Patients and doctors must collaborate for a successful office visit and ongoing relationship. Public health expert, Christie VanHorne, shares important tips for both patients and doctors on how to successfully navigate the conversation neither were trained on how to do.
What we Discuss
The history behind why women tend to be dismissed
How to find a doctor to meet your needs
How to prepare for and optimize your doctor appointments
Lessons for both patients and doctors
What you can do if you have a bad appointment
NOTE: I made a reference to 2 types of HPV. To clarify, there are multiple HPV types but 2 that indicate a high risk of cervical cancer.
Georgie Kovacs What are the foundations for an effective relationship between doctor and patient?
Christie VanHorne: Communication skills are necessary, and it is important to understand the role of the patient versus doctor. What I like to say is that patients are experts on themselves, and doctors are experts in medicine. What we need is a partnership between the two. This is a paradigm shift, where we start to see medicine is more of a partnership between two people, instead of this authoritative figure where, when you walk into your doctor's office and feel like they're the ones with all the answers. But remember. They don't always have all the answers, especially in our specialized medical system. We have so many specialists these days, which can also cause complications when it comes to diagnosis and getting the care that we need and deserve.
Georgie Kovacs What should patients to in order to have a more effective doctor appointment?
Christie VanHorne: I'll start with some of the gaps that I see in healthcare. A part of the problem is that, especially when we're talking about women's health in particular, is that our society doesn't necessarily trust women, and this includes some of the medical community.
Experts link this problem to the history of hysteria. Hysteria dates back as far as ancient Egyptian times. Freud made things worse for us in stating that, what was seen as a neurological problem, and defined it as a psychological problem. This mentality of “it's all in our heads” originated here. Women are seen as having a mental health disorder, when they actually have a condition that needs to be diagnosed.
Women are more likely to be dismissed when they're presenting with heart conditions, endometriosis, and other conditions. Even though hysteria was removed from the diagnostic manual in the 1980s, a lot of experts argue that mental health conditions like depression and anxiety quickly replaced hysteria as the catch all diagnosis.
Women do obviously experienced depression and anxiety. There's no question. However, we know the difference between when we're experiencing anxiety and depression and when something else is wrong. Pain is a good example too. It’s been very challenging to overcome this idea that we're crazy hypochondriacs or things are "all in our heads." So yeah, Freud really screwed us over there.
Georgie Kovacs I'm thinking about a book that I had read. It's called How Healing Works by Wayne Jonas. And there's a sentence that I highlighted. He stated that medicine is not properly set up for success when it comes to chronic conditions. If it's acute, it’s very easy.
And when you think about it, like even Dr. McGregor in her book, Sex Matters, talks about the hysteria, especially with heart conditions women may have. It was only recently learned that women have heart conditions as frequently and maybe perhaps, if not more than men. Yet the drugs were mostly studied in men and applied to women and women weren't believed they could have a heart attack. What do you do when you're not believed? You go doctor to doctor, you scream, because you're not being heard. Eleven years in order to diagnose for many women.
I interviewed Dr. Lara Briden last year, and she said that when she had published her book, Period Repair Manual, there was a lot of debate to put the word period as part of the title, and now we're able to publicly say the word period without shame. We just need to get to being able to say vagina and vulva. More so, we as women need to know all of our parts!
Another dynamic is that the FDA mandated only recently – in 1992 – that women must partake in clinical trials, but this has been slow to progress as has funding for women’s health.
What are healthcare barriers that we as a society need to overcome?
Christie VanHorne: That's where it becomes extremely complicated. We have a ton of work within our society to do right to overcome these systemic barriers to care, which include health insurance, but also the addressing bias and discrimination in health care, as well as the social determinants of health. If I am a working black woman who is an hourly worker, how do I take time off? I'm a single mom, how do I take time off to go to the doctor. And not to mention, transportation is one of the biggest barriers to getting into a provider.
We have to start accommodating for all of these things. And it happens in many ways. We need paid leave, we need a higher minimum wage, all of these things that people think they have such a direct relation to improving health for those people that need it the most.
It’s a systemic problem, and the solutions are very complex. We're not going to see change overnight. And that's part of the reason that I started How to Talk to Your Doctor, because I know that there's these huge systemic, I'm a public health professional, I have my MPH, this is what I study.
I absolutely believe that we have to address these systemic problems, no question. But at the same time, change at that level is very slow.
Georgie Kovacs: How do we overcome these healthcare barriers?
Christie VanHorne: These are simple, easy to implement suggestions to optimize your experience with your doctor.
Get Referrals/Do Your Homework:
Talk to family members, friends, and current doctors that you already have to see if there's a specialist, if you're in need of a specialist.
Take what you read online with a grain of salt. I have personally had a horrible experience with a doctor that had 5-star reviews, yet I've had a great experience with my primary care provider who does not have great reviews.
Assess Your Doctor from the Start:
The experience begins from the moment you speak with them on the phone. If you get a bad feeling from the second you call a doctor's office, if it's possible, move on to the next. I also want to say that, obviously, this comes with a privilege. If I live in a rural area or in a place where I don't have transportation, this proves difficult. I do hope we will see more around telehealth. I think that that is one silver lining resulting from COVID. And I do think that that will help people especially those who are managing chronic conditions.
View your appointment as an interview. If the appointment doesn't feel right, it is not going to change the next time you go in. Make sure that you really center yourself around this concept and ask:
· How did how did you feel?
· Did the doctor asked you if you had questions?
· Did you feel rushed?
· How were the frontline staff?
· How was the nurse?
All of these things matter so much. It absolutely matters how you're being treated at your doctor's office.
Georgie Kovacs: I agree about the reviews. I find it helpful to read the comments. For example, in the fertility space, doctors who got a woman pregnant will get 5 starts and those who don’t receive a less positive review. When I was going through it, I would look at the reviews that provided other specifics to better assess the doctor.
What can a patient do if there is a poor experience at a doctor’s office?
Christie VanHorne: Write a letter directly to the doctor or to the health system. They don't read the reviews.
Georgie Kovacs: With the way health insurance coverage changed, doctors now have to see more patients, which has now created a rush, which has now impacted our healthcare. It has led a huge downstream impact.
What can patients do if we feel rushed at the doctor’s office?
Christie VanHorne: First, let’s start with key statistics. The first statistic is doctors spend about eight to 12 minutes with each patient. The second statistic, which, in my opinion is even worse, is that you have about 23 seconds, that’s seconds, before it feels like you're being cut off by your doctor. However doctors refer to it as redirecting. I want to highlight that you have such a limited amount of time with your doctors.
To combat this, one of my biggest tips is to have expectations for your doctor's appointments, and it's also why it's so important to prepare for your doctor's appointments. Let’s assume that you haven't been to a doctor in a long time, and you have a laundry list of problems. Throw that laundry list away. Focus on what keeps you up at night, what worries you most about your health, and make sure that you're thinking through what you want. For example:
· Am I going in for a diagnosis?
· Am I going in for medication?
· Am I going in for a referral?
Be very specific and think about it before you go in.
If you go in with a laundry list, a lot of people don't realize that that the primary reason that you're going in is also how doctors bill. If you do have more than one problem, talk to your doctor about the primary concern only. If you have other problems, see if the staff can book you for a double appointment. Sometimes that is possible.
The other tip is about preparation. Think through your symptoms, write down what's been going on, so that you feel you feel confident and talking about it. And when you're talking about symptoms, make sure know:
· When it started
· What makes it worse
· What makes it better
Also, write down your questions, list of medications, supplements, and diet.
If your doctor cuts you off, one of my favorite recommendations is to just remind the doctor that it took a lot for you to be there. It helps to bring and redirect the doctor back to you, and it acknowledges that they have a lot going on too.
Georgie Kovacs: I’m learning how much diet plays a significant role in your health. How do we navigate that with our doctors given they are not trained in nutrition to a proper level of detail?
Christie VanHorne: This is not answering your question directly. I think that if holistic medication is important to you, you need to find a doctor who's going to work with you, because there are so many out there now. I have a very good friend who is a registered dietician, and she would kiss you because doctors don't understand diet and food. It’s really complicated.
Georgie Kovacs: Tell us what doctors share with you about what they would love to see from the patients or what's hard for them on a day to day basis, because I think it's really important to understand their world and the pressures that they're under, too.
Christie VanHorne: Doctors went into medicine for a reason. They care. And not all doctors are perfect. Absolutely not. But you find that in any field. If a patient comes in prepared and a patient comes in knowing how to describe their symptoms, they can get more accomplished.
You can be diagnosed up to 90% faster if you have your medical history, which includes your family
When it comes to medical records, try to keep them and try to get them as you go through the system. Wherever you're wherever you are, at this point, start requesting your medical records, especially if you move or switch doctors, take those with you and ask for copies. I also really want to stress that it is your right to have access to your medical records.
Georgie Kovacs: What would be your key takeaway? Let's do one for patients and one for doctors.
Christie VanHorne: My tip for patients will always be to trust yourself. If something feels wrong, don't let it go. My tip for providers is to listen and ask questions with sincerity.
Georgie Kovacs: What is your greatest hope for women's health?
Christie VanHorne: I hope that women receive the care that they deserve in a timely fashion. And this would really mean an overhaul in so many parts of our healthcare system, making sure that all women have access to health insurance, making sure that all providers trust women's health experiences and their symptoms. And that women trust themselves to be their best experts.
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Referenced in the podcast
Courses for patients, parents, and professionals
Resources to Find a Doctor
How Healing Works by Wayne Jonas
Period Repair Manual by Lara Briden
Body Belief by Aimee Raupp
More About Christie VanHorne
Christie is the President of CVH Consulting and founder of How to Talk to Your Doctor, a project that aims to address health literacy with patients and health professionals. As a consultant, Christie develops health curriculum, leads train-the-trainers for nonprofit and healthcare professionals, and facilitates community coalitions and working groups to improve health outcomes.
With 20 years of experience in the health sector, two masters (Education / Public Health), service in the Peace Corps, and appearances on numerous health-focused podcasts, Christie is passionate about bringing her expertise where it is most needed. Christie has consulted for organizations such as the Hemophilia Federation of America, Temple University, National Environmental Health Association, Malcolm X College, Multiple Sclerosis Association, United Way, and Planned Parenthood. She lives in the beautiful Hudson Valley, NY with her husband and two dogs.
About Fempower Health and the Founder
Georgie Kovacs, is the founder of Fempower Health, the go-to resource for all things women health serving women, their providers, and companies looking to build/improve on products for women. She also hosts the Fempower Health Podcast, where she interviews experts to help women better understand how to navigate their health both day-to-day and in partnership with their providers. Her mission is to minimize the years many take to seek proper diagnosis and treatment.
Georgie founded Fempower Health after her first-hand experience with infertility and endometriosis. Leveraging this experience along with her 20+ year tenure in the biopharmaceutical industry and consulting, she leads this movement to empower women. With limited research dollars and women’s “training” to grin and bear it, both women and doctors are in the impossible position to diagnose and treat conditions with little information. Women deserve more and better information, insight and innovative health solutions.
**The information shared by Fempower Health is not medical advice but for information purposes to enable you to have more effective conversations with your doctor. Always talk to your doctor before making health-related decisions.
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