Latest / The YMyHealth Podcast | Wellness and Healthcare Insights for Millennials / How to Be Your Own Self-Advocate at Your Next Doctor's Appointment
Transcript
- Melissa Schenkman (00:42) We are very excited today to have Dr. Jessica Gray with us. She is a board-certified family medicine physician in Texas and her name may sound familiar to you because we've recently had two stories on our site with your insights on self advocacy. One of them focused more on how patients can be their own advocate in the doctor's office and the other on searching Google before you go to your provider and talk about that and how that might not be always so good for you or your provider. And so we're going to delve into both those topics today and answer your questions on self-advocacy. So welcome, Dr. Gray. Dr. Jessica Gray (01:22) Thank you, thanks so much for reaching out and having me and kind of focusing on all these really important topics and really just helping patients take control of their health and their life better. Melissa Schenkman (01:32) You're very welcome and thank you. That is our goal for sure with Why My Health and we hope to help as many people as we can. First thing is we've had these two articles recently as I mentioned on whymyhealth.com. And so I'd like to start with talking about what health advocacy really means and why you think this is such an important topic in healthcare. Dr. Jessica Gray (01:55) When we talk about someone being an advocate for themselves, what we're talking about is being able to stand up for yourself and come to your physician with knowledge that will help them help you. A lot of patients are wanting to come in and have their doctor fix them. They just say, okay, let me come in and have you fix me. And that's not really possible most of the time for just say, okay, well, this is the solution with no input from a patient. So, we really need to make it a partnership and a team together. so having somebody be their own advocate to know their health history, but provide the information that's needed. Stand up when they're concerned about something is going wrong or they're not feeling right. It's really, really important. But definitely there's a lot of ways to be an advocate for yourself and I think we'll touch on those as well. And there's some good ways to do it and maybe some not so great ways to do it. Melissa Schenkman (02:41) No, absolutely. And the other area which I know is also of importance to you is women's health. And so, you know, I was thinking about in terms of self-advocacy for women in particular, why that's also so important for millennials. Dr. Jessica Gray (02:54) Absolutely. If you think about things like preventative care, we actually as women have a lot more preventative care things we have to pay attention to at a much younger age. Starting at 21 years old, we're talking about things like pap smears with screens for cervical cancer. know, once you hit older ages into, you know, 40 years old, we're starting to do mammograms, 45, colon cancer screening. Men actually have a different set of guidelines and they are not as many things that they have to worry about as we do. And some of these things are about touchy subjects. Some of these things are subjects that women may feel embarrassed to talk about and they don't want to talk about these symptoms or maybe embarrassed because they think that the physician they're going to or the nurse practitioner or physician assistant they're talking to may not understand where they're coming from. They may be worried they're going to judge them, which none of those things are true. They should never be judging you and we really want you to feel that you're in a safe environment where that is our 100 % our job is to help you and discuss these topics. Melissa Schenkman (03:51) Absolutely. And why do think people struggle so much with advocating for themselves, for their own health? And do you have any tips on combating fears about doing that? Dr. Jessica Gray (04:01) I think that there's a lot of misinformation out there. And I think that sometimes a lot of people think that they already know what that needs to be done. And maybe that's not something they heard from a family member or something they saw on TikTok or Instagram. And they think, okay, well, that's what it needs to be. Or they hear about bad experiences that someone else has had with a physician or in a doctor's office. And they think, well, that's gonna happen to me if that happened to that person. And so really coming to the doctor's office with an open mind and understanding that these people went to school for a lot of years and did a lot of training to help you and to guide you into taking care of yourself and finding solutions to problems. And that's their passion is to find solutions to problems. When you're talking about, what are some things that you can come into your office doing to really be the best self advocate you can. First thing I would say, come in knowing your health history. The first thing we're going to ask when we establish care with you is have you ever been diagnosed with any medical problems in the past? This includes, you know, a lot of times patients will say, nothing, never anything. And then we'll look and they say, okay, well, you're on 10 different medications. Sometimes I use that as a guiding point. I'll say, okay, well, we're on this medication. So perhaps you have a history of asthma, diabetes, high blood pressure, depression, anxiety, kidney disease. You know, we go through those lists. Come in knowing that history. Know maybe when you were diagnosed, how long have you been? Diagnosed with diabetes, how long have you been struggling with it? What medications have we tried? Especially with mental health aspects, you know, is this a new thing? Have we tried multiple medications in the past? How long were you on those medications for? What were the side effects? Why were they discontinued? You know, all of that information is really beneficial and it will help your physician be able to make a better treatment plan for you. Melissa Schenkman (05:46) Absolutely. And I wonder too, for some people they've had different conditions for so long and it's become such a part of their everyday life that they don't, it's just part of who they are. I don't know if you find that sometimes too with people they don't view it as though this is something that's problematic or that would matter now because I've had it for five years and it's, under control. Dr. Jessica Gray (06:06) Absolutely, that happens all the time. Sometimes it's something they maybe don't take a medication for, so we don't know sometimes how to prompt that health history from them. So, anxiety is a great one to talk about because maybe you've had been diagnosed in the past and you've had flare ups before that required maybe medical treatment with maybe medicine or some therapies. And that's one of those things that when somebody has a diagnosis of depression and is treated, they're actually 33 % likely to have another one. or 33 % of those patients that have been diagnosed will have a flare up again, even if they've gone on remission and been treated well. So having that history and just knowing that is really helpful, but it may not be something that you think of right away to say, you know, I have been diagnosed with depression or anxiety in the past. I was on, you know, this one medication and I did really well on it. I did some cognitive behavioral therapy. Things went great. So. I've been off of all my medicines and doing well for the past two years. That might be good information for your physician to know just in case, you know, down the line that starts clearing up again, or perhaps you have some other symptoms like maybe some palpitations in the heart and we're trying to think about all the different things that could possibly be related to that. Melissa Schenkman (07:15) Well, absolutely great point. And I know we may have people thinking, okay, I know all of this, but my doctor just won't listen to me. And this is true sometimes for millennials in particular. I feel like, you know, what would you say to them? And, you know, how can they get their doctor to view them as a partner in their own care? Because we've talked about this something as well… Dr. Jessica Gray (07:34) I think definitely coming in again with that open mind. So the majority of physicians are going to be open minded and want to be in a partnership with you. The majority of them are going to know that they will have a better relationship with you if they also, you know, listen to your complaints, concerns, and then try to provide feedback. I think one thing where even as a patient, you know, myself, if I were to go somewhere, get caught up or get into a little bit of trouble is if you go in convinced that you already know what's wrong. You know, I can't tell you how many patients will come in and see me and they're like… Okay, TikTok told me that my thyroid is off and all my hormones are way off and they need to be balanced. you know, start telling all of this stuff and we'll see, you know, as a physician, you say, okay, I understand. We should never throw it off and say, oh, nope, you're making stuff up. No, we should listen to all the concerns and be thinking, okay, how do we look at all of this? But sometimes if a patient comes in too forceful and says, nope, I only need X, Y, and Z labs, I saw this, I did my own research, we want you to do your own research, but we also have to have a trusting relationship that your physician did go to a lot of years of schooling and training and sees a lot of patients and they need to explain to you. Why maybe that's not the best course of action? Why maybe that medicine won't fix everything? Maybe why that lab doesn't work that way? So it's okay to ask, know, okay, so this is my thought process. This is what I heard from TikTok or Instagram. Is this correct? And if it's not, can you explain it in a way that I may understand it and be able to say, okay, that's why it doesn't fit my specific situation? Melissa Schenkman (09:09) So that's a great way to go about it because I think that's a lot of it has to do with the understanding and the explanation of things as well. And of course, almost everything with health and medicine is very complicated to lay public. So breaking it down makes a huge difference. That's a great way to approach it. Thank you. Dr. Jessica Gray (09:24) Every physician breaks it down when they talk about it. They may have some super sick patient in the other room that something happened. There's lots of stuff going on and there's not an excuse, but I think that that's why you can advocate yourself to say, okay, I feel strongly about this. Can you kind of explain to me in a way I might understand it? And then, you they'll explain it to you. And that's the thing is that if they're not explaining it to you, then that's obviously definitely not fair, right? But if it's something that they're explaining and they're using the science that they know and the evidence based medicine that's out there. That's something we've got to trust in our physicians that they do have our best knowledge of heart and they are using the best science that is available. Melissa Schenkman (10:06) Absolutely. There are so many things that come out, as you know, every single day. So many different studies to say, you know, up to date on, but everyone really, really tries their best to be as, at least everyone I've been talking to, but then within our community and outside of that, professionally as well, just always really tries their best. So yeah, definitely. And another thing we hear a lot from people is they're going to their appointment and they don't really know, you know, what types of questions they should be asking while they're there. Are there standard types of things that you should either have on your list, which is always the best thing to do it myself. I get out the post-it before I go. And I've got my five things, whatever I want to talk about. Because you do get caught up sometimes. And if you haven't seen your physician in a while and talking about other things. But yeah, there are different types of questions that you think that millennials should think about as they're preparing for their appointment. Dr. Jessica Gray (11:00) So first and foremost, you know what I kind of mentioned before, but preventative care things. So that's going to be really dependent on lots of times it's going to be your age. Sometimes it's going to be your gender. Sometimes it's going to be lifestyle things, know, things like smoking, drug use. We're looking at things that are all related to things that go on in our lives and our bodies. And so, you know, for a 21 year old female with a smoking history, you know, you want to ask, okay, what kind of medical things should I be thinking about? What kind of things do I need to be doing to ensure that I, you know, catch cancer, don't develop, catch cancer with screening or don't develop a cancer? Maybe it's you're in your 30s and we're talking about screening for cardiovascular disease with checking your cholesterol or are you at risk for things like diabetes? So really asking them, you know, based on me, my health history, my vital sign, my blood pressure, my weight, all of my family history, what am I at risk for and what do I need to be doing for preventative care? On that note, know your family history because family history plays a huge role in your medical care and things like genetic cancer screenings are really, really important. You are focusing a lot on that these days, working with cancer centers who really advocate for getting that done as early as possible. So if you have a family history of mom had breast cancer at 45 years old, maternal grandmother had breast ovarian cancer, uncle had colon cancer, certain risk factors there. Breast, uterine, ovarian cancer, colon cancer, pancreatic cancers, those are huge. We need to know about those because that actually tells us if we need to change the normal screening guidelines. For example, if you have family history of colon cancer and it's at a younger age than 50, instead of starting at 45 like we normally do, we could be doing colon cancer screenings in your 20s or 30s if that family member was in their 30s. We always do it 10 years before the age of that closest relative diagnosis. There's things that have to be adjusted to you and to fit your health specifically and go in and ask those questions. What based on my history do I need to be doing for prevention? Melissa Schenkman (13:03) No, absolutely. And that's incredibly important to us here at YMI Health, especially with the March colorectal cancer awareness is already on our mind. But that's a great piece of information because a lot of people just with that alone, I don't think really know if they've had a family member either with Paula or who've had a colon cancer that they need to get their first screening 10 years before. found in talking to people that was something new for them. So it's great to point that out as well and for us to think about prevention because that's a big part of our health care. Julie Woon (13:33) Now we’d like to take a minute to talk about today’s sponsor. Diekman Dysautonomia. Have you or a loved one been struggling with symptoms like fainting, a racing heart or crushing fatigue only to feel dismissed or unheard by doctors? You may be experiencing dysautonomia POTS or long COVID. 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And in saying that also, what would you recommend? We do and the steps we take when we first realize, okay, something is off, something I'm experiencing, something unusual for me, how should you go from there? Dr. Jessica Gray (15:02) So I mean, we use Google nonstop every day for so many different things, right? You look up the phone number for your favorite restaurant, when you've got to find an address, you know, when you're looking at where to buy a certain product. Google's great. And I love Google. It's just when we put doctor and Google together in one thing, we have into a lot of trouble. Even things like WebMD and these algorithms that they come up with. If you just type into Google chest pain, you know, female blah, blah. It's going to come up with like 20 different diagnoses, including cancer. And then maybe heart attacks thrown in there, stroke, lupus. I mean, they're going to throw everything at Unfortunately, as awesome and amazing as the algorithms that the developers at Google have, they cannot create an algorithm that replaces what your physician can do in their brain with their actual experience and seeing you and understanding and knowing your background, your history. We just haven't been able to be replaced, which is probably a good thing. Yeah, it's a good job of security there. it can come across interesting when a patient comes in and says, well, I've done all my research already. I just think that I have this based on my research and my searching. I love when patients do research, but you've always gotta be careful about where that research is done. Like we talked about before, TikTok is not research. Even when we see people that claim to be a doctor on TikTok, doctors are loose title these days too. So you gotta be careful and do some research into who you're talking to. Are they an actual MD or a DO when they say they're doctor? Or are they doctor of something else that may not actually have that medical school training background, board certified. And we have a lot of, in order to maintain our licenses and be doctors of medicine, we actually have a lot of stuff we have to do to maintain that and then keep that education going. And we can get a lot of trouble if we don't do the right things and are not practicing correct medicine. So careful where you're doing finding that, know, doctor says this online situation, but it also can start off on a bad foot for some doctors. You walk in and just kind of are telling them already that this research that the algorithm from Google told them is more important than their years and degrees on their walls and everything else. And it's not about ego. It's more about just trying to be like, okay, where are going to start? Because sometimes when a patient comes in, already set on this diagnosis, what I must have, because Dr. Google told me, it actually can make it harder for the doctor to try to actually make a decision of what really is going on. Because most of the time they're trying to weed out the other parts of the confounding information that was being given from the Dr. Google search. I'm all about research and so what I will tell patients is come in with an open mind and then when we talk about it, ask how can I learn more about this? What other information, what are good tools, what are good resources that I can use? And we should be able to give you a long list of actual reputable resources that have information about where you can go. know, like Mayo Clinic and things like that are great and they have some of that information, but also ask about what diagnosis they should be looking at. Because a lot of times doctors are not going to use big fancy doctor jargon with you all the time on purpose. They should be communicating in a way that both you can understand and that also gets their point across. So maybe there's a very specific term for your wrist pain that needs to be, you know, that you can help look up and actually use that term. There's a condition sometimes that happens to moms postpartum called De Quervain’s Tenosynovitis. So, you know, maybe that's some hard mouthful to say, but it's easier than Googling wrist pain and coming back with, I have risk of cancer in my wrist or something. So ask your doctor what you should be looking up, what terms they should be using, and then what resources are available. And perhaps they'll even send you home with some pamphlets that are good information, are reputable. And a lot of us have EMR systems, the electronic medical record systems that have that patient education stuff that they can print out and send with you on the way home. Melissa Schenkman (18:54) That's great advice and great information. Actually, one of the things I was going to ask you about is if you had any particular resources, speaking of resources, about where people can go to get information on self-advocacy or tools they can use to be better self-advocates. it sounds like even Mayo, you know, when you're looking at information, you've just learned you've been diagnosed with something, things like that. I think that's part of the, should I say struggle with Google and issues with Google too is reliable sources of information, which you can point people to. Dr. Jessica Gray (19:23) Yeah, definitely. You know, start out with things like you want something reputable and nationwide known. Yes, Mayo Clinic is a great one. So that's one option. The other thing is if we're talking about things like, let's say, a cancer. So you can look for like the American Cancer Society and they will have very specific information about your diagnosis as well as links to groups that they have vetted and recommend that can continue to provide good information. Endocrinology societies for things about related to thyroid dysfunction and management there you've got to look for more of some of these societies that create some of the science fund some of these research studies more than just you know somebody created a blog page and this is their experience because we all have different experiences every single person is a different human being with different makeup and metabolism and so You and I are not going to have the same, well, you know, just because we might have the same exact thing. We're not going to have the same experience. We may not respond to medication the same way. And so these bigger societies and groups, they're trying to make recommendation on a larger scale, taking that in effect and having studied that with certain people. So. You got to look for the bigger groups and ask your physician or use those resources and use them to guide. You know, if we're talking about heart disease, American Heart Association is a fantastic one. You know, there's diabetic societies where, again, you're looking for something other than, know, somebody's personal blog experience or, you know, a for-profit maybe medical clinic that, you know, is saying, you know, we're going to sell you this cure if you pay $9.99 a month or something like that. Melissa Schenkman (20:55) Absolutely great points. And again, half the battle to finding those resources so your doctor can be very helpful for you, pointing you in the right direction. What are some things that patients can share with you that and share with their doctors in general that really is most helpful when they go in for an appointment? Dr. Jessica Gray (21:14) Kind of what we touched on before, it's really helpful for them to know their health history. Come in with your history already known. Come in with a list of your medications already known. You don't have to have them all necessarily memorized. We hear all sorts of cute ways to say certain medications like atorvastatin. People come up with different ways to say it. We love it. But we do need you to know exactly what medicines you're on, whether you bring us a physical list that also has dosages. We don't just need to know the name of the medicine, but the dosage and how often you take it on a blood pressure medicine, let's say you say, well, I'm on this medicine. I think it's called metoprolol. Well, there's multiple different kinds. Are you on metoprolol tartrate, metoprolol succinate? Are you taking the succinate once a day like you should be? Or are you taking the metoprolol tartrate? You're supposed to take that one twice a day. Are you only taking it once a day? It can lead to a lot of confusion. So, have your list of medications and include the dosages, the amount times you take it in a day, tell them how often you're taking it. And know, are you, be honest, if you haven't taken your thyroid medicine in three weeks and your doctor's about to draw your thyroid labs, make sure they know you forgot to take it for three weeks. You're not going to be in trouble. It'll just help them. So when they draw that lab and it's off, they say, don't just start messing with the dose a whole bunch. You know, you can say, okay, no worries. We'll recheck that in three weeks after you've been on your medicine, four weeks after you've been on your medicine a little bit longer. You know, we can recheck that value again. So. Health history, medications, family history we talked about again, because that has played a huge role in cancer screenings for yourself, for your family members as well. And just understanding that if you were on a medication in the past, maybe also saying what happened when you were on that? Well, I took this one medication and it dropped my blood sugar so low or my blood pressure so low I was passing out. That's really good information for your doctor to know. And that way, maybe it doesn't change what they're doing right then and there, but they can make a note of it. And so next time, If there was something that was affecting that, that history maybe affected their medical decision process, that might be beneficial. Melissa Schenkman (23:12) So all really excellent points. And I was going to say to your point about telling them what's happened with other medications is an especially interesting one because there's always a place on the forms that you're filling out to list allergies or allergic reactions and things that doesn't necessarily get at those types of things because they weren't necessarily allergic reactions that you experience with medicines. And that's a great point to be able to let your doctor know about so that you don't end up having that same experience again. Melissa Schenkman (23:40) Absolutely. So good to know. Definitely, no great points. Well, I want to thank you again so much for being here today, Dr. Gray, and I know our viewers have found this really timely, really informative. I have learned some new things myself as well that will be helpful in my own healthcare and sharing that with our community. So I really appreciate it. We've covered it all. Dr. Jessica Gray (24:01) Yeah, we covered a lot, you know, as far as being an advocate, it kind of summarizes it up.I think that I feel bad saying sometimes, you know, that maybe don't go with Dr. Google, you know, thought process or tell your doctor, I know exactly what's wrong. Because I've been on both sides. I have a patient myself as a physician. So I get that, you know, you have to balance both and you want your doctor to do their job and do it right. But you also want to make sure that, you know, they know all everything that's going on with you and they know how you're feeling. You know, don't be afraid to say, hey, when I take this medicine, makes my depression way worse and I feel apathetic and just, you know, I don't feel like me. You know, your doctor actually wants to know those things so that they can change your medicine or look at other options. You don't have to live with some of the side effects sometimes. you know, but we probably don't know that happening. We won't be able to help. Melissa Schenkman (24:51) No, absolutely. That's a great point. And it is even sometimes hard to bring those things up, I think, for our age group. So definitely want to encourage, encourage the way to optimize your care. And you can check out both of Dr. Gray's posts at whymyhealth.com. And thank you so much, Dr. Gray, for your work and for all you do for patients and coming and joining us today. Dr. Jessica Gray (25:14) Thank you for having me. I really appreciate it. Melissa Schenkman (25:17) Very welcome.