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There are times in life when a big surprise is enjoyable. A surprise birthday party, or winning the lottery – those are unexpected surprises that make life fun.
But other than a clean bill of health and confidence that verdict is correct, there are few conversations, results or events that take place through medical care that we want to be surprised by. In fact, the fewer surprises, the better.
Let’s look at Nancy’s experience. Nancy was diagnosed with hypertension - high blood pressure. Her doctor prescribed blood pressure medicine, carefully explaining that she would need to take one pill per day and that within a few weeks, her blood pressure would come down. Nancy left the appointment feeling like the doctor was taking good care of her.
What Nancy didn’t realize was that the newly prescribed drug was very expensive. Then the pharmacist explained that hypertension was a chronic problem that would probably require Nancy to take medicine for the rest of her life. She was upset.
But she filled the prescription, paid the $45 co-pay, and took the pills as she had been instructed. A few days later, the skin on her feet and hands began to itch. It even kept her up at night. She called her doctor’s office to ask if itching could be a side effect, and the nurse told her to use skin lotion. Not much help. Nancy stopped taking the drug hoping the horrible itching would subside and rationalizing that she would be saving herself more than $500 per year.
When she returned to the doctor a month later for a follow-up, he was very upset with her, telling her she should not have stopped the drug without calling first or making an appointment. In turn, Nancy was upset with her doctor because he had never mentioned that she would have to take the drug for the rest of her life, nor that the drug might cause her to itch and that his nurse hadn’t provided a good solution, plus that $45 a month co-pay was too much for her.
The bottom line – one month later, Nancy and her doctor are upset with each other. Nancy is out $45 for a drug she didn’t take. And most importantly, Nancy’s blood pressure is still out of control.
What can we learn?
In general, and for a variety of reasons, most doctors are not good communicators. That means we patients need to take responsibility for making communications work for us. We need to manage our own expectations and our provider’s expectations too. In fact, it's good practice to manage expectations among all care partners, including caregivers and advocates.
None of this is difficult. It requires only a sense of curiosity. At every point in your interface with your providers and care partners, ask, “What’s next?” Or, “What else should I expect?” Or, "If I do this (or don't do this), what will happen?" Then, let the other person know what to expect from you.
If Nancy had asked those questions, she would have known ahead of time that itchiness was a potential side effect of the drug, and possibly that it would be an expensive co-pay for the rest of her life. Then she could have helped her doctor understand what to expect from her by asking, “What should I do if I suffer a side effect?” and “If I can’t afford this drug, is there one you can prescribe that costs less?”
Eliminating surprises is the goal. When each party knows what to expect from the other, it builds mutual respect, and a better patient-doctor relationship.
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