My, what a beautiful blog you have!

"Your blog always provokes thought, Dr. Deb." "Coffeeyoghurt, you always give me a new spin on things". "Health Skills, your blog offers such useful clinical skills". I could go on complementing many of my deserving blogger pals but this is enough to illustrate the point.

That's right. It's National Compliments Day.

Most of us can feel a little uneasy about giving and receiving compliments. On giving, we might worry about how the other person might respond. On the receiving end, we might start thinking about the motives underlying the compliment. Giving and receiving compliments can be a communication minefield!

However, both giving and receiving a compliment can increase a sense of positivity and enhance self-esteem.

Giving a compliment

There are a number of things to bear in mind:

Be sincere A fake compliment usually stands out like the proverbial sore thumb. I certainly didn't buy it when Practical Man told me 'you look like Heidi Klum in that bikini'. Hmm.

Be specific "That's a great haircut" carries more impact than the simple "You look good". It demonstrates the complement giver is really paying attention.

Back up your compliment It doesn't hurt to expand the compliment by adding a little detail, thus reinforcing your belief in the compliment. "That's a great haircuit, it really frames your face."

Be selective Avoid complimenting on things that the other person really has little control over. Avoid complimenting on things that may have been complimented on frequently. If a compliment is expected, it has much less impact. Try to find something really unique about the person.

Receiving a compliment

How many of us are guilty of discounting a compliment? For example, I just got a couple of papers published and what did I say in response to compliments about that? I said, "ah, but they're only review papers". Discounting a compliment in that way immediately sucks out the positivity and really deflates the opinion of the compliment giver.

Think of a compliment as a gift. Accept with a smile and a thank you.

To read more about compliment giving and receiving, read the Psychology Today online article below.

Source:

The art of the compliment. Psychology Today

Playing the odds

Recently, I was reading about some of the work being done by Dr. Phyllis Butow on the value of decision aids for patients in making treatment decisions.

Having all the information is only one part of the equation. Anxiety, denial, information overload, poor doctor-patient communication can all get in the way of understanding, particularly when faced with a serious illness.

Decision aids are tools that help people make difficult choices when faced with multiple treatment options by providing information on the options available and the associated possible outcomes. Decision aids can consist of pictures of squares, coloured dots and simple charts to graphically represent the probability of benefitting from a particular treatment.

One such decision aid is the 100 person diagram which consists of a large square box containing 100 smaller boxes, with each small box representing how one person in 100 responded to a given treatment for a disease or condition. By putting various colored dots in the correct number of boxes, doctors can show patients how high the probability is that they will benefit from a number of different treatments.

It was therefore interesting today to read about the work of researchers at the University of California who have developed a decision aid in the form of a roulette wheel. The developers, Dr. Jerome Hoffman and colleagues, say it can be used for any clinical question, although they have set up a working example for use in determining whether to be screened for prostate cancer with a standard prostate-specific antigen (PSA) test.

"Many of us have trouble understanding numbers, particularly in the context of risk and probability. It's hard for anyone to comprehend the difference between a 7% and 8% chance - is there a meaningul difference? And this is exacerbated when we try to deal in more extreme probabilities, such as three in 10,000."

The researchers hope that the roulette wheel will allow patients to visualise the probable outcomes associated with various treatment options more easily.

A demonstration version of the Prostate Cancer Decision Wheel can be accessed from the link below. How useful would you find such a tool?

Some further reading on decision aids:

Can coloured dots help patients make decisions?

Decision aid research at the University of Sydney

The Prostate Cancer Roulette Wheel
The Roulette Wheel: An aid to decision-making

Treatment decision aids in advanced cancer

Prognosis good communication

In a couple of weeks, I'm due to see a new medical specialist. I had to, I simply could not persevere with the one I was already seeing. The doctor in question did not like me to ask questions about my diagnosed health conditions, dismissed the concerns of my primary health care doctor and another specialist (as told to me), refused requests for a consult from other specialists when I was an inpatient (again, as told to me) and was often rude and abrupt. Now, the last two I can handle. After all, I'm only looking for good medical care and not a new best friend but the other matters..well, much as I hate changing doctors, what choice do I have?An excellent doctor but obviously we didn't have a good working relationship and we're probably both to blame for that.

So it was interesting to see a BBC news story (UK) concerning a study undertaken by the Picker Institute, a medical research company, examining data from six international surveys of the extent to which health professionals are supporting patients to become more involved in their own healthcare. The report showed that what people want from their health professionals is good communication, respect for their preferences and support in helping them to help themselves.

Good news for some of us, bad news for Britons. The UK lagged behind Australia, Canada, New Zealand, Germany and the US in enabling the individual to play a more active role in their own healthcare. In particular, the report drew attention to the 'paternalistic attitude' of UK health professionals. British individuals were less likely to be given information about their conditions or be involved in treatment decisions.

It doesn't surprise me. I am British and the comments I hear from family members in the UK tell me little has changed in the years I have been away. My experiences in Australia have been largely different. Most doctors are welcoming of a patient who takes an active interest in their health management. Most are more than happy to take time to explain things and clarify options according to their patient's preferences. After all, some people prefer to have less information and personal involvement.

So what went wrong in my scenario?

Poor doctor-patient communication

Well, this isn't intended as an exercise in doctor-bashing. Good medical care is a partnership and both parties are usually at fault.

The medical side of the equation

One of the major problems is simply a failure to listen. In an attempt to manage the interaction, doctors frequently interrupt their patients. While understandable from the point of time constraints, this can result in the loss of potentially significant information.

A second major problem is the use of medical jargon. My previous general practitioner was always using complex medical terms that went straight over my head but I'd remind him, he'd explain and then we'd laugh about it. Some simply forget, it's simply what they're used to, the cynics amongst us might suggest jargon may be used to dissuade the patient from asking too many questions. Blinding us with science!

Of course, sometimes things can go in the other direction and the language used can be overly simplistic. I'm afraid I don't appreciate talking about my "tummy". You get my drift. In a stress-inducing situation, such childish talk can make the individual feel even more helpless.

Balance. It's a word I use a lot. The truth is most of us prefer our information to be delivered to us somewhere between the two of these extremes.

There are other issues but I consider these the main bones of contention.

You can read a summary of some of the key research here.

The patient side of the equation

Being a patient can be anxiety provoking, particularly when experiencing strange and worrying symptoms. Anxiety can make it hard to concentrate and take in what's being said. It might seem like we're not listening and that can be frustrating for the doctor.

Also, we can often give doctors misleading information about our true concerns. Sometimes, fearing the worst, patients may downplay a key symptoms as unimportant or, worse still, fail to mention it. Similarly, they may fail to ask questions because they're worried about what they might hear in response. In these situations, in the absence of ESP, it can be very hard for the doctor to work out what's going on.

The benefits of good communication

People often have more confidence in their health care when they are informed and can exercise some choice in what happens to them. This increased confidence means they are also more likely to adhere to advice or treatment given to them.

What can we as patients do to facilitate it?

Again, a good doctor-patient relationship is a partnership. Doctors are often busy and time-pressured. Building a good relationship means taking into account the demands on your doctor and putting in some effort yourself to maximise the benefits you can achieve from his or her time.

Be prepared for the appointment

Be able to list your current symptoms, current medications and past medical history, if required. Mention anything that has changed since your last appointment.

Because people can often forget what they are told during a medical consultation, take a pad, be ready to make notes. Some people even tape consultations but, note, this requires the prior approval of your doctor.

Communicate your health concerns

Remember your doctor's time will be limited. If you are experiencing a number of problems, prioritise and start with the most important one.

If you are feeling embarrassed or worried about the examination, tell your doctor. Be honest about your situation, don't simply say what you think the doctor wants to hear. Quit smoking yet? Of course! Hmm. Your doctor needs the truth.

Mention any non-health concerns that may be affecting you.

Ask questions

If your doctor says something you don't understand, ask the doctor to explain in simpler terms. Doctors are used to complex medical terms, they sometimes forget this when dealing with lay people.

If you would like more information about your condition, ask the doctor to elaborate or if he or she can direct you to a reliable source of information. Many health conditions have associated support groups.

And if it's still an issue..?

Then maybe you're in the same situation as me and you've just simply got to consider finding someone else more prepared to work with you.