Subject: Dr. Patient Communication and Interaction
Recap by: Don Jeffries
When the patient comes to the Doctor’s office, they presumably have something they want to address,
but too often they don’t let the Dr. know what it is.
From the Dr.’s point of view they come to the office and they look at the schedule and see how many
patients they are going to see that day; 20-40, maybe 60 patients that day! If the Dr. is going to see that
many patients in a day you can be sure that YOU are going to have to be very focused and organized,
other wise, the Dr. will say do you need your refill, and usually that is not what you need. Most Dr.’s can
figure out why you are there from a medical point of view, but not why you are here point of view. WHY
ARE YOU HERE? Sometimes what you are there for is very different from what the Dr. thinks you are
there for. So you are not on the same playing field.
Remember---the average time in the United States a patient spends with the doctor is about 7 minutes.
It is up to you to you to be organized, and to the point. Always come prepared.
When you go to the Dr.’s office for the first time (and all other times) know what you are going for, write
down what you want to talk about, what you have done about your problem, what medications you are
taking, WHAT NATURAL REMEDIES YOU ARE CURRENTLY USING, if any.
Have a list of the Dr.’s that you have seen, what treatments that have been done, how successful were
they. I have tried this, and this is the result. What complications you had from the medication and any
procedures that you have had done.
You must be organized. If you keep a list of things you want to cover, and take notes about your visit,
there will always be a smooth flow of communication from your very first appointment. Keep a
stenographer’s notebook with the date and time of your appointment. A list of your questions, and write
down what you and the Dr. talked about—(paraphrase it, not necessarily word for word.)
If you do not understand what the Dr. is saying or the recommendation that s/he is making, ask for
clarification----don’t be afraid to ask questions! You need to understand what is going on, what are the
pros and cons of the medication, What are the little nuisance side affects and what are the major side
effects. Ask the same questions about the procedure that you are going to undertake. If you feel the
need, bring along a family member or a friend to take notes and have the list of questions checking
them off to make sure your have covered your questions and concerns.
Even when you telephone, have a pad and pencil handy to write down any instructions.
The human memory is notoriously faulty. Call early in the workday when the Dr.’s assistants are on duty
and hospital laboratories are able to give their best services. Remember do not write down what you
think they said but what they ‘did’ say.
Be sure to let your doctor know how things are going in their office. Is the staff efficient or inefficient?
The doctor needs to know either way. The office staff always functions better when they get a
compliment on the organization of the office and their people skills. But if they have not displayed this,
the doctor needs to know.
When taking medications, remember that the Dr. is looking for the lowest dose that will work, and then
gradually work up to higher doses until the medication works.
Another thing to think about: the patient is having headaches 25 days a month, the doctor gives the
patient medication and the headaches are cut to 10 per month, and the patient comes back and says
the medication isn’t working. Everything doesn’t work 100% all the time. That may be the best that can
be done with what is available. Most doctors use the motto, “start low go slow, leave the medication
long enough to see if it is going to work.” Usually a month is long enough to find out if the medication is
going to work.
Q. How did botox come into use in TN?
A. In the early 80’s patients with severe facial ‘tic’ problems would come in to have botox injections to
get rid of the wrinkles. Dr.’s found that botox didn’t just work on the muscles, it also worked directly on
the trigeminal pathways, it blocks the release of neuro-transmitters from the trigeminal nerve fibers. It
worked very successfully with migraine sufferersTN sufferers must be very careful using botox,
depending on what part of the face is affected. If it is in the 1st division, it may very well be extremely
effective. In the second and third divisions one must be very careful. When using botox for TN we must
think of cosmetics as well as the pain. You can’t have one side of the face sagging, while the other is
normal
Q. Is this procedure covered under insurance?
A. By and large, insurance companies usually don’t look at what it was used for. If they saw that it was
for TN, and not cosmetics, they would probably OK it. If the botox procedure is done in the Dr.’s office
it is considered a medical process and not a pharmaceutical procedure.
Q. Would you look to a more radical procedure if the medication is working?
A. Personally I wouldn’t rock the boat. If the medications are working and the patient feels comfortable
with it, why change? If you are on your second or third medication and are having problems then the
patient and the Dr. need to sit down and decide what they are going to do.
Usually I say, “do something other than damage the nerve. Damaging the nerve is a last resort.”
Q. Is botox safe?
A. It is exceedingly safe, one of the safest applications known to man. I have treated patients for over
twenty years with botox. It is also one the most powerful toxin known to man. Usually very few side
affects, and that’s if you happen to be off a few centimeters with the injection. However these side
affects are usually temporary in that botox is almost pure protein and is absorbed into the body after two
or three months. Then the injections must be repeated.
We are now working on electrodes implant in back of the skull, we stimulate the nerves with a remote
control to block or jam the circuitry we can turn off the pain! This is the same principal as a pacemaker.
Q. Injecting botox around the eye, is this dangerous?
A. It could be if the Dr. doesn’t do a job, it could do damage to the eye. However for TN, we would not
inject that close to the eye, in that we are working with a nerve and not a muscle. So there would be little
chance of doing damage to the eye.
In closing, no matter what the problem; ask your doctor how many TN patients have you worked with,
how many procedures have you performed?
· Bring a note pad with your questions ready to ask—take notes on what you and the Dr. talk about.
· Bring a friend or family member to take notes and make sure that all your questions are answered.
· Don’t be afraid to speak up—Ask questions.Always be prepared for you ‘seven’ minutes of fame!
Closing the “Gate” to Trigeminal Pain By: John Weigel- recap—Don Jeffries
Trigeminal neuralgia patients can ease the severity of the facial pain attacks by learning techniques that
‘close the gate’ to pain. John Weigel, a psychologist who specializes in pain management, says mental
strategies such as maintaining a positive outlook, keeping busy and focusing away from pain can help
shrink severe pain by as much as 60%.
“Ever hear anybody say your pain is all in your head? Well they’re right he says. “The pain center’s are
your brain. That is where you experience pain.
Weigel says that the mind not only registers physical pain, it can work the other way and actually bring
on physical symptoms.
There is a connection between the brain and the body, and that connection can be your best friend or
you worst enemy.
He says that how we handle and react to pain explains in large part why some people seem to have a
higher or lower threshold of pain than others.
Pain and suffering are not the same. The sensation of pain is one thing, but how you experience it is
entirely different. There can be pain without suffering.
He suggests that those who seem to have a higher ‘threshold’ of pain have learned ways to ‘close the
gate to pain,’ while those struggling the most with pain are often doing things that ‘open the gate.’
Weigel mentions that these are among things that worsen the pain:
• Tensed muscles. This may be nerve pain you are having, but your muscles also tighten up when
your are having an attack. That accentuates the pain.
• Depression. This is that helpless, hopeless, down feeling, the feeling where you say things like, “I
can’t stand this,” or “Here we go again!” The more you experience that, the worse the pain will feel. •
Fear or anxiety over pain. Worrying about the next attack to the point where it affects your life and the
choices you make.
• Anger. “This is when you are mad at the pain, mad at your doctor for not helping more, mad at your
spouse for not understanding, even mad at yourself for having the pain.
• Focusing on the pain. One of the worst things you can do is sit back when you’re having pain and
think, “oh my, am I in pain.”
• Inactivity. Staying busy is one way to keep the mind occupied with something other than pain.
The above behaviors can all make a bad pain even worse. On the other hand, opposite strategies can
help make a bad pain at least a little more manageable. Some of the “gateclosers ” Weigel mentions:
• Relax. Try not to tense your muscles. Don’t breathe fast and shallow when you are having an attack.
Watch someone when they are sleeping and see how deeply and slowly they breathe. That’s way you
ought to be breathing when you’re in pain. This is one way those living with you can help by reminding
you of that.
• Stay positive. Focus on as many positive emotions as you can. When you have a positive outlook,
pain doesn’t find a nice home!
• Try visualizing. Picture the problem going away. There have been studies in cancer patients where
tumors have shrunk when patients visualized them shrinking. These things are possible because the
body and mind and emotions are all connected.
• Enjoyment and laughter. Laughter secrets chemicals throughout the body that relieve pain, have fun,
laugh, enjoy as much as you can. Especially when you are not having pain.
• Stay busy. Don’t sit around just waiting for your next attack.
• Focus on the present. Weigel doesn’t think anybody could deal with the thought that they are going to
be in excruciating pain the rest of their life. Dontt worry about the future. Concern yourself only with
dealing the pain at the moment.
These are the kinds of things you need to work on to help yourselves. Weigel advises, it help’s to
appreciate what you do have rather than focus on what you have lost. Remember the man who said, ‘I
thought I was bad off with no shoes until I met a man with no feel.’
Chronic pain also can put a strain on relations. To combat that, he offers four other bits of advice for
trigeminal neuralgia patients and their families:
• Be patient. Realize that chronic pain is difficult to deal with, especially when it’s something you can’
see.
• Communicate. Talk and report accurately how you are feeling.
• Make allowances. You are not always going to be your ‘old self and you are going to have bad days.
But also make allowances for the spouse not fully understanding the pain.
• Be willing to make adjustments. You may sometimes need to change plans or do things differently
because of the pain.
Weigel said he is encouraged to see support groups forming so those with TN have an outlet to talk to
others in a similar situation.
One of the things that helps is to talk about what your are going through and have people around you
who nod their heads and really understand. That’s the value of a support group.
Sometimes there is a lot we don’t understand and can’t control. We may not always understand, but
there are things we can do to help ourselves.
Dr. Jack Schim
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Recap of the June 4, 2005 meeting