Episode 32 – Betsy Wurzel – Preparing for a doctors appointment
Preparing for your doctor’s appointment is key to getting the most from the visit. Today we will discuss how to improve your care outcomes with good communication.
Betsy Wurzel – Preparing for a doctors appointment
Diane Carbo: Hi, this is Diane carbo and I’m with caregiver relief. Today we have Betsy Wurzel our podcast host and contributor, a caregiver coach dementia care specialists. Betsy has her own podcast. Chatting with Betsy and she as the admin for. The Facebook page kick Alzheimers ass.
Diane Carbo: I’m so excited to have what you here with me today. We’re going to have a very good topic on how to prepare for a doctor’s appointment.
Betsy Wurzel: Thank you, Diane. Always a pleasure to talk to you. Cause we’re like kindred
Diane Carbo: spirits.
Betsy Wurzel: Yes. So many people as Diane, cause you worked as a nurse, we go to a doctor’s appointment.
Betsy Wurzel: I want to ask the audience. Are you ready? When you go to doctor’s appointment, do you take a notepad? Do you have someone with you to help you understand if you need that? Do you have your questions written down? I want to tell the audience, your average doctor has maybe 15 minutes a person you have your questions ready?
Betsy Wurzel: You have to be prepared. Know what you want.
Betsy Wurzel: I have someone with you as the doctor, you could even record the answers so that you could remember later on, it’s a very important to write down your concerns. Any questions about if it’s for yourself or someone. Also Diane, as far as like tele med, which is now very big cause of the pandemic and it might continue afterwards.
Betsy Wurzel: There’s still have your questions ready and to be ready for your appointment and make sure you could have a good connection and be dressed.
Betsy Wurzel: Don’t be naked. Especially that tele med have your medications right there with you. In case they ask you what medications you’re on and know your history. It’s so important when the doctor gives you. The bad news. Nobody wants to hear bad news. And that’s a shock when you get bad news, don’t be afraid to ask the question.
Betsy Wurzel: Don’t be afraid to call them up and ask, can I speak to doctor? I didn’t understand.
Diane Carbo: Or if you sit at
Betsy Wurzel: nurse practitioner, cause now you’re seeing a lot more nurse practitioners and a doctor’s practice because doctors are fewer and farther between and that’s only going to get worse,
Betsy Wurzel: It’s so important to be. Prepared as saves time. Just write down what you want to discuss with the doctor changes in your loved one. If it’s your loved one changes in yourself, if it’s for yourself.
Diane Carbo: Know, one of the things I want people to understand is if you have Medicare, Medicare only pays for a 15 minute
Diane Carbo: visit. That’s why doctors are stressed and pushing to go to the next patient. There’s not much in doctor can do in 15 minutes. I really take offense to this, but it is what it is right now. We are working with a low rate. So doctors in order to pay the staff and meet all the requirements.
Diane Carbo: So it behooves everybody to be prepared. I think one of the things you have to do. These decide what you’re there for, what your list of concerns are and you have to prioritize them. Don’t spend a lot of time talking and and say, oh, I have this and this be very concise and specific so that you get the biggest bang for your buck.
Diane Carbo: I think that’s really important. Are you having some issues about your treatment? Is it affecting your daily life? I think one of the things, every patient that sees a doctor should do is once a year go over all their medications. And ask, do I need to stay on these medications?
Diane Carbo: Can I take away any or decrease the amount? Because as we get older, that becomes an issue. As far as our body detoxifying and our kidneys clean everything out of our system. So there are things in everything you take. Has a consequence, whether it’s a vitamin or even anherbal tea we don’t know how , our body’s going to respond, I also think people need to plan to update their.
Diane Carbo: On what’s happened to their health. If you’ve been to the ER or you saw a specialist, let your doctor know, and if you’ve had changes in your appetite or your sleep or your energy, your vision, or hearing, you need to address that as well. And I think that’s really important. Yes.
Betsy Wurzel: Yes. That’s very important.
Betsy Wurzel: I agreed Diane because doctors are not mind readers. Some people think they are, but a doctor doesn’t know your. Problem is your difficulty, unless you tell them. Yeah, you don’t know.
Diane Carbo: And this is why communication is important.
Betsy Wurzel: I never knew that about Medicare 15 minutes because I don’t have Medicare and it’s still only 15 minutes.
Diane Carbo: You know what the reimbursement rate is. So low doctors are really challenged right now. That’s why we’re losing so many doctors and specialists there because they can’t meet the requirement. Of the paperwork and all the government who ha that they have to go through to pay the staff.
Diane Carbo: That’s a whole nother ball game, if you’re going to have changes in your health or insurance, you need to notify the doctor, but here’s something I have an issue with many clients is make sure it. Wear glasses and a hearing aid wear them to the doctor’s office, or if you’re a person that has having a hard time with hearing or seeing you gotta say, Hey, slow down.
Diane Carbo: My hearing makes it hard to understand and people that can’t hear don’t want to acknowledge that, but it’s detrimental to their health. Don’t hesitate to tell the doctor or somebody like me.
Diane Carbo: We also have doctors that are foreign speaking, so they have an accent. And if you’re hard of hearing. It can be a challenge to understand what they’re saying. So don’t be hesitant to say, Hey I’m having a little hard time here, understanding everything you’re saying. Could you speak slowly or can you record it?
Diane Carbo: Have have somebody recorded or write things down for you?
Betsy Wurzel: Yes. And I think a lot of times people are hesitant. To ask a doctor to repeat themselves or a nurse practitioner, because they don’t want to seem like they don’t understand. I always tell my son this it’s better to say. I don’t understand.
Betsy Wurzel: Can you please explain it again where I can understand it then to have the misconception that you do understand when you don’t. Exactly because it’s your life’s folks. This is your life and you have to be diligent.
Diane Carbo: I think it’s also important that the people that are foreign speaking and English is their second language.
Diane Carbo: If they don’t have a family member, they need to either arrange for an interpreter to come to the doctor’s with them, or they should the doctor’s office set up a system where an interpreter can clearly understand their symptoms and conditions and, give that information accurately to the doctor.
Diane Carbo: So if you’re somebody who has English as a second language and , the doctor is not able to accommodate you. Have it plans for an interpreter if you need one, because it will make it so much easier for you. If the staff knows, is able to understand your diagnosis and or that you’re able to understand the treatment
Diane Carbo: instructions.
Betsy Wurzel: Yes. Yes. That’s very important. Not so much a problem here in my area because we’re very diverse and there’s usually someone in the office that speaks other languages because I do live in such a diverse area here in New Jersey where they’re actually now, most of the doctors are Foreign.
Betsy Wurzel: And it’s hard to understand them. So sometimes I have to tell them, can you look at me and repeat it? I don’t like it when the doctor’s face is in a computer. Tell the doctor, can you please look at me? And when you’re talking to me, because it’s important communication is very important during the doctors.
Diane Carbo: It is. And I think no matter what age you are, it’s really easy to forget a lot of what a doctor says to you. So it’s important that you do take notes, jot something down or ask if you could record the. Because that’s important. Don’t hesitate to sit down while the doctors talking to you and make notes in the waiting room after the visit.
Diane Carbo: So that if you have a question you can say to the staff, did I understand this right? Or did I understand that right before you leave, it just would make it easier. And the thing is, I it’s so hard. For people to ask to say, I don’t understand. Or could you tell me what that word is? Could you explain a little more to me?
Diane Carbo: What does it mean? They’re afraid and then they’ll go. Yes. If that’s when the doctor explains it again, and if they still don’t understand, and one of the things they need to do is repeat back what the doctor is saying to them and say, Hey, is this correct? Is this what I’m understanding? But people are so afraid to.
Diane Carbo: Question the doctor or to waste his time. Here’s what I tell my patients, my clients. I say, look, you are employing that doctor. You are paying him for his time and his expertise. You need to get the biggest bang for your buck. He’s not doing you a favor. You’re doing him a favor pain. So if you look at.
Diane Carbo: You’re his employer and you want to get the most out of that visit then that’s what. Changes your perspective. One things that, he’s there to help you, you need to, and you’re paying for his services. So get the biggest bang for your buck.
Betsy Wurzel: That’s right. I love that. I know a lot of times, we think we don’t want to upset that doctor.
Betsy Wurzel: We don’t want to say we don’t understand or refuse a medication or treatment. But you are right, Diane. We are employing the doctor. And if you do not agree with the doctor or you don’t want to take a medication before, your own personal reasons, maybe it’s not working for you.
Betsy Wurzel: Maybe you’re having side effects, then you need to tell that to the doctor. And, make it very clear. I cannot tolerate this medication and tell them why. This goes right back to advocacy, Diane. It’s always, I think it goes back to being an advocate for yourself. And you’ll lose one at an expression during a doctor’s visit and you have to be and I think it’s hard, also difficult for people of the older generation.
Betsy Wurzel: Not so much our generation Diane, like my mom, God bless her. She’s 91. Very difficult time questioning the doctor because they were taught not to question. And that’s not changed.
Diane Carbo: The other thing is a lot of patients, aren’t honest. They tell the doctor what they think the doctor wants to hear and not be honest, they’ll say they’re not smoking, they’re eating a more balanced diet, or they’re doing this. They’re taking the medications. When in fact they’re blatantly not doing any and the blood work and everything shows it. But they have a tendency to not be honest. As if the blood work and the test results and everything are not going to show what they’re really doing.
Betsy Wurzel: Doctor will tell someone, you need to lose weight. They’ll ask her, have you maintained your diet? Oh yeah, me change my diet. And meanwhile, they’ve gained weight. Their blood sugar is
Diane Carbo: off. Exactly. Exactly. And another thing is You have to stick to the point,
Diane Carbo: Your doctor’s there for you to share your point of view about the visit. So if you’re feeling rushed or uncomfortable or having questions about things you might want to say Hey, I’m feeling rushed. But I know you have a lot to see. Can I make another appointment to have another conversation about this?
Diane Carbo: Or could we talk about this little more in another setting, whatever, it’s important that you share your point of view? I go in and I tell them, look, I’m not going to take this medication that you want me to take, or I’m not going to do this, or that’s not of interesting. I don’t believe in this medication, some people will say I’ll take it and then they don’t.
Diane Carbo: It doesn’t do you any good? I know here’s a perfect example of statins. People either want to take them where they don’t want to take them. Statins have terrible side effects that may not go away. If you stopped taking them, if you have an adverse reaction. So I’ve chosen, I’m going to be healthy and do things, but I’m not going to take a statin.
Diane Carbo: I don’t care. I don’t want it. I do the cholesterol lowering stuff, a diet and all that. And I am good with that. I’ve been really good, don’t tell a doctor you’re going to take it and then not take it. But then we have an issue where seniors are not compliant with the medications because they can’t financially afford to take the medications that the doctors prescribed for them as well.
Diane Carbo: So they get so close to that donut hole. They stop they have to choose, do they eat, do they pay their rent? Or do they a perfect example. I was on duloxetine, which is an antidepressant, but it was also for pain and I was on it. And when you go off of it, you have to wean yourself off because if you.
Diane Carbo: Don’t wean yourself off and you stop suddenly which happens with many medications. You can have terrible side effects, terrible withdrawal effects. I had a situation where I was under Roxa tin and for my pain and it was working and I wanted to get the refill. The refill was going to cost me $7,000.
Diane Carbo: Wow. Yeah. And I’m like whoa. So I tried to call the doctor. I tried to get this done, trying to find ways to get it. I know how to find cheaper meds, but I, it was really a struggle. By the time that I got everything worked out. I Had gone through withdrawal and it’s terrible.
Diane Carbo: Oh, it’s just terrible how you feel. So I decided I’m not putting myself in a situation again, I’m not taking that damn medicine. I’m just not, I’m not going to be held hostage by a medication. So it was a choice that I made, I suffer for it because I have chronic pain and it was working for me. But, you have to make choices.
Diane Carbo: And that was a choice., when I found a cheaper medication, of course it’s over the holidays and a cheap, cheaper way to find it. The doctor’s office was closed . So I ended up doing without, and I thought, Nope, I’m not going through this again.
Diane Carbo: I’m just not going to go through.
Betsy Wurzel: Yeah, you brought up a great point, Diane. That aside my late brother, the doctor wanted him to take a medication. It was $600. He said, I can’t afford this. My mom goes, no, I’ll take it anyway. Then my brother’s I can’t afford it. So he told the doctor that and the doctor said, okay, take a baby aspirin.
Betsy Wurzel: And I, had a talk with some of them and the insurance company, a nurse man. And we’ve talked about the subject of, she says a lot of people would non-compliant. I said make, did you ever think that maybe they’re noncompliant because they cannot afford their medication and they don’t want to be, but they have no choice.
Diane Carbo: And I’ll tell you what . I did case management for years and years, and I’ve always worked with seniors and that’s one of the things that I always address is I tell them, please just tell me if you can’t afford something, let’s work on it to find a cheaper way or get you on a different medication.
Diane Carbo: But that’s, is really an issue that people don’t want to address is that they’re embarrassed. That all, I can’t tell the doctor, I can’t take this medication, not me, man. I told him after I, after you go through withdrawal and I was crying and so emotionally upset and it’s terrible, you can’t control it.
Diane Carbo: And it was just an awful, terrible feeling. I said, I am not going to put myself through that again. Too harmful to me. So I’d rather live with the pain and do other things, try other things, which I’m doing alternatives, but it’s not as effective, but it’s the same as Gabapentin. I can’t take Gabapentin, which is a medication that, oh my God, it’s just a terrible medication that for me, It makes me off balance and stuff and they always want to give it to me, but I’m saying Nope.
Diane Carbo: And then it caused me blurred vision. So I’m done with that medication, but it’s just people don’t understand. Now, one of the things I want to do is address questions that people should ask. The doctors are going to tell you they’re going to do medical tests for. On you and they don’t explain anything to you.
Diane Carbo: My husband, John, my second husband said to me, I laughed because when I had an MRI, I told him, I said I’m going to go. I thought you went through all the way through the other end, not knowing that you were. In a casket that sounded like trains were going. He laughed at me cause I said, oh, it’s not going to be that unpleasant.
Diane Carbo: I’ll live through this. Thank you that I was going to be on this little thing, that conveyor belt that took me through this machine all the way through to the other end. It wasn’t like that at all. I recently had a dear friend had a small bowel. GI tests done and she had to do the barium swallow, and she got violently ill from it and couldn’t believe this.
Diane Carbo: And nobody told her what to expect. So I tell people if you’re going to have tests done, ask what, why are you having the test done? What does it involve? You know how much, always ask if there’s going to be a coast pay and don’t be hesitant to ask, are there dangers of side effects to a test because heck yeah.
Diane Carbo: You have to know. I know for me. I can’t have a colonoscopy because I have to fast for 24 hours or did the clear liquids. And I it’s, I’ve never been able to do fasting because I have I’ve sensitive stomach and it’s causes a vagal response that sets me into vomiting for hours, a migraine, a heavy duty migrate and vomiting for 10, 12.
Diane Carbo: Ours. When they’re telling you, you need to do this, I tried it. I did, I knew what was going to happen, that I thought, okay, I can get through it. And I couldn’t, so I don’t have colonoscopies done. It’s just the reality. My body can’t do it. So you have to ask, you know about the tests because I think people need to understand that.
Diane Carbo: And you were talking about a diagnosis when you get a new diagnosis, it’s always frightening. I do have on my site, a list of 10 questions that you should ask a doctor as soon as you get that diagnosis. So it helps you, but you want to know. What may have caused this condition or how long it will last, or is it a permanent thing for you and what are the treatment options or is this something you just have to manage with lifestyle?
Diane Carbo: And what are the long-term effects? And people, you always have treatment options . I think that’s important too. Think about too, what are your treatment options? And, you want to know about the benefits and risks. Then you have to ask those questions to the doctor. A 15 minute appointment may not be enough time, but you can say I’ll schedule another appointment specifically for that to ask those questions.
Diane Carbo: And I think that’s a fair trade off, we’re already in the doctor’s a lot and we don’t want to be there any more than we have to, the reality of our healthcare system now.
Betsy Wurzel: Yes. And Diane, I agree with you with the Statens. I was on Statens for a few years. I cannot tolerate them anymore, and I will not have to take them with, tests.
Betsy Wurzel: People don’t know. But they have a right to refuse a treatment or a test. And, there is a patient bill of rights. When my late husband, he had hemorrhoids and he got them banded. I knew that the gastro doctor was going to suggest a colonoscopy. I knew it. I said, no. And this was probably 2017, that was midway with his old timers.
Betsy Wurzel: And he was saying anesthesia wouldn’t affect his dementia. I went to Karen.
Diane Carbo: Oh no, that’s total ignorance. Oh my God.
Betsy Wurzel: Yes. I said, oh no, I just agree. And he goes I could do a partial. Yeah. If you could give him any money, he could run to bet on myself. No, I said, first of all, Matt would never tolerate an enema and he doesn’t run.
Betsy Wurzel: He shuffled compliment to me. He didn’t realize it. He goes, are you his daughter? I said, no, I’m his wife. Sorry. I said, don’t be and made my day.
Betsy Wurzel: So you have to really. Being informative yourself and you know what, Diane, this goes back to education. Yes. You have to be an informed consumer because you’re buying a service.
Diane Carbo: Okay. That’s in this makes it a really good point. I’m going to bring up when you talk about dementia, there comes a time when testing, while when a person’s in different stages of dementia.
Diane Carbo: Really needs to be addressed as far as is it necessary? What are the options if they do have it? I’ve told this story before, but I had a patient. I went to a Catholic nursing home to do agency work and. They had this lady, she was a school teacher in the mid to late stages of dementia and . She was still able to walk and get around, but she was always smearing feces everywhere.
Diane Carbo: It was just her level of dementia that she was in. I can remember, they tried to take her out to do a mammogram. I’m like, are you kidding me? What planet are people on that they would send a patient who’s so confused and disoriented out to have a mammogram? Not only did they send her out once, but they brought her back because she was totally uncooperative surprised.
Diane Carbo: And then they sedated her and sent her back out again. , I didn’t understand that because if she had breast cancer, really, where you going to treat the breast cancer based on the information of her dementia, why would you even put her through that? It made no sense to me. And I think that.
Diane Carbo: Often forget, you know that, Hey, the brain is dying. They’d literally having brain cells. They’re going to get worse, not better. And anesthesia does have a negative impact on anybody with dementia. I’m sorry. It has a negative impact on seniors that are fine.
Diane Carbo: I can’t tell you how many times I have had clients. This is even when I was a young nurse, I have had patients come in, they were healthy. 90 something year olds that had fallen had broken a hip or whatever. They were alert, oriented, and living alone and whatever for, and doing well after surgery. , they lost it. They weren’t able to go home. It just anesthesia had a negative impact on them and they were never able to get back to baseline.
Betsy Wurzel: Yes. Very true. Diane. I even said to my husband’s primary and he agreed with me. He said that he has not had cancer. What are you going to do?
Betsy Wurzel: Anyway? He’s terminal. You got to put his with treatment surgery. I said, no, I wouldn’t. He goes, then why have it done? He says, he supported me. You just have to, do what’s right for you. And on your loved one, I would never put me through unnecessary procedures. And this is why I’m going to bring this up.
Betsy Wurzel: It’s so important to have that medical director. Power of attorney. You have to have that folks. They’re going to ask for it at the doctor’s also, they’re going to ask for it at the hospital. You need to have that that paperwork done. It’s so important and you need to be an advocate. Yeah. It’s really at the point where you have to stay in.
Diane Carbo: And I will going to make a one more recommendation to people, seniors. When you’re traveling, please take all of your health history list of medications and allergies, wherever you go, keep them on you somewhere, because you don’t know that when you’re traveling that you’re going to be able to Communicate.
Diane Carbo: If something happens to you I have, I created the home health care notebook and I’ll tell you what I use it for myself. And I use it for my family members and I keep emergency contact information in there. I’ll list of all my doctors and their contact information. And I have a list of all my medical conditions.
Diane Carbo: Okay. Any past medical conditions what’s important is if you have this information easily accessible to you, it can make life so much easier. When I go to a new doctor. Now, all I do is take a copy of my medical history that I have in my system. With all my medications, my allergies, all that.
Diane Carbo: And I just put on there, see my medical record, and I provide that. It just makes life so much easier. And if you’ve had an allergic reaction or adverse reaction, to any kind of medications or food, have that as well. Again, I also suggest, when you’re traveling, take that advanced directive or aPOLST or whatever you have with, so that it’s easily accessible.
Diane Carbo: To providers, if something happens to you in
Betsy Wurzel: an emergency, that’s a great idea. And you could also, I didn’t think about this till a guest on one of my shows said it, you can download it if you have a smartphone. So it’s on your phone.
Diane Carbo: Exactly. . I
Betsy Wurzel: never even thought about that and I had a smart phone at the time, but it never occurred to me to put it on my phone.
Betsy Wurzel: Yeah. Your medications and important information.
Diane Carbo: As you get older, there’s so many, you keep adding things to it. I know my allergy list keeps going higher and higher, and if I don’t write it down I don’t remember them all. And
Diane Carbo: that could be very dangerous. So it’s important that, you have that information and you keep it updated and it can be hard especially if you have changes in medications, but it’s really important.
Betsy Wurzel: Yes. Yes. That’s very important. I just want to throw this out there, Diane. It does.
Betsy Wurzel: That’s a nice thing to do at the doctor’s office, but I do want to suggest to people when you’re Medicare age and you have to pick out a prescription program, go to your senior center. They have people there that are not sales people that will help you, and they don’t make it to.
Betsy Wurzel: That’s how I found out about all the services that are in my community that I had no clue about. So check your senior centers. Go to your senior centers or call them and ask if they can help you navigate Medicare and prescription products.
Betsy Wurzel: It’s a big
Diane Carbo: help. It really is. The other countries don’t have the issues with cost of medications that we do because of the way our medical delivery system is. And it has to do with our government and big pharma in bed together which is a whole nother story, but The best, and I think that we covered a lot today and I really appreciate your information.
Diane Carbo: You have lived it you’ve been a caregiver for forever, and I appreciate that. You’re willing to share your information with other caregivers.
Betsy Wurzel: You’re welcome. And it’s my pleasure. And thank you for having me on, I want people to learn from my mistakes, so they don’t make the same ones that I did.
Diane Carbo: Exactly me too. I’m trying to help them to offer on that note. I’m going to say caregivers. Remember you’re the most important part of the caregiving equation without you? It all falls apart. So learning to be gentle with yourself, practice self-care every day, because you are worth it until next time Betsy. Thanks. Talk to you soon.
Betsy Wurzel: Okay. Bye. Bye.