Tips for Visiting the Doctor

So I was browsing through the current issue of Parenting magazine (early years), and came across an article called How to Talk to a Doc. This article offers tips, given by doctors, about how to prepare for your next Dr. visit. The article is geared toward parents and offers advice about well visits, but what I found was that the tips actually apply to anyone preparing to visit a doctor.

Presumably when you are an adult you are visiting for some sort of health problem. It isn't like when you take a baby to the doctor every month in the first year, and then every year after that for check ups. But regardless of the reason, visiting a doctor is a lesson in time management. Generally you get about 15 minutes with a doctor. Sometimes less. Their schedules are usually back to back, and your schedule is probably pretty tight too. It is important to not waste each others time. So we need to be prepared, and sometimes we need lessons on how to do that.

I know that any time I visit a doctor, whether it is for my daughters' check ups or my husbands medical problems, I have to write down questions before I go. Here are some more tips offered in the magazine about how to arrive prepared.

Number 1: "Find a go-to health care provider." So the magazine says you should create a "medical home" for your child. A place where they have records about everything to do with their health care since you started going to them. I have been taking my kids to the same practice for over 10 years now. While I don't really know them all by name and do not really have a close relationship with them, they always have my kids charts, and when we go for a visit, the chart is right there for them to look through and check on things. When my daughter was about 8 she started suffering from ear infections quite often, and the doctor warned me that because she had taken antibiotics quite a few times for them she might build a resistance to them if we kept giving them for every instance. If I had taken her to a clinic or ER, they might not have known she had been on meds so many times. They would not have had her history, and I might have forgotten to mention it in my worried state.

My youngest after getting blood taken at the doctor.

Number 2: "Know your child's medical history." The magazine suggests keeping a folder or even a smartphone app with all your child's immunizations, etc. This would be a great way for me to keep track of the number of times my daughter has been on antibiotics for something, and so if we ever do need to visit an ER you have all that information stored and don't need to remember it all. With three kids, and multiple Doctor visits it can become very confusing for me to try to remember everything. I would suggest going one step further and maybe even keeping a journal, writing down each visit and what the Dr. said each time. I am going to start doing that, it will be nice to look back even for nostalgia's sake and see how they have changed over the years.

This tip could also of course apply to adults. I know I keep a folder with all of my husbands medical information, and I keep a list of all his meds. I never know when we will need it, so I am also going to start using a smartphone app. The one that I am trying is called "My Medical". This is through iPhone and is only $1.99. The thing I like about it most is that I can keep track of the medical info for everyone in my family. This app takes down all the information, from height, weight, blood type, to allergies and medications you are currently on, and even medications you have taken in the past. I will keep you up to date on how well it does.

Screenshots from my iPhone of the My Medical app.

Number 3: "Arrive prepared." Basically, don't forget the folder with your child's (or spouse's) medical information. Be sure to bring the questions you have been thinking of with you also.

Number 4: "Take notes." Yeah, I always forget what the doctor said. I take notes all the time at the doctor, especially regarding medications. Sometimes I even have the doctor write it down, if they will, because they know the names and dosages more readily. I always write down what the doctor said about medications because the pharmacy can make mistakes. This is where the journal would come in handy. The iPhone app has a notes section for each patient you are keeping track of.

Number 5: "Don't be afraid to second-guess." This is seriously not a problem for me because I already don't completely trust doctors. Especially in Er's. But some people really find it hard to go against what a doctor tells them, even if their gut feeling is really telling them it is wrong. Trust your gut. And if you are still concerned, get a second opinion, or even a third opinion. Remember that you are your own best advocate, and when it comes to your children or your spouse, you are their best advocate also. A nurse friend of mine told me recently about my husband "you are his best nurse." That is so true, who better to provide the most personal care possible than your own mother or spouse.

Anyway I thought these tips were important, and that tutors could easily make a health literacy lesson out of these. Let me know what you think!

From A to Z: Literacy Treasures

We posted about this story on our Facebook wall, but I wanted to share this with all my followers as well. First let me say that I am totally guilty of not always reading to my kids at night. Lets face it, sometimes we parents are so tired we can barely keep standing. Even before reading this story I had made a secret promise to myself that I would fight the urge to just put my kids to bed and I will read them at least one story every night. No matter what.

After reading this story I am more committed to that than ever. I should never ever take for granted the fact that I can read, and therefore can read to my children.
Please read the story and get inspired yourself!

A new learning center is opening in Massachusetts. A one stop shop for all adult learning needs. We need more of these all over the US.

"Lives will change as a result of this building," said Robert Pura, president of Greenfield Community College. "Lives will change for the better."

Read the story on gazettenet.com

This print for sale on Etsy:

Introducing HONEY! Bringing awareness about adult literacy. Oh and she is a dog!


W stands for WOW. Please read this blog post, written by an MD, on the NY Times website. I literally said OMG when I read it.



My husband and I recently decided he needs to be wearing some sort of medic alert jewelry. He told me he would be the least annoyed with a dog tag necklace. Here is the one I found on Etsy. I think anyone who suffers from a medical issue like seizures, or diabetes or such should wear something like this. But how much more important for someone who can't speak the language. If they are taken to an ER, they show their bracelet, the team automatically knows they suffer from seizures and are on this medicine for them.


Understanding prescriptions and medicine labels is a huge part of health literacy. It became very clear how big an issue, after the tornadoes in Joplin.


Good News! NJ Health Literacy Coalition now has a website! I will be adding it to my "My Favorites Internet Trips" page. Check it out!

Adventures with Kidney Stones

Or "Tales from the ER!"

So by the title of this post your first thought is, okay, since she has stopped tutoring she has REALLY lost her vision for the purpose of this blog. But stick with me, I have a purpose.

My husband was recently in the hospital for 3 days, intermittently, for kidney stones. I have never had them personally, but every time I told someone he had kidney stones, the person's face would get all squinchy (it's a word) and they would say "OH, I/My Spouse/My Aunt/My Grandma/My Hairdresser's Sister's Cousin, had those and that was the worst pain I/They ever experienced.

So I tried to understand the pain and be supportive while with Tom in the ER.

I really dislike hospitals. The smells, the sounds, the sick and sad people every where. And then there is the staff.

Now before you start in on me about how You or Someone You Love or Know works in a hospital and they are the nicest most caring person you know, I am totally aware that there are exceptions to the rule. I also have a mom and sister in law who are nurses, and many friends who are nurses, and my Aunt and Uncle are doctors. It doesn't mean I don't love THEM, it means I generally dislike the people in hospitals OTHER than them.

Anyway, the first time he was in the emergency room of our local hospital, Sunday evening, he had a really sweet nurse, who actually took the time to explain everything to us. But the doctor was the opposite of this. Dr. Mean Face (her face was scary) was about as warm and caring as a metal chair.

After Tom had been there for about 500 hours (I realize that is an exaggeration, sue me), had thrown up all over the bed from the pain, had a CAT scan, been given 3 different pain meds. that did not work, here comes Dr. Mean Face. She came in and said "I am sending you home and I am giving you prescriptions for these meds., drink lots of water and see a urologist."

My husband is on many many meds. already. He has seizures and needs meds. for that, and then he also has these weird hives and joint pain that we are working with an allergist for, so he is on 3 more meds. for that. So I said to the doctor "Can you please write down instructions for when and how he should take these." I figured this was a reasonable request, and wouldn't take much time, and wouldn't she want to make sure we knew all the information we needed?


Tom after brain surgery in 2005.

She looked at me like my face was on upside down, and had spoken in Klingon language, and said "The information will be on the prescription bottles." And she promptly walked away. Thanks, for that Dr. Mean Face. Luckily Nurse Sweety was nice enough to take the ONE minute it took to write it out for us.

Next time in the ER, Monday afternoon. The urologist, after hearing that Tom had been vomiting all night, totally writhing in pain, and incapable of keeping any of the pain meds., or any other meds. down, told us to go straight back to the ER. The Dr. said he would call ahead and make sure they knew he sent them. I felt a little better about this, and figured, hey maybe they will actually treat him this time. WRONG!

We get there, tell the NURSE, NURSE'S ASSISTANT, DOCTOR, NURSE PRACTITIONER, JANITOR, LADY IN THE HALL, everything that has been going on for the past 24 hours.

In comes Dr. Speedy (he talked about a mile a minute and saw Tom for about 2 minutes and then left for about 3 hours, so I am assuming he was on Speed). He asks what has been going on, feels Tom's stomach and back for one second and says, "It's a Kidney Stone."

I wanted to scream. Instead I said, "Yes we know this, we were here LAST NIGHT for this, but the Urologist sent us back because he has been vomiting and is still in great pain." Dr. Speedy looks at me like my face is on upside down when I also tell him that the Urologist wants this test done (KUB) and he would like you (Dr. Speedy) to call him (Urologist) and speak to him about it.

Dr Speedy says, with obvious contempt, "I don't know why he wants THAT test done, all it is is an X-Ray."

"Please call him (Urologist)." I say.

"Let me go call him." Dr. Speedy says as if he just came up with that idea.

After sitting in the ER for another 3 hours, which included being moved from an actual room in the ER, into the hallway, then back into another actual room, here comes Dr. Speedy again.

This is my favorite part of the whole day.

Dr Speedy says, "Did you have your CAT scan done here yesterday?"

"Yes, we were here in the ER why would we go somewhere else?" (I was obviously losing my patience with Dr. Speedy by this point.)

"Well I can't find the report in the system, would it be under another name?"

"Um no, he only has one name." (I look at Dr. Speedy like his face is on upside down this time.)

"Can you check again?" I say

"I can't pull up a report that isn't there." says Dr. Speedy

At this point I want to punch Dr. Speedy in the face but he walked away. He came back about 2 minutes later and hands the report to the Nurse Practitioner who is now taking Tom's entire life history back to when he fell off his bike in the third grade.

Dr. Speedy looks at ME and says, "The report was under just his name without the Jr."

Then he says with serious annoyance in his voice, "That is why I ASKED you if it would be under any other name."

What I said back to him at the time was, "Oh good."

What I wanted to say back to him was, "You flipping idiot, how many years of education does it take to have the common sense to know that if you can't find the report under the person's name and they have a Jr. at the end, MAYBE I should try looking it up WITHOUT the Jr."


Tom wearing a portable EEG machine in 2008.

Sigh...

So after spending the night in the hospital and not being able to eat, and possibly getting exposed to about 5 million other illnesses, Tom came home in pretty much the same condition. He is not in as much pain, and is able to keep food down, but honestly it was not because of anything the doctors did. From what I hear from Tom, he was pretty much left alone in the room the entire time with intermittent visits from Dr.'s and nurses saying "Everything looks fine you should be able to go home soon." Obviously the definition of soon means something entirely different to them.

Why am I telling you all of this? Well first because it is making me feel better to share this experience. But mostly because it made me think about the health literacy epidemic.

I call it an epidemic because it really is everywhere, and while there are few people working to make it better, the health care professionals and systems in general are pretty much ignorant.

When I asked our Dr. Mean Face if she could write down instructions for us about the meds., why did she treat us like that? Isn't the goal of doctoring to make people feel better, and doesn't that include making sure they understand their medications? What if my husband and I could not speak English. When I think about the implications of that, I literally get knots in my stomach.

When Dr. Speedy was "helping" us, was it really that difficult for him to treat us with just a little compassion? Was it necessary for him to have speak to us with annoyance and contempt?

The main thing I kept thinking while we were there is "what is that smell?" But also, "where is the disconnect?"

When did it become THE DOCTOR on this huge pedestal, and the patient, down here in this little hole? Or was it always that way and now there are some of us who are saying, "this is not acceptable."

Just because we did not go to med school, we have every right to know what is going on with our bodies and to expect that our questions about that will get answered with the same respect we show them.

Maybe I am generalizing too much, but I don't think I am, the statistics prove that most people do not know what their Dr. is saying to them, and even if they ask, what are the chances that the Dr. is going to answer them with any kind of respectful thoughtful answer. My fear is that those chances are slim.

Now like I said before, I know that not all Doctors and Nurses are like this. And I will say that most Nurses seem to really care and be concerned for their patients. Also most of us have health insurance and are lucky enough to pick and choose who we go to for help. But when you are suddenly hurt, and sick and afraid and you visit an ER, you don't have that luxury.

The CDC released a study in 2010 showing that about 46.3 million Americans do not have health insurance, that is about 15.4%. In my mind these people are at the greater disadvantage because they are sometimes forced to use only the Er's or Urgent Care Facilities. They are faced with over worked, over tired, doctors and nurses. And it is abundantly clear to me that they are severely understaffed.

I think more than ever we need to put an emphasis on the need for health literacy for anyone working in the health care arena. It should be a requirement.

Even more importantly we as patients need to stand our ground and not allow ourselves to be bullied. That never means it is ok to be mean, but maybe it means we can get a little bit angry, and a little bit loud, and make ourselves heard.

My husband and I are coming away from his experience with knowledge and understanding. We understand that doctors and nurses have a really hard job. We now know that in order to break through that barrier we have to be much more assertive.


Tom with a little home health aid.
(He obviously decided against the ER that day.)

Do you have any stories like this? Any thoughts on how to handle them? We all need to be our own best advocates!

From A to Z: Weekly Treasures

Hmmm. I am really unsure how I feel about this first article I found on EducationNews.org. On the one hand I know from personal experience how difficult it really is to tell the level of a person's intelligence simply by testing. On the other hand it is really the only tool available to determine the levels across a broad range of people.

I do however agree that testing can be improved, but then that requires more funding and more manpower. Shouldn't those resources go to helping people instead of testing them. Read the article, Maliteracy Practice in the Assessment of Adult Literacy , and see what you think. I am interested in know your thoughts!

I am so impressed by anyone who holds these large conferences. Mainly because I know how much work goes into them.

I love to hear about a literacy program getting honored!

A very informative article from about the problem of health illiteracy specifically regarding consent forms.

More stories that illustrate how important health literacy is. I love the line at the very end: “I never ask, ‘Do you understand?’ ” she added, “because they say, ‘Uh-huh,’ and you don’t know what they understand. So instead I’ll say, ‘I know your daughter is going to want to know about this, so what are you going to tell her?’ ” From the journalgazette.net.

I did not know this! Obama Administration Announces Start of Student Exam Window for 2011 National Financial Capability Challenge.

Does anyone have a high school student who took this? I am really interested to find out the results!

April is National Financial Literacy Month. Check this unofficial website to learn about the 30 steps to financial wellness.

And finally this, it is powerful.

From A to Z: Weekly Treasures

From the Oak Cliff Advocate, a story about a literacy tutor helping to make a difference in Texas. I LOVE stories like these!!

The Open Doors program in Winnipeg Canada is helping to change the learning experience for adults who can not read. Here is the whole story from The Times website.

Ok, this is so cool. I found out about this on the BBC website. Well known personalities in South Wales were approached to write short novels that are aimed at new adult readers. What I want to know is when are we going to do this in the US?

Quick reads boost adult learners

Health literacy is a two-way street. Agreed Agreed! Check out this blog post from the timesunion.com. It is written by a doctor who seems to understand that improving health literacy comes from both sides. I really enjoyed the "Mom's RX" list at the bottom, especially the advice: "Talk to your doctor when you are fully dressed, not while sitting in a hospital gown."

Take this test which is an excerpt from he Newest Vital Sign written by Dr. Barry Weiss. This blog post written by Joe Rojas-Burke challenges: "Are you health literate?"

This video of an adult literacy student named Edward is so awesome! Brings a tear to my eye!

Literacy is NOT Defined as Reading

A common misconception among most people is that just because you can read you are literate. Not true. What if you don't understand what you are reading?






What do you think when you read the word "Hypertension"? Of course if you are a doctor or nurse, or actually suffer from this and have learned what it is you would know. But what if you have never heard this term before, you go to your doctor, and they say, "well you are suffering from hypertension so I want you to take this prescription and come back in a month." If you don't specifically ask what it means what would you think? I am too tense maybe?


A study done by the CDC (Centers for Disease Control) back in 1996 showed that patients with low literacy thought the term "high tension" (what they used to call hypertension) meant "a disease of the nerves caused by stress, worry, or an anxious personality." The book Explaining Illness: research, theory, and strategies, written by Bryan B. Whaley, says that these patients "believed the way to treat "high pretension" was to rest and relax-to take it easy."


I looked up the word and it means, High Blood Pressure. I don't even know what that means. The medical websites say it is high tension in the arteries. Well what does that even mean? There are a lot of words that I did not understand when I tried to look it up. Systolic, Diastolic, oh and then there was pre-hypertension.


Basically after wading through all those terms I got to the heart of the matter, and basically if you have a "High Blood Pressure" (what is high anyway), you could die from it.


So if an adult, with only a 3rd or 4th grade reading level, or an immigrant who does not understand the language very well and is maybe somewhat intimidated by the whole health care system was told they have "hypertension" with no other explanation; would they know what it meant? Would they know where to go to find out? What is the likelihood that they will do what is required to take care of it?


Here is another example. You walk into a doctor's office and the receptionist hands you the "Privacy Statement" that you are required to sign. If you are like me you just sign it without really thinking about it, because let's face it I am there to see the doctor and whatever I need to do to get into that room faster and get out and on with my life I am going to do.


But I challenge you to actually read it the next time, and tell me honestly if you recognize all of the words and acronyms that are used throughout. Here is an excerpt taken from a local doctor's privacy statement:





Okay, because I am pretty well read and went to college and was forced at college to learn most of the words in this paragraph, I think I can easily figure out the gist of it. But what about an adult that only reads at a 3rd grade level. Do you think they would understand this paragraph? The word "Pursuant" for example. Or "Provision" or "Disclosure".


These privacy statements aren't life threatening, and they aren't meant to hurt us as patients, but they are confusing and somewhat intimidating in nature. Isn't that how most forms are at the doctor's office, or hospital, or clinic?


I went to an in-service on Tuesday at the Plainfield Public Library. It was titled: "What Adult Literacy Tutors can do to Increase Health Literacy." This workshop was taught by a well known expert in the field of Health Literacy. She is one of the founders of the Health Coalition of NJ and has given many workshops to tutors, students, and even health care professionals.

First question: What is Health Literacy? Well Health Literacy is defined many different ways actually, and has changed throughout the years. One definition put forth by The Centre for Literacy of Quebec states:

• Health literacy allows the public and personnel working in all health-related contexts to find, understand, evaluate, communicate and use information.
• Health literacy is the use of a wide range of skills that improve the ability of people to act on information in order to live healthier lives.
• These skills include reading, writing, listening, speaking, numeracy, and critical analysis, as well as communication and interaction skills.

All these skills are required to be able to understand health and wellness: Reading, Writing, Speaking, Numeracy, and Critical Analysis.

Honestly it never occurred to me how really cut off low literate people are from really understanding health care. I am thankful for this workshop, for opening my eyes to the facts.

I learned that according to the 2003 National Assessment of Adult Literacy that 88% of the country is below the proficient level in health literacy. To me that is way too high and it is so obvious that there is a clear disconnect between how the information is being given to us and how it is received.

So what can be done? The workshop presenter gave us tutors, tips and ideas, and resources to use to help introduce the topic into our tutoring. But she also mentioned that it is a two way street. She feels, and I agree, that the health care providers need to learn to make it simple. That doesn't mean dumb it down, it means make it easier for everyone to understand the important information that we as patients need to know. And maybe doctor's and even nurses could take a little extra time to make sure their patients really understand and not just assume that they do.

My mother is a nurse and I have an aunt who is a doctor, and I have many friends who are in medical professions. I love these people and have learned many important things from them, and because of them I do not feel intimidated to ask questions. But I know many people still are, and I challenge those who work in this profession to learn to look out for these patients. In the mean time I will do my best to help my student with whatever health literacy needs she has or wants.

If you would like more information about Health Literacy in NJ, please click here: