Your Doctor’s Advise – Misunderstanding can lead to BAD Decisions

Posted on March 21, 2019March 21, 2019 by Michelle Fritsch, Pharm.D.

Good communication with your doctor — Let us help you avoid misunderstanding with your doctor.

Have you ever experienced misunderstanding with someone? Did that lead you to make a bad decision? If you had understood the original message, would you have made a different decision?

I have had two client examples this week.

Misunderstanding what the doctor said

In one instance, the doctor had said something about the pain medicine and the stomach acid medicine should not be taken together. This person has had a long history of Barrett’s Esophagus – a severe inflammation of the esophagus cause by extreme gastroesophageal reflux disease (GERD). To break that down, this person’s stomach acid was going back up the esophagus – the tube from the mouth to the stomach. Normally there is a sphincter that closes to keep the acid safely in the stomach. In many of us, that sphincter can become loose or have a condition that keeps it from completely closing. When that happens, the acid can go back up the esophagus. Indigestion, burping, pain and/or burning in the mid chest area can result. The acid inflames the esophagus lining. When that inflammation becomes severe, the inflammation can lead to Barrett’s Esophagus. So the stomach acid medicine was VERY important!

This person’s other issue was low back pain due to a herniated (bulging) disk and sciatic pain. Sciatic pain results in pain and burning from the lower back and spreading through the buttocks and the leg. It is caused by irritation of the sciatic nerve, common with lower back issues.

When this person heard the doctor say the stomach acid medicine and the pain medicine shouldn’t be taken together, the person decided to STOP the stomach acid medicine. The sciatic pain was the ‘bigger issue’, so if both couldn’t be taken, the pain medicine took priority. The doctor was not told.

The client heard ’these medicines shouldn’t be taken together’. The more complete answer is, the pain medicine will make the stomach acid and esophagus irritation even worse. There are safer pain medicine options that won’t make the Barrett’s Esophagus worse. The person should DEFINITELY be on both a stomach acid medicine and a pain medicine. The pain medicine should just be changed to a safer option.

This was explained, and this person is now on a safer medication regimen for both conditions.

Another Misunderstanding Example

Another recent example was a man with severe vascular issues and lung cancer.

The lung and cancer doctors had together told him and his family there is no more they could do. They recommended hospice care. Hospice care was accepted.

The vascular issues caused very little blood flow to the feet. As a result, one foot and lower leg had been amputated a few months ago. The second leg and foot are now very infected. The foot infection is causing severe pain. Hospice is treating the pain with morphine. The morphine makes the patient’s stomach upset and dulls his thinking.

His wife understands that the hospice doctor is now his doctor rather than his specialists and primary doctor from before. The hospice nurses visits regularly, but the doctor has not. His wife is very upset that the doctor is doing nothing to heal the infection. She also feels he is very overmedicated since his memory and decision making are slowed due to the morphine.

When we discussed goals – quality vs quantity of life – they each indicated the specialists who recommended hospice had asked that. They chose quality. However, they didn’t understand that this would mean a rather rapid decline with the untreated lung cancer and foot infection. They thought he would be able to back to the things he loves like working on projects around the house and cooking. They see a decline in quality of life rather than the expected increase.

Now they want to go back to the specialists and change their minds. It has been six months of no curative treatment. There is most likely no way to alter the pending outcome.

Essential Clear Communication

Healthcare visits can feel fast and pressured. Any time there is bad news involved, it is hard to fully hear and process all that is being communicated. These and other communication issues lead to misunderstanding of healthcare information. This is NOT an uncommon problem.

Another contributing factor is difficulty reaching the doctor after getting home to request clarification. Most doctors are given schedules that make it difficult to squeeze in phone calls. So, it is always best to receive, process, and fully understand the information while you have the doctor’s full attention during an appointment.

At Meds MASH and Retirement Wellness Strategies, we are your advocate. You have guidance to prepare for medical visits by assuring you have your questions ready and the information your doctor needs organized and clear. We also attend the visit with you by video when you want that.

After the visit, we can provide a wealth of information to further explain any new conditions or medications. We can even contact your doctor(s) on your behalf to obtain any needed clarification.

Call today at 410-472-5078 and ask for Michelle Fritsch, Pharm.D. Or e-mail at michelle@medsmash.com. Check out more at www.medsmash.comor www.retirewellness.com.

BIBLICAL APPLICATION

Miscommunication and misunderstanding can lead to so many preventable problems. I often ask this question of students in the health professions. ‘Tell me about a time miscommunication led to a bad outcome.’ Usually the answers involve people going to different restaurants or friends having an argument. One time, while teaching active duty military healthcare providers, the example was of an international hunt for a notorious terrorist. The terrorist had been found and surrounded, but a delay in the order to detain him resulted in his escape. What an example!

The Bible has much instruction about good communication.

This Psalmist knows exactly how much trouble our words can cause:

Psalm 141:3 ESV

Set a guard, O Lord, over my mouth; keep watch over the door of my lips!

Our communication is instructed to build people up and turn them to Christ.

Ephesians 4:29 ESV

Let no corrupting talk come out of your mouths, but only such as is good for building up, as fits the occasion, that it may give grace to those who hear.

Colossians 4:6 ESV

Let your speech always be gracious, seasoned with salt, so that you may know how you ought to answer each person.

I know I have spoken in frustration and said words I regretted. I know I have neglected to speak up when my support could have been very helpful to someone else. I know I have said the wrong thing and caused more harm than good, usually out of complete ignorance or insensitivity.

Proverbs 15:2 ESV / 176 helpful votes

The tongue of the wise commends knowledge, but the mouths of fools pour out folly.

One of my frequent prayers in the morning is, ‘Lord please fill me up and pour me out today.’ I ask to be poured out with the Lord’s words and attitudes and sensitivities.

Psalm 19:14 ESV

Let the words of my mouth and the meditation of my heart be acceptable in your sight, O Lord, my rock and my redeemer.

I certainly can’t be trusted to do this on my own, but with the Lord’s guidance, excellent communication can make a huge positive difference in the lives we meet!

Blessings,

Michelle

Use reflective statements to enhance communication and decrease conflict

Communicate Your Way to Better Health

Posted on February 26, 2017 by Michelle Fritsch, Pharm.D.

How do you handle conflict? For most of us the answer is, ‘not very well’. Conflict can raise your blood pressure, constrict your veins and arteries, and make your heart beat harder and faster.

Did you know that communication is NEARLY ALWAYS at the heart of conflict. As people, we miscommunicate on a regular basis. Part of what makes good communication so difficult is that it involves at least two people. Once is communicating and one is interpreting that communication. Let’s take a look at both important parts.

Communicate a consistent message

I was at a retreat this weekend where we played a game about consistent messaging. Think about a time when someone was talking with you and their message was not consistent. Their words said something that did not match their tone or their face or their body language. Imagine someone saying, ‘I love you’ with a grimace on their face and a mocking tone. Or picture someone saying, ‘So nice to meet you’ while glancing around the room looking for someone else. Has anyone ever tried to express anger with you then started laughing? It is hard to express anger while laughing. Someone was just telling me a story about a toddler rearranging a bunch of decorations and falling into a box headfirst with her feet sticking out of the top. The decoration was too heavy and pulled her over. This parent had to stifle giggles and get a picture before retrieving and correcting the toddler.

So, when you are communicating, carefully think about saying the same message with your words, your tone, your eye contact, your facial expression, and your body language. That will help avoid misinterpretation.

Check for understanding

When you are the one communicating, make sure the receiver actually understands what you are saying. It is ok to ask them to repeat it back. Or to ask what questions they have. If we assume the other person understood exactly what we were thinking and trying to communicate, we can often be disappointed. Think about the last time you thought someone understood and they did something completely different than what you asked.

If you are the listener, this is a critical step to assure you are understanding the message.

Reflective Statements

When you are the listener, one of the best techniques you can use is ‘reflective statements’. State back to the person communicating with you what you hear them saying. Put it in your own words. Here are some examples:

You are saying you are upset about _________ because _________.
You are asking me to _________________ and have it done by _________.
___________ frustrates you when he/she ______________.
You want to ________________ before you agree to a hip surgery.
You heard that I ______________, and it has upset you.
Your son forgot to _______________, and not you don’t know what to do.

When you respond with a reflecting statement, you are making sure you understood the person’s message. It is a chance for them to clarify if you misunderstood. It is also a chance for them to feel heard and understood if you are correct.

Making sure you understand before taking any action, even before getting angry, and help avoid a lot of conflict.

If someone is upset or angry and respond also upset and angry, the situation escalates quickly. I have seen this happen where the two people don’t even realize they are saying the same thing. Neither is listening, they are just yelling. Now that will really get your blood pressure up!

I have found that FREQUENTLY, what I think I heard and what the person really intended were different. Especially when the topic is emotionally charged. It is our natural reaction to get defensive when someone comes at us angry. It is very hard to listen well in that state. So, a really deep breath and a calm reflecting statement can often help the situation calm back down. Sometimes when we are angry or frustrated we just want to vent. Once the venting is done, and the recipient reflects understanding, the situation doesn’t seem so bad.

Communicate with your Healthcare Team

These same techniques are very helpful when you communicate with your doctor. Sometimes the news we receive from our doctor can be upsetting. The words used in medicine are big and scary all by themselves. It can be hard to understand all of the technical information.

I highly encourage you to state back to your doctor what you just heard. Say it in your own words. This will help the doctor know where to clarify. I have had many patients get upset by a medical term that was actually no big deal. It just sounded scary. My grandfather, after 40+ years of smoking, a heart attack, a stroke, and stomach ulcers quit smoking cold turkey. We had been trying to get him to quit for years. None of those scary medical issues made him quit. But, when he was diagnosed with hiatal hernia he quit on the spot. [Hiatal hernia is when the sphincter between the esophagus and the stomach can’t close all the way. This allows stomach acid to come back up giving you heartburn. For him, this was the mildest of his issues.] I ask him why. His answer, ‘That’s a really scary word.’ I was in pharmacy school at the time. I had all sorts of scary words I could have given him. Who knew that was all it would take to get him to quit.

So, I encourage use to be clear and consistent with your communication. And, ask clarifying questions and use reflective statements when you are receiving communication. Especially if it seems upsetting, make sure you really understand the message before you make any decisions. This could help you avoid a lot of conflict.

Your heart will thank you for managing conflict better and keeping your blood pressure down.

For more information about communication techniques for your health, please contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

When we react without first understanding, we often get ourselves into trouble. Throughout the Bible we see examples of people making bad assumptions followed by bad actions.

The people of Israel, after God had gotten them out of slavery and out of Egypt and led them through the desert supplying food and water and protection, still made bad assumptions. While Moses was on the mountain with God himself, they assumed he wasn’t coming back, so they made a golden calf to be their god.

Exodus 32:1 NIV

When the people saw that Moses was so long in coming down from the mountain, they gathered around Aaron and said, “Come, make us gods[a] who will go before us. As for this fellow Moses who brought us up out of Egypt, we don’t know what has happened to him.”

When Jesus was talking with his disciples about what was coming next for him, including his death, Peter jumped right in and disagreed.

Matthew 16:21-23 NIV

From that time on Jesus began to explain to his disciples that he must go to Jerusalem and suffer many things at the hands of the elders, the chief priests and the teachers of the law, and that he must be killed and on the third day be raised to life.

Peter took him aside and began to rebuke him. “Never, Lord!” he said. “This shall never happen to you!”

Jesus turned and said to Peter, “Get behind me, Satan! You are a stumbling block to me; you do not have in mind the concerns of God, but merely human concerns.”

In the bible we are also told to expect miscommunication in the future. There will be false prophets and all sorts of misinformation.

Matthew 7:15 ESV

“Beware of false prophets, who come to you in sheep’s clothing but inwardly are ravenous wolves.

1 John 4:1 ESV

Beloved, do not believe every spirit, but test the spirits to see whether they are from God, for many false prophets have gone out into the world.

We are called to be discerning. Ask questions. Get the full story. Make sure you understand and that what you hear matches the messages of the Bible.

I feel better when I read this passage. There will be no doubt when Jesus returns. Other people can claim what they want. I won’t believe it until it is this obvious:

Matthew 24:29-31 ESV

The Coming of the Son of Man

“Immediately after the tribulation of those days the sun will be darkened, and the moon will not give its light, and the stars will fall from heaven, and the powers of the heavens will be shaken. Then will appear in heaven the sign of the Son of Man, and then all the tribes of the earth will mourn, and they will see the Son of Man coming on the clouds of heaven with power and great glory. And he will send out his angels with a loud trumpet call, and they will gather his elect from the four winds, from one end of heaven to the other.

That doesn’t sound too subtle. So, until it is extremely obvious and visible to all of creation, let’s not fall for false messages.

Blessings,

Michelle

Healing Our Wounds – Skin and Relationships

Posted on November 1, 2016November 1, 2016 by Michelle Fritsch, Pharm.D.

Healing skin wounds is a complex process. The same is true for relationship wounds.

Civility, caring for other people, conflict management, self-control, integrity are constructive traits. I am disappointed and dismayed by the negativity in society right now. As we near our national election there is blame, ridicule, slander, questionable integrity, and division. Candidates and regular people on the streets are tearing each other apart. These wounds can be hard to heal. Consider what love, patience, and goodwill could do to aid healing in our society right now.

Healing skin wounds

Do you have any scars? The body’s primary defense mechanism and largest organ is the skin. Any breach in the skin’s integrity can allow bacteria and infection into the body, alter the body’s ability to regulate temperature and water storage, and it usually hurts. The skin is a very sensitive organ.

Any cut, tear, wound results in an influx of parts of the immune system to start healing the wound.

If the wound is small enough, the skin on either side of the cut can rejoin, sometimes without even a scar.

If the wound is larger, the gap is too big to allow the two sides of the skin to reattach. In that case, granulation tissue forms to fill the gap. New small blood vessels grow in to the area, fibrin ‘scaffolding forms’ and cells build in around the fibrin. Then, more small blood vessels are formed, more fibrin ‘scaffolding’ forms, and more cell fill in the area. This continues until the whole space is filled with granulation tissue. This appears as a scar. The space where the wound left a gap that was filled with granulation tissue is noticeable. That skin will not be or look the same. Granulation tissue contains fewer cells and blood vessels compared to normal skin.

Healing relationship wounds

This scar tissue is only 60-85% as strong as normal tissue. So although the body heals itself, it is not like the wound never happened. That is so true of our emotional scars as well. It’s too easy to let words fly when we’re angry. In a rage, your objective might be to win and tear the other person down. This might feel ‘good’ in the moment. But what happens later? What about the guilt and shame? What about the damage done to the relationship? Some things can’t be completely undone. But much healing CAN be done, and a 60-85% healed relationship is better than no relationship at all.

For more information about how the body heals itself or the health impacts of negativity, contact us at http://www.medsmash.com/contact.

Biblical Application:

It can distressing to see so much negativity all over the media. It seems to be adding to the negativity in the workplace, the community, the church, and the home. I encourage us to take a deep breath and focus on our one stable source of hope and joy.

Our interpersonal differences can lead to cuts and wounds in families and groups. If those cuts can be identified and resolved quickly through skilled communication and love, they can often heal without so much as a scar.

But, when they are left unaddressed or allowed to get worse and worse, the healing process can be messy and less effective than it would have been if handled quickly. This is not to say that healing is impossible. Just as the human body is amazing in its resilience, with mediation, healing, communication, and forgiveness, relationships can heal and grow. They may not look the same, changes may occur, but reconnection and resumed integrity can be achieved.
Psalm 147:3
He heals the brokenhearted and binds up their wounds.
1 Peter 2:24
He himself bore our sins in his body on the tree, that we might die to sin and live to righteousness. By his wounds you have been healed.

May your wounds, your relationships, your faith be strong.

Blessings,

Michelle Fritsch

yourhealthandsoul

Do you have any scars? The body’s primary defense mechanism and largest organ is the skin. Any breach in the skin’s integrity can allow bacteria and infection into the body, alter the body’s ability to regulate temperature and water storage, and it usually hurts. The skin is a very sensitive organ.

Any cut, tear, wound results in an influx of parts of the immune system to start healing the wound.

If the wound is small enough, the skin on either side of the cut can rejoin, sometimes without even a scar.

If the wound is larger, the gap is too big to allow the two sides of the skin to reattach. In that case, granulation tissue forms to fill the gap. New small blood vessels grow in to the area, fibrin ‘scaffolding forms’ and cells build in around the fibrin. Then, more small blood vessels are formed, more fibrin…

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