05-09-2021

sunDay, sePTeMBeR 5, 2021
5
KRissy BRaDy
There are a number of scenarios that
could lead to you not getting what you
need out of a doctor's appointment.
Sometimes the blame falls solely on the
physician, who may not take you
seriously when you explain what's
wrong. "There are also patients who
come to me with a great deal of medical
trauma due to inadequate care," said
Casey Kelley, founder and medical
director at Case Integrative Health in
Chicago. "Frequently, these patients
have dealt with dismissive doctors for
years, so they tend to downplay their
symptoms and pain."
There's no need to be embarrassed
about anything you're going through -
the more honest you are from the jump,
the sooner your doctor can get to the
root of the problem. "I promise you,
we've heard it all before," Kelley said.
But in some cases, if you're not
getting what you need out of your
appointments, it may be because you're
unintentionally standing in your own
way.
Here are 10 things you might be
doing during your visits that can
negatively impact the quality of your
care - and what to do instead.
You typically have three
opportunities to state the purpose of
your visit: when you make the
appointment and the receptionist asks,
when the nurse who checks you in asks,
and when the doctor comes into the
room and asks what concerns you have.
"It never fails, someone will mention
they have chest pain as I'm about to
walk out the door," said Alicia Shelly,
an internal medicine physician with
Wellstar Medical Group in
Douglasville, Georgia. "I believe people
either get nervous and forget about the
symptom or have too many problems
they want to discuss and end up waiting
until the last minute to mention a
Things that frustrate doctors during appointments
Physicians reveal how small behaviors may be affecting your overall
care.
Photo: FG TRaDe
major symptom."
Unfortunately,
doctor's
appointments are usually only 15 to 30
minutes in length - and that includes
checking you in, the nurse taking your
vitals and the actual doctor's visit.
"It's important to tell your provider
the most important problems right
away so they can ask the right questions
and order the correct tests within the
timeframe allowed," Shelly said.
A doctor's time with each patient is
already so limited and gets backed up
even more by emergencies or
administrative tasks. Even one
appointment running long because
you're on the phone further adds to the
scheduling pileup.
"We need your undivided attention
so we can stay on schedule and provide
the rest of our patients with the amount
of time and attention they deserve,"
said Dagny Zhu, an opthamologist and
medical director of Hyperspeed LASIK
in Rowland Heights, California.
It's important to be your own
advocate - but it's just as important to
keep an open mind during a consult
with your doctor.
"I've had patients come in who
demand LASIK when cataract surgery
would be the better option," Zhu said.
"The practice of medicine is very
complex - we consider a multitude of
tests, clinical findings and other
patient-specific factors in order to come
up with a final diagnosis and treatment
plan."
Ask questions and challenge your
doctor to clear up topics that you're
genuinely confused about, but also
trust their expertise. If all it took to
diagnose and treat patients were a few
Google searches, "I would never have
undergone 13 years of post-high school
training," Zhu said.
An annual physical is about how your
doctor can help you prevent future
illness; follow-up visits are when you
should address specific problems.
"Physicals focus on what preventative
tests you need at this age and what your
cancer risk is," Shelly said.
Don't try to get a physical when
you're visiting a doctor for a particular
concern. That can throw a wrench in
your doctor's schedule - plus, insurance
policies might mean you can't actually
get a physical that day.
"You need to know what type of
business you're here for so I can focus
on why you're here and address your
specific concerns," Shelly said. "If
you're here for a physical and there's
also a problem you have, make a
separate follow-up appointment to
discuss and look into it."
If you have too many concerns, your
doctor might have difficulty evaluating
any or all of them.
"When you have over three problems,
it's harder to focus and sometimes
things get missed," Shelly said. "As a
result, your care is less effective."
Instead, streamline your list of
concerns to no more than three things
you'd like to discuss. If you're not sure
what to prioritize and what can wait,
make a list and show it to your doctor
so they can assess what needs to be
evaluated right away.
You might be holding back out of
shame, but that missing information
can impact the care you receive.
"When patients aren't using their
glaucoma drops because of redness or
burning, for instance, we may think
their glaucoma is uncontrolled and
recommend surgery, instead of simply
switching medications," Zhu said.
The same goes for sharing
information like how much you drink
or any other medications or substances
you used.
The bottom line? Always be truthful.
"There's no shame," Zhu said. "Our
goal is always to ensure you receive the
best treatment possible."
When you're late, it throws off the
schedule. Not only could you end up
waiting longer, but your doctor will
probably have to rush through your
visit, because multiple people might be
ready to be seen.
"I'll have the first patient come right
before the 15-minute cutoff, then the
second patient comes right on time and
the third patient comes 15 minutes
early, so now I've got three people
waiting to be seen at the same time,"
Shelly said.
Some people hop from doctor to
doctor when they don't notice any
improvement in the condition being
treated.
"The problem with this is each doctor
is seeing the patient for the first time,"
Zhu said. "Much of our ability to
diagnose and treat comes from seeing
the patient's course of illness and
response to certain medications over
time."
If something isn't working, a doctor
you've seen before can try something
new and take a step based on whether
you're doing better or worse.
"It's always best to stick to one doctor
for the duration of the treatment, if
possible," Zhu said.
Of course, there's a big exception to
this: If you feel like you're not getting
adequate care or you're not being
heard, you should definitely find
someone who makes you feel seen and
comfortable.
Not telling your doctor exactly what
you're taking and how much can lead to
them prescribing the wrong dose of a
medication, and that can lead to
adverse reactions.
Come to your appointments as
organized and prepared as possible,
with an up-to-date list of all the
prescription and over-the-counter
medications you take and their
dosages. "If you're a new patient and I
don't know exactly what you're on and
how much you're taking, I can't
accurately put together a new
treatment plan for you," Kelley said.
This is particularly true when it comes
to addressing ongoing health problems
you may have.
"It's unfortunate when we don't have
enough time to address every question
that a patient may have," Zhu said.
"The rest can be sent over email or
continued at a second visit where we've
allocated more time. We're always
happy to help."
The odds of being exposed to
COVID and not getting sick
Remote workers are often seen as less disengaged, less productive employees. But research has debunked these
assumptions.
Photo: ivan Pantic
Some myths about working from home
Monica ToRRes
The state of the coronavirus pandemic
has made remote work standard for a
large group of people, and by and large,
many of us are adapting. But a lot of
unflattering myths about what happens
when employees work from home have
persisted nonetheless.
If you believe the worst assumptions
about remote workers, then we are an
unproductive, disengaged lot. But
research says otherwise. Here are a few
studies and surveys that have debunked
the most common myths about the
supposed downsides of remote work.
Many higher-ups like to say they need
workers back in an office because that's
where chance interactions between
colleagues can happen and spark more
creativity and innovation. Case in point:
what JPMorgan Chase CEO Jamie
Dimon wrote in April in an annual letter
to shareholders.
"Remote work virtually eliminates
spontaneous learning and creativity
because you don't run into people at the
coffee machine, talk with clients in
unplanned scenarios, or travel to meet
with customers and employees for
feedback on your products and services,"
Dimon wrote.
But this vision of the office as a place
that facilitates great face-to-face
interactions is false. In fact, offices can
actually prevent such conversations from
happening. Two researchers observed
interactions at a couple of Fortune 500
firms before and after the companies
transitioned from individual cubicles to
open-plan offices and found that face-toface
interactions actually dropped by
roughly 70% while electronic interactions
increased. It turns out most office
workers don't see someone's physical
presence as automatic permission to
spontaneously strike up a conversation.
"People in open offices create a fourth
wall, and their colleagues come to respect
it. If someone is working intently, people
don't interrupt her," the researchers,
organizational behaviorist Ethan
Bernstein and Humanyze co-founder
Ben Waber, wrote in Harvard Business
Review.
"Although the open-office design is
intended to encourage us to interact faceto-face,
it gives us permission not to,"
they wrote. After all, why walk over to a
co-worker when you could simply send
them a quicker email or Slack?
For women and people of color, offices
can also be places of unpleasant
surveillance and interactions rather than
a great foundation for spontaneous
collaboration with co-workers.
In a 2017 study published in the journal
Gender, Work and Organization,
researchers at Anglia Ruskin University
and the University of Bedfordshire
followed 1,000 U.K. government
employees as they moved into an open
plan office with transparent glass and
large, undefined spaces for collaboration.
Although some women said they
enjoyed feeling more visible and getting
to see colleagues, many reported feeling
more watched by male co-workers and
restricted their own movement, choosing
not to show up in spaces unannounced.
One woman in the study said she stuck to
her department area because venturing
outside of it felt too visible: "I don't tend
to come out into the atrium to eat because
you always feel so overt if you sit there,"
she said.
In other words, the office was not
exactly a safe environment for everyone
in which to have chance meetings.
A common argument is that remote
workers miss out on the in-office cultural
offerings that can help cement loyalty to
an employer and always have one foot out
the door as a result.
But surveys find that the chance to
work remotely can actually increase an
employee's commitment to the job. In a
2020 survey of 7,487 employees in 14
countries including the U.S., U.K., China,
Mexico and Canada, people were 68%
more likely to say they had a higher
organizational commitment when they
had the option to work from home,
compared with employees who didn't
have that option. Women who had child
care responsibilities were 32% less likely
to consider quitting their jobs when
teleworking was an option, compared to
their peers with no option to work
remotely.
And for workers who are marginalized,
the opportunity to stay remote may be the
only thing keeping them at their jobs. In
one recent survey led by Slack's research
consortium, Black workers valued remote
work the most and felt a higher sense of
belonging at their company when they
were able to work away from the office.
"Ideally, I would like to work in an
office where I'm not reminded that I'm
the only one," a Black engineer told
HuffPost, noting that "Working from
home is the next best thing."
It's true that remote workers can feel
left out and become disengaged. A survey
released in May found that people hired
during the pandemic - a time when nearly
half of them said they started their jobs
remotely - were less likely to feel
welcomed by their team. But that can be
addressed by bosses who are proactive
and intentional about setting up one-onone
interactions and making employees
feel seen and heard. A person's boss and
co-workers often have more influence on
whether they feel engaged with the job
than whether or not they work in an
office.
In 2013, Best Buy ended a remote work
experiment that had allowed corporate
employees to work from anywhere, as
long as they got the job done. Top
leadership said one reason was that
management was too hands-off. "Anyone
who has led a team knows that delegation
is not always the most effective leadership
style," the company's then-CEO, Hubert
Joly, said at the time.
Julia Ries
If you've been out and about
living your life since being
fully vaccinated, you might be
curious if you've come in
contact with the coronavirus.
Could you be one of the lucky
ones who had an
asymptomatic infection? Or,
is there still a good chance you
haven't encountered the virus
yet?
The delta variant is
everywhere, and it's spreading
much more rapidly than the
previous variants. Many
people infected with delta are
extremely contagious and
have viral loads hundreds of
times greater than they would
have with the original strain.
So if you're going to places like
restaurants or gyms with a
bunch of strangers, it seems
inevitable that you'll be
exposed at some point.
"It really is so transmissible
that I think there's a high
chance, depending on the
community transmission rate
in your area - if you have
substantial or high
transmission rate in your area
based on the CDC definitions -
that you may have been
exposed," said Monica
Gandhi, an infectious diseases
specialist with the University
of California, San Francisco.
If you've been out and about
living your life since being fully
vaccinated, you might be
curious if you've come in
contact with the coronavirus.
Could you be one of the lucky
ones who had an asymptomatic
infection? Or, is there still a
good chance you haven't
encountered the virus yet?
The delta variant is
everywhere, and it's spreading
much more rapidly than the
previous variants. Many
people infected with delta are
extremely contagious and
have viral loads hundreds of
times greater than they would
have with the original strain.
So if you're going to places like
restaurants or gyms with a
bunch of strangers, it seems
inevitable that you'll be
exposed at some point.
"It really is so transmissible
that I think there's a high
chance, depending on the
community transmission rate
in your area - if you have
substantial or high
transmission rate in your area
based on the CDC definitions -
that you may have been
exposed," said Monica
Gandhi, an infectious diseases
specialist with the University
of California, San Francisco.
Jennifer Nuzzo, an
epidemiologist at Johns
Hopkins Bloomberg School of
Public Health, said it's crucial
to differentiate between an
exposure and an infection.
Being exposed, or being in the
presence of virus, doesn't
necessarily mean you will
become infected or develop
symptomatic illness (though
some people, regardless of
their vaccination status,
definitely will).
Delta is so transmissible
that if you've been out and
about in an area with a lot of
spread - and you weren't
wearing a mask or social
distancing - there's a solid
chance you've been exposed,
according to Gandhi. When
case rates go up, so does the
probability of coming into
contact with the virus.
There's a good chance a lot
of us have been around the
virus by now, but whether that
exposure caused an infection
depends on a few factors,
Nuzzo said.
The first consideration is
how close you were to the
infected person who was
shedding virus. Second is how
much virus that person was
putting out, as some people
spread a lot more virus than
others. Third is what the
ventilation was like - if you
were exposed in a poorly
ventilated room, there's a
greater chance the virus could
have gotten into your cells.
The host, or how your body
handles the virus, also plays a
role. It depends. Many
vaccinated people who were
exposed probably wouldn't
notice. They may have
produced an immune
response that successfully
fought off the virus before it
could cause symptomatic
disease. That, after all, is the
goal of the vaccines.
You might be able to sense
the activation of your immune
system. Upon a close
exposure, your memory B
cells will start rattling and
producing antibodies, Gandhi
explained, and your T cells
will gear up to fight. Some
people might be able to feel
that immune response, which
could potentially feel similar
to some of the side effects
experienced after vaccination
since those were signs that
your immune system was
revved up.
"In the context of now,
where we're all hyperalert to
symptoms, it is possible that
people would feel down or
tired," Gandhi said. This one's
complicated. Some research
suggests that being exposed to
infectious doses of SARS-
CoV-2 strengthens the
immune response.
"There's known evidence
that being exposed to
infection after you had a
vaccine dose strengthens the
immune response. It makes
your memory B cells produce
antibodies, it makes your T
cells replicate," Gandhi said.
(Those new antibodies
produced by B cells, by the
way, will target the new
variant it sees.)
We definitely need more
data on how exposures affect
our immune memory.
Scientists in the United
Kingdom are conducting
challenge trials, in which
they're exposing young,
healthy adults to the
coronavirus to better
understand the doses that
cause infection and how
different people's immune
systems respond to virus
exposure.
However, this does not
mean you want to become
infected or get disease. There's
really no great way to predict
if you'll get sick, how sick
you'll get, or whether you'll
develop long-haul symptoms
if you do get sick.
This is especially true if
you're unvaccinated with no
natural immunity from
Whether exposure leads to infection depends on many factors, including how
well-ventilated the space was.
Photo: Getty
previous infection. "The nice
thing about being vaccinated
is that you're much less likely
to get disease, but [exposure]
will stimulate your immune
response," Gandhi said.
The point of the shots is to
prevent severe disease, not
every single infection.
"If you're around virus in a
good enough way, there's a
good chance you're going to
be infected," Nuzzo said. The
hope, she added, is that the
vaccines will prevent people
from becoming seriously ill.
And in some cases, they'll
prevent people from having
any illness whatsoever.
The growing consensus
among infectious diseases
specialists is that we're all
going to meet COVID at some
point. Delta, being as
transmissible as it is, has
changed the game - COVID is
becoming endemic.
"I don't think we're going to
eliminate it," Gandhi said.
"That, to me, means that we're
all likely to get exposed at
some point."
And if we're going to be
exposed to COVID, it's best to
do so with some immunity.
Get those vaccines.