Empowering Patients: Navigating Healthcare and Communication Strategies

In this episode, we dive into the challenges and strategies of discussing intimate and potentially embarrassing health issues like bladder leaking with healthcare providers. I revisit an insightful conversation with Dr. Kara Wada, a board-certified allergist and immunologist, who emphasizes the importance of patient empowerment and effective communication in the healthcare system. Dr. Wada, a certified life coach and autoimmune patient, shares valuable tips on how to take ownership of your health story, prepare for appointments, and establish clear communication with your doctor. The discussion also explores the complexities of electronic medical records, the benefits of virtual visits, and the shared humanity between patients and physicians. This episode is packed with practical advice to help patients feel more confident and in control during their medical appointments.

Timeline:

00:30 Introduction

01:39 Meet Dr. Kara Wada: Background and Expertise

04:29 Navigating the Healthcare System: Challenges and Tips

06:02 The Importance of Owning Your Health Story

09:39 Effective Communication with Your Physician

16:06 Virtual Visits: A New Norm

25:42 Conclusion and Final Tips

Transcript

Hi there. I've been getting a lot of questions lately about how to talk to your provider about bladder leaking. It can be difficult to talk to a provider, but especially when the topic is one that is pretty intimate and feels so embarrassing to a lot of women. But being comfortable with your provider and being able to talk about pertinent health issues is so very important, and that is why I'm pulling an old podcast out of the vault.

My friend Carta is a board certified allergist, immunologist lifestyle and functional medicine physician. She has a passion for helping people navigate our complex healthcare system, and her mission is to empower patients to thrive in systems that sometimes feel like they were built to overwhelm. She is such a delight and has so many important things to say.

I know that I have tweaked how I interact with patients since meeting her and listening to her suggestions. So let's listen to Kara. Okay. Hi there. I'm here today with Car Wata who is a physician in Columbus, Ohio, and I'm just gonna ask you to introduce yourself and tell us what you do. Yeah, thank you so much for having me.

So yeah, my name is, um, Dr. Car Wata. I am a board certified pediatric and adult. Allergy immunology and lifestyle medicine physician. Um, I practice at, um, the Ohio State University in Columbus, Ohio, and I see patients from age four all the way up. Um, those dealing with different allergy conditions and immune system issues.

I lovingly refer to it as misbehaving immune systems. Um, and, um, I, in the last several years, um, have evolved not only from my patient care, um, avenues, but I myself have, um, entered into the world of being an autoimmune patient. I was diagnosed with systemic Sjogren's, or also known as Sjogren's syndrome in spring of 2019, and.

One thing led to another, and here I am now certified as a life coach and helping really advocate, um, for, and help folks learn to navigate the huge healthcare and wellness industries with more confidence and feeling more empowered. Because there's nothing like being, you know, buck naked in a hospital gown to make you feel like.

The least in control that you can be. Um, and I'm sure you see that all the time, especially in your area of medicine. I, I do see that a lot. Um, I, yes, definitely. So I, I love everything that you just said. I love the fact that you know, your own personal, um. Travels have helped you to evolve in that you see it that way and that you're helping to empower people.

I really feel like I, you know, I've learned a lot being a physician, but I think I always learn more being the patient or the patient's mom or the patient's daughter. There's so much that. We assume when we're on one side about how things are working, and it's not until you're on the other side that you really start seeing, you know, the problems and the, and the faults and, and everything.

Um, and so I really applaud you for this great work, especially at this time because I, I think right now the healthcare system is just so much more. Uh, hard to navigate than it, than it ever has been. Right. And there's just a lot of frustration on the part of physicians, but you know, also more importantly, on the part of patients.

So, yeah. And you, um, so you've done this work and, and you're really looking to empower people and to help them navigate the healthcare system. And so what kinds of things have you done to do that? Yeah. So one thing I love to do is just to, to share with people, you know, some of the things that they can actively do when they are getting ready to have that upcoming medical appointment.

Perhaps a medical appointment that they're pretty anxious or nervous about. Um, so many folks that I end up seeing in large part because of where I practice being at a referral center. And in an area of medicine that tends to be like that place that folks are sent when no one else can figure out what's going on and they kind of are like, okay, hail Mary, we're gonna send you to immunology and see if they can figure it out.

It's not uncommon for me to meet a lot of folks who will experience not feeling seen, heard or believed when they've been to medical appointments or seen, um, seeing doctors along the way. And the term that's used now sometimes to describe that is medical, gas lighting, which we can have a whole conversation on, use that word, but that's the term that's kind of unused.

Um, and I lovingly refer to this other situation that will commonly happen in those patients, which is the game of hot potato, where, you know, folks will get bounce from specialists to specialists trying to figure out what the heck is going on. Or, you know, when folks don't really wanna. Have to put in that extra time, energy, or effort into figuring out what's going on or having more challenging conversations.

So some of the things that, um, we can do in that, you know, in that patient sphere is we can own our own story. So when we, um, and, and how does that show up? So one is to, to really take ownership of your health history. To know and understand, you know, what those diagnoses are, what medications you're on, and one thing that can be incredibly helpful to streamline things during that, that office visit, which is never long enough, is to have a, a little summary of your health history and to, you know, even think about kind of the timeline of how things have happened.

So much of how we diagnose patients. It doesn't rely necessarily on the lab work or the imaging studies. It's your story, and so being able to communicate that story effectively is really helpful in in that whole process. Can I ask you a question about that? Yeah. Um, can you just comment a little bit on EMRs, because I think a lot of time phy uh, patients will say, well, it's, it's all there in front of you from, right.

It, it's in the EMR. Yeah. And there isn't just one EMR that consolidates the information. That would make sense. Yeah. And so will you just talk about that a little bit? Yeah. Because I think, um, that absolutely, in some ways it makes the information more difficult to gather sometimes. Yeah. So the average patient, average patient generates the equivalent of 40,000 pages worth of data every single year.

Um, so if you are, you know, more than average, which I think we all would like to think we're, you know, a plus, right? Maybe not. Not medically. Yeah. Um, but that's a lot of data. And although it may be there somewhere, it may not be in front of your physician at that moment. Or it may be really hard for your physician to find in that short office visit.

Um, sometimes even I, I feel like I'm pretty well trained in the medical record system that we use, which is a common one. It's called Epic. Um, there are, well, first off, there are different versions of Epic. So even within, um, my Columbus community, there are several hospital systems. Three or four that I can think of off the top of my head that use the same program, but they're not exactly the same.

So although they kind of talk to one another, if someone has an x-ray that's performed at one of the like competing hospital systems, I can't see the images, I can read the report. Even then the report, I have to go in like a separate area and know to look for it, to find it. Like sometimes it's like a phishing expedition to find this data.

And so if you're able to, you know, you can ask for copies of your reports, you can ask for, you know, CDs with your images. That is well within your right as a patient. And I think sometimes that is not. Communicated to people. Yeah. And I frequently see patients who, you know, when I ask them to fill out their forms, they don't fill them out completely because they think I have the information.

Right. And, and, um, you know, I, I mean, I agree with you. I think coming with the, the full story is so helpful. Yeah. The other things that I think are. The, the second thing I tell folks is we can take the pressure off through preparation. So often when we get into the office, um, myself included, I kind of go into that like fight or flight mode and we have a really hard time using like our whole human brain.

And I, when I get into kind of that fight or flight mode, I send, I tend to quiet down. And my mind tends to go blank and I forget about what I actually wanted to ask my doctor about. Um, even, even though I, like, I know her socially, like, you know, like, but it's, it's that, it's still, there's always been that like power inequity, um, between physician and patient.

Um, and for a long time and still, especially for marginalized communities like that has been a huge gap. Um, and so. Taking down some notes, thinking about what you need to communicate during that visit, um, what questions you have. One of the things that I think sometimes gets missed or not lost in translation is sometimes as physicians we may not ask or we may not hear how much certain symptoms are really affecting your quality of life.

And I think that. Sometimes what helps me know how hard I need to try to relieve those symptoms or to find an answer is to know like, oh gosh, this is interfering with you, playing with your kids or having a meaningful relationship with your spouse or partner. Like, you know, those are really helpful things that we don't always think to ask.

I, I think that's a great point, especially when I think everyone wants to present their, um, their best face, right? Mm-hmm. So communicate their symptoms, but maybe take some of the emotion out of it. Um, you know, 'cause it does make you feel so vulnerable. What do you think when someone sends you a letter or an email before their appointment?

Well, sometimes it's rare for it to get through the blockade. I mean, part of, um, where I practice, um, there's so many pros and cons to working in a, uh, a large, you know, state university, um, and. It certainly opens up a lot of resources, um, and, you know, super specialized folks that I'm able to connect people with.

But it also sometimes inhibits better communication between, um, between myself and my patients. And at least not always ideal, but when I am able to communicate with folks ahead of time, um, I think it's helpful to. Many times, just like give them a little bit of, of preparatory advice. So if it's something simple like, well simple in my realm, but like an allergy evaluation, knowing that there are certain medications that ideally they should go off of beforehand, like is really helpful and um, but in other instances that's not the case and sometimes that gets missed.

Um, when scheduling is through our central scheduling, which. There are so many details, right? That that make things a little bit more complicated. Yeah. Many times though, a lot of offices will have information on their websites now that will say like, before your visit, you know, what should you know? And so I think that's also a really.

Smart place to look, or if you're calling to make that appointment, you can, you know, ask the schedulers, you know, Hey, is there anything specific I should know before my appointment? Just to prompt them to make sure they didn't forget anything. The other, you know, little tip that I, um, share with folks that, you know, I, I don't think ever I ever knew until I was a practicing doc is.

You are scheduled for a specific amount of time. Your appointment has a start time, but it also technically has an end time too. And so when you call the schedule, you can ask, Hey, you know, about how long is a new patient scheduled for? Like, about how long would I expect to have time with the doctor? Um, so that, you know.

Kind of what, what, and anticipate kind of what that may look like, um, and what your timeframe may be. Um, one of the issues that I have in clinic is, you know, I, I deal, my clinic is all about kind of TMI and too much information. And so there are a lot of really personal symptoms that women have and sometimes it, it takes a while to.

Uh, fess up to those really bothersome symptoms. Um, and so sometimes people won't bring the most bothersome thing up until the very end of the appointment. Mm-hmm. Um, does that ever happen to you? And do you have any comments on that? Yeah, and I mean, I've been guilty of that too. Mm-hmm. Me too. Um, I think, you know, um, we've, we've talked in the past and one of the early symptoms of my systemic Sjogren's was.

Pain with intercourse. And here I was, you know, in my like, probably mid later twenties, you know, normally it wasn't, I hadn't had babies yet, so it wasn't an issue of like breastfeeding, you know, kind of related dryness. And um, it was one of those like things I mentioned to my ob, GYN as she was on the way out the door.

Even I know her for years, you know, it was just something that I like still. It took a lot to right, um, to bring up and. I think that's where the preparation part and thinking ahead of what you might wanna communicate is helpful. I think there also needs to be some awareness that sometimes you do have to get a little comfortable with being uncomfortable in those situations, um, so that you can get the care that you need and that you deserve.

Um, and some of that it, it, it takes some. Some time and some, some mindset work too, to realize that you, you do deserve that care. Mm-hmm. Because for a lot of us that hasn't been emphasized. Yeah. One of the things that I've started doing, um, and, and this is really a, a pandemic thing, is that I do a lot more virtual visits now than I ever have.

Mm-hmm. And I've found that with new patients, um, it's, it's kind of a delightful. Thing because they're in their own environment and, and it seems to me, and there's no exam, no, no pending scary exam. And you have your clothes on, right? You have your pants on. Um, and it seems to me that it's a much easier place, um, to discuss some of these symptoms.

Oh, that makes so much sense. Yeah. And so it's something that, you know, just kind of came about, but it's something that I really like because I feel like it's just an easier place to have that first discussion. Absolutely. And I am just reflecting now, so I'm about three or four weeks into an eight week training, kind of continuing education course I'm taking on the role of trauma and trauma in how we interact with.

People in particular for me, thinking about how I interact with my patients and part of trauma responsive care is really helping our, our, our patients feel safe. And what a, what better way to help people feel safe than in their home and in their home environment typically. Yeah. Yeah. I mean it's really, not everybody likes it and some people feel like it's a little bit of a waste of time, but I think it's such a lovely way to start, start our professional relationship.

Right. Just by, by talking before the pandemic, I used to try to talk to my patients in a separate room while they were clothed and then move them to the exam room. 'cause I felt like that was super helpful. But then, you know, with protocols that just became. Way too complicated and not feasible. Um, but, but this I find even, even better.

Plus you learn a lot when you see people in their own environment. I do like, so I like it from an, an allergist point of view. I get to, so one of the, the scary things about an allergy visit is the testing, like the scratch testing, which I know isn't scary because, um, I see it and do it right. It can be, and it's uncomfortable, especially if you're a really allergic person, you get pretty itchy.

Um, but if you've never had that happen or you've only talked, talked with friends about it, there can be a lot of anxiety and built up, um, concern about that. And so that is one of the other big changes with the pandemic. Occasionally I will meet people, telemed beforehand, um, and then I get to meet their other allergic triggers too, so they're packed right over.

Or the one patient who, you know, bless their heart, they, um, they told, I don't know if it was the resident or the fellow or the, the, the nurse who got them roomed. Um, that they were not smoking and then they, um, they were smoking during our visit. So that was, you know, no, they felt very comfortable with, you know, and, and no judgment.

We meet people where they are. Um, but that was a little bit, you know. It's a little more honest. Right. When you see people in their Yeah, absolutely. In their own environment. Right. Memorable. Um, yeah. So what other tips do you have? Um, so, you know, I really, going back to owning your story, getting comfortable, kind of knowing that you can ask for your records, getting access to your portals can be really helpful.

The other aspect that I think, um, really we struggle with from both sides of the coin is that, you know, is, um, mi mismatch and expectations in how communication will happen after an appointment. So, you know, this is advice that I give my colleagues, um, but. You can take ownership of this as a patient too, to say, Hey, you know, I see we're going to order labs.

You know, you're at the end of the visit. You can summarize with your, with your doc to say, Hey, okay, this is the plan I heard. I'm gonna go get my labs drawn. You're gonna do X, Y, and Z, and then we're gonna reconvene in X number of months. But you can just say, okay, I'm getting my lab work done. How, what should I expect in regards to getting my results?

Are you, will a nurse call me? Will it be released to the portal? Do I need to come in for a visit? You know, so that you can understand, you know, the timeline and how that will be communicated. Um, and you can also ask, Hey, if I have a problem or a question that comes up between now and my next visit. Is there a way that I can get in touch with you or the team?

What can I expect from that standpoint? And that, um, can also, I think, just kind of helps, you know, even the playing field so that we know what those expectations are and we're using what's called closed loop communication, um, in, you know, kind of repeating back and confirming that that is the plan. I, I think that's great advice.

And I think, um, you know, there's frustration when we don't communicate those things carefully. Or if someone assumes they're gonna send an email communication and they'll get a response within, you know, 24 hours. But you know that, you know, our response time is, let's say three to four days. Um, you know, all of those things become really important just to decrease mm-hmm.

Frustration and set expectations. Yeah. I think the other big, you know, mission I have in, in sharing my story, you know, it, it, it's, it's multifocal, but one of the missions is to show that as physicians we're human for, you know, for many years. Most docs were male, you know, for generations. And there was this, um, also this sense that docs were God-like.

And then, you know, we've kind of evolved for a while into kind of this superhero paradigm and, you know, there was this whole talk of like healthcare heroes. And in really, really, no, we're, we're human beings. You know, we have devoted a significant amount of time. Energy and money into, you know, into going into this career.

Um, but at the end of the day, we're human beings who get sick. We have families, um, and who may get sick. Um, and we have good days and bad days and, and just like all of us. And so it's really helpful for just as humankind to understand that shared humanity and. To give each other a little bit of grace along the way too.

I, I think that is an amazing sentiment, especially at this time and place in the world, right, where everything just feels a little bit more difficult. Mm-hmm. Um, yeah, and I think, you know, coming into your appointments, being really clear about what you want. Um, just really helps set the stage. Yeah.

Especially for appointments that are so wanted. Um, so precious scheduled so far in advance, scheduled with not enough time. Right. How do we all get the most out of that? Yeah. Yeah. I think there, as we talk about, one of, one of the things I talk a lot to my colleagues and peers about is, you know, how can we ensure that we are not gaslighting patients in kind of working towards solutions From that side of things, the reality is the latest statistics show that 62% of physicians have symptoms or meet, you know, the criteria for burnout and hurt people.

And people who are in burnout have a hard time connecting, have a hard time, um, you know, being their best selves. And part of the solution is going to be helping with physician and healthcare, professional wellness too. That's a whole nother huge topic, isn't it? Mm. Mm-hmm. Yeah. Well, I wanna thank you for your time.

I think that you're brilliant and, um, so good at sharing your personal story, which is hard for all of us. Um, and I really commend you on this mission because I think it's so needed right now. Right. Um, you know, physicians want things to be better. Patients wanna want things to be better, and we have to figure out how to do this together.

Absolutely. Because there are a lot of competing interests with a lot of money at stake that we're up against in many ways. Yep. And we all just wanna do the best job we can. Yep. Oh, thank you so much, Dr. Sarah. Yes, thank you. I really enjoyed this time and, uh, you know, hopefully we'll get together soon. I look forward to it.

So I hope that was helpful for you. I think for me, the big suggestion that I always give women is to write your concerns down and give it to your physician before the visit, maybe through the portal, or give it to one of the assistants. I think this is always a great idea and can really facilitate your visit.

Good luck and be well. Okay.