Dr. Joshua Tepper, CEO of North York General Hospital, shares advice on how to talk to your doctor, including: come prepared with a list; ask lots of questions; if you’re Googling your symptoms, consider the quality of your sources; and lots more! We have all felt unsure, and some of us have felt awkward around our doctor. Here is our chance to learn how to optimize our communication with our doctors so we can receive the best medical care.
- 5 Key Learnings
- References & Links
- Andrea’s Commentary
- Interview Transcript
5 Key Learnings
- Whether it’s on paper or on your phone, Dr. Tepper encourages us to make a list of everything we want to cover in an appointment.
- He also suggests prioritizing. Tell your doctor what your primary concern is first, then share the whole list, so the doctor can validate what is most important.
- By the way – it is ok to make an appointment focused on one thing!
2.Bringing people to our appointments
- Sometimes bringing a friend or family member can be a good idea, particularly in terms of asking all of the relevant questions and remembering everything that the doctor says.
- If we are accompanying someone on a medical appointment, Dr. Tepper suggests that we should also give the patient some time alone with the doctor. Sometimes the patient might be shy about sharing important things when their friends or family are around.
3.) The Google effect & quality of our information sources
- We have all heard about how people google their symptoms and then get hysterical with their self-diagnosis, and how this drives doctors crazy! Dr. Tepper reminds us that this has been going on since the beginning of time, just with different sources. Our sources used to be friends, family and books. Now it is the internet.
- The most important thing to consider is the quality of the source. Random opinion websites and many for-profit online resources are less dependable than government sanctioned resources or academic articles.
- Tepper encouraged us not only to be careful of our sources, but to also ask our doctors for recommendations of online resources that might be more useful for us.
4.) Asking QUESTIONS
- In Dr. Atul Gawande‘s book Being Mortal, he highlights that “hope is not a plan” – and that applies to both patients and doctors. It is human nature to avoid the negative, and in the medical context, this is not effective.
- In order to get the most thorough diagnosis and treatment, Dr. Tepper encourages us to ask lots of questions. He suggests open-ended questions, such as, “is there anything else I should be thinking about?” “Is there anything else that other patients who are in my situation have also considered?”
5.) Strategies for when we are feeling awkward or embarrassed
- Tepper suggests we ask ourselves WHY we are feeling awkward. If it’s because we think the doctor might judge us, we can start by saying that. Be honest.
- If you are feeling awkward because you are concerned about privacy or confidentiality, Dr. Tepper suggests asking, “who else can access this information?” If here is something in particular that you don’t want on your file, you can ask your doctor to “black box” that information.
- Tepper encourages his patients who are embarrassed to share something, that instead they write him a letter. Sometimes it is a lot easier to write something than it is to say it.
References & Links
Dr. Joshua Tepper & North York General Hospital
- Joshua Tepper – http://www.nygh.on.ca/Default.aspx?cid=4658&lang=1
- On Twitter – @DrJoshuaTepper
- North York General Hospital – http://www.nygh.on.ca
- North York General Hospital Foundation – https://nyghfoundation.ca/
- Newsweek’s 2019 Hospital Ranking – https://www.canhealth.com/2019/04/10/newsweek-ranks-top-canadian-hospitals/
Medical Resources & References
- Dr. Tepper’s education & past affiliations
- Medical School – McMaster University
- Family Medicine – University of Toronto
- Public Policy – Duke University
- eMBA – Ivey School of Business
- Inner-City Health Associates
- Inner-City Family Health Team
- Society of Rural Physicians.
- Health Canada
- Institute for Clinical Evaluative Sciences (ICES),
- Canadian Institute of Health Information (CIHI).
- Ministry of Health and Long-Term Care
- Sunnybrook Health Sciences Centre.
- Kaiser (Henry Kaiser Family Foundation) – https://www.kff.org/
- Public Health Agency of Canada – https://www.canada.ca/en/public-health.html
- Center for Disease Control & Prevention (CDC) – https://www.cdc.gov/
- Cancer Care Ontario – https://www.cancercareontario.ca/en
Other Resources & References
- Atul Gawande, “Being Mortal” – https://amzn.to/2Qa5kRc
- Tim Ferriss, “The Four Hour Work Week” – https://amzn.to/2WoMPib
- Marie Kondo, “Spark Joy: An Illustrated Master Class on the Art of Organizing & Tidying Up” – https://amzn.to/2WeQ5aT
- Gretchen Rubin, “Outer Order, Inner Calm” – https://amzn.to/2WPuUAu
- Christine Elliott (Health Minister, Ontario PC party) – @celliottability
- Doug Ford – @FordNation
- France Gelena (Ontario NDP health critic) – @NickelBelt
- Andrea Horwath – @AndreaHorwath
- Justin Trudeau – @JustinTrudeau
- Donald Trump – @realDonaldTrump
- News Sources
Talk About Talk
Dr. Andrea’s Commentary
Welcome to Talk About Talk, the communication focused podcast that provides us with the knowledge, strategies and confidence to enrich our relationships and enhance our career success. I’m Dr. Andrea Wojnicki. Yes, you can call me Andrea. And no, I’m not a medical doctor. I have a doctoral degree in business. I only respond to marketing emergencies…
Our guest expert today certainly is a medical doctor. Today, we are talking about a very important topic. I’m hopeful that what you learn in this episode will physically, medically, benefit you. We are Talking about How to talk to your doctor!
Whether you have a regular a wellness checkup or some sort of medical testing or urgent care or even palliative care, our goal as a patient is to receive the most accurate, complete and effective diagnosis and treatment.
The general question we will focus on in this episode is how to communicate with your doctor to ensure you receive the very best care.
I met Dr. Tepper through my role as a Foundation Governor at North York General. Let me first tell you a bit about the hospital. North York General is situated near the corner of one of Toronto’s busiest intersections: highway 401 and the Don Valley Parkway. So huge volumes of patients are coming in to this community and academic hospital from every direction. Yet, this hospital does a remarkable job of delivering exceptional patient care.
I could list these accolades for you, but instead, let me just tell you that recently Newsweek did a comprehensive review of 1,000 hospitals in 11 countries, and ranked North York General Hospital the second-best hospital in Canada and one of the top 100 hospitals in the world. With a score of 91.0, they missed the top spot in Canada by just 0.1! I can tell you from my personal and professional experience with this hospital, that North York General is truly WORLD CLASS.
Now, let me introduce Dr. Joshua Tepper, the CEO of North York General Hospital. After the interview, I will summarize his main points for us. You do not need to take notes! The summary is available for you in the shownotes. If you go to TalkAboutTalk.com and click on PODCASTS, you will see the shownotes there.
Dr. Joshua Tepper completed Medical School at McMaster University and his residency in Family Medicine at the University of Toronto. He holds a degree in Public Policy from Duke University, a Masters of Public Health from Harvard, and an executive MBA from the Ivey School of Business where he was also valedictorian.
Throughout his career, he has always remained in active practice, serving marginalized populations and taking on clinical leadership roles. He has served as the Medical Director for the Inner-City Health Associates and President of the Inner-City Family Health Team. He was also previously the Vice-President of the Society of Rural Physicians.
Dr. Tepper’s various positions have included:
- senior medical officer for Health Canada,
- adjunct scientist at the Institute for Clinical Evaluative Sciences (ICES),
- research consultant for the Canadian Institute of Health Information (CIHI).
- Assistant Deputy Minister (ADM) in the Health Human Resources Strategy Division of the Ministry of Health and Long-Term Care.
- And Vice President of Education at Sunnybrook Health Sciences Centre.
I don’t think this man sleeps.! As you will hear in our conversation, his most productive work time is 11pm to 1am! What?!?
On the morning that I met Dr. Tepper, he told me had an important meeting immediately afterwards, and then he was headed downtown to teach for four hours.
I met Dr. Tepper in his office on the 9th floor of North York General. Yes, you will hear ambulance sirens, amongst other things, in the background.
Dr. Andrea Wojnicki: Thank you very, very much for joining us and sharing your expertise on how to talk to your doctor.
Dr. Joshua Tepper: Good morning. Thanks for having me.
AW: So I’m going to start with a very basic question. What do doctors wish patients would do in preparation for and during an appointment?
JT: First of all, we just want people to come in and see us when they need to. We wouldn’t want people at the end of this to feel deterred, because there’s all this work to do. Ultimately, if you’re not feeling great, or you have questions, just come and see us. But it is helpful if you can give a little bit of thought ahead of time to
what you need out of that appointment. What are the important things? I increasingly have patients make lists for me. And those lists are really helpful. And then when you actually come into the appointment, you pull up the list and use it. I’m not upset that you made a list. So pull it out and use it and start with the most important things.
AW: Okay. Okay, so you said at the beginning, “don’t hesitate to make an appointment.” And I have to tell you personally, and I’ve heard this from other people, “well, should I make an appointment? No, I’ll be fine. The doctor will think it’s nothing, I’m wasting their time, I’m wasting resources…” How do you know when to make an appointment?
JT: You know, I think you have to be your own best judge. And it’s more important to err on the side of caution. And the other thing is, even if it turns out to be physically not important, if it’s emotionally distressing for you, that’s enough reason to come in just for the mental reassurance. I don’t want you at home worrying for three weeks, I want you to come in and have this conversation.
AW: Right. So a written list.
JT: Yeah, I mean, written on your phone, whatever.
JT: But it is helpful because I do that before coming in… like you and I today, you thought ahead of time about the questions to make this process go smoother. And it just makes this interaction go a lot smoother. And you know, you’re getting the important stuff out.
AW: One of the things that I’ve started to do, actually, partly because I have three kids, and I’m managing their healthcare as well, is I’m keeping a list in my phone of all the appointments that we’ve had. And I’ve personally found that to be really helpful. Because when you’re in the moment, and they’re asking you questions about
the health history, about previous appointments, I have dates and everything all. there So I guess that that’s part of that too.
JT: Right. The other thing… Two other quick thoughts. One, I think more and more in the future, we’re going to see what’s called asynchronous appointments, meaning text messages, emails, phone calls. We have not had a lot of that in healthcare in Canada right now, right? But in the United States, places like Kaiser, 50% of their interactions are digital and largely asynchronous. So you can have digital live skyping type things. But these are texts back and forth. And that will really encourage people to say, “Listen, this is happening. Should I come in or not?” And I now text with a lot of my patients through secure means and email. And again, we can triage. And the one other clarification is you shouldn’t wait until you have a full list. If they are truly minor for you, that’s fine. But I don’t want people to take away that you have to have a list before you come in.
AW: You can come in with just one thing, right?
JT: The list could be one.
AW: I think about your point about prioritizing as well. So, tell the doctor first what your primary concern is, and then go down the list.
JT: And then what I do, what I think especially when I see a list, is, “Oh, this is good.” And so they may say, “oh this is the first thing on my list.” And what I’ll often do is say “why don’t you don’t just read me your whole list,?” Because then I can actually help prioritize as well. Because the worst thing for me is when I spent my 15-20 minutes with somebody, talking about their tennis elbow, or whatever it is. And then they say, “okay, and by the way, there’s been this horrible chest pain as well, when I play tennis.” And like maybe we should have started with that. And so if I see a list, I’ll often just say, this is great, tell me what else is on the list quickly. And then I’ll say what’s most important to you? And if it aligns with what I’m hearing, I’ll say great.
AW: I’ve also heard that sometimes I guess, depending on what type of appointment you have, that bringing a friend or family member can be a good idea, what do you think about that?
JT: Absolutely. I’m very open to that. I just always try to make sure it’s true to what the patient wants, what I don’t want, especially sometimes with teenagers, or even elderly people that this is truly voluntary? – the other person in the room? As opposed to somebody else intruding into that. And so I will try to just find a quick moment to really just say, “would you like this person here?” In case there’s something they didn’t want to say in front of their partner. Because it can be hard. Somebody said, “Oh, I’ll totally come with you.” What do you say? No, like it said, it feels like a generous offer. So I’m very open to it. I just try, as a physician, to assess, is this truly what the patient wants? Or is somebody else inserting themselves?
AW: It can be very helpful to help remember things.
JT: It can be very helpful for the patients who have memory issues or who are anxious or confused. And especially from mental health, and I have a lot of patients who have very severe mental health problems, it can be really helpful.
AW: I think your point about it being common for teens, and for older people, to have someone with them, and not necessarily have that person be welcome in the patient’s mind is a great one.
JT: And again, sometimes that physical exam is a time when I can then be along for the patient. And I’ll say, “okay, Mom, why don’t you step out?” And then when I’m taking the blood pressure and listening to the lungs or examining the knee or the ankle, or whatever it is, it’s just a chance for me to ask a few other questions or just open the door and say, “Oh was there anything else you were hoping we could chat about?” And that’s when things like I’m worried about my acne, I’m worried about sex, I’m worried about birth control, all these things, or I have a question. Just try to create that space and see what happens and they otherwise might not come up.
AW: Is there anything that patients do with some regularity that make you roll your eyes? Or that you just wish …
JT: Honestly? No, I mean, I honestly, I think patients,… my experience is just patients are generally quite grateful and appreciative and thoughtful. And when I find they’re not, when they’re angry, or they’re
quote, unquote, demanding it’s usually coming from a place that I can understand they’re in pain, they’re suffering, they’re depressed, they’re anxious, they’re in a state of crisis. I understand,
why this behavior is what it is? And is it pleasant to receive? No, but it’s not personal to me. It’s reflective of the way this person is, unfortunately, in that moment. And so no. One of the best parts about medicine is it’s a people profession, for the most part, and you have to like people and be present with them and be where they’re at.
AW: So talk to me about the Google effect. People are self-diagnosing, from googling their symptoms on the internet.
JT: It doesn’t drive me nuts. It’s modern healthcare in modern society, right? People are checking you out before they go into a restaurant people are going on to the Facebook pages of organizations, people are going on to websites, people are googling every aspect of their life to try to inform themselves better. From where they want a burger, to who’s going to be their heart surgeon. And so why would I suddenly expect them to use the vast internet for every part of their life: for buying a house; searching for mortgage; and then suddenly, on something that’s so important to them, like their health, they’re gonna be like, “oh, now I’m not going to use the internet,” right? That’s not what I would do as a patient. Or why would I expect them to suddenly isolate information from themselves? What I do though, is I try to guide them towards good sites.
JT: I try to help them curate the web. You know, I think the challenge for all of us on the internet is, what website do you go to? Do you go to Yelp? Or do you go to this? Or do you go to that you go to and so I do try to recommend to my patients and help them navigate the web and curate. And so if they’re worried about vaccinations, I’ll say these are the two or three websites, I really recommend that you go to the Public Health Agency of Canada, the Center for Disease Control, if they have questions about cancer treatment, or screening, I’ll say go to Cancer Care, Ontario’s website, so I do try to help them curate and navigate.
AW: So it sounds as if, based on other conversations I’ve had with other doctors that you may be a little bit more enlightened in terms of being open to patients coming in and being informed to some extent from internet sources. But I’m also hearing that, if you’re going to do that, make sure you’re on quality, non- “fake-news” websites. Can you share with us what are some of the more highly regarded ones that are more, for example, grounded in science?
JT: Yeah. So you know, just one quick point, I don’t know if I’m more enlightened, or more realistic,….
AW: Also more humble.
JT: But it used to be not “Oh, I went to this website…” No. It was, “oh, I was at a party last night and such and such said this” or “I was talking to my mom,” right? Chatting with my neighbor. People have always solicited outside information. Now it’s just easier, and there’s more of it. But people would always come in and say, Oh you gave me this. But my aunt always says it’s much better to use this. Now, it’s not their aunt, it’s somebody on a chat room over in some other country.
JT: But this idea that people are still living getting third party information of various levels of quality. And other times, I remember people coming in saying, actually, my dad’s a neurosurgeon down in Texas, and naturally, he wondered about this-and-this and you’re like, Okay. That’s like going to a better website, than your, whatever, neighbour who’s had a couple of drinks and has a view of your rash. So the point is, there’s the fact that people have always solicited outside information and advice is not new. It’s just now it’s digital. And there’s more of it.
AW: So when patients are sharing the information that they have with their doctor, they should tell them the source.
JT: Yes, I think it’s helpful when people say I was reading, I always say, oh, were you reading that online? Or tell me more? What website? And then that leads to your question about what websites do I recommend
I typically do like publicly funded, typically, government type sites, like the Center for Disease Control, or the Public Health Agency of Canada type agencies. People are incredibly sophisticated these days. And so people will go and even read medical journals now because they’re online, and a lot of them are free, or don’t pay five bucks for the article or three bucks for the article. And so again, some of the I’ll talk about if you’re interested in that, people are very specific. You’ve got a PhD yourself, right? You’re very capable of navigating some fairly sophisticated material. But I might say – if you’re interested in this, here’s three or four journals, and you’re going to go and spend a bunch of money on buying a couple articles about a health issue. Here’s a couple journals that we think are really reputable journals. And so we’ll have that. What I say is – Be very careful about online blogs, or opinions.
AW: So, when we’re reading the news, we try to always have in the back of our mind to be careful, right, in terms of considering the source, and not falling for the clickbait. And I know that the clickbait exists out there in the medical websites or the opinion websites that are masquerading as medical websites. So that’s, that’s a great point. Just to shift gears a little bit. I’m a big fan of Atul Gawande. And in his book Being Mortal, he highlights that hope is not a plan. And I was re-reading in preparation for this interview, one of the things that I read said that he means that for both the patient as well as the doctor or the care provider.
AW: that hope is not a plan. And so this is a question, it’s a little bit turning the original question on its head, but how can we as patients, encourage our doctors to be as open and forthcoming as possible? We know that it’s important for us to be open and transparent and thorough in what we’re communicating. But we also want the doctor to be the same way, how can we encourage them to do that?
JT: That’s a great question, actually. And it’s funny, I spend most of my time on this as a physician thinking, How do I create a safe space for people to talk openly and feel they can share? whatever it is they need to? But it’s a, it’s a good question. What allows me to be as open and forthright? You know, one is to ask questions, because your questions, will push me farther in thinking through and sharing. And so the more questions you ask, the more it will prompt me to be fully disclosing. And it can be open ended question – is there anything else I should be thinking about? Is there anything else that other patients who are in my situation might also have asked? – Things that will broaden my mind to giving you more information. You know, simply saying I’m somebody who likes to know all the risks, I’m somebody who likes to have as much information as possible. So if there’s anything else you’d like to tell me, I really, I’d be very open to it. I tried to do that for you as a patient, is there anything else today? These can be hard conversations, but I want you to feel comfortable talking about these things. Things like that. You can flip it back, if you will, and so to say, is there anything else you think I should know? I’m somebody who likes to have a lot of information, etc.? Is there anything else? Are there any risks? Is there any other options or risks? Is there anything else? This could be beyond what we’ve talked about?
AW: I feel like some of these questions might be good things to add to our list before we come into the doctor. Right?
JT: Yeah, I think they can be. Now, again, these are follow up questions to a specific issue. So as opposed to open-ended questions. They are more like – Okay, I’m coming in with these headaches. And now, as we talked about the headaches here – some ways of broadening that conversation.
AW: Okay, here is the ultimate question. We all know that we should tell our doctors, everything. We should not be shy. And we’ve all heard that “doctors have seen it all.” Right? It’s basically become a cliché. But many of us are still hesitant and embarrassed to tell our doctors everything. Do you have any advice for patients on how to get over the embarrassment of sharing everything? Peeing in a cup, seeing me naked, whatever the horrible thing is that they don’t want to talk about?
JT: A lot of it does rest with, to some degree, the physician and the health care structures. I’d like to think we’re getting better at some of this stuff. I’d like to use those two examples. I remember when I was in training we sort of had people that come in the room and pointing down the hall, and they’d carry the cup down the hall with them. And actually, now in my clinic, those cups are all in the bathroom. You can just go into the bathroom and take the cup from there. And then there’s a little door that you can put it in. I remember when I was in training that we used to write notes, and the patient would step behind the curtain and change. And now I just completely leave the room, and give them total space, as opposed to just sort of drawing this curtain and pretending I didn’t know they were undressing on the other side – or knowing, but ignoring it. And so I think we’re much better, hopefully, at prompting questions. The questions they ask now. And how I ask them. Before, I might have said things like, “do you have any concerns about your sex life? Or are you sexually active?” And now I asked questions like, “are you sexually active with men, women or both?” We are much more explicit. Now these days, especially in the populations I serve, when I first meet patients, I’m like, “Oh, hi I see your name is Andrea, how do you like to be identified and called?” And for somebody who never would have – or might have taken years for them to get to the point of saying, “actually, I’m not sure where I identify as a man or a woman or where I am on this gender fluid thing.” I’ve suddenly created a space in the very first moment. And even if at that moment, they said, “Well, no, Andrea,” they know, I planted a seed that next time they can come back and say, “actually, it’s more Andrew.“ Right? Or I’ve wondered, and you just create an openness. Or ask questions. I used to just say, “oh, how are things at home? You know, are you married or not married?”
JT: And I would say, “what are your living arrangements? Do you have any concerns with intimate partner violence? Be it like physical, verbal?” When I ask, I try to create space for the uncomfortable. And if people look embarrassed, I say, “I ask everybody.” Right? I ask this to everybody.
AW: And now everybody wants to be your patient, Dr. Tepper.
JT: No, I don’t know about that. But it is, it is trying to give permission for these hard conversations. It is trying to anticipate what people may not want to talk to them about. And creating that opening. And even if they don’t take that opening today, they might take it in six months or a year. Or you know, it’s just trying to allow, to create a really safe space. And then I think for patients, it’s just – what is what is keeping you from sharing? And sometimes it is just that physical embarrassment.
AW: I think oftentimes, it must be right?
JT: I think it is, but other times, it’s where’s this information going to go? And especially now that you see us, you have seen us writing, but actually now, for better, for worse, it’s typing into a screen. And we all have this sense of – where the heck does this data go? And who has access and we read about files being lost? And so if it’s just pure embarrassment, that’s one thing. But if it is a concern about data, you should ask , “if I tell you about this, who else knows? Who else has access to this chart? I see these notes. Who else gets to read these, right? If that’s part of what’s driving your reluctance, it’s fair to inquire. And then, in fact, a lot of our charts can have what are called black boxes. And so we can black box certain information. So patients can say, “Listen I don’t care if you know about my peeing and my pooing, whatever. But when it comes to whatever this is, I want this black boxed.”
JT: And we have ways of sort of carving and locking certain information differently than other information.
AW: I hadn’t heard of that.
AW: If you had a family member who was having health issues, but told you in confidence that they were shy about talking to their doctor about it? How would you coach them in terms of their mindset going into the doctor to be more transparent about their questions?
JT: Yeah, I think it would be, why are they shy? Is it something about that how that physician or nurse practitioner has interacted with you previously, that has made you shy? Did they act in a way that made you feel like judged or judgmental? Did you talk about sex toys, for example? And they seemed to react uncomfortably? So now you don’t want to talk at all about anything about your sex life? When in fact, you have all these questions about you know, how to clean them, the risk of sexually transmitted diseases and sharing sex toys,… Maybe there’s a whole range of questions you have now. But you felt judged. Is it something about what the providers created a space for? Or is it actually just you have a hard time? In which case I say, this is important. Just ask it. And if you need to use euphemisms, sometimes what I’ve asked patients, when I can tell them is this: write it out. Just give me a letter, send me an email.
AW: that’s a great idea.
JT: So I have had patients write me very detailed letters, draw me pictures, write out letters. And I’ve just sat there. They’ve literally walked in to the next appointment. And often when people are talking about very difficult things – around spousal tension, and they just feel they’re betraying their spouse or they don’t, they can’t talk about it without getting too emotional. And they’re too embarrassed to talk about it. They can write me a letter, and they’ll drop it off ahead, or they’ll come in and I’ll hand it to me, and I’ll just read it. And then
I’ll thank them for sharing it. So often when it’s hard to talk about, it you can write it out.
AW: That is great advice. And I heard you say something previously, I think, if a doctor is making you feel that uncomfortable, that you’re feeling judged, you probably need to get a new doctor.
JT: Yeah, I think or if you’re confident enough to say, if you feel like you can engage. Like I had a patient once come in and say to me, like, we talked about this last time, and I really felt you didn’t hear me, or you didn’t listen to me and … that was great. I was so apologetic. And I said “that was not my intent at all. And I apologize.” And I thanked him. I said, I hope you can always feel you can let me know. I said, I don’t know if I was distracted, but I apologize. Let’s revisit it or let me try to hear you better. You know, and I for example, I had a transgender patient. And I was pretty consistent and calling them by their preferred name. But then one time, I got it wrong. And they said, “just a quick reminder, I’m not upset. But I just please, if you could really call me by what I prefer.” I said, Oh, I’m so sorry. You know, I do try, and I wasn’t upset, to be reminded. Don’t assume that people take offense, don’t assume that your doctor or nurse can’t receive feedback and improve because we want to do a good job. Maybe you thought they were recoiling, because you were talking about whatever you’re talking about. Maybe you misread them,…
AW: Right. Maybe they had a stomach ache!
JT: Maybe … maybe their phone was going off and they were distracted or responding to their buzzing phone in their pocket, right. And you thought they were responding to you. So before you change providers, give them a chance to do better, and explain what better looks like for you.
AW: Again, I think people are going to be lined-up to be one of your patients. Is there anything else? Is there anything else you want to add in terms of advice to people who are looking to optimize their communication with their doctor?
JT: Just to, really see it as communication. You know, obviously we do tests and we do physical exams and stuff. Most of the value is coming from the communication. And so yeah, I’ll do a physical exam. And yes, I might order an X ray or some blood work or whatever. But most of what I need is coming from the communication. And most of what you’re going to need to get out of this is coming from the communication. And so again, as we’ve been talking about, the more we can structure the communication part to be as successful as possible is really the key.
AW: That really speaks to the significance of this topic, right?
JT: Absolutely, yeah.
AW: When I, when I was thinking about this topic, I said, this can really help people, it’ll help people hopefully disarm them from any embarrassment they have, but also give them strategies. So that next time they go to their doctor, they feel more in control, but they’re also just improving the quality of the communication and therefore the care that they’re receiving.
JT: You know, as I’ve gotten older and more experienced, obviously, I still do lots of physical exams, but it has become a smaller part of how I use that 20 minutes or 15 minutes or whatever. Because I’m really appreciating that so much of the nuance and so much the what I actually need is coming from the communication, and not just the laying on of hands, there’s still the laying on of hands. But it’s really the communication that allows that laying on of hands to be much more focused and much more, extracting more relevant information.
AW: Interesting. Okay. Let’s move on to the five Rapid-Fire questions.
JT: I was nervous about this.
AW: You shouldn’t be nervous! That’s funny. First question, what are your pet peeves?
JT: So I think we share one. This one, which is clutter… I do tend to like some white space. And I’ve talked a lot about this with my spouse, who perhaps has a different view on this. I think our lives are so full and so intense with information and with activity and with so much, that the more there’s this sort of additional visual noise, or where it’s hard to find things as easily. And it hasn’t always been that way. But I think as I’ve gotten older and as you know, in our mid-life, and things are so full with young kids and a busy clinical practice and administrative practice. There’s so much to do that just the shoes in the middle of the hallway, the bags casually thrown down in the middle of the hallway, papers strewn over the dining room table. It just, it just feels like it just adds up.
AW: I agree. And I think when you believe it, it becomes even more true.
AW: You know what I mean?
JT: Absolutely. And so I did actually read, the night before I started in this new job, that Maria Kondo book.
AW: Tidying up?
JT: The tidying up book. And it really resonated. it’s a funny story. So I was nervous. I was a first-time hospital CEO, and I was nervous. And so I couldn’t sleep. So I went on the library, I downloaded an audio book. And it was this book, and I thought, This is great. So I got up in the middle of the night, like one in the morning, and I spent like three or four hours, doing the first two chapters of the book. My wife woke up, and there’s bags of all my clean stuff. But I must say, my drawers have not reverted back. I didn’t get through all the chapters in the whole house. But when I open the closets in the morning, when I come home at night, whenever, it just feels a little bit easier.
AW: So Gretchen Rubin, who originally was studying happiness, recently published a book called Outer Order, Inner Calm, but I feel like you could write the book.
JT: I don’t know. I think I’m a fan of it.
AW: Okay, question number two, what type of learner are you?
JT: I typically need to read, to really assimilate knowledge. And especially I think, as I’ve gotten older, and there’s just so much more visual information, noise. I’ve just appreciated that. And it’s interesting, I read a good book a few years ago, on Harvard Business for Management series. And they just sort of talked about different learning styles. And it’s really important as a leader, to know what your learning style is, and to communicate that to make best use. And so now I tell people, like I’d really love to meet with you on that. But if you could send me you know, just a couple bullet points ahead of time for me to think about, or learn about or… In fact today, you very thoughtfully sent these questions ahead of time. It really helped me. I did read them, and it gave me a chance to think. And I’m an active reader. So I’ll make notes. The copy I first had actually has notes all over it.
AW: Oh, really?
JT: Just quick bullet points, because I’m an active reader. So I underline. I highlight. I write in the margins.
AW: Do you write in your books?
JT: I used to yes. I’ve gone mainly digital on my books. Yeah. But when I had paper…
AW: Because you don’t want clutter around.
JT: Right, that’s exactly why.
AW: I have to show you my bookshelf, they’re all categorized by color.
JT: That’s awesome.
AW: That IS awesome.
JT: That is awesome. Treatable. Diagnosable. But awesome.
AW: That’s funny! Okay, question number three, introvert or extrovert?
JT: I’m actually right in the middle. I’ve done the Myers Briggs a couple times, and I think it is actually true, I’m pretty much right down the middle.
AW: So you get energy both from being in a group and from solitude?
JT: yeah, solitude. And I find I need a bit of both. This interview well, this interaction, and the excitement of it will really get me through my day. But I also know, if I’ve had a day where I do three or four of these, and actually, today is going to be an interesting day. I’m going from here to see an international visitor, and then I’m going down to teach a bunch of doctors. And I know that by the end of the day, I am going to need a little time. This day is going to have a lot of … teaching for four hours this afternoon and this, and so, it is a balance. And so I do find I am right in the middle.
AW: sounds intense. But it’s good to be aware that you need both right?
JT: Yeah, exactly. And I think I’ve become more aware with time.
AW: Question number four, communication preference for personal conversation. So I’m not talking about the work emails where you’re copying the chair of the board on your next steps or whatever, it’s more about, you’re trying to get something off your to do list or answering a question from a friend or family member, what do you use?
JT: So it’s changed. And in fact, I would say it’s been a bit of a full circle. A while ago, it was just all face-to-face. And then I really just started using emails, because I love the asynchronous nature of it. You know, I love the fact that – I’m a night owl. And so I love the fact I could just sort of sit there from 11pm to 1am, which is my prime thinking time. And, just send emails and feel focused on it. But now actually, I’ve been shifting back a little bit to a bit more of the face=to-face. So then the phone, particularly the phone,… One thing about this job I was dreading was the commute, because my old drive was like a seven-minute bike ride. Maybe a 10-minute bike ride. Now I’ve got 20 minutes in the car. But actually, I really use that time now to reconnect with friends and I call my family. So it’s just really a nice sort of downtime …
AW: so it sounds as if you’re strategically using the various communication medium, depending on what your objectives are, right? And what the constraints are, I guess,
JT: I think I have in the last three years become much more purposeful and mindful of them – mediums for communication. I think I’ve just been much become much more mindful. I’ve read a lot around email management, inbox management, time management. But I have been much more deliberate thinking about communication as part of an act of leadership and communication in its role in my personal life, and then how to be sort of deliberative about it.
AW: emails are really getting trashed right now. Have you noticed?
AW: people are like, just stop with the email!
JT: So I think so. I actually now teach a course about how to manage information, and particularly email. Because I think there’s very good evidence about its impact on culture in an organization, its impact on personal wellness, its impact on effectiveness and efficiency. And so it’s like anything else? It’s a tool that can be transformationally positive, but also transformation can be risky. And it’s how do we use it effectively.
AW: Agree. I’m going to do episode on email. I think everybody wants that?
JT: Oh, absolutely. And there’s so many good books. There’s somebody who did a really good book on this is The Four-Hour Workweek.
AW: Tim Ferriss.
JT: Tim Ferriss.
JT: Yeah, he’s fantastic. And so I read, I listened to his audio book, The Four-Hour Workweek, and much of it did not relate to what I do. But he has a chapter on email. And that chapters and when I get out as reading Oh, really, yeah. And there’s a couple other books like that.
AW: you know what I’m going to do, I’m going to put a link to that in the show notes so that the listeners can go take a look at that. Well, last question. It’s related to Tim Ferriss, maybe. Is there a podcast or a blog or an email newsletter that you recommend the most?
AW: Oh yay! Ha-ha.
JT: OK. It depends on the context. In the context of my medical learning, I use certain podcasts and stuff. For others, for personal enjoyment and for learning outside of the medical world, in my leadership, I tend to go to other sources. And so what I think what my view is, is just be very diverse. I think one of the biggest risks of social media is that we create echo chambers. And I think that’s the biggest risk. We delude ourselves into thinking that we’re in this massive internet taking in all this information. And actually, what we’re doing is we’re just defining tiny, tiny echo chambers, where we reinforce our own messages. And so, I scan Fox News almost every night I scan CBC every night, I scan the New York Times every night, I’ll take a look at the Washington Post every night. I’ll take a quick look at the Huffington Post every night. For my Twitter followers. I follow you know; I follow Trump I follow Ford. I follow Trudeau. I follow… You know, I’m pretty careful to follow an equal number of people from all parties. I follow Andrea Horvath, I follow from Gelena who’s the health critic for the NDP. I follow the Health Minister from the PC party. And I get podcasts from NPR, but the I also get podcasts from the UK, and I get podcasts that are Canadian based. And I just tried to do some fiction, but I try to do some nonfiction. And I just think that the biggest risk in this information world is that we actually kid ourselves about how much information we’re getting.
AW: It sounds as if you have exceptional media hygiene, which is something that I also am trying to do. And I’m the same way, warning my kids about – sure you can follow Donald Trump, but careful who you’re liking and be definitely be careful about what you’re saying.
JT: what do I recommend, is diversity, and true diversity. The New York Times has this great new series, I don’t know, it feels like 18 months old, we’ll say it’s called writings from across the spectrum. And so they’ll take a topical issue, a new bill was brought in the abortion issue, which is very topical now. And they will present you with links, and a quick summary of somebody who’s writing from a very far right conservative perspective from a far left, and from an economic …
AW: I’ll put a link to that, too.
JT: Yeah, and it changes I think, I don’t know if they do it every day, but every week, and they’ll pick something that’s really – like the Brett Cavanaugh nomination, and they’ll put in three or four writings from the republican from Fox News, from people who are right of center. And then they put in some from the far left, and put in some in the center, they put in some with a high political tone, some from a sort of a women’s advocacy group who obviously had certain views about the nomination. And you can just skim it and sort of really, I think it’s just so important.
AW: It sounds as if it’s efficient.
JT: Yeah, right, but also an effective way of scanning multiple perspectives. And what I’m also really looking for is just the gap, I’m looking for the difference. So one thing I am not interested in. One risk when you read all this stuff is just reading stuff to reinforce. If I’ve picked up Fox News, and it’s sort of the first paragraph is saying exactly the same thing is the New York Times, I’m not going to finish the article. But if they’re coming at it and something new, I’m like, okay, and I sort of think there’s something there for me, then I might do it or even just scan the headlines right now is fascinating. If you just open the headlines on five online newspapers, you would actually think you’re in completely different worlds.
AW: Amazing, isn’t it?
JT: You know, what one person puts us above the fold, or their landing page article may not be anywhere on another send your stuff?
AW: That’s fascinating.
JT: It is. Because if you’re only reading that one paper, you sort of think that’s the issue of the day. And another large paper hasn’t even put it anywhere on their first page. It’s like nowhere.
AW: I love that you call it paper. You don’t use the paper though.
JT: The only time I use paper is when I get to fly. And then I love taking these papers on the plane.
AW: That’s funny. Okay, is there anything else you want to add?
JT: No, I just think it’s great. I think it’s great to have these types of conversations. I think it’s very important.
AW: Thank you so much for sharing your perspective on how to talk to your doctor and everything else. Thank you.
Well, that was fun. I knew Dr. Tepper was intelligent. But he really is a good guy, isn’t he? Once we were done the interview, we immediately left his office and took the elevator down to the main floor of the hospital where he had an important meeting. All along the way, he was pleasantly greeting hospital staff. He has so much energy!
Let me now summarize some of the main points that he provided in terms of advice for us and how to talk to our doctors. Again, you can easily access this list in the Shownotes on the Talk About Talk website. Just look under the PODCAST tab.
First though, I want to highlight again how he started the interview. Dr. Tepper said, “we just want people to come in and see us when they need to.” He added that we should not hesitate to make an appointment. It’s more important to err on the side of caution. And the other thing is, even if it turns out to be physically not important, if it’s emotionally distressing for you, that’s enough reason to come in – just for the mental reassurance. So go see your doctor!
Five takeaways that might help you talk with your doctor more effectively:
- Whether it’s on paper or on your phone, Dr. Tepper encourages his patients to make lists of things they want to talk about in their appointments. He also suggests — prioritizing. So tell the doctor what your primary concern is first, then, share the whole list so the doctor can validate what is most important.
2.)Related to BRINGING PEOPLE to your appointment
- Sometimes, this can be a good idea, just in terms of remembering everything that the doctor says.
- Tepper added that if we are accompanying someone on a medical appointment, be it a teenager or someone elderly or whomever, we should also give the patient some time alone with the doctor. Sometimes the patient might be shy about sharing important things when their friends or family are around.
3.)The Google Effect
- We have all heard about how people google their symptoms and then get hysterical with their self-diagnosis. And how this drives doctors crazy.
- Tepper reminded us that this has been going on since the beginning of time, — just with different sources. Our sources used to be friends and family and books, now it is the internet.
- The most important thing here is that we need to consider is the quality of the source. Random opinion websites and many for-profit online resources are less dependable than government sanctioned resources or academic articles.
- Tepper encouraged us not only to be careful of our sources, but to also ask our doctors for recommendations of online resources that might be more useful for us.
4.)ASK lots of Qs
- I mentioned to Dr. Tepper how in Atul Gawande‘s book Being Mortal, he highlights that hope is not a plan. And that applies to both patients as well as doctors. It is human nature to avoid the negative, and sometimes, at least in the medical context, this is not effective.
- In order to get the most thorough diagnosis and treatment, Dr. Tepper encourages us to ask lots of questions. He suggests open ended questions, such as , “is there anything else I should be thinking about?” “Is there anything else that other patients who are in my situation have also considered?” Got that? Ask Qs!
5.)STRATEGIES FOR WHEN we are FEELING AWKWARD around our doctor
- Tepper suggests that we ask ourselves WHY we are feeling awkward. If it’s because we think the doctor might judge us, we can start by just saying that. Be honest. You could say something like “I hope you don’t think any less of me, but I have a Q.” Most doctors are more open to things than we might believe. And they really have “seen it all”.
- If, on the other hand, you are feeling awkward because you are concerned about privacy or confidentiality, Dr. Tepper highlighted that this is a very common concern that doctors hear a lot, so don’t hesitate to bring it up. You could simply ask, “who else can access this information?” OR, if here is something in particular that you don’t want on your file, you can ask your doctor to “black box” that part of the information. Tepper suggests saying something like “Listen, you know, I don’t care if you know about my peeing and my pooing, whatever. But when it comes to this particular thing, I want this black boxed.” Done.
- Tepper also shared how he encourages his patients who are embarrassed to share something, that instead they write him a letter. Sometimes it is a lot easier to write something than it is to say it. I love that idea.
In summary – 5 things we can take away in terms of how best to communicate with our doctors:
- Considerations regarding bringing people to our appointments
- The google effect and quality of our information sources,
- Asking Qs, and last
- A few strategies for when we are feeling awkward or embarrassed.
I hope you found this helpful. I know I did. Dr. Tepper concluded by highlighting how significant communication is between a patient and a doctor. He said, and I quote:
“Obviously we do tests and we do physical exams. But most of the value is coming from the communication. I’ll do a physical exam. And yes, I might order an X ray or some blood work. But most of what I need is coming from the communication. … The more we can structure the communication part to be as successful as possible — that is really the key.”
Well put. Thank you so much Dr. Tepper.
THANK YOU for listening!
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