medications you are taking and what is going on that is making you nervous. Activated and engaged patients tend to have better outcomes, incur lower costs and are generally more satisfied with their medical care.
- Family doctors (and all doctors) use search engines like Google all the time, every day like the rest of the world. (really- there was a survey and everything.) It’s not that you are searching the internet that gets them all worked up, it’s the sheer volume of misinformation and the difficulty patients have knowing what to trust and what to discard. We have such limited time to meet with you that spending half of our visit debunking internet myths is frustrating. Oh, and sometimes your tone when sharing your findings is well, … more on that later.
- When you visit the office set on a particular diagnosis or test you shortchange yourself and sometimes distract me from the work I need to do to figure out what is actually ailing you. You don’t want your doctor to skip steps in the diagnostic process. Confirmation bias and early anchoring are cognitive biases that have landed more than one doctor in malpractice hot water.
- There is no need to disrespect my education and training because you found a symptom tracker app. Telling me what I am going to write a prescription for, demanding that I order anything and being dismissive of evidence-based medicine (or even the rules your chosen insurer has placed on your ability to access certain tests/medications) is off-putting to say the least. Basic courtesy in communication extends both ways. Between you me and the internet, if you have to be that abrupt with your doctor, maybe it is time to choose another physician who you can communicate with in a more collaborative way?
- Encourage patients to use trusted sources of online information for medical searches. I don’t tell my patients not to look up information. I tell them to choose trusted sources and then I try to point them in the right direction.
First, we talk about how symptom checkers DO NOT DIAGNOSE they just help you figure out if you should get checked out or not. Hopefully someday Watson is going to be available via app to diagnose you, but that day isn’t today!
Next, we talk about where I would send my mom for information. (If it isn’t good enough for me to send my mom there, then I’m not sending you there either.) My favorite go-to source is the AAFP’s familydoctor.org.
Familydoctor.org: Now I am biased given that I am on the editorial board so I know how much time and effort we spend fact checking the articles and ensuring the content is clear. I love that it has information for adults and kids (even topics about pregnancy, sports medicine and things like that). It is my one stop shopping for patient education.Some other sites I direct my patients to:
CDC.gov: I love the CDC’s website for a wide range of things, but it is definitely on my go to list for things like travel, infections, vaccines and public health issues.HealthyChildren.org: This is the AAP’s website so it only has information about kids, but it is a place for parents to look if they have a question.
Finally, we talk about websites that make me nervous for medical information– Wikipedia, sites with no references, sites from manufacturers or selling a product and sites with unclear authors don’t get much time from me. And if they ever find something and are unsure if it is accurate, print it out or send me an email through the patient portal and I’ll give you a thumbs up or down.
So the TL;DR bottom line? No, doctors don’t hate Google. Yes, you should be an engaged and informed patient. Being informed means also knowing the limitations of the websites you are using. Looking for a reliable site? Try familydoctor.org
Why Can’t You See Me?
This past week my #LifeofAFamily doc experience took me Baltimore, Maryland to complete the Myers-Briggs® Type Indicator Certification course with The MBTI® Training Institute.
Yes, I had a crab cake. Yes, it had Old Bay Seasoning. Yes, it was delicious.
Along with several other professionals across a variety of disciplines, I took a fascinating journey of enhanced self-discovery while learning how to apply these tools to coaching and developing others. Our tour guide (perhaps sherpa would be more accurate?) was a fantastic educator, psychologist Elizabeth (“Murph”) Murphy, Ed.D. Dr. Murphy has researched type concepts since the early 1980s by verifying (with video support) the development of normal personality differences according to the theory of psychological type.
As a fan of leadership development I’ve known my MBTI type since college (and it hasn’t changed), but I also know a wealth of things like my DiSC, my HBDI, my TKI, Kolb learning style and oh so many other assessments. And despite that, to say I learned a lot about myself in discovering how to administer and support clients using the MBTI tool would be an understatement. Given my strong drive to reflect on things, I know there will likely be a few posts about my “A-HA!” moments this past week- like the moment in class when I finally came to understand why a recent business meeting went so horribly wrong or my thoughts on why it makes total sense that so many of my friends were shocked to learn I was actually an introvert.
The aspect I am chewing on today though is a bit more basic. I finally found the answer (or at least one explanation) for why I often feel frustrated about why other people often don’t seem to actually see me. It turns out that many of you may never actually see me because most of my life experience happens inside my head!
“many of you may never actually see me because most of my life experience happens inside my head“
So first things, first (apparently that is my sequential loving Sensing side showing) about my MBTI type:
| A Brief Summary of Margot’s MBTI Type | |||
| How I focus my attention or get my energy | I – Introversion preferred to extraversion: ISTJs tend to be quiet and reserved. They generally prefer interacting with a few close friends rather than a wide circle of acquaintances, and they expend energy in social situations (whereas extroverts gain energy). | ||
| How I perceive or take in information | S – Sensing preferred to intuition: ISTJs tend to be more concrete than abstract. They focus their attention on the details rather than the big picture, and on immediate realities rather than future possibilities. | Introverted Sensing is my dominant and most well developed way. I will prefer start here by instinct. | Extroverted intuition is my inferior or 4th dynamic. When I am under extreme stress I will find myself trying to use this underdeveloped skill set to my own detriment (I’ll be “not like myself at all”!) |
| How I prefer to make decisions | T – Thinking preferred to feeling: ISTJs tend to value objective criteria above personal preference. When making decisions, they generally give more weight to logic than to social considerations. | Extroverted Thinking is my auxiliary go to or the balancing side for my dominant. | Feeling is my third dynamic. |
| How I orient myself to the external world | J – Judgment preferred to perception: ISTJs tend to plan their activities and make decisions early. They derive a sense of control through predictability. | ||
Some other insights from my week included learning that my:
IJ combination is also called “decisive introvert” meaning when you propose a new change to me I am likely to go first to may favorite process (for me it happens to be Sensing) and if the changes fit I will quickly move to implement them. But if the changes don’t fit, I will likely resist and become quite stubborn in my opposition.
IS combination is also called “thoughtful realist” meaning knowledge is important to me when trying to use information to decide what is true.
TJ combination is also called “logical decision maker” meaning I tend to be a leader who makes decisions based on principles and systems, the overall impact and a rational assessment of the likely outcome. I respect hierarchy and can be tough minded in implementing policies and procedures.
Of all of these insights, the part that struck me is that my go to place is focusing on details of the here and now and reflecting on them internally. That means that me at my very best- doing what comes most naturally for me is all going on inside my head and therefore is not visible or accessible to my family, friends, teams or colleagues!
“me at my very best- doing what comes most naturally for me is all going on inside my head and therefore is not visible or accessible to my family, friends, teams or colleagues!”
Which also means me at my very worst (when extremely stressed) I will be a vocal, verbal outward display of catastrophe, doom and gloom. So you could work with me and only really hear my thoughts when I am predicting utter and complete failure without knowing any of the times I had detailed and extensive reflections on the process or project plan in my mind. Well now, that is a game changer!
So how does an introverted sensor open up to share her inner thoughts and reflections in her most comfortable setting?
Why, a blog of course!
Having the opportunity to write down reflections allows private time for processing and clarity while the option to share them with friends and family provides for insight into the Margot behind the seemingly critical stare (honestly most of the time I was just thinking…)
Off to get some work done, but I have so many notes from this week, I just know there are more reflections just waiting to be shared!
Microaggressions in Medicine
Earlier today I told my Facebook friends what to me was an annoying but relatively common experience in my life. I’m rounding in the hospital this week overseeing a team of family medicine residents. We are a little short this month so the attending doctors are splitting the service with the residents to avoid resident duty hour and work issues. Basically it means I had the pleasure of seeing some of the patients myself before the rest of the team had come in to see them. I headed in to see the second of the new admissions from overnight and the follow exchange occurred:
Me: *hand foams and then walks over to patient laying in bed and family sitting on side wall* Hi! Good morning Mr so and so. I’m Dr. Savoy and I’m in charge of the family medicine team that is taking care of you in the hospital today.
Patient: Hi. *proceeds to ask for his pain meds and why his test was cancelled*
*more family show up*
*my resident shows up*
Wife: Oh good the doctor is here now!
My resident: *looking confused and turning very red* Umm she’s the boss. I’m the resident.
Patient: Oh I just figured she was the nurse or something.
Me: I’m standing right here and to be fair I started this conversation with ‘Hi I’m Dr Savoy’
Wife: Oh yeah. I guess you did say that.
Me: *Turns around and walks away. Remembers I forgot the hand foam… Walks back, foams and leaves room*
For my fellow mocha doctors (aka doctors of color), this wasn’t an isolated event or even a rarity. Many of you can probably tell dozens of similar stories without even trying and frankly that makes my soul cry. We talk about it amongst ourselves all the time. If I ask my fellow female doctors, they can share stories of how often they are mistaken for the nurse, called by their first names even after introducing themselves as Doctor and the like. What I realized today is that maybe we should talk about it more out loud with everyone. Because this stuff happens all the time, it’s not acceptable and simply accepting it in silence simply isn’t productive.
“If you are silent about your pain, they’ll kill you and say you enjoyed it.”
― Zora Neale Hurston
So, no time like the present… let’s talk about microaggressions.
Microaggressions are the everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalized group membership. In many cases, these hidden messages may invalidate the group identity or experiential reality of target persons, demean them on a personal or group level, communicate they are lesser human beings, suggest they do not belong with the majority group, threaten and intimidate, or relegate them to inferior status and treatment. (Sue, D.)
Microaggressions are the everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalized group membership.
So these aren’t the overt “I don’t let Black people touch me” or “women can’t be doctors” comments that occasionally get hurled your way during a day at work. These are much more subtle (dare I say insidious?) and in many cases unintentional by the other person.
Usually when I attend a lecture about microaggression it is generally designed to teach me how my personal unconscious biases can hinder my ability to deliver safe and effective patient care. I heard a great talk about it at APHA last year (https://www.apha.org/~/media/files/pdf/webinars/racism_webinar3_part2.ashx). And bias certainly plays a role in the healthcare disparities we see in medicine. These patient experiences are real and do need to be addressed.
Unconscious bias refers to a bias that we are. unaware of, and which happens outside of our. control. It is a bias that happens automatically. and is triggered by our brain making quick judgements.
What I have yet to hear in my lectures on physician burnout or resiliency is anyone speak to the toll of this daily exposure to dehumanizing behavior on top of the constant daily stresses of medicine in general. At times it feels like I’m fighting a multi-front war (and those are rarely if ever successful). And I can only imagine the added slights experienced once you add a layer of gender or sexual identity. I’m not here to say whose experience is worse, and I only claim to speak firsthand about my journey through this life. But I don’t think medicine is doing enough to protect me from the people I am supposed to be taking care of. I’m a person too.
#DelFamDoc
Some of you may not know that one of my greatest joys as President of DAFP was getting our communication upgraded to the 21st century. We added social media (@DelFamDoc), stepped up our website (www.delfamdoc.org) and launched DelFamDoc- the official peer reviewed journal of the Delaware Academy of Family Physicians.
Recently I wrapped up the 12th issue that will be out in mid-July (that’s 3 years y’all!), and I was struck of just how far we’ve come. From a glimmer of an idea to a full fledged 32 page collection of clinical articles, practical practice management tips, community and public health pointers and advocacy news. Each issue reminds me of the vast beauty of Family Medicine because we can literally include an article on just about anything and it will be relevant because we really do see the whole family in the context of their neighborhood/community.
Each issue reminds me of the vast beauty of Family Medicine because we can literally include an article on just about anything and it will be relevant
Being the editor of the journal is sometimes stressful. Last minute changes and tight deadlines that somehow land on the one day you seem to have no time are the norm. But there is something quite empowering about having the opportunity to bring your colleagues knowledge and perspectives that can improve the health of the entire state. And it is super awesome to have a supportive publishing team at Publishing Concepts, Inc.
#DelawareCAN
Today my #LifeofAFamilyDoc took me back to class! My Family Medicine Centers at Christiana Care Health System officially joined the #DelawareCAN movement by participating in the first of a two day practice-wide training.
Umm, Margot- didn’t you learn how to place an IUD in residency? I sure did, but for this project, all clinicians and staff were asked to attend the refresher course.
So what exactly is Delaware CAN? Delaware CAN (Contraceptive Access Now) is a a public/private partnership between Upstream USA, in partnership with the Delaware Division of Public Health designed to reduce unintended pregnancy in the state of Delaware. In addition to providing the training for staff and clinicians, the program will ensure access to low or no cost LARCs for women across the state.
Why does Delaware think this is an important topic to tackle now? Turns out the First State is first in unintended pregnancies and that simply isn’t good public health. In fact,
Did you know that:
• In 2010, 57% of all pregnancies (11,000) in Delaware were unintended.
• Delaware’s unintended pregnancy rate in 2010 was 62 per 1,000 women aged 15–44, the highest rate among the states.
• The teen pregnancy rate in Delaware was 60 per 1,000 women aged 15–19 in 2010. The national teen pregnancy rate was 57 per 1,000.
• In 2010, 42% of unintended pregnancies in Delaware resulted in births and 46% in abortions; the remainder resulted in miscarriages.
~ From the Guttmacher Institute
What is the ACIP?
Three times a year I head down to Atlanta, GA for the Advisory Committee on Immunization Practices meeting at the Centers for Disease Control and Prevention on behalf of the American Academy of Family Physicians. Recently someone asked me what the ACIP was and why it is important that I attend. Here is my answer!
ACIP June 2016
Here is a sneak peak inside the ACIP meeting I attend 3 times a year at the CDC in Atlanta, GA as the American Academy of Family Physicians Liaison to the ACIP. Want to know more about the ACIP? Check out this post on “What is the ACIP?”
Field Trip to Fair Oaks Farms
During the Honor the Harvest Thought Leaders Summit I had the opportunity to visit Fair Oaks Farm in Fair Oaks, IN. What an experience! Check out the video for a few chuckles and a little knowledge.