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Melanie Cole (Host): Healthcare has evolved especially in terms of patients’ role in decision-making. Patients come to their doctor with a diagnosis already in mind and with many pages of information printed from the internet. Is this a good thing and how can you be your own best health advocate? My guest today is Dr. Margaret Anderson. She’s a Physical Medicine and Rehabilitation Specialist, and she works as part of Aspirus Spine and Neurosciences. Welcome to the show, Dr. Anderson. How has healthcare evolved in your opinion in terms of the patients’ role in their own decision making?

Dr. Margaret Anderson (Guest): Oh, it’s really changed. I think the traditional – a long time ago you went to your doctor and you did whatever your doctor told you to do, and then you just trusted them, and that was it. I think now, people are a lot more engaged and a participant in their healthcare, and I think it’s because they have more information and they know that there are more choices.

Melanie: So, as you see parents and family members getting involved, do you as a doctor, like it when the family members start questioning you about the diagnosis, or the condition, or some treatments? Is this a good thing when the family members are involved?

Dr. Anderson: Well, I think it’s important to actually have more than one person present because there’s a lot of information that is given and to have another set of ears or have someone else question why you’re there because maybe they don’t understand it the same way. I think the process of having a partner or a parent or both parents present is very helpful. I think it also helps to have some idea of the information, but at the same time, there’s a balance of how much that you can explain or that people learn about, so there’s a balance on what they bring to the table and what the physician can bring to them.

Melanie: When patients come to see you, if they’ve already been diagnosed with something, sometimes they have -- as I’ve said in the intro -- pages of information that they’ve gotten from the internet, do you like it when they come prepared with information that may or may not is reliable?

Dr. Anderson: Well, I think the biggest thing is sometimes patients will come in and they’ll already have the diagnosis and they’ll tell me, “I have sciatic,” or “I have a herniated disk,” and I’ll say, “Well, let’s go back to the beginning and try to figure out really what your symptoms are and then let’s decide if that’s true or correct.” Because sometimes we jump to conclusion and that’s not the right answer, so I really want to make sure that we get the right information because they’ve already gone too far down the path without really making sure that the diagnosis is correct, but it is okay to question and ask when you’re there. I think that’s important because you will get differences of opinion.

Melanie: So what about establishing that relationship with a provider? Do we wait until we’re sick to look for one? Do you like for patients to seek an internist -- their primary care provider and have all of their ducks in a row?

Dr. Anderson: Well, I’m married to an internist, so I really believe in using your primary care provider, but I think it’s very important because the primary care provider is the one that knows your entire health pattern. They know where you are as a person and how you cope with things and your other medical problems, so they’re the first person to start with, and then they can help start you on a treatment plan. If that’s not successful, then you go on to the specialist. I think that’s the ideal way. If I see someone as a specialist and I can get them on a treatment plan, then they can go back to their primary care and then they can continue that later on, so involving your primary care provider is important.

Melanie: And what do you tell people about getting their regular physical exams because sometimes they’ll say to themselves, “Well, last year I got my mammogram, so maybe I won't need to get it this year,” or “I’ve heard some things in the news about Pap smears not necessarily being what I need to get anymore because of HPV,” and what do you tell them about these regular physical exams and the importance of knowing their numbers?

Dr. Anderson: Well, I think that’s where your primary care doctor can tell someone what is important and where the information has changed. The other thing is that sometimes patients only want to go see their doctor when they’re sick and then we really don’t know what they look like at their best. Having an established relationship with a physician, so they know you as a person so then if you are in a crisis situation or if you’re having a problem, they know, “Well, this isn’t the way Jane is normally like. There really is a different issue,” so there’s value of seeing someone when you feel good because then you have a relationship and a positive relationship that you can build upon, but if you only see someone in the crisis situation, they don’t know how to help you as well.

Melanie: And what about symptoms? And again, we can look up our symptoms on the internet and think that we have every disease known to man and then -- we feel to ourselves, I don’t want to be looked at as a hypochondriac by this doctor. When should we not ignore symptoms when we’re feeling like maybe something’s not right?

Dr. Anderson: Well the general rule of thumb about symptoms is if they become increasing in severity, they happen more frequent or at a lower threshold, they don’t go away or become more severe, then that’s something that prompts someone to look at. If I have some symptom – an ache or a pain – and then it goes away, and then it never comes back again, and it was pretty minimal, then that might be something I’m not quite as concerned about. It's usually the trend in the pattern that if it’s going happening more frequently or it’s more persistent that you would want to get treatment. The exclusion is if you were having chest pain and it’s a cardiac thing, those you don’t want to necessarily wait on. But a lot of other symptoms – people say, “My elbow hurts,” and then it goes away, well if it doesn’t come back then I’m not going to worry about that. I’m not ordering a lot of big tests because there are a lot of things that with time, resolve.

Melanie: Are there some do’s and don’ts for families and for patients that you would really like them to know because now’s your chance to really tell them you want them coming in with their list of medications, whether you don’t want them coming in with too many of those forums that talk about diseases. What is it you want them to do and what don’t you want them to do?

Dr. Anderson: Well, it’s really important to keep track of your medications that you’re on and bringing that list is very, very helpful. And I think what -- your medical history and being part of it and aware of that is important, particularly if you go through doctors in many different systems because the transfer of information can be difficult so knowing your medical history is valuable and it helps me. What I don’t really want patients to do is to be caught up in looking at all of these rare diseases and to maybe have some trust or faith in the physician that we’re really looking at a process and trying to figure out their diagnoses, so it’s important they don’t jump to a conclusion and not trust that sometimes the physician really was trained in trying to sort out this problem, so having a list of questions really makes the clinic flow go well because we say, “Okay, did we get all your questions,” and that’s great. But if they’re so set in what they want and their agenda sometimes that interferes with really what kind of patient care you can give.

Melanie: Dr. Anderson, are doctors insulted by second opinion requests?

Dr. Anderson: No, I believe knowledge is power. Someone needs to be confident in what they believe is their treatment care and if they’re not confident in it then they go to someone else, and they get a second opinion. Now sometimes people want to get five opinions and they’ve heard four people say, “No, you shouldn’t have surgery,” and then they go to the fifth person – if you go enough times, you will find someone that will offer you that surgery, so that’s some common sense to that, but having someone else look at their problem again a second time totally makes sense.

Melanie: And women, in particular, Dr. Anderson, we are the caregivers of the world and they always say, “Put your own mask on before you put the mask of your loved ones,” what do you want to tell women about caring for themselves so that then they can be strong enough to care for everybody else in their life?

Dr. Anderson: Well, I think a lot of times, people think that exercise should be extra time. We don’t really prioritize the things that we need to do to keep ourselves healthy. We have this sense that eating well is an extra thing, or taking the time to exercise, or taking the time to get good sleep is something superficial, and that’s not the case. I think we need to prioritize that taking care of ourselves is very important and by doing so, we’re actually modeling to our children to show – the best way to show our children and our family what’s important and what’s good care is to do it. If I take the time to go exercise then I’m reinforcing that to my kids, it’s important to exercise. I can’t just talk about it; I need to do it, so don’t undermine the time that you need to take care of yourself.

Melanie: Is it okay if we ask our doctors about, for example, our medicines, what they are intended to do and what about medical billing because that’s so complicated, how do you tell patients to be involved, to look over their bills, to ask questions when they can?

Dr. Anderson: I know from personal experience it’s very confusing to look at all these different EOBs and forms and not understand it, so if that happens in my clinic I really refer them to our billers and coders and say, “Help, can you explain this to them and help sort them out?” Because there it’s becoming more and more expensive and I don’t think that people realize that. The other thing pertaining to that is that when I prescribe physical therapy, sometimes people go and they’re really not getting benefit out of it. I say it’s fine to tell that therapist, “You know, this isn’t really what I was thinking. I was expecting more,” or “I would like this more,” and to try to direct that care. That is an appropriate use of your visits and your time to say this is what’s beneficial. You can be polite about it and get more out of the healthcare money that you do spend.

Melanie: So, wrap it up for us, Dr. Anderson, with your best advice for listeners about being their own best health advocate and what you want them to know, as a physician, that you can tell them that will help them be a partner in care?

Dr. Anderson: Well, I think being willing to listen to their physician and be a partner in that decision-making is really very important, being knowledgeable of what your medications are and then having someone with you if at all possible to be that second set of ears so that they can reinforce what was said was actually said and to make sure that you get it all because it’s a lot. The other thing is if the doctor goes too fast and uses a word you don’t understand ask them to write it down because we forget sometimes the words that we use and the terminology is confusing to people.

Melanie: Thank you, so much, for being with us today, Dr. Anderson. That’s really important information for listeners to hear. You’re listening to Aspirus Health Talk, and for more information, you can go to Aspirus.org, that’s Aspirus.org. This is Melanie Cole. Thanks, so much, for listening.