The Legal Drug Dealer Podcast
Getting Pharmacy as a profession Closer to The Patient
June 2, 2020
#25 Learning how to understand your doctor
With Lynn Stiff, MD & Marilena Grittani, RPh
On this episode we will continue to show you a different way to perceive your doctors, this time from the health information they give the patients. The doctor I invited today is Lynn Stiff, MD
Some of the most relevant points she made are:
- Not all patient’s understand what the doctor says
- Patients should always ask for clarification when they have a doubt
- Patients must consult with the doctor about thier own opinios and they should be respected
- It is better when you tell the doctor how you take a medication, to show that are you are doing it correctly
- Among a ton more….
Lynn Stiff, MD. You can see the love that she has for nutrition and healthy foods... she is in the kitchen!
Listen To The Episode Here
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Lynn is not only an excellent physician, she is also a deeply involved doctor on her patient’s needs. That is why she is so focused on helping as many people as she can, and one way is through a podcast.
Her podcast name is Medicine for Life Podcast. Go take a listen and tell her what did you get the most out of her podcast.
Let me know what you think about our conversation and if you have any questions!!!
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Marilena Grittani, RPh 0:10
Hola! And welcome to The Legal Drug Dealer podcast. Marilena Grittani. Here. I am a registered pharmacist. I’m also your host, thank you for listening to this new episode number 25, where we’re going to learn how to understand your doctor and our guests is Dr. Lynn Stiff she is the physician and she has dedicated a lot of her professional life to understand why patients don’t follow what the doctors honor them to do, why patients are not that involved with their care. And what is it that is going on that there is a disconnect between some of the patients and the doctors. So we’re going to talk today specifically about something called health literacy which is the knowledge that People have about health, it doesn’t mean that you are not an expert in whatever area you are, or that you’re not educated. It just means that you are not that much of an expert on medication knowledge, which is perfectly fine because that is not your area of expertise. That’s what we are here for. But at the same time, whenever you have a disease that you need to treat, or you have family members that you’re supporting under treatment, or if you make medical decisions for somebody like your children, yourself, your parents if you have power of attorney, same thing for your spouse, then you need to have enough information to make the decisions that you need to make to understand what the doctors are telling you to see and to get what this test or that medication is going to do on on yourself or the patient. And then what this drug or this exam or whatever treatment is going to do for the patient. So you are able not only to see if it’s working, if it’s improving the situation that is supposed to be improving, or if it’s causing effects that you were not expecting, something is wrong with it, something is not working. So you can talk to the physician or the practitioner or even your pharmacist and decide what is it that needs to be changed or done for it. So health literacy is something that people don’t think about. We in the healthcare are very aware of it, and we try to keep that in mind. But we’re very guilty of not taken enough time to go through the steps that Dr. Lynn Stiff mentioned in this episode, that I would ask you to make sure that your practitioners your physicians, your pharmacist, your your PA or medical assistants do to you so you get exactly what you need to get from that visit. So I’m not gonna keep giving it away, but I wanted To make this specific intro, so you guys understand a little bit what we’re going to talk about, and then that way you will, your brain will get to that mode. Okay? So here’s Dr. Lynn Stiff talking about health literacy, welding.
Thank you so much for coming to The Legal Drug Dealer podcast, it is something that we were looking for four months, and we finally made it to work. So thank you for coming.
Dr. Lynn Stiff 3:25
Oh, yeah, thanks for having me. I’m really excited to talk about something that I see in everyday interactions with patients. And I feel like it’s something that is not talked about nearly enough.
Marilena Grittani, RPh 3:36
I agree with that. And then we’re going to do the best that we can to help our listeners to understand a little bit what we’re talking about, and for them to see what they could do to be a little bit more prepared to avoid this kind of issues. But before we start talking about what we’re going to be talking about, I just want to know a little bit about you. So Lynn Stiff is an MD she’s a physician, but when Did she graduate? Why does she become a doctor? Tell us the gossip.
Dr. Lynn Stiff 4:04
Oh. Yes. So I actually before I was a physician, I was a dietitian. So I did my undergrad in human biology with an emphasis in nutrition went down the dietetics path. And then during my dietetic internship in my master’s program, I kept noticing I was a little different than the other dieticians wanting to know about more details than just the nutrition care plan. And I had always thought intermittently about wanting to be a physician, but I didn’t know any physicians besides my personal doctor. No one in my family was in health care at all. And so I sort of thought it was this career for other people like I wasn’t part of that group, and I couldn’t do it so but I kept having this itch to do it throughout training and then after So, it really got strong during my dietetic internship since that’s a clinical piece and I was in the hospital, and I worked as a dietician for two years and then decided to go back to medical school. And so did the all the remaining prerequisites and went back to Medical School and graduated in 2015. Now for medical school, and then I did a family medicine residency in Colorado, a full spectrum program that really focused on training physicians in all aspects of health. So they called it cradle to grave. So we delivered babies, took care of all ages, did hospital work, continue to care for people in the nursing home and then helped with hospice, so really all areas of health, and then I the last two years, I’ve been working as a hospitalist at a local Colorado hospital. And I just recently started working both as that hospitalist and then working with the residency program to start teaching future doctors so I guess actually, they’re all doctors but doctors and training and and trying to do a little more clinical because I had in the clinic itself as opposed to just the hospital because in the hospital you really see once the disease has gotten I’m so bad that you need to be hospitalized and I really am have a strong emphasis on prevention. And so I’m trying to get back into that clinic setting where I can do some more prevention work.
Marilena Grittani, RPh 6:10
Well, that’s something that we pharmacists are focused on as well, because we do believe that the solution is not a pill. We think that the solution is to prevent it from happening. And you start when you’re healthy. If you start once you’re sick already is a little bit too late. So education and getting prepared and knowing what it is and what you need it for rather than saying all people saying that grandmas say, well, that’s okay, I’ll be fine. I’ll take a tea of this and I’ll be fine. That doesn’t necessarily help you to build a strong future for yourself or your family or your loved ones. So yeah, I totally agree with that. So tell me why. What is it that motivates you to help your patients Why are you so dedicated to this that you started with something as personal as nutrition and Then you said no, I want more. I want to get more into health in general. So you became a physician?
Dr. Lynn Stiff 7:07
Sure. So I am a huge empath. And so I always am both an empath and a very strong critical thinker. And so I the empath side, I really feel for my patients, so when I’m with them, I want so badly to help them. And I have seen with through this other critical thinking side, how important it is to deal with the underlying cause of things. So I’m not a big fan of someone came to me with cough, I don’t really want to just give them cough syrup and send them home, I want to figure out, why do they have a cough in the first place. And because I care so deeply about my patients, I like feel very motivated and need to get to the bottom of it. And so and so really, that being able to help patients not only treat their symptom, but feel empowered, that they’re able to actually manage the underlying cause or the disease that’s that’s occurred, and then help them even try to prevent it. from getting worse or reverse it is really the biggest driving motivator about 80% of chronic disease is related to diet and lifestyle. And I think I kind of knew that back when I was a dietitian. And that’s why I kept having this itch to become a physician. And it wasn’t until I was in the clinical setting, and I saw how little it was talked about, especially back in the early 2000s. Not many people were actually addressing that. And so it’s really this motivation to sort of get this message out that all people can achieve health and wellness and that you can be empowered to take charge of your health regardless of how you know far down the path of various disease you are.
Marilena Grittani, RPh 8:38
Absolutely and then doing that you will also become a model to follow whether it’s your family or your friends and to say, hey, he, you were able to do it, she was able to do it. How did you do it? I want to do the same because I’m going in that path and I just want to prevent it. So it’s never it’s never too late.
Dr. Lynn Stiff 8:58
And I think what you’re saying about being a model for your community is so huge. We work with a lot of underserved individuals who have a lot of stressors in their life and health might not be a priority. But once they see someone like them, who is able to take control of their diabetes, or really take charge of their health, you know, start eating more produce and going for walks, once they see that they realize it’s not just for other people that it’s for them to and they feel more motivated and empowered to do it themselves. Yeah,
Marilena Grittani, RPh 9:25
well, I will be too if I was one of them. Because is the way that it is, you see people that are similar to you, and the general public believes that doctors are so different to them. And if there’s underserved or uneducated, like lower level of education in general, they think the doctors are a different type of humans, that the expectations first of all is just beyond whatever anybody could think about. And also, as soon as I see the doctor and I talked to her, I will be fixed. So That is a misunderstanding the most patients have. What is your experience with your, you know, with your patients regarding that particular situation? Have you had that? Have you? Do you have that thought as well?
Dr. Lynn Stiff 10:13
I do get a sense, I think this is that empath thing too. I feel like I can read think cues that aren’t said. And so I do get a sense that patients feel like they’re different than me, and that they might not be able to relate to the suggestions that I have. I really try to do reflective self talk and ask them what they think the problem is and what they think they could do. And sort of what motivates them. So I’m giving them advice as we go, that’s in alignment with what their goals are, because I think a lot of times we don’t do that. But the discussion in healthcare, especially primary care does seem to be changing from this paternalistic setting where it’s, you know, the doctor telling you what to do, to more shared decision making, because obviously, I have all this knowledge and information that I can give you to help you get better, but it’s all meaningless. If you don’t feel that whatever that issue is, is important or you don’t feel like you can do it. So I think there has been a shift in the last five to 10 years with trying to incorporate some of that in training. There’s still a long ways to go but I I do try my when I’m talking with patients to use those techniques as well.
Marilena Grittani, RPh 11:17
I believe that listening is very important and most of the time when you go to the doctor, you just hear them you have you wait two hours, I mean, the total appointment is two hours might come that you take you get there, they register you that you paid for to recall and then the insurance you get paid to work. What have you done, the MA comes over and then when the doctor comes over, it’s not even 10 minutes and it’s basically Okay, tell me what’s wrong. And then people say, Well, I can sleep on this, okay, this is the pain pill by that’s it. And then you’re like, hold on, but no, that’s not what I want. Most people go for it because they don’t understand what it is and how or what could be the underlying of the reason why they can’t sleep but Also, the fact that insurances limit, the time worth of physician with the patient is also a big barrier. So communication in that little little time is very important. And the fact that the patient comes to the consultation with a little bit of information is also helpful. What do you think is a good approach from the patient to get this, the way that it will represent something better for them?
Dr. Lynn Stiff 12:26
I think having a very clear reason for your visit, when you make the appointment is huge because the physician gets their list in the morning of who they’re seeing that day. And it has a very brief reason for the visit. And they might mentally prepare for that patient knowing that in mind, they might look back at other notes where they’ve seen that patient before and seen when that’s been an issue and sort of have a very narrow focus with what they’re going to talk about when they go in that room based on that specific chief complaint, or reason for visit is what we call a chief complaint. And so I think if you can give as specific of an issue example of why you’re coming in when you make the appointment that will help. And then having a very clear goal that you want to get out of the appointment and maybe writing it down in advance. I do think sometimes patients get nervous. And when they’re in the room with the doctor, they just sort of blank and they can’t even remember why they’re there. Aside from that they’re sleepy.
Marilena Grittani, RPh 13:19
To me, I’ve been around doctors all my professional life. So yeah, I see that,
Dr. Lynn Stiff 13:24
especially if you have this whole ordeal that takes an hour or two, you know, and you’re finally there. It’s finally the moment and then you just blink. And so I think if you have written down what your main concern is, and then some bullet points of what you know, examples of how that’s been a problem in your life. So if it was sleeping, for example, maybe being more clear, are you having trouble falling asleep, or you have having trouble staying asleep, how many hours you’re sleeping, if you’ve noticed some patterns, and so try to take some time to think in advance about what that problem is. So that when you’re in the office and they ask those questions, it’s not the First time you’ve heard them, and so really asking as many wives about your reason for visit in advance, so that you can kind of lay out the questions that you have for the doctor. And then having I know it can be hard, because sometimes you need to wait, you know, for a month to see the doctor. So it can be a barrier. But having too many problems that an appointment makes it really difficult to get anything meaningful out of it. And so if there are 10 problems, or even five problems to address in 15 minutes, you know, the doctor doesn’t have time to really get to the bottom, unless they’re all linked together, you know, get to the bottom of what’s going on. And so then that is when things like here’s the sleeping pill, here’s another blood pressure pill, walk a little bit more, eat some vegetables, see you later, you know, people that just don’t have time to go into the detail that they want to go into and that the patient needs. So I think if you’re able to really figure out what the biggest issue is and then trying to be in touch with your doctor more frequently, that can help with trying to get on top of multiple chronic issues because patients have so many more problems than they used to in the past, you know, before a problem list might be five or six long. And now they can be 15 problems long. So if you only go to the doctor a few times a year, it can be really hard to stay up to date on all of those problems and make sure they’re being treated the best way possible.
Marilena Grittani, RPh 15:17
I want to add to that, that sometimes using the medication causes side effects or problems that you are not expecting, and sometimes you don’t even know what it is. And that might be another problem that you are having and you know that they’re related. And then when you bring that to the doctor, maybe the doctor because doesn’t have time to talk in depth about it, or maybe because the doctor is not aware of those side effects specifically from a specific medication. Then they order another medication for it. I remember having a patient that was in a very strong sleeping pill because she couldn’t sleep and she was a psych patient, a patient that has mental issues and she was taking this medication that is called Wellbutrin. To the XL version, and she was taking it at night, because it was more comfortable for her to take in and we’ll get you into some medication that wakes you up. So she was taking it at night. And of course she couldn’t sleep. And then the whole day she was all lethargic to sleeping, because she couldn’t sleep at night. And then they thought she was having other issues that she needed another pill to wake up and then she drink so much coffee. And then she had irritation on her stomach because she couldn’t. So all this problems were resolved just by me saying, well, let’s just try this. Why don’t you start taking this pill in the morning and see for a week how it goes and then all the problems the sleepy the non sleeping at night and sleeping during the day the acid reflux that she was getting the stomach heartburn that she was getting from it. And the excessive amount of jitters that she would get she was getting from coffee went away just by switching that so I think that another way to approach certain problems is to talk to your pharmacist as well because again, we have a little bit more time with the patient that the doctors do If it’s a simple issue like this and stuff that we have at the top of our minds every day, we can we can help. Sometimes you just have to ask the question to the pharmacist, and then they will tell you, you know what? You need to go to the doctor. Or they could say, Well, how about if we try this? So give us a try, because we are there to help. And I know a physician would say, you know what, thank goodness, you did think about it, because I was thinking about something bigger and more complicated. And, and that that’s helpful.
Dr. Lynn Stiff 17:28
Yeah, that is so accurate. We have a pharmacist in our clinic, and she is a lifesaver with going through these things. She does have more time. She can do visits. Now with the COVID stuff going on. She can do, we can all do phone visits, too, but she can, you know, talk to the patients about what their medications are and the time course and really dive into the side effects because there are so many pills. Now it’s really hard as a physician to memorize every single side effect, and it would be easy for something to be a rare but possible side effect. That’s like you saying causing all of the underlying issues. You know, everyone thinks about things that are at the forefront of their mind. And so for a physician, the medication might not be at the forefront. And so they might not even really be going down that path. And when you only have 10 or 15 minutes, it’s really about what comes to your mind first based on the clinical picture you’re looking at.
Marilena Grittani, RPh 18:16
Yeah, absolutely. And then it for us, it’s different because all what we think is drugs, or medications. That’s why talk to me Talk dirty to me talk about drugs, and that’s what I know. And then it will be at the top of my mind. I remember once having a patient in one of the hospitals that I worked, her husband came to me and he said, I think my wife is going crazy. She’s having hallucinations. She’s telling me that the the ET is coming to visit and stuff that are she’s not like that she’s a police officer, she would never say something like that. And I’m scared. So I went to her room and I started talking to her and she said, Did you see that little guy that is in the plug? He’s inside of it. He’s waving at us and I’m like, okay, she’s having hallucinations. Let’s just talk about it. And we started talking and start researching and well she was taking a pain medication Tramadol. And that is one of the very small side effects or adverse effects or stuff that happens that you were not, they’re not good for the patient, it takes away the pain, but also might cause these problems and and she was very sensitive. She never had that pill before. She had surgery, and she needed it. And then she went dispatch. And as soon as I determined that, that that’s what it was, we changed the drug, and the hallucinations went away. And the husband was like, thank you for giving me my wife back, because I thought I was losing her. So again, it’s just a little tweak that could be done, that we because we are the drug experts, we might be in help with that. Because that’s, as I said before, you are so busy and you have so many things to think about that the drugs will just give it to us, we will take care of it and the patient can take advantage of that. But tell me what is one of the barriers that you find in your practice that patients have for not being compliant or not following the treatment that you have assigned to them
Dr. Lynn Stiff 20:02
so I think there are two main things one is not understanding the importance of either the disease or the treatment plan. I think we say things with big words because we talk with those words all the time and patients may or may not understand I’m sorry my things making nice so we we may or may not understand what or think about what a patient understands at the moment. And so I think not having a clear understanding for the importance is one factor and then the second that goes along with that is not having it spoke as I guess that’s to say, I guess it goes together at the same sorry, maybe I can redo this part.
Marilena Grittani, RPh 20:39
Okay, let’s go. Okay. Ben, she’s the one that will it Oh, Sean chichi, cute got it. Okay.
Dr. Lynn Stiff 20:46
Yeah. So I think I still think it’s two main things are barriers for compliance. The first is the patient not understanding why it’s important so they don’t feel a strong purpose for needing to treat this to a certain level in order to make sure that they stay on track. So, for example, maybe they think it’s kind of important, but other things in their life are higher importance. And so, you know, maybe they have so many tasks they have to do in the morning, and they just can’t take their libothyroxine, before they’ve eaten food, like it just in there, like, Oh, it’s not a big deal. And so because of where that ranks in their level of importance, they still do it, but they might not be doing it properly. And then to piggyback on that, the second thing is just not really understanding why it’s important from the sense of how we explain it. And so so the first one was internal belief of the importance and the second is really understanding based on their health literacy, which we’ll be talking about more here but really understanding why that disease is something that needs to be treated, how the treatment regimen works, and then also, what the treatment regimen actually is, because sometimes it can be misleading when they read the pill bottle incorrectly or don’t quite have an underlying standing for the difference between their pills and how to use them.
Marilena Grittani, RPh 22:03
So So what can they do? What is it some? What is something that patients can do on their own? Because, well, first of all is their lives and they shouldn’t be taking responsibility for that. But what should they do? What is it? What is something that we could do from your standpoint, that as a patient will improve our understanding of what it is of what you said,
Dr. Lynn Stiff 22:26
I think when you’re visiting with your doctor, there’s this great resource that I’m hopefully you’ll be able to link in the show notes called Ask me three. And it’s, you know, three questions that you should ask your doctor when you’re there about kind of summarizing everything that you’ve just talked about. So the first is what is my main problem? Because you could go on, you know, you might be thinking that the most important problem is your arthritis because it really hurts and your doctors like no, no, no, you have heart failure, and that is really what we’re focusing on. And so making sure you ask your doctor, what is the main problem and if you and the doctor disagree, it’s okay to say that and come Because you need to come with up with a shared plan and how you want to approach your health. And so even though your heart failure might be more deadly, maybe right now, the arthritis is really the biggest barrier in your life, and you need to focus on that more. And so kind of finding that confidence to be able to speak up for yourself and say, I know you feel like this is my biggest problem, but I can’t do my daily living activities because of this other one. And once my arthritis is better, then I can focus on my heart failure. So that frank conversation is super helpful. The second one, one for the Ask me three is what do I need to do? Again, the doctor might tell you a lot of things during that visit. And if you really kind of pin it down at the end, and you’ve asked what your main problem is, and then say, so what do I need to do right now in order to address this problem and have it be very clear. And then the third is, why is this important for me to do so that you fully understand why you need to be taking that pill, because let’s say you have heart failure, and they give you a water pill like called lasix. And you think that it’s just because your legs swell once in a while, and that you need to make sure that that doesn’t happen that much. So you only take it once in a while? Well, the doctor actually wants you to take it every day because there is swelling in your body, you might not notice and it affects how other organs are working. And so if you ask the doctor, why do I need to take this water pill and you realize it’s not just for the aesthetics of your leg swelling a little bit more for other reasons, it might motivate you more to want to take it every day.
Marilena Grittani, RPh 24:30
I remember having a patient saying, Well, if I don’t drink water, I don’t take the water pill. Because that’s what she thought it was four. She didn’t understand the basics. So yeah, I totally see that point. So question for you about the family and the health providers or I’m sorry, the health. What is it that I’m trying to say? Hold on, let’s just repeat that. What do you think the patient the caregivers and family members are to do for the health of this person? What should they do? What how should they help? What is it? What is their role on this, following the patient’s health.
Dr. Lynn Stiff 25:08
And I think having a family member there is really important, especially as people get older, and medicine becomes more complicated because there’s a lot to take in in this visit. And maybe you only get to go every two months in, it’s jam packed with information. And so having a family member there who can write notes, while the patient is listening is very helpful. And then the family member can feel free to ask those three questions as well. Just to reiterate, sometimes a patient might understand something one way and the family member a different way. And so if they both kind of do a teach back, so they say so I think you’re telling me I’m supposed to do this, or I think you’re saying my mom should do this. That helps both the patient hear what the family member is hearing and make sure they’re on the same page and then also tells the doctor what you’re hearing so that they can make sure everyone understands what the plan is.
Marilena Grittani, RPh 25:57
Like, it’s like a recap before they’re done.
Dr. Lynn Stiff 26:00
Yes, I think a recap is so important. They talk a lot with health literacy, about trying to do teach back. And I try to use this with my patients also. But not all physicians have been trained in that or even are aware that that’s something they they should be doing with their patients. And so, you know, patients can take that into their own hands and sort of use that method themselves by reverse a little. So if a physician were doing it, they might teach a patient about a medication regimen or how to treat a disease. And then they would say, Tell me, in your own words, either what I just said, or how you will take this medicine, or how we’re going to treat this disease. So they’ll say one phrase, one of those statements and ask the patient to tell them it back. And that just really gets an idea for how much the patient understood. Now, if your doctor doesn’t say that, then you as the family member could say, so I hear you’re saying we should do this, is that correct? And so it’s kind of like a teach back to the doctor to make sure everyone’s on the same page.
Marilena Grittani, RPh 26:58
And for the patient to make sure The patient understood. Yeah, I think that that is vital. I remember being working in retail, showing people how to use their inhalers and I would just do it myself. What would you say you need two fingers out of your, your lips, and then you put the inhaler there. And then you use Did you know I know how to do it like flight attendants that they do all the signaling. And then at the beginning, I would let them go on the boat. I already showed them what to do. And then I realized that they It was not only for me to show to them, I needed to see if they understood, so I would say okay, now I did it. How would you do it? Let’s just do it for the first time you sent me see. And most of the time they didn’t get 30% of what I said, because they thought I got it. And then once they started doing it, it’s like okay, what do I do? Same thing when you see a cooking show and you see a recipe and you’re like, I got it, I can make the same and then it’s like not even close to it. It’s better when you repeat it and when you try to be us. First of all, let’s focus on the conversation. But secondly, to find the little areas that you’re not that clear with the person that is teaching us or explain it to you. So you, you know, clear them out before you go on your own. Because after it’s complicated, because it’s like, I’m not going to go call the doctor because they need to talk to the nurse, and then the nurse is going to talk to the doctor, and they will not understand my question, and it’s going to be too complicated, and I won’t do it. So the best time to do it is at the moment that you’re there.
Dr. Lynn Stiff 28:26
Definitely being proactive, just like all of the things that we’ve already kind of mentioned before, too, with, you know, diet and lifestyle things too, you know, whatever we can do in advance is going to make so much more effect down the road. And it takes a little more time upfront, but the impact it can be, you know, exponentially higher. If we do put that time in. And in medical training, which I probably have this in pharmacy training too. We always were told, you know, read one, do one teach one. And so it’s kind of the same thing. You know, someone could just tell you how to do something, and that’s just the basic level but then can you actually do it yourself and can you teach someone to do So there are these layers of learning. And I think that’s really important to use with the patient doctor relationship as well.
Marilena Grittani, RPh 29:06
Well, I did. And also I did some marketing training. And what we think is that when somebody’s capable to teach it, that person truly understands it. So that’s why that’s why it’s called they make you do presentations. It’s not because they want to see how good you’re doing presentations is because when you study to teach it, that guarantees that you really, really learn that subject. So yeah, I do agree with that. So because of not knowing what happens within a doctor office in the background, which is no what we see, would you give us a little bit of details of why is the time with a doctor so short, why we can talk about everything why you need to go Why are you always in a hurry? Why is that a problem? Because if you had two hours for me, maybe we can take care of everything.
Dr. Lynn Stiff 29:53
Mm hmm. This is such such a complicated question because there are so Many things at play this so I work in an employed position. Some physicians do private practice or they do something called direct primary care. And in those situations, they can set their own schedule and do things however they want to. So they might have two hours to spend with their patients and really dive into the details. But when you’re in a standard healthcare setting, you know that it’s a business and they have the business set up in a way where you need to see so many patients a day. Occasionally, you can request to have slots longer or blocked depending on various patient needs. But you know, there’s really some pressure to be able to see as many patients as someone who’s much higher pay grade than me determined was the appropriate number of patients to see and a half day and so that tends to be somewhere between 10 and 12 patients and a half day, which used to be much more achievable before the electronic medical record. But now the EMR has numerous things that we have to review before we go into the patient room. I’m not even always related to that visit, but related to different metrics that the health system monitors. And so kind of to think about how the whole patient encounter would go before in the morning before I even see patients, I review all their charts to be refreshed, because maybe I haven’t seen them for a while. And the key issues that we usually talk about, I look at that chief complaint for why they’re coming in to see if there are things I need to check in advance, you know, dig up an echo from 10 years ago or something to see when different things have been done. And then so that takes a significant amount of time sometimes and occasionally can be very brief, depending on the patient. And then before when the patient is at the office. You know, before we go in the room, we have some click box things that we have to do in advance. And then when we’re in the room, that computer often is a distractor. We’re trying to talk to the patient. But there are things that we are required to put into the EMR while we’re with the patient. So we feel those things in and when you add all that up, there’s only so much time In the day, and so it can become very challenging to spend longer periods of time with the patient. One of the hardest things for me is it kind of stopping a patient and saying, let’s talk about this problem next time, because I do want to help everyone. And I’m still trying to find that balance. Because the barrier is if I spend 40 minutes with you instead of 20, that means that I’m 20 minutes late for my next patient, who’s probably going to be frustrated that I’m late. And then maybe they need 40 minutes too. And so it just kind of piles up like that. So even though it’s not ideal to only have 15 minutes, I do think if if patients understand like, we’re also trying so hard to give you the best experience when you’re in the office as possible, by you know, addressing your problems in a way that will get to the root cause. If patients come prepared, like we talked about at the beginning, I think that can really help make that 15 minutes much more efficient. And then also kind of prioritizing problems can make it efficient. So these are the Three things I have to talk about today. And you could come in with your list. And then these other things, if we have time we can talk about Otherwise, I’ll come back, you know, in a week or two, and I’ll talk to you about them, then I think having that approach can be very helpful.
Marilena Grittani, RPh 33:13
I also know that you get paid by what you do, by the insurance companies or by Medicare. So you have to report what was done if you treat it or talk about one specific area. And that’s how you get paid so and you have limitations you cannot build or ask to be paid for five things in one 15 minutes, appointment because that’s not what the rules are. That’s why you’re asking to have more visits during the year so you can dedicate kind of each issue their time. The other problem is that when you work, and when you have limited time and you have kids and you have a busy life, going constantly to the doctor is not that feasible. So it would be Depends on the patient to get as much information as they can before they go to see the physician. And then once the doctor tells what it is and what to do for the patient to do their own research and be more involved and help. That’s why I believe personally, the family members and caregivers are important because his two brains thinks better than just one. And you’re more than two. Yes.
Dr. Lynn Stiff 34:22
And some clinics have nurses that will specifically call and follow up with how your condition is going. Maybe you started a medicine they might call and follow up with how your blood sugar’s have looked at the last week, or if you’re having any side effects and sort of reinforce some of the teaching points that you had during the visit, which I think is a great way to extend the visit afterwards and prevent someone from having to come in again. And it doctors do often get paid by how many visits they see it’s sort of tricky. every type of employment contract is a little different. Some are completely RVU based, which would mean you know the more complicated patients they see the more money they will make that visit. And other things like physicals are well child are sort of a set amount every time regardless of how complicated it is usually. But then others have a kind of a split contract where you get more of a salary. And then there can be some bonus if you see a lot of patients, but you’re not necessarily incentivized. And so it makes it really tricky. The system as a whole would like you to see as many people as possible though, because the payments go to them.
Marilena Grittani, RPh 35:26
Yeah. And I do, I do not envy your position. I want it to be a physician when I was little and until I fainted when my dog started bleeding once and she was at the doctor and I’m like, okay, I cannot be a doctor. But I’m happy. I’m not because you guys become like the ham of this sandwich you are between two slices of bread that is whether it’s the insurance company or the health system that you’re working for. And then you will have the patient and the other slice of bread and then you’re the ham in the middle. You want the best for the patient. You want the best for the company. You want to be a good employee, but you want to be a good physician. It’s not easy. And and I want everybody that is listening to this to remember that physicians are also people. And then having the responsibility to have the health of that many people in their shoulders is not easy to handle. And then on top of that, they have to remember every single requirement for the health system or the insurance company, and then they have to listen to the patient because they want to do the best for the patient. And then if the patient, you know, is not cooperative or not following through or not following the steps that they need to do is frustrating. Then you start thinking about what do I do? How do I do it? It’s just, it’s not easy. Just Just keep in mind that talking to a doctor is not the solution. Talking to a doctor is one step to get to where you need to be. But nobody should be more involved and more interested on your own health than you.
Dr. Lynn Stiff 36:48
Yeah, exactly. It’s such a complicated system that we have set up and most primary care physicians, they’re not doing it for the money because you can make a lot more money doing other things that don’t mean that you’re You have someone’s life in your hands. And so you know, there’s a lot lower stakes. And so most primary care doctors go into medicine because they truly want to help people. And so that that makes this poll so challenging because you want to spend all this time with the patients. But you also know that you only have so much time and you have other pressures that you’re trying to balance. So I think that is great to highlight all of that.
Marilena Grittani, RPh 37:22
I think it’s a combination that the patient or the caregivers need to take in consideration whenever the appointment is made. First of all know what what is it that you’re going to talk about, or these are the three things are and then I will put that in the show notes, the links that you gave us about what three things to follow up on each subject or each topic that you’re going to be discussing. And then make sure you understood and you repeat it back to the doctor to make sure you got everything the same way. And then also go home and read and research and if anybody offers you help, whether it’s the pharmacist when you go pick up the medication said you have any questions, let me talk to you about this. Or if it’s a nurse that culture to follow up and see how you’re doing. The answer never should never be my doctor told me everything I got it, because it’s impossible the doctor can’t answer anything Yeah, I believe that is so much pressure and you guys, that you need to know everything and anything is impossible, you can’t. So other areas of healthcare that are designed to support to help you to listen to you and to give you the information, you should be utilizing them and take the pressure away from the physician to be everything because well, grandma used to say so the doctors she taught me I’m done. I’m like, really not works. I wish.
Dr. Lynn Stiff 38:41
Yes. If only were that easy. And I think how complicated diseases have become, you know, in our healthcare, we’ve gotten really good at keeping people alive for a very long time and, you know, extending life with diseases that you know, had 10 years or less life expectancy previously. So people are living with multiple medical issues and I agree it’s it’s too challenging to have the doctor do all of that when we have people who have skills and knowledge that can, you know, augmented different pieces of the patient care, I think that we should be utilizing them because it healthcare has to be a team approach. It can’t just be, you know, a single sailor in the night.
Marilena Grittani, RPh 39:17
I don’t think anything in life is like that just one person dedicated to that it cannot be that. So before we move over to another area, do you have anything else to emphasize about health literacy that you would like to say?
Dr. Lynn Stiff 39:31
Yeah, I think with health literacy, it’s important to realize it’s different than standard literacy. So there are very highly educated individuals who have low health literacy, because it’s your understanding of that one sub specialty, so health, so you could be an amazing lawyer, but you still might be at the same level as a sixth grader and understanding the health concept that you’re trying to grasp. And I think that gets missed a lot by both, you know, patients and doctors, I think very educated people. Sometimes they’re hesitant to ask questions because they don’t know. And they don’t want to seem like they don’t know. And so they just say, okay, yep, I have no questions, but they really don’t understand. So I think, first, you should not be afraid to say, I have no idea what you just told me. Can you please tell me again, in a different way and kind of dive into what was confusing, you know, 20% of the population is at a fifth grade level or lower or health literacy. And the average health literacy level is just eighth grade. And many people don’t realize that especially, you know, physicians where there’s college, and then four more years of medical school on top of that, so we typically speak at a much, much higher level than eighth grade. And so regardless of your education, if you don’t understand what your doctor is saying, I would really encourage you to not feel like you’re stupid, most people don’t understand. And so you can just ask your doctor to explain it a different way and just say I really want to be in charge of my health and I want to be sure that I understand what you’re telling me so I can do the right thing when I leave the doctor. Through, any good doctor would say, Oh my gosh, of course, I want you to understand too, and they’ll explain it in a way that makes sense. So even if their hand is on the door, and they’re walking out of the room, if you don’t understand, you need to say, I don’t understand what you told me, I need you to come back and explain it. It will only take a few minutes, and hopefully everyone will be on the same page then. So I think it is important with health literacy to realize it affects all people. And sometimes I think we spend almost too much time talking about people who have low literacy to start with and that and that they have poor health literacy. But really all people have struggled with health literacy, and we need to make sure that we’re addressing people appropriately.
Marilena Grittani, RPh 41:37
Yeah, it actually happened to me, um, I’ve been in healthcare for almost 27 years and I have worked in big hospitals and small hospitals and, and I was a patient last year and at the beginning of this year, I was lost, because will, your feelings play a role there too, and then I always say that the doctors and pharmacists are worse patients because we just become we get, I mean, we know if we’re treating somebody but when he’s us that had the problem, then you’re like I forget because I’m a person too today my brain is on a person way and not in the I’m a doctor or I am working way so it happens to all of us and being honest with yourself and asking questions, doesn’t take anything away from anybody. And but keep in mind that our words when we talk about big words and doctors do the same. It’s not that you want to be mean it’s just that the way that they communicate all day long and then they forget that you don’t know it because it’s so common sense for them. second nature that it just I remember talking to a patient once and say well the lab say and she said laughs Are you talking about my dogs? I have Labradors. Is that what you were talking about? I’m like, No, I was talking about blood tests from the laboratory and that’s how we call it so Again, it’s not that we’re trying to be mean and disrespectful. It simply is the way that we communicate and for us is so normal, sometimes we forget. I know we need to make a bigger effort to communicate with people at their level, because that’s the goal. If they don’t get it, we’re not doing anything.
Dr. Lynn Stiff 43:15
Marilena Grittani, RPh 43:16
So let’s just ask you something really quickly about your experience with pharmacy. You already talked about some a pharmacist that I happen to know, that worked with, with with you and in the clinic and the changes that have, you know, causing your practice. But why is there a pharmacist so important in your practice for a doctor?
Dr. Lynn Stiff 43:38
So I do both hospital and clinic and we have pharmacists in both areas, and they are essential. Because there are so many medications, you probably know the number that comes out every year. I mean, it’s hundreds of new medicines every year. And sometimes they’re just little variations of things that we’re used to using. But there are lots of side effects with those medicines and drug interactions and things that we need to watch out for. So if somebody’s kidneys don’t work as well, we have to adjust the dose. And that can just be a lot for us to remember, along with all of the other medical things that are constantly changing. And so having a pharmacist who can, you know, either check your orders in the hospital to make sure that everything’s dosed the correct way for the kidney function, or, you know, you can call them and say, there’s this new antibiotic, I’m not familiar with it, will it treat these these different bugs or bacteria. And so I think in the hospital, it’s so helpful, because it’s that acute setting. And it’s nice because patients are sort of captive, you know, we can really see how those medications will affect other medications and affect their laboratory lab studies. And we said laboratory but affect their lab studies and in all their blood work. And so that is very important in the clinic. It’s so important because they’re not captive. And so we need someone who is checking up on interactions that might be happening and making sure that patients taking the medicine properly and understanding the importance of it, because those patients are just out, you know, we kind of just set them free and we don’t know how things are going in the hospital, we can check and see how things are going. But when they’re in the outpatient setting, it’s different. So I think having a pharmacist who is up to date on all of the new medications and interactions is so vital. And they also help with things. So I and ours are becoming a little less common. It’s a blood test for clotting that we use. And so it’s becoming a little less common to use now with some new medicines, but we still have quite a few patients because of their insurance that have to take those medicines. And so our pharmacists does a lot of education on, you know, foods that interact with their medicine, their warfarin, and checking that INR. And then also diabetes is another area that our pharmacist is very active with. And they help with our dietician together to help people better manage their diabetes. And those are just things that the physician doesn’t have enough time to spend with patients on modifying their medications and their diet to the level that the pharmacist and dietitian do. So I think they’re just so essential and part of the care team.
Marilena Grittani, RPh 46:06
Well, I appreciate that because as a pharmacist, it’s not something that we hear every day. We feel undervalued. But just something that I keep saying is that it was very surprising to me that I was taking the schools of medicine I was comparing Harvard Medical School versus USC University of Southern California pharmacy school, and that was taking how many classes of pharmacology and therapeutics each profession has and I noticed that Harvard has one pharmaceutical one pharmacotherapy and one therapeutic class, which is one semester and then pharmacy has a total of 20. So that is a big difference. That’s why everybody’s different what they do. We are experts in on drugs, but we can’t we won’t know what to use on the patient on to the doctor diagnosis and and one thing that is available Know patients understand is that we give suggestions, but we are not prescribing. So the physician is the one that needs to approve it. So basically, we are the specialists in something that gives you the information for you to make the decision. So it’s not that we do it, but you rely on you trust us on those areas that you mentioned, to make it work the best for the patient, because you know, what, you know, and your focus in your area. And that’s what we’re here to. I mean, you don’t do nursing stuff, you know, you would know how to do it, and you oversee them, but you have experts doing it every day. So it’s about the same thing.
Dr. Lynn Stiff 47:36
Yeah, it’s so vital. And the pharmacist sends a note to me every time they talk with a patient to update me on what was discussed and what the plan was. And they might suggest, you know, changing to a different medicine and like you said, it’s not that the pharmacist does the change, but oftentimes I will go along with their recommendation because when I read it makes perfect sense and then we carry forward.
Marilena Grittani, RPh 47:57
Well, there’s no more nerds in healthcare on pharmacy. We read and we’re always studying and we are so nerdy that we go with the micro decimals to make a decision and adults. And even if it’s a baby, oh my gosh, I cannot tell you how picky you are with babies. So yeah, we we do extensive research as part of the personality and the requirements for the job. So it’s been really, really informative. I just hope that this conversation was informative and somehow eye opener to our audience and people that are listening to this will be more mindful of it, not only as the patient but also for their kids as a patient for their spouse as a patient for their kids or the parents as a patient or any loved one that you might have is important. I know that you don’t mind but it’s important that you go with your loved one to the doctor office, because again, for years, you’re better than two and two brains thinks better than one. So whatever. And also the person is not that scary a little bit more relaxed, it’s easier for the conversation. And if one doesn’t understand the other does so I think that support from the family members, caregiver support is always important. And showing love to, and commitment to the person that you love for them to get better.
do you have anything else to say to clothes? That I’m forgot? Or you just want to recap, with the three steps that you talked about? Maybe?
Dr. Lynn Stiff 49:29
Oh, sure. Yeah. So I’ll I’ll restate those asked me three. And then one kind of big thing to keep in mind. So they asked me three was, what is my main problem? What do I need to do? And why is it important for me to do this? And this, those who asked me three really highlight the importance of empowering the patients to take charge of their health, no one can take care of your health except for you. And so it’s essential that you feel empowered, and you find a provider that helps empower you because with how complicated and Plex healthcare will continue to be into the future. It’s just really essential patients feel like they are in control as opposed to other people just doing things to them and they don’t know what’s happening. So whatever you can do to feel empowered and having family members, there is a great way. I think that’s such an awesome example.
Marilena Grittani, RPh 50:17
It for the best of their own health. I agree. 100% Well, thank you so much, Lynn for all this time, and I know people are gonna have questions. So I have all the information that you have given me to put in the show notes, if you go to TheLegalDrugdealer.com/25 because this is Episode 25, you will find there all the information not only the three steps that you need to go, I will I will have the links there and you know what we have in in Spanish, we have it in English. And I think it’s another language there too. So I will put all the links there for you. You have to register in this page for you to get access to this information. But it’s very easy, very simple. You get access almost immediately. And then you have very simple information to follow and then You can even print them, and then take it to the doctor’s office or you can make the notes directly on it. So you have a little bit of control or you can be a little bit better organized so you don’t forget stuff. So everything is going to be there, again, TheLegalDrugdealer.com/25. And I will also put your podcast because we didn’t talk about it. But we really quickly what is your podcast about?
Dr. Lynn Stiff 51:25
Oh, sure. It’s called medicine for life. And it’s using lifestyle to prevent, modify and treat disease. And so it’s just different tips. They’re usually about 20 to 30 minutes long on various areas of lifestyle medicine that are meant to be easy to apply to anyone’s life. And so hopefully you can get some tangible things to help improve your overall health.
Marilena Grittani, RPh 51:48
So you take charge, so it will also complement what we were talking today about. You need to take ownership of your own health and do what you need to do and the tips and suggestions that you gave in your podcasts will definitely help them. That is a great way. So you’re doing everything you’re working to clinic, your work in the hospital, you give in podcasts, you, you’re doing interviews with me, thank you so much for all what you do and for your dedication and for the passion that you have for your patients and their health. Thank you so much.
Dr. Lynn Stiff 52:15
Yeah, thanks so much for having me. I love what you’re doing with your podcasts. And hopefully this will help inspire and empower hundreds of patients.
Marilena Grittani, RPh 52:22
I love that word, empower. So feel empower people and take over your health.
So there you have it. That was a lot of information. That was an eye opening, I believe episode all the information that Lynn shared with us and the conversation that we had, I think it would make you feel a little bit more entitled to empower yourself to take over your own health, to be in charge of what your medical decisions need to be, whether it’s if it’s for you, or if it’s for people that you make medical decisions, or if it’s for your parents, your grandparents. or your spouse, how you could help support and educate yourself to help them to make the best decisions that is possible for their care. So hopefully this is going to be what you got out of here. And as always, if you have any questions, just please email them to me to TheLegalDrugdealer.com. And I will be more than happy to answer them for you. So this is it for this episode. Thank you so much for listening. Don’t forget to subscribe to the podcast and to visit The LegalDrugdealer.com website. So there you would look around and see, you know, the stuff that I have for you. And of course, the show notes and all the links of the resources that Lynn mentioned, everything is copied there. She also has a Facebook group that I would suggest that you guys are following because she gives a lot of information there and she focused on wellness in general, of course medicine as well, but it’s very interesting with the information that she’s getting up there. We Also are working together on the secret project that I’m working on. She’s going to be part of it as well. So keep posted on whatever this surprise surprise is going to be that is coming very soon. And I know you would be very happy with that information. So anyways, that’s what I need to tell you. That’s all for today. Don’t forget that next week, we’re going to have a new episode that is number 26. And we’re going to be talking about all what you need to know about your medications insurance coverage. We’re going to have Marian Hayes again, one of my wonderful awesome super cute and very, very smart pharmacy techs, and we are going to be talking about why is your medication cover not wide. Why did the insurance decide to get this medication this March and data the medication is so much more wire stuff not covered? Why do you need to bring the card why the cart changes and you don’t even know What it is, and why do you have to get the card before you get the price for the medication that you are going to purchase? It’s a lot of information that I know you don’t think about. But it’s important that you know so you make the best decisions and you focus on what you need to focus when you go to pick up your medication at the pharmacy. I know you’re going to learn a lot with it. And you will see how Marian explained everything super easy and not only easy to understand, but also easy to remember. Okay with that I’m done. But before I go on, just in case no one has told you today I wanted to take a minute to remind you of how awesome you are. And how lucky are those that have you in their lives. Thank you for being the awesome you that you are have a wonderful rest of your day. This is Marilena Grittani, The Legal Drug Dealer
Bye for now.