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Join Ann M. Hester, board-certified internal medicine physician, in a thought-provoking podcast episode. Explore the challenges of the health care system, including the shortage of doctors and the nursing crisis. Ann shares valuable insights on the importance of patient empowerment and the need for collaboration between patients and health care professionals. Don’t miss this empowering conversation on shaping the future of health care with Dr. Ann M. Hester.
Ann M. Hester is a board-certified internal medicine physician with over 25 years of experience and can be reached on Twitter @Patient101Book, TikTok @patientempowerment101. She is the author of Patient Empowerment 101: More than a book, it’s an adventure!
She shares her story and discusses her KevinMD article, “Patient empowerment: the key to solving the health care crisis.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Ann Hester. She’s an internal medicine physician. She’s the author of the book Patient Empowerment 101: More than a book, it’s an adventure! And today we’re going to talk about her KevinMD article titled “Patient empowerment: the key to solving the health care crisis.” Ann, welcome back to the show.
Ann M. Hester: Thank you so much for having me, Kevin.
Kevin Pho: So we’ll get into your article in a little bit, but for those who didn’t listen to our first episode together, just briefly share your story and journey to where you are today.
Ann M. Hester: Sure. I spent most of my time as a hospitalist. I also did work as a primary care doctor and so forth, but I’ve always had a passion for empowering patients. In my third year of medical school, that’s when I got started picking out different types of literature. I’ve been doing things online for a long time, writing articles. I wrote a book over 20 years ago. It was called Your Family Medical Record: An Interactive Guide to Getting the Best Care. John Wiley and Sons published it, I think, in 2000.
But at that time, people didn’t want to be empowered. It was like the doctor said, “This is what you do,” and they said, “Yes, sir. Yes, ma’am,” and they would leave, and they may or may not follow through. Now people have taken a different stand. They realize the significance of becoming empowered, of becoming true partners in their health care. They realize that they cannot afford to leave such vital matters up to anybody, no matter how brilliant he or she may be. It’s their body, it’s their life, and they deserve a rightful place at the table.
And so there has been a coming of age, so to speak, an enlightenment among patients, and now they want to know and they want to be involved. And then I ended up writing the second book as a result of realizing that this time, people are now there. They’re ready to do the things that they need to do to empower themselves.
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Kevin Pho: So as an internal medicine physician, give an example of how you see that patient empowerment manifest in the hospital or the clinic. Share a quick story.
Ann M. Hester: One of the things that I did when I was in private practice is I asked a patient a yes or no question. It took her 10 minutes to answer because she wasn’t prepared. She was talking about, “And then this happened, and then I drove down the street,” and she was going on and on. And I let her finish, because I wanted to adequately time it and see how long it really took. Instead of interjecting, I just let her finish. We don’t have that kind of time, and it is important for patients to understand what they need to do to go in, see the doctor, get to the heart of the matter quickly, and help expedite their own care.
So I did, I timed her, around the time I wrote my first book about 20 years ago, just to reinforce it. You know, patients are not given this information. We go to medical school, nurses go to nursing school, but there’s no patient school. They don’t know what we need. They don’t know what we’re looking for. They communicate in a way that’s normal for them, just like we do. And unfortunately, sometimes we communicate as if we’re talking about the creatinine and the BUN and all these things. That’s our norm, and it’s above the heads of most people, but that’s what we’re accustomed to. And patients do the same thing. There needs to be more of a meeting of the minds so we can work together to optimize the outcomes.
Kevin Pho: And we’re going to talk more, of course, about patient empowerment in your KevinMD article that’s titled “Patient empowerment: the key to solving the health care crisis.” Now tell us, how did your article come together?
Ann M. Hester: The Association of American Medical Colleges is predicting a dire shortage of physicians. And of course, a lot of places in America already have somewhat of a shortage. But if they consider the needs of people who have health insurance, and then add the needs that are unmet of those in rural America and some other underserved areas, the people who actually do not get appropriate health care now, they look at the true needs of Americans. In, I think, 2034, we anticipate we’ll be short 180,000 doctors. That’s not sustainable. There’s just no way that we can provide people with the care that they need, let alone the time to hold the hand and listen and comfort. It’s just not going to happen. These short visits are going to be fly-by visits, and we need to be prepared for this coming tsunami, and we need to reposition ourselves.
America is a very wealthy nation, but America is not at the top as far as health care in the world. And we’re looking at this huge shortage of physicians, and the World Health Organization estimates a shortage of 10 million health care, not just doctors, but health care workers in the future. We’ve got to be doing things differently. We can’t wait until the tsunami comes and we all float away. We need to be proactive to do those things, and one thing that we can do is help patients, teach them what they need to know.
We know, when they come into the office, the eight elements: the severity, the quality, the location. We know those things. We know how we bill, and it’s not just about money. It helps us narrow down the list of possibilities. We know that, so why don’t they know that? One thing that I do, I actually teach a course on this on a platform that’s going to be launched through PatientWorld.net, and I talk about this in my book as well. If patients know, “OK, if I have abdominal pain, these are the eight elements I need to think about, so when I step foot in my doctor’s office, I can tell them the severity, the duration, the timing, the location, all of those things.” And instead of spending 15, 20 minutes going through everything, in a minute the doctor will have a short list of possible diagnoses. That means fewer tests, fewer procedures, and less need for follow-up visits that take up the time that somebody else who has an acute issue could use. We need to be wise. We need to see this horrific storm coming and do those things to minimize the damage and to empower our patients and our health care system.
Kevin Pho: So tell us how patients can do that right now. You mentioned, of course, your book and your upcoming website. If a patient has some type of acute symptom, what are some ways that they can do that research, empower themselves, and ask more informed questions when they do see a clinician?
Ann M. Hester: CL STADIUM. C, character; C, context; L, location; S, severity; T, timing; A, associated symptoms; D, duration. Then I say I and U have nothing to do, they’re just part of the mnemonic, and M is modifying factors. When you develop an illness, if you think through those things, do an elevator speech. Prepare before you see the doctor. Think through what’s important, because that’s what he or she is going to want to know.
Do the research. Don’t go to all of these out-of-the-way sites and bring in a list of potential diagnoses a mile long or a stack of websites. Go to reputable sites. You know, WebMD is reputable, government sites, associations, the American Medical Association, the chest physicians. I’m not sure exactly how much information they give the public, but the associations, the American Heart Association, the American Cancer Society, those things are going to have evidence-based information. And so learn about your condition, prepare for the visit, and prioritize your concerns.
Your doctor might plan on giving you 10 minutes, and then when he gets in the room, the nurse knocks on the door, and the person in the next room may be having a stroke. If the visit is truncated, make sure you’ve had a chance to get through the most important things. Prioritize what’s most important so you can get through what matters the most before your doctor walks out. And if your doctor gets through all the things that are important, that might be the time for the extra hand-holding or the extra, “Hey, how was your last fishing trip?” sort of thing. But take care of the business first. By doing that, you’ll get better care, and you’ll be less likely to need a lot of excessive tests and procedures. And we all know that tests can have side effects. Not only can they be painful, they can be dangerous, and sometimes, with false positives, they can lead to unnecessary tests and procedures, which can be expensive, and they can have their adverse health consequences.
So I advocate for patients and physicians to work together in a methodical, well-thought-out manner to expedite patients’ care. And it’s not just the doctor’s responsibility. Doctors are absolutely inundated and swamped. When the nurses used to come to see me, I would be so happy, because they knew, “This is what’s important,” and they would get to the point. And then the next patient, she may not have a clue, and she may take up the extra time that the nurse didn’t use. But there needs to be a balance. And the more people who are able to really partner, to be efficient, effective partners in their health care, the better situation we’ll be in. As time goes by, more and more doctors retire. We don’t have enough to replace them, and the nursing shortage is another nightmare that’s threatening the status quo in our health care system. So there are so many factors that are going on now. You just can’t afford to just sit by and wait and see what happens. We need to do something.
Kevin Pho: So I think you’re certainly describing an ideal, and I completely agree with everything that you say in terms of patients prioritizing and empowering themselves before they see the clinician. What are some effective ways of getting from where we are now, which is clearly, in most cases, not what you describe, to where you want to be?
Ann M. Hester: I think mutual respect is important, mutual appreciation, so that doctors respect and appreciate their patients’ input, and patients respect and appreciate their doctor’s input and their time. And so if you know that you’re going to be seeing a very busy physician who’s running from the hospital to the office, maybe an hour behind, think that through. Be prepared to help him help you. So instead of fostering an environment where the doctor is interrupting and asking questions, be forthcoming. Give a concise history. You can give a history of your illness in 60 seconds and hit the key bullet points. And if you can do that, you’re going to help your doctor. When your doctor sees you, your doctor is going to be smiling rather than thinking, “This is going to be a long visit, and I have all these other things to do.” Develop this mutual admiration society, where you all are working together, and you do so in a kind and respectable manner. That would be what I would recommend.
Kevin Pho: Now let me flip that question, because there are a lot of physicians I talk to who are a little bit wary when patients do their own research and empower themselves. What do you say to those doctors who actually discourage their patients from doing their research on what they have?
Ann M. Hester: Patients have a right to know what’s going on. And I have had the one-inch-thick internet file brought to me, and I can’t read it all in this 15-minute visit. You know, we’ve all been there. So instead of the three inches of medical files, you give the patients the sites that you recommend. If they are going to these outlandish sites, say, “You have heart failure, and I want you to know about it. Go to the American Heart Association.” Give them handouts, whatever you feel would expedite their care, expedite their understanding, in a way that you feel comfortable with.
Because they can go to 100 sites, go on YouTube, go to all these places, and come to you with all these horror stories: “Oh my gosh, I have amyloidosis. I have sarcoidosis. I have restrictive cardiomyopathy.” They can do all of these things. But direct them. If you direct them on the path that you want them to take, and you feel comfortable, you’re going to respect heart.org, and you’re going to respect a lot of other sites. And so if they know where to go, then you’re on the same page.
Kevin Pho: Now, you’re in Washington, D.C., so you are no stranger to the polarizing political climate, of course, right? And especially during COVID, there has been a decreasing amount of trust in health care authorities, whether it’s physicians or public policy experts, and sometimes it’s hard for patients now to trust health care experts. What are some ways that we could regain that trust going forward, given the polarized climate that we live in and that decline of trust that was exacerbated during the pandemic?
Ann M. Hester: I think it’s when physicians actively work with patients and let them know that they’re respected: “You need to know this information. Let me give you some great resources to learn about the information. The next time you come to visit me, if you have a list of questions, we’ll go over them.” Let them know that you’re on their side. It’s one thing to say, “This is what you need to do.” It’s another thing to say, “We’re going to work together to get through this together, and I’m giving you some respectable resources, some means by which you can take a deeper dive and learn more about what’s going on, so when you come back, we can have an even deeper conversation about what we can do to help you.”
A lot of people say people don’t care what you know until they know that you care. Once you show a patient that you respect him or her, that you’re willing to work with him or her and try to be a partner in the care, some of those boundaries, some of those obstacles, are going to fall. But until that trust is established, there are going to be problems.
Kevin Pho: Now, we both know that the doctor-patient relationship has evolved in the past, from what was once a paternalistic relationship to now more of a partnership, right? What are some phrases and questions that you use in the hospital room or the exam room to really foster that collaboration and partnership? What are some things that you say to really encourage that?
Ann M. Hester: Well, I was a hospitalist for about 15 years, and I’ve stepped out of clinical medicine, and I am in administrative medicine now. But things that I would do, when I would go in, first of all, I would just talk to the people, unless they’re on a nonrebreather or something. Just develop rapport. If they’re reading a book about a topic that I enjoy, just start talking to them. Let them know that you’re genuine, that we have something in common, that we enjoy some of the same things. “What’s important to you? These are my thoughts. You don’t necessarily have to give me your answer now. This is what I think we need to do, and I’ll check back with you a bit later. Or is there a family member you want me to call, so we can all go through this together?”
Find out what’s important to them, because what’s important to me is, “This is the diagnosis. I’m going to check this box and this box and this box.” The patient may not be there. The patient may have a completely different set of priorities, and until you understand what’s important to the patient, you’re not going to get the buy-in that you want. That means you’re not going to have a good doctor-patient relationship. So there is a clear means by which you can establish rapport. And often, if you look around and you just start chatting, there’s going to be something you can pick up on that you have in common with the patient. And once some of the barriers come down, when they’re smiling and you’re all talkative, then that is the better time to delve into things. And they’re going to trust you more, because they’re going to see you as someone like me, someone who thinks like me, and not this white coat who’s arrogant and is going to tell me what to do, and, “My uncle had this horrible experience. I don’t trust doctors.” Treat people like you want to be treated, and show them the dignity and respect that we all want, and take it from there. Once that baseline is established, it’s a whole lot easier to move forward.
And also engage family members. If you have a person who, whether due to anxiety, depression, or prior stroke, or whatever the case may be, is not really able to fully engage, engage family members. Certainly there are HIPAA issues. If the person needs to be able to give permission, of course they need to do so. But if you walk into a room and family members are present, don’t ignore them. You’re there to see the patient, but you may have somebody like his son or something. Develop relationships.
Kevin Pho: We’re talking to Ann Hester. She’s an internal medicine physician. She’s the author of the book Patient Empowerment 101: More than a book, it’s an adventure! Her KevinMD article is titled “Patient empowerment: the key to solving the health care crisis.” Ann, tell us some of your take-home messages that you want to leave with the KevinMD audience.
Ann M. Hester: My take-home messages are that we are facing a potentially horrific time in health care, in this country, and not just this country, actually, around the world. We can’t handle the status quo. We’re not going to be in a position where we can be 180,000 doctors short and treat citizens with the dignity, respect, and expertise that we all want. What works for me may not work for the next physician, but everybody needs to realize where we’re headed. Look at his or her practice and practice style, and make a plan. What are you going to do to protect your practice, to protect the viability of your practice, to protect the patients you serve as you move forward? Your roadmap may be very different from mine, but do something. Don’t wait until the storm hits. Be proactive.
Kevin Pho: Ann, thanks again for coming back on the show and sharing your time.
Ann M. Hester: Bye-bye.
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