Health and Wellness

Getting Better Health Care

Dr. Steve Feldman MD

Getting Better Health Care – The People’s Pharmacy for Drug and Other Health Information (part 2)

This week, we speak with Joe and Terry Graedon, whose radio program The People’s Pharmacy, provides patients a wealth of up to date, cutting edge health information, information patients might find difficult getting anywhere else, even from their doctors. Joe Graedon has a Masters in Pharmacology, and Terry Graedon, has a PhD in Medical Anthropology. Last week, in part 1 of this two-part program, we discussed their radio show and what doctors think about patients getting information from their show; this week, we discuss their newest book, Top Screwups Doctors Make and How to Avoid Them.
The People’s Pharmacy is more than just radio program. The Graedon’s have published about 15 books, starting with The People’s Pharmacy in 1976. Other books include: The People’s Pharmacy Quick and Handy Home Remedies: Q&As for Your Common Ailments, Best Choices From the People’s Pharmacy, The People’s Pharmacy Guide to Home and Herbal Remedies, Dangerous Drug Interactions, and The People’s Pharmacy, Completely New and Revised. Patients can also get information from the Graedon’s many podcasts, newspaper articles, and videos, as well as from a series of inexpensive guides available through The Peoples Pharmacy website. The Graedons get inspiration for shows, books, and newspaper columns from letters they get from their listeners. Listening to others, they point out, is critical.
There’s so much money around, in the health system, and the Graedons have developed a successful formula to keep from getting corrupted. Their principles include respect for people’s ability to make informed decisions about their health, honesty and integrity in communication and actions, and care, compassion and fairness as the guiding principles for all institutions serving people. They don’t take a penny of drug company money, so they can be viewed as objective umpires and referees.
Terry Graedon describes her concerned about direct to consumer advertising, particularly when it is related to serious health conditions. Driven by money, this advertising affects health care costs. The financial incentives in the health system can have a negative impact on health care, particularly the short visits with doctors. In contrast, on their program which airs on public radio stations, they have a full hour for intelligent conversation in which they can explore issues in depth, not overly broken up by commercials. Moreover, after the show, their listeners can go to the Internet and dig down for additional information on health topics.
Joe and Terry have a mixed, Love/hate relationship with doctors. On the one hand, Joe and Terry are always telling people to see their doctor for specific medical advice. Doctors express love for the guests and the information they share. But there are other doctors who listen get angry, who get defensive, and who ask that Joe and Terry avoid talking about “unscientific stuff” and to stick to experts. We discuss how selection bias may impact what they hear from their listeners, how the happy listeners may be unlikely to write in to express themselves while the—hopefully very few— fuming angry folks may be highly likely to write.
Joe and Terry’s new book Top Screw Ups has critical information for patients, with specifics on what can go wrong in medicine and how to avoid those pitfalls. Doctors are trying to do their best, but Joe and Terry think that doctors not listening to patients is a fairly common problem. Studies show that doctors interrupt to early when patients are describing their conditions. Joe and Terry look to the successful communication strategies employed by pilots and air traffic controllers as a model for better doctor-patient communication. A key component of this is verification or “teach back.” This can be as simple as asking “Am I correct that you said…?” or “Could you tell me what you heard me say so that I know I got the facts across?”
Misdiagnosis is too common in medicine and may come from lack of time. Doctors may get “anchored” to a provisional diagnosis too quickly and may not pay sufficient attention to facts that are in conflict with the provisional diagnosis. The Graedons recommended Dr. Jerome Groopman’s book “How Doctors Think” for more information on this. To avoid this problem, patients can ask questions, asking their doctors how confident they are of the diagnosis, what other tests might be helpful, and what else could it be?
Joe and Terry’s book Top Screw Ups provide a host of lists with tips for avoiding problems. Patients need be sure they receive their lab test results and information on proper medication use and the potential for drug interactions. Patients need to make sure their story is heard. While patients may feel intimidated and should try not to come on too strong, they need to be assertive in getting the information they need.
Patients should also communicate with their pharmacist. Pharmacists have important information to share about medications, in particular drug interactions. Patients should also get information in writing. They can bring a patient advocate or recording device to visits to make sure they capture the information they might otherwise forget. Relying on package inserts isn’t a great way to know about medications because those inserts have too much info.
Patients need to anticipate that mistakes will be made in the hospital. They need to take advocate, someone who can be on the lookout for mistakes, and they should verify that everything is being done properly. Patients should be assertive in communication, getting clarification of anything they don’t fully understand. Only then can patients fully participate in the partnership of ideal medical care.