Good or bad, I'm not sure

I'm not sure if this is a good thing or a bad thing. There is a new program available called Smart Scheduling for doctor's offices. What it does is:

"Smart Scheduling mines patient scheduling histories to determine who is more likely to cancel or miss an appointment. It then sends alerts to the scheduling programs that doctor offices use to book appointments."

So it digs into your history and looks at your background to see if you are likely to show up for an appointment or not.

"If a patient is in a high-risk category, for instance, it prompts office schedulers to call with a reminder. If the patient cannot be reached, there is a good chance he will not show up at all. So, the doctors could then book another patient for that time slot, keeping the patient flow consistent throughout the day."

Younger patients, new patients, and those without phones are least likely to show up. Established patients, older patients, married patients, and for some reason 10am appointments are most likely to show up.

I'm not sure what happens if an expected no show, shows up. But I'm not sure if I like this kind of intrusion into my file. I mean it makes me want to be a no show a few times just to break the mold.

My thought is people should stick to appointments - it doesn't matter if its a doctor appointment, a business meeting, or meeting a friend for coffee - just show up. Or And call if you are running late. Its called politeness in case you have forgotten.

But I really don't want a computer looking into my background to decide if I am going to be a no-show.

Politeness and compassion matter

Its not your imagination but people these days I think are ruder in general than in the past. You heard about the rant by the woman her husband put on Youtube.... Or the trolls on Facebook who snipe at innocent people. Never mind the people who cut you off in traffic or exhibit road rage to a life threatening degree. Manners including please and thank you seem to have gone by the wayside. Thank you notes? What are those? Compassion? What's that? Privacy boundaries are gone as well. But do not let me get too far off track.

But its not just the general public. The newer doctors are exhibiting lack of politeness and compassion compared with more established doctors. Maybe they will acquire some politeness and compassion over time but int he meantime the patients suffer.

A study at Johns Hopkins showed that the newer interns didn't take time to introduce themselves to the patients or to sit and have an eye to eye conversation with them. The problem is that good bedside manner on the part of the doctor improves patient outcomes.

"The observers recorded whether the interns used five valued communication skills like introducing themselves, explaining their role to the patient, touching the patient, asking open-ended questions like, "How are you feeling today?," and sitting down with the patient for a conversation.

In some areas, interns scored high. For instance, they touched their patients 65% of the time (though that was sometimes in the process of giving physical exams) and asked open-ended questions 75% of the time during hospital visits. But interns only introduced themselves 40% of the time and explained their medical role 37% of the time. The interns sat down with their patients only 9% of the time.

In total, interns only performed all five behaviors during just 4% of their visits."

This week I went to a doctor appointment with my father. The doctor was running late and he stopped by the room where we were sitting to tell us he was coming but was running late. (Points for him). He introduced himself to me (more points) and greeted my father very nicely. He sat down and answered questions. He also asked open ended questions and was extremely patient with my father's questions even sketching diagrams. 

We left the appointment with a good deal of comfort in that he was the right doctor and would offer the right treatment.If the doctor had been abrupt and not communicative, we probably would not have the good feelings. Politeness and compassion do matter.

Worthy organizations (and one unworthy)

As a blogger I am approached by organizations who find me on line somewhere - sometimes my blog and sometimes through Twitter. Most of them I ignore but occasionally I like them and will blog about them. This is the case this morning.

First I found (I think I found this one instead of it finding me) the Informed Medical Decisions Foundation (www.informedmedicaldecisions.org). Their name says it all. They '...believe that the only way to ensure high quality medical decisions are being made is for a fully informed patient to participate in a shared decision making process with their health care provider.' This goes back to the basics of bring a list of questions to ask your doctor, give your input to your doctor, and don't sit there like a bump on a log listening to what your doctor says.

I pride myself in being the problem patient in that I go in and tell my doctors what I want. The other day I had an appointment with my back doctor. I don't think my back pain meds are working, they are not a preferred brand name drug so they are expensive, I don't like its side effects, and because I am taking it, I can't change some other meds I want to switch as well. I told my doctor this (little list of whines) and he gave me something new to try for two weeks. If it seems to be working, I can then taper off the one I don't want and stick with the one I want. But I got what I wanted in the long run.

The next organization (this one discovered me) is 'Is My Cancer Different' (www.ismycancerdifferent.com) which focuses on individualized cancer treatment. One of the first things you learn as a cancer patient is that everyone's cancer is different. Which is why when someone says to me that their cousin's hair dresser's dog walker's neighbor's uncle had a specific cancer treatment protocol and asks why I didn't have it, I tend to go from annoyed to fairly ticked off at their stupidity and insensitivity. Individualized cancer treatment is the next step in treating cancer by looking at genetics, the individual, and their circumstances.

I have a group of women friends who were all diagnosed at approximately the same time with the same stage of breast cancer and had relatively the same course of treatment. But we are all different. One has since passed away, one has had a second cancer diagnosis, and the rest of us are coping with a range of health issues. So I tell these other people nicely to SHUT UP and I will support individualized cancer treatment.

Then there is another organization who managed to mildly tick me off. They emailed me and asked if I would blog about their type of cancer of which I know nothing - complete with their guidelines on what to say. I sent them back a reply - which I thought was above and beyond because I could have just deleted it - and politely said no thank you as I don't blog about things I don't know about or that don't interest me. They asked again and said they could write the blog post for me. I wrote back and said 'Let me just say this again. No. Thank you.'. I haven't heard back. If they do ask again, I might be forced to be a bit more drastic.

They reminded me of the door to door political guy who stopped by yesterday afternoon when I was out in the yard trying to get the cat back inside. I had to tell him three times I had something on the stove and no I wouldn't give him money - the cat could have been cooperative and come back sooner so I could have run inside.... What is wrong with the word no?

Negativity online

I can't claim that I have never been negative online but I think there is too much negativity and it doesn't need to be mean. When I write about someone or something I do not swear (the only thing I swear about is my health) nor do I mean to write rants and diatribes that go on and on. I write my blog assuming my mother is reading it (she does) and write not to offend but to provide an opinion. However if you look around, it is not hard to find obscenity laced websites promoting a negative point of view.

Any business these days will have an 'anti' site. Google people against Walmart, Target, Bank of America, etc and you will probably find several sites dedicated to people who are mad at the business. That is fine. I am all for people expressing their opinion and uniting against the new bank fee or whatever. But it can be done politely.

I belong to about a million email lists, websites, message boards, etc. The one thing that turns me off is swearing. An occasional f-bomb or other four letter words do not bother me - as long as they are few and far between. If someone has seemingly forgotten there are other words in the English language, I promptly stop reading. Or if all someone writes about is anti-something, I often get turned off as well. I read a blog that has some pretty firm opinions against an organization, that is fine. But when they post more than ten times in one day, I stop reading.

Can I just politely ask that people be a little nicer online? And occasional apologies for offending someone aren't out of the question either.

I wasn't evasive

I detest evasiveness. At times I find it rude. If someone asks you a question and you don't want to answer, it is polite to give some sort of answer and then change the subject to something you are more comfortable discussing. That is basic. But its the one's who will never answer any questions  on any subject that really rile me. If you say 'did you have a nice lunch?' and they can't give any kind of answer - from it was okay, I had a tuna, I skipped lunch and went shopping or whatever but the lack of any kind of answer becomes rude. I don't need to know everyone's life story but sometimes a light conversation becomes impossible. Someone who is incapable of answering any kind of question, especially if they seek you out for social events, either has significant 'issues' and/or no social skills.

I know a few people but don't spend time with them because they don't answer questions. They only ask me questions.  If you ask them an innocuous question such as 'what did you do for the holiday?' they evade the question. That is an easy question you could answer it in any number of ways 'I saw some friends, got together with family, went to a restaurant, brought a pie over to join friends for dessert, etc'. One woman said to me 'I didn't do anything'. A few weeks later another friend told me that she came to their house for the holiday. The original answer was basically a lie which is very rude.

I find when I spend time with people like this, I feel very frustrated. It is impossible to have a conversation with them, you can never get a clear answer, and I come away from it resenting them. They seem to want to know everything about me but refuse to tell me anything about them in return. It should be an even trade. You asked me what I did for the holiday and I told you but when I ask you, you lied. You asked me what I did for lunch and I told you but when I asked you in return, you couldn't/wouldn't answer.

I have had this happen with these people even when making choices on a menu at a restaurant - Caroline, what are you going to have?' 'I'm thinking of the chicken. What about you?' 'Why are you choosing the chicken, what do you think of the steak?' 'I'm in the mood for chicken.' 'Are you getting a salad or vegetables?' And on and on and on. Um, is my opinion that important to you or are you just incapable of making your own decision or have no social skills or practicing your skills for the next inquisition?

What happens in the end is I refuse to spend time with them and avoid them. I don't consider them a friend at any level and don't waste my time with them as I think they are rude.

However there are times when a little evasiveness is called for. I am sometimes evasive with my health issues when I am not ready to discuss them. If asked if about something I am not ready to discuss, I simply say 'I'm waiting to go back to my doctor', or 'I'm feeling okay these days', etc. Which is some sort of answer and allows for a conversation. I also sometimes use some evasiveness to edit myself. When I wear my lymphedema sleeve - which is only at the gym or when my arm is bothering me - sometimes people ask what it is. I have taught myself to just say it is a compression sleeve and that's it. Its the truth, its a compression sleeve but there is no reason for me to go on and say 'well I had breast cancer and now lymphedema'. I do not need to spew out my medical history to virtual strangers.

Earlier this week, a woman walked into the locker room a t the gym as I was putting on my sleeve before going to lift weights. She asked what the sleeve was for and I said it was a compression sleeve due to arm issues. That was enough. That was all she needed to know. I was slightly evasive I felt but told as much of the truth as I wanted. She got an answer that she was seeking and was satisfied. We both were happy with the interaction.

I left the locker room and went into the weight room where there was a woman working out. She asked me 'did you have an axiallary node dissection? I'm a physician. But I don't mean to pry." I said yes and we had a discussion about how long after surgery that I developed lymphedema (1.5 years) and what caused it (a fall on my arm on ice). But we didn't discuss my cancer etc. It wasn't part of the discussion. In the second  conversation I told what as much of the truth as I wanted and she got the answer she was seeking and was satisfied as well. We were also both happy with the interaction. I felt I was a little evasive by not telling the whole story but I also didn't feel the need to unload my medical history - she wasn't my doctor.

The balance of evasiveness with telling the polite truth can be a fine one. Not everyone wants to know my medical history anyway. Its also me coping with my issues in learning to talk about things politely without evading and without recounting my entire medical file. I don't want to be rude and think I have figured out basic politeness by now.