No Dumb Questions! Episode 55 with Dr. Yona Saperstein
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Do you ever feel too nervous or embarrassed to ask your healthcare provider questions? Sometimes we may think our question is too silly or dumb – other times we may feel too overwhelmed after a diagnosis to speak up.
For today’s episode, I’m joined by my husband, Dr. Yona Saperstein (back by popular demand!). We discuss the importance of asking questions and give helpful tips to help remember the information given to us at these appointments.
This week on All About Audiology:
- 2:03 – A listener of the podcast shared a story of when her son was an infant and diagnosed with unilateral hearing loss. For a few days, she didn’t fully understand what the diagnosis meant. If you are unfamiliar with the terms your doctor is using – ask! It can completely change your outlook on a situation.
- 5:44 – Even doctors have questions! Yona and his colleagues regularly ask each other for advice. This helps them to provide the best care possible for all of their patients.
- 11:44 – It’s always important to confirm that you are taking medication correctly. Don’t be afraid to contact your doctor if you have forgotten the advice they have given you, or are unclear on the directions.
- 17:16 – Bringing a list of questions with you to an appointment isn’t annoying! This will only help your doctor make sure they are providing you with the answers you need during your visit.
- 23:36 – When a patient asked for Yona’s advice about having her children vaccinated, he explained that there is ample data showing that vaccines have been the number one life saver in the history of medicine.
- 26:25 – Vaccines do not cause Autism. This theory has been disproven multiple times. If you have questions about what information to trust or who to listen to, the best thing to do is speak with a trusted healthcare provider.
- 36:00 – Healthcare providers are the experts in their field, and parents are the experts on their children. When we respect one another’s expertise, then we become a team. Two way communication is key.
- 37:51 – if you aren’t comfortable with a healthcare provider , you have every right as a patient and parent to get a second opinion or switch doctors.
- 42:46 – Hearing From Both Sides is a unique program for parents and professionals to come together to share experiences, concerns and suggestions. There will be 3 Zoom discussions, where many of these issues will be discussed in depth. If you are interested, reach out on the Facebook group, the Instagram page, or send a message through the website.
For more resources and research visit:
All About Audiology Website
All About Audiology Facebook group
AllAbout Audiology Instagram
Mentioned in this episode:
Listen Next/Related Episodes
Episode 50 – All About Therapy – with guest Dr. Yona Saperstein
Next time on All About Audiology:
Episode 56 – All About Early Intervention: Speech and Language Development
Welcome back to the All About Audiology podcast. I’m your host, Dr. Lilach Saperstein. And this is the podcast where we talk about audiology and how it relates to your life. What does it mean if your child has a hearing loss? How does that affect your family, your relationships, and your connection to that child? (We talk about) where hearing loss intersects with parenting, and also talking to the other side, the professionals, a lot of students listening, international students studying audiology, speech pathology, and deaf education, hear listening to the podcast, and many professionals, all of the people who are so devoted to caring for your child.
We are all in this All About Audiology community together. I’m so grateful that you’re a listener. And I want to invite you over to the Facebook group where we’re always having great discussions, and go and start a thread over there. Introduce yourself, tell us what your connection to audiology is, and your favorite podcast or come and ask a question. Tell us about what’s going on in your life with audiology. So, come on in join the All About Audiology Facebook group.
And now we’re going to jump into today’s topic. Today’s topic is, no dumb questions. And I have to say, back by popular demand, I am bringing my husband in for another topic, another episode together. The last episode that we did together, it was all about therapy with my husband, Dr. Yona Saperstein. And that episode, quickly surpassed in terms of downloads and listens every other episode that came before it. So, that was the most popular episode ever. And I’m really excited about that, because therapy is something that I find to be very, very valuable. And you should go listen to that episode, it will be linked in the show notes.
But today we are talking about asking questions, asking questions of your healthcare provider, asking questions when you get a diagnosis or when you’re at the doctor’s office. How does that affect your ability to advocate? And do you sometimes feel like, maybe I can’t ask a question or is my question too simple or too dumb? And I wanted to just bring up this recent conversation I had with one of you, a listener of the podcast, who shared with me that her son, who has a unilateral hearing loss, hearing loss in one ear, said that when he was an infant and got this diagnosis, there was a good couple of days where she did not fully understand what the diagnosis was or what was going on.
She was just overwhelmed with all this jargon and testing here and appointments there. And it took many days until someone actually explained to her that unilateral means one side. Until then she had assumed or thought or was led to believe that the hearing loss was in both ears. And when she realized the diagnosis was actually completely different, and just because of not knowing this jargon term of unilateral, she all of a sudden had a very different response and a different intervention strategy, a different outlook for a child with hearing loss in one ear versus two ears. And so, I think this is an important topic, it comes up a lot. And I want to encourage you to ask questions and not be afraid.
Dr. Lilach Saperstein: “So, welcome to the show. Dr. Yona Saperstein.”
Dr. Yona Saperstein: “Hello, Lilach.”
LS: “How are you?”
Dr. Y: “I’m very good.”
Dr. L: “So, this is another one of those impromptu, you’re in the middle of telling me stories. And I say, “Wait, put it on the podcast.” Hahaha.
YS: “Well, I’ll start with a different story, not the story I was telling Lilach. So, when I was a medical student, the first two years of medical school are spent, at least when I was a medical student, that was a couple of years ago, I think things have changed. But the first two years of medical school were spent in classrooms in lectures. And then the next two years of medical school were spent as clerkships, which means that basically, I got to be a student hanging out in the hospital with residents who are doctors and training after medical school and attendings, which is when the doctor finishes residency, and is, as they call it, a full fledged doctor.
So, on my second day, as a student working in the surgical ward, the resident asked me to help her out. So, she said, “Can you please call this particular department and ask them to perform a certain test?” So, I said, “Okay, how do you do it?” And her response to me, this resident says to me, and I had just started my clerkship, she says, “Don’t ask questions! Figure it out yourself. And asking questions is a sign of inadequacy.”
LS: “You mean, how do you get in contact with the other department? Like, what’s the extension to call that?”
LS: “I mean, how are you supposed to know that?”
LS: “Was there a list somewhere with all the extensions or something that you didn’t know about?”
YS: “Apparently, there was. However, I wasn’t given any orientation. I was just dumped in there and told to do a task and not ask questions. Eight years later, here I am. I’m an attending physician. And I still find myself asking a lot of questions. And I personally do not think I’m inadequate.”
LS: “Well, I just can’t get over this lady. She’s like, ‘Don’t ask me a question that isn’t even Google-able’. Like that’s an internal hospital policy thing. How should you know, it was your first day in the hospital?”
YS: “Second day. The first day they didn’t ask me any favors. The second day.”
YS: “So, then basically, the next thing I was going to talk about, was the fact that in light of this story, how I personally think it’s very, very important to ask questions. First of all, I myself, despite the fact that I am an attending physician, I ask questions all the time. There is a more senior physician than me in the clinic that I work at. And I ask her a lot of questions. You know, especially because two years ago, we moved to another country, and the system was very different. And I always asked questions. Well, you know, actually the way it works in our clinic, there’s a chat app, kind of like, you know, g-chat, which is protected, which means that you can talk about private patient information and it doesn’t get released.”
YS: “It’s kind of part of the EMR, electronic medical record, like the hospitals, or the computer system?”
LS: “So, you can chat with other doctors that you work with, that are either senior to you or that you’re senior to them?”
LS: “There’s kind of this culture of, if you have a question, ask.”
YS: “Yes. And I chat with the senior physician a lot. And sometimes she would even chat with me occasionally, even though in fact, she has many years of practicing more than I was. Sometimes, she would actually ask me to come into the room, just, you know, to get a second pair of eyes on the patient.”
LS: “Yeah. And sometimes younger, or more recently trained doctors could have more up to date information from their training.”
YS: “That’s also true. And I would often (chat) with the other staff, for instance, the nurses and the office staff. We’re always chatting each other, we’re always asking questions. Sometimes, if a patient asked me to do some sort of administrative thing I have no idea how to do, I chat the people in the front desk, and they would usually tell me what to do.”
LS: “Right. So, I think that’s exactly it. The asking of questions shows that you view the whole thing as a team. And the goal is to get the best care and get answers and not so much about if you specifically know it off the top of your head. I also know, you share this often, that you’ll sometimes look up medication and dosage and things like that in front of the patient with them to say, I know that this is the right medicine for what you’re talking about, I’m just gonna double and triple check before I actually put in this prescription, and make sure that it doesn’t coincide with some other medicine you’re taking or you know, just to do a double check on dosages, right?”
YS: “I do that all the time. The patients see me and I will literally have the up to date application open in front of the patient.”
LS: “And this is a question from the patient side, now I’m asking all of you. Listeners, when you see a doctor who does something like that, does that make you feel more confident in their ability and trust them more and know, oh, they’re gonna double and triple check everything? Or do you sometimes have a feeling like wait, does this person know what they’re talking about? Because it can go both ways. It really depends on what the rest of the interaction is, and your whole rapport with them and your whole trust with them. And I think that’s where the issue of asking questions comes in. We get afraid that if we ask a question, we’ll be seen as incompetent like this lady from that original hospital interaction, which was like, hey student don’t ask questions, because then you look dumb. But if you don’t ask, how are you going to learn? Can we tell them that old joke? Haha.”
YS: “Oh, of course. So, there’s a story. A kid asks, ‘Daddy, why is the sky blue?’ And the dad says, ‘I don’t know son’. So, he asks, ‘Daddy, why is the grass green?’ ‘I don’t know son’. So, the kid asks again, ‘Daddy, why are the clouds white?’ So, the father says, ‘I don’t know son’. So, the son says, ‘Listen Dad. I’m really sorry that I keep asking you questions that you don’t know’. The father says, ‘No, no. Please keep asking. If you don’t ask, you don’t learn’.”
LS: “Haha. ‘Daddy, am I bothering you?’ Hahaha. It’s so funny.”
YS: “I actually wanted to make a very interesting point. You know, I personally, as a family doctor would much prefer that patients do stay in contact with me. Sometimes, if I give a patient a medicine, like I’ll start a new medicine for instance like a blood pressure medication, I will say to the patient, ‘If you start to feel any side effects, contact the clinic immediately. If you have any additional questions, please feel free to contact me.’ If the patient does not want to contact me, and they’re afraid to bother me, which I’ve had that sometimes we were, then you know, the patient will take the answer, you know, if whenever I give an antibiotic, then the antibiotic must be taken for the full course. You know, sometimes the patient will have like sinusitis or an ear infection, I’ll give an antibiotic and I’ll be like, take twice a day for seven days. And usually I will specify to the patient, do not stop in the middle take until the end. Occasionally, either maybe I may have forgotten to say it, or the patient may have selectively not heard me say that.”
LS: “Or, you know, they take it for a few days, then they feel better. And they’re like, yeah, I’m done. So, I don’t need to take it anymore.”
YS: “Well, you’re not supposed to do that everybody, because taking the antibiotic for half the course will make the patient feel better. But it won’t completely kill the bacteria and the infection may come right back. So, it really frustrates me when patients come in with ear infection, throat infections, sinus infection, I give them antibiotics. And they come back around two weeks later with the same exact complaint. And they’re like, no, I took the antibiotic for three days and felt better. So, I’m like, ummm…. And they are like, ‘well, it started to get worse again, but I didn’t want to bother you’ and I’m like, ‘no, please bother me. Talk to me. This is how you get better, please, I’d much rather be contacted.’
You know, patients will ask me all sorts of questions. Sometimes, patients will confirm certain things that I thought I said, but I guess I didn’t. And you know, I’m not perfect either as a doctor. I try to literally say every single point to every patient, and I can’t say that I’m totally successful. For instance, sometimes a patient will come to me with conjunctivitis. And I’ll give the patient eyedrops and the patient will confirm, ‘Um, you put those in the eye, correct?’ And yes, you know, for some, it may seem like a stupid question. But no, it’s a very smart question, because there are certain medicines which come in droplets which are meant to be taken by mouth. So, for the patient, it was a very smart question to ask. And from my point of view, I’m so glad you asked. Because I literally do not want you taking this medicine the wrong way, it’s important that you ask the question and confirm that you’re doing it right.
One time that I was in the hospital, there was a patient with an outer ear infection, among other issues. So, I had clearly given an order for acidic acid, that’s vinegar and I wrote “odek” which means to the ear and I even wrote, put it in the left ear. Apparently, whoever’s job it was to administer the medicine did not bother asking a question or clarify. The patient complains the next day that her eyes burn. Apparently the nurse who was tracked with caring for this patient did not read the order correctly and put the vinegar in his eye.”
LS: “To treat their outer ear infection?”
YS: “Yeah, it’s like, for goodness sakes, if you have a question, ask, you know. If you ask enough questions, you have enough avenues of open communication and then everyone will know the same thing. If somebody is afraid to ask a question or communicate, then there will be lack of information. And that will, that can literally lead to disaster. The acidic acid was a minor point. I’ve seen worse cases, which I do not want to put on this podcast.”
LS: “Okay. So, no dumb questions, but there can be dumb mistakes. I remember hearing that from a high school teacher, who was a science teacher. It was the day in lab and Mr. Solat taught me a lot of Earth Science and chemistry in high school. And shout outs to Mr. Solat. And he said two things in lab that I will never forget. His first thing was he taught us that when you heat something, it gets hot. And he said, we are going to turn on these Bunsen burners, young ladies, but let me tell you, they are fire. When you heat something, it gets hot. When we put things on the Bunsen burner, that gets hot. Because when you heat something, it gets hot. And he says every year I give this entire story in the beginning, this little lecture about heating things, and then they get hot, cause and effect. And you know, you’re in high school by now so you know about fire safety. And yet every year someone burns themselves touching a beaker. It’s like wait, it was glass? Yes. When you heat up glass, it gets hot. That was a total tangent. And I think about Mr. Solat all the time, every time I ehat something, honestly, hahaha, and I don’t want to burn myself.
But the second piece of that lecture on the first day of lab was, there are no dumb questions, but there are dumb mistakes. And if you’re going to cause noxious fumes to be filling this lab, that’s a dumb mistake. But if you want to ask a question, you should. So, I think, you know, back to what you were saying, that we as audiologists, as speech pathologists, and as educators, everything that we do, all of our goals basically are geared towards communication. And we want people to be able to have access to communication with their loved ones, access to educational material, access to the world around them and being able to communicate in whatever modality with other people. That’s like a big tenet of our entire field of communication, communication sciences. And sometimes, we call them communication disorders because we look at what can go wrong. But you know, the whole idea is to try and get good communication for our patients.
And then we go and sometimes miss the mark in terms of communicating with the other side, with our patients, as professionals or with our providers, when you are the parent or the family, or the patient. So, I really think that this is a topic that’s incredibly important about bridging this gap and opening the dialogue. And recently, people were talking about how COVID has, obviously, given us exponential growth of tele-medicine, where not everything requires a visit. So much of medicine, so much of healthcare practice is quick, in and out kind of questions, or let me send you a picture or let me ask you about this, you know, or here’s the list of medications, can I take this or that, or here’s my list of symptoms. And of course, I’m sure you’re going to come back and tell me the physical exam, and actually seeing the patient is hugely valuable, duh, we get that. But there is this whole other focus on how much can be done just by opening lines of communication, in addition to or outside of the physical face to face encounter. What do you think about that?”
YS: “I think that’s an excellent idea. And that happens to me all the time. Like a lot of times, you know, I’ll get a chat from the people at the front desk saying, please call this patient, she has a quick question. And she needs an answer immediately. You know, so, when they say something like that, I’ll stop what I’m doing, call the patient, and it’ll take two seconds. Like, the medicine you gave me yesterday, do I have to take it with food or not? And you know, very simple question, which, usually, if a medicine has specific directions, I will usually give the patient directions. But if there’s no specific direction, it’s okay with food or without food.
Sometimes, I just, you know, won’t say anything because I’m not thinking about it. So, you know, I’m so glad that this patient asked the question, because otherwise, how are they to know? They can guess. Are they going to guess right, are they going to guess wrong? What if this is a medicine that needs to be taken with food and I didn’t tell the patient anything and the patient guessed. So, I personally was very glad that the patients caught me and asked me the question, and got the answer.
I would also like to make another point, a little bit unrelated. One of my favorite patient interaction is when the patient comes in with a list, you know, the patient comes in to the appointment prepared with a list of questions. And the patient, you know, reads off the list and goes well, ‘Doctor, I have six questions for you. One, can you look at my right toe? Two, can you look at my left nostril? Three, do you think it’s a good idea to take vitamin D and vitamin C to protect me from Corona and D, look at my bald spot.’
So, basically, this is someone with a lot of questions, which are all, you know, very unrelated to each other. And, of course, three of these, three out of four of these are things that I would have to see the patient for. And the answer to one of those questions, do I have to take vitamin D and vitamin C? The answer is we don’t really have enough information. There have been some studies that show that taking vitamin D and vitamin C actually can help a patient have lighter symptoms of coronavirus. However, the data is very, very scant. It’s not a good double blind study. My answer to that question is usually, it won’t hurt. But I don’t have enough information to say it actually works. Tangent!”
LS: “Yeah. Which is a whole other point of saying, I don’t know, is one of the smartest things that very smart and educated people say because the more you know, the more you realize how much you don’t know or how much you can’t know. So, that’s like a huge tenet in research that we have a question. Usually the research question is like, super, super obvious or a dumb question. I don’t know if that’s what I mean, if it’s a dumb question, but the research question, many times when you read the actual question, you’re like, duh, we already know the answer. Or then the general wisdom will already give you the answer. But then we do the research anyway, and try to find specific evidence to give us that answer. So, even as researchers in academia, the whole model of knowledge of getting knowledge, of doing research is asking questions.
So, let’s start breaking more of that shame around coming in with a list of questions. Because you’re not going to be that annoying patient or you’re not going to be you know, oh, I’m inconveniencing my audiologist when I come in with these articles asking them things because now the audiologist can tell you exactly what it is that you want to know. I know sometimes people will get frustrated when somebody comes in with a 15 page article and says, Doctor, I read this and Doctor, I read that, and some professionals will say, Okay, here we go, this is gonna waste some of my time.”
YS: “It doesn’t frustrate me, it’s a good intellectual challenge. I’ll have to read the article. Usually, I’ll have an answer. One time, my answer was, that’s a really good article, let me look into that. And it turns out, I actually did change the treatment based on the patient’s article, which actually has happened. Just because I went to med school for four years doesn’t mean I know everything. I learn things from patients all the time. Well, usually my answer is, that’s an article from 10 years ago, I will show you an updated article.”
LS: “Yeah. And look at that, that there’s such a level of trust, that you can bring something and say, you know, you don’t have to hide things from your doctor, or say, ‘Oh, my doctor said this, but I don’t believe them or trust them.’ They come from a different model. What if you open up the conversation and see, hey, there are certain controversies, definitely, you’re gonna have doctors that disagree about things. For sure, you’re gonna have audiologists that have different views on communication methods and different things.
However, if you don’t even bring up the conversation with them, how can you know where they stand on those issues that are then going to affect you and your child. So, when you have this level of trust, you can bring up things that maybe are more sensitive, or you’re maybe embarrassed to ask about. So, it’s not only about thinking you might be dumb, but also about thinking you might be like, on the wrong side of something, or you might be judged for what you’ve been doing, or what you’re thinking. I know you have a story about that. Do you want to share that with us?”
YS: “Sure. First of all, as an intro to my story, just on everything that Lilach was saying, lines that I often tell patients when they kind of feel a little embarrassed to ask a question is, you know, I often say, if you don’t ask, how would you know? Sometimes people ask me a question, and then feel embarrassed about the fact that they asked you, like, ‘Wait, is that a dumb question?’ No, my answer is always, if you didn’t ask, how would you know?”
LS: “That’s really a great tip for providers to say, you can ask anything. And sorry to interrupt you, but one more thing. You know how sometimes you have to ask certain things like, ‘did you take any recreational drugs and other maybe more sensitive questions? Are you pregnant,’ or these kinds of things? And I know that you say you preface that by saying, I asked this question of all my patients.”
YS: “That is correct.”
LS: “So, I think there’s something there also, with doctors who are asking patients questions also can put in some more of this. In speech therapy, you know, or in auditory training, we call this a carrier phrase, that’s like, don’t just say, dog, to try to teach your child that this is a dog and just go around saying dog, cat, ball, more, cookie, but actually use carrier phrases, like, look at the dog, here’s a cookie, let’s go to the park. So, you’re giving context and giving much more language input instead of just like naming things. So, I don’t know why that just, you know, my audiology brain is working here.
So, sometimes, when you’re giving that context to the question, it’s not just like this brusque, how old are you? What are your symptoms? What’s wrong with you, la di da di da. You know, just like rattling off your questions. But you’re actually doing that rapport building, that trust building. And you’re saying, the reason I’m asking you these questions is because it is relevant. You know, sometimes we ask, did you have a major life event, a surgery or a car accident or a major stressor when we’re talking about tinnitus, or we’re talking about a noticeable drop in hearing? And then the person will say, ‘Yes, it started around the time that…’ Then that’s very important medical history, case history information. So, it goes both ways. This podcast is the community where we come together from both sides. And we’re going to talk more about that at the end. So, stay tuned. But back to your story.”
YS: “All right. So, I’ll tell the story. And then I want to add an additional point. So, I’ll tell the story first. Around two years ago, I think it was actually, I had actually brought my own kids in to get a flu shot in the clinic in which I worked. At the time, a patient comes in. It was actually a patient who I’ve seen for the first time and she asked me some certain questions about you know, her own medical history. Okay, fine. And then they actually called me out while I was with her to hold my younger daughter down so that they would be able to put the flu vaccine in her arm.”
LS: “Because I had brought the kids in and I was in need of support. And you were right there. So, I’m like, Can you call the doctor?” Hahaha.
YS: “Yeah. So, the nurse chatted me on this G-chat. And basically asked me, please come in.”
LS: “I’m sorry. We’re just like, throwing the perks in everyone’s face. We were both having to hold her down. That was a tough one. But um, because we believe in flu vaccines, so… Hahaha.”
YS: “Okay, so then, around three months later, after my kids had gotten the flu vaccine, there was a measles outbreak in certain communities in New York and certain communities in Israel. So, this lady calls me up, calls the clinic and has a question to ask. And she says, ‘Doctor, for years, I haven’t vaccinated my children, because, as you know, and everybody knows, vaccines cause autism. But now, there’s a measles outbreak. And I always knew that doctors don’t believe in vaccines and that doctors don’t vaccinate their kids, but I saw you vaccinating your children. So, maybe you can answer me this question, should I give my children the measles vaccines? And are there any other vaccines that you think I should be giving my children, anything that won’t give them autism?’
So, this patient came from a totally different background, and the background that I have come from has a totally different training, then the training that I come from. For the record, we have ample data, that vaccines, including flu vaccines have been the NUMBER ONE lifesaver in the history of medicine for time and eternity. Well, anyway, I try to be a non judgmental guy. And even people have come from totally different worldviews than I do. I try to be all non judgmental, and listen, we’re all people. And, you know, we’re all trying to have open communication. So, I basically, very sweetly, you know, told the lady this data, and then I said, if you want my opinion, I would personally recommend doing all the vaccines and most of the doctors I work with, also vaccinate. But then I said, if you want to limit your vaccines and do the highest yield, then I would do the measles vaccine and mumps and rubella, because those are the most important. And then I also recommended for her baby to do another vaccine.”
LS: “Do vaccines cause autism?”
YS: “No, they do not. There has been a study that has shown that vaccines do cause autism. However, the fact is that the study has been replicated afterwards multiple times with different results. And then the original publisher of the study that shows that vaccines cause autism has later lost his medical license, not because of this study, but because he had forged data in other studies. However, it is likely that he had forged the data in his vaccine causes autism study, due to the fact that very similar studies bigger than his have been redone and redone and redone. And all of them with the results that vaccines do not cause autism.”
LS: “So, the final answer is, vaccines do not cause autism. Vaccines save lives from life threatening, life debilitating diseases, such as polio, measles, mumps, which have been near eradicated. Wow, this entire podcast just took a huge dive over here. And now everyone knows our pro-vax position, which is kind of like, you know, almost a difficult thing to say sometimes, because you don’t want to introduce this, like, we disagree. And now things are different between us.
But actually, that’s the point of the conversation is that, if you don’t bring it up, then we can’t, as providers, can’t come back and say, well, it’s very interesting that you have that data, let’s talk about the information you have. Hmm, the information you have has been recalled and known to be falsified. And the person who originally said it has their medical license revoked, but I can see why you thought that because the information sources you are looking at were citing that as accurate. But the information sources that you are not aware of, say this and this and this on, you know, on whatever topic, whether it be vaccines or not.
But I think, the important and crucial point of this story, to me, is that she would have been embarrassed, she was embarrassed. She was trying to keep that a secret or trying to keep that from her medical team. Well, you said it was only one other time she’d met you so probably, you know, it’s hard to say what she was doing all those years. But without asking the question, then how can you engage in the conversation? And you have to build up that trust that when someone comes to you with a question, you don’t say, oh, with ridicule, How could you believe that? And how could you think that? That’s totally false! Well, I know how you can believe that, because of the information you were presented, and the content that you had known. And it is true that vaccines sometimes have side effects, and that there are sometimes negative outcomes from some things that also have enormously positive outcomes.”
YS: “That is true. However, if you basically crunch the data, let’s say you have a scale. On one side of the scale is the morbidity and mortality from vaccines and their side effects. On the other side of the scale are the morbidity and mortality of all of the diseases that would be prevented through vaccinations. Clearly, the data shows without any question that vaccines save thousands, thousands of lives.”
LS: “I think one of the other very timely issues of the year 2020, of COVID pandemic era, is a question of where do we get our information from? Who do we trust? Who do we listen to? And how trustworthy is data? So, I think the most important thing you can do is have a trusted healthcare provider that you have a rapport with, that you can go to with questions. And when you’re coming to an appointment to say, Doctor, you recommended such and such surgery, but I don’t really understand what it’s going to do. I’m not sure that I know how long is it? How long is it going to take? How long is the time to wait in the hospital after? Will we be discharged home? What side effects can we expect or have you dealt with? And some of those questions, it’s almost assumed, oh, well, this is a surgery, you should kind of like know what it is, know what it’s about, or you heard it one time from the doctor. But you like, also had a toddler in your lap? And maybe you didn’t take all that information in, it’s high stress. So, what are some tips? What are some things that patients can do when they’re at the doctor’s office in order to try and remember and retain some of the things that they get answers to from their question?”
YS: “So, this is something that I also find very important. I mentioned before about how I personally, highly respect and like really enjoy the visits when the patient comes in with a notepad and a list of questions. So, some of these, a lot of patients what they do is they have paper and they write down the answer. You know, if they have a question, then in their notebook next to the question, they will write down the answer, or they will take another paper and they will write down the answer. Sometimes, when I’m talking to a patient, and they’re asking question, I’m giving answers, and then it just seems to me like the patient is confused. What I will often do is I will then pull out a paper, and then I will write all the important bullets on the paper in an organized bullet point fashion, and then have the patient read it back to to make sure that the patient understands it.”
LS: “Excellent. And even draw a picture, when you’re explaining the different systems.”
YS: “I’ve done that too.”
LS: “Yeah, I think it’s important to also have all kinds of visual material pictures and written material. And this is something that as providers, you know, we can prepare ahead of time and have pamphlets and booklets and printouts or even links that we have available, kind of like, here are all the links about this procedure, here all the links about these devices. And then you can have those kind of templated handouts to give people or tips.
One of the earliest things I did when I started working with cochlear implant patients is that I had this handout for activation. That was, here’s what to expect for the next couple of days, here’s what level of programs you’re on, here are our biggest goals. And some of it was already in there. And some of it I would change or circle or cross out or choose what was relevant to each patient so that they can leave, not only with a new hearing device that would be perhaps overwhelming and different, and a big change, big milestone, activation day. And all these different pieces and the equipment and everything that goes on in that day, they also had this paper, which also had our contact information, email address, that was the clinic email address that I had access to. And that was, you know, something that I think was very appreciated.
So, if you’re a provider, think of doing that and implementing some of these tips. And if you’re a parent, take notes. And one of my favorite tips also is to take a video of how the audiologist puts a hearing aid in or how they put all the pieces together or how they change the batteries. Like all these little things that they’re demonstrating to you, at the time of the appointment, you can take a quick video, a quick clip, you know, ask permission that they’re okay with it and just get a little reference for yourself that’s on your phone. And now not only that, you can share that with your other family members, other care providers, maybe the school or anybody else who’s going to be involved in caring for the device.
And this is not only for parents. This advice I gave also for our adult patients who were there with their children, their adult children that sometimes they had a health aide, they had an aide with them or someone who helps take care of them. Or maybe they were in an assisted living facility or things like that. So that this written information or that video, or those emails could be easily moved around and passed to the other people who are helping to care for them.
So, no dumb questions, ask more questions, whether or not you’re on this side or that side of the interaction, you know, both sides of the desk. I think it’s an important topic for us to talk about, not having so much of a barrier and so much of this kind of power dynamic, but making medicine, making the delivery of health care, much more of a partnership, patient centered, family centered, and about shared decision making, making decisions together. The providers are experts in their fields, and parents are experts in their children.
That is one of the posts I put up an Instagram that got a lot of comments from you guys, about times that you did feel respected. And like your expertise as a parent was seen, you were asked questions, and you were respected for the things. Because parents spend the most, most, most amount of time with their kids than anyone else. And most, especially when we’re in all kinds of remote learning situations, and homeschooling and zoom schooling, and pandemic life. Basically, if anybody knows your kid, it’s you even before all that. So, when that expertise is respected, and seen for the value of what it is, that’s when these relationships can be really productive.
And then on the other side, the people who train for years and years, do extra training, do years of residencies, and higher education and graduate school, and all the things that professionals do and train and clinical hours, in order to become experts in our field, that also needs to be respected. And so, when we come from this whole outlook of respecting one another’s expertise, then we’re a team. And we work together, and we respect each other’s humanity, and each other’s experiences and perspective.”
YS: “Yeah, and a line that I often both believe in and tell patients, when they sometimes tell me stories about specially seen, is that if your doctor should be a source of information, your doctor should not be your army general. It is not that the doctor commands, you follow. That should not be the correct relationship that a person should have with their doctor. Because otherwise you’ll be afraid to ask your questions. And the doctor will say something, what did he say, I have to do exactly what he says because he knows best and I don’t want to bother him. And I must do what he says otherwise, it will fall down on me.
No, you know, doctors are human beings. And oftentimes a doctor will give a recommendation based on the information. But the more open communication you have, the more information the doctor is going to have and the better recommendation he’s going to have. And it should be a two way communicative relationship with your healthcare provider who is a source of information, rather than the Army General of doctor says, take ABC, you do what doctor says, bye! And sometimes patients will even tell me, can you do the bloodwork on Wednesday and not Tuesday, because if I go to the specialist, and I don’t see exactly as he gave me, he’s gonna be angry.
And I’m like, I’ll do it for you, I’ll do anything for you. But this specialist is here to basically give an expert opinion on your heart, this is a case that happens to be a cardiology (patient). So, I just told the patient, I know what they’re gonna write. It’s not gonna matter whether it’s on Tuesday or Wednesday, I also kind of knew 90% of what the cardiologist was gonna say. I was in doubt about one particular point, which again, brings to the point of the fact that everyone’s asking questions. Here I am an attending and here I am asking questions of a cardiologist sending a patient to a cardiologist to ask a very specific question, which I personally just did not have enough information, expertise or experience to know the answer and wanted this patient to get the absolute best. Good.”
LS: “Yeah. And that brings us to also the thing that I often say on this show, and otherwise, which is that if you’re not comfortable with a healthcare provider, if you don’t like your doctor, or if you think someone was disrespectful, or curt, or wasn’t listening to you, you have every right as a patient, as a parent, to get a second opinion, to go to a different practice, to switch doctors. This is such an important point. And I think that not a lot of people recognize that because there is this kind of authority built in to, well, I mean, they’re my doctor and they helped me and they did this for me and they did that and like leaving them would be a rude thing or an ungrateful thing.”
YS: “Patients leave me all the time, do what’s best for you. Patients switch to me all the time, and patients leave me and go to the senior doctor all the time. Do what you want!”
LS: “Yeah. And another piece of this is that in obgyn care, a lot of pregnant people might experience difficulty with their pregnancy care, and then they feel well, I’ve already had six or seven or ten appointments with this provider, then they must be also the attending at the birth, which you know, you can switch care providers at any point in time. And if you’re not happy, I’m telling myself things now that I wish I knew at some point in previous. So, a lot of my my work here and my advocacy for this comes from my own personal experience of feeling disrespected and unseen and unheard, and felt like I was being told what to do. And it was like, What do you know? You’re just the actual patient, but I, doctors and surgeons and all sorts of people saying, I know for you and not only that, but I know everything, and I’m not going to explain it to you. And I’m not going to take the time to make sure that you understand or feel comfortable.”
YS: “That is horrible care.”
LS: “It was terrible. Yeah, absolutely horrible and traumatic.”
YS: “I’ve been a doctor now for almost four years. So, you know, I’m not coming from absolutely nowhere, that’s horrible care.”
LS: “I mean, it was very horrible. Okay. But anyway, we’re not focusing on that today. Just bringing that up to to let you know that you’re not alone. And even if in the past, you felt like there was some of that kind of relationship where it was like, you know, I can’t leave, I can’t just leave. Are they going to give me my medical records, or we’re already halfway through candidacy? So, we kind of have to go with the surgeon? No, you don’t, you can go to another surgeon, you can go to a different hospital. I mean, you know, in the times where there’s access to that, and I fully recognize that not everyone has the luxury of having, you know, multiple cochlear implant centers near where they live. You know, but this goes for anything. This goes for your pediatrician, your speech therapist, anybody who’s giving care to your child, you need to feel comfortable and safe and cared for with them.”
YS: “A line I’ve often told people and patients, a doctor is like your plumber. If you hire a plumber to fix your sink, and if you like your plumber service, then keep your plumber and continue to hire your plumber to fix your sink. If let’s say you’re unhappy with the plumber, either because they don’t come on time or every time they fix your sink, it leaks, then hire a different plumber. So, doctor/patient relationships should be the same exact thing. And yes, you know, yeah, patients leave me sometimes because they happen to not like my plumbing skills.
But that’s, you know, it’s the same thing with a doctor. You are paying your doctor for them to help you.”
LS: “Yeah, seeing them as a service provider. Yeah.”
YS: “They are providing service to you the same way your plumber is providing service, even though you’re not paying them directly. In the States, or wherever you are, you’re paying the insurance company, the insurance company pays them, you’re basically paying your doctor to help you. If you don’t like a doctor, same way you don’t like your plumber, fire the plumber and hire a different plumber. Same thing. You don’t like your care provider, fire them and go find a different one.”
LS: “Yup. So, let’s ask more questions, let’s take back more of our power in these kinds of situations, and actually make it that it’s not really about a power differential or power dynamic. Don’t minimize yourself as the expert that you are. Again, a lot of times I feel like I’m speaking to our two segments of the audiology world and the audiology experience. I talk a lot to parents, and through my workshops and through other work that I do one on one with families. And I also am deeply passionate about my colleagues and I having conversations about our profession. So, in the all about audiology community, we are dedicated to listening and hearing from both sides.
And I want to invite you to a new program that is going to be three zoom discussions, we’re going to be talking about a lot of these issues in depth, and sharing your own experience and coming together from both sides. A lot of parents, when you’re on that side of it, you’re wonderful to have the resources of local support groups and online support groups, which are with other parents. And that is so valuable. And I highly recommend that you surround yourself with people who are on this journey, who are on this path, especially people who are a bit ahead of you and those who are far ahead of you. So, you can get some of their experience and advice and learn from their journeys. And also, you know, peers that are going through it with you, maybe taking an infant care class, a parent infant class or things like that, to have that kind of peer support. And that’s awesome. It really is. I really love that. And I’m so grateful to be able also to come in and teach and give workshops to nonprofit organizations that are parent led and support groups for parents.
And then on the other side, we have, you know, all of our professional associations as audiologists, we have our audiology Facebook groups, and we have all of our conferences and our journals, and we talk to each other a lot, which is great because we’re developing best practices and doing research and learning from one another. That’s wonderful, but I believe that there’s a mismatch here. There’s something missing. So, that’s why I created this program. You know, we’ve been talking on the podcast all the time. And in the Facebook group. So, I want to invite you to join us. This is going to be quite a small group, an intimate setting where we can do this and hear from both sides so that we can help each other find the language that would that would have helped us or that is going to help us in the future, to care for the children in our care, whether there are our children, and we are their parents, or they are the children that we care for, in a professional sense and provide service for.
And that conversation I think needs to happen in this kind of safe container that’s going to be these live calls and community, there’s going to be other elements to it. So, if you’re interested, definitely come and reach out, come into the Facebook group, the Instagram page, you can always send me messages through the website. And I hope that I’ll see some of you and hearing from both sides, which it’s really going to be transformational. And I hope some of you can join.
Yona, thank you so much for joining me for this podcast episode.”
YS: “It’s been my pleasure, again.”
LS: “Awesome. You’re really a wonderful guest and you give me great ratings.”
YS: “Why, thank you.”
LS: “So, come again! We’ll have to hear the reviews.”
I’m Dr. Lilach Saperstein and this is the All About Audiology podcast.
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