This week’s medical thought leader is Margo Corbett, author of The Savvy Patient’s Toolkit. Ms. Corbett has created a new method that enables patients to prevent medical errors, manage their own health care and make effective use of the doctor’s time before, during and after an appointment.
Margo is also the founder of The Savvy Patient School, a program that teaches people how to fully engage in their own health care. An experienced patient advocate, medical technologist and researcher, and the survivor of three nearly fatal medical errors, Margo has a compelling story to tell.
1. You have a master’s degree in storytelling and a background in medical technology and research. How has this influenced your work on the Savvy Patient’s Toolkit?
It’s been an interesting journey. I did my internship at Mary Hitchcock Hospital, with classes at Dartmouth Medical School with the second year medical students, attended classes at MIT in systems thinking, worked as a medical technologist, worked in the virus research program at Yale, and have worked as a total quality & knowledge management trainer & consultant. When I retired from the workforce in 2000, I decided to get a master’s degree in storytelling. Medicine has been an interest all my life.
Over the years, I’ve survived three medical errors and cancer. My medical background plus the health issues I’ve had to deal with kept me involved in the field. In 2003 my husband was diagnosed with kidney failure and due to missed diagnoses we were told he might not live through the night. The first form for the book came into my head that night. If I’d been advocating for him at his appointments he probably wouldn’t have ended up in kidney failure. I continued to develop forms as I advocated for him and an elderly neighbor and the book evolved from there.
I was just finishing the storytelling degree and it occurred to me that every time we go to the doctor we’re telling a story. How we tell that story and what we include has a major impact on the health care we receive. Studies show that the doctor will interrupt us in the first 18 seconds of our appointment because they are used to getting information from patients in a way that’s not useful, so they start asking their basic seven questions.
Studies show in the first 20 seconds 85% of diagnoses are made. The first words to come out of the patient’s mouth and the way they present themselves make all the difference in the world. We found over time that we were actually changing the way our doctors were interacting with us – they weren’t interrupting anymore and we could tell our stories in the right order with most of information they needed. They were then able to think more and look at more options regarding the diagnosis. They were asking us better questions and we in turn were able to give them better information because we had it all at our fingertips.
What we’ve done is created a system to help the patient connect the different parts of their story, tell their story more effectively, prevent the interruptions, and present that information back to the doctor in a way that he can really help the patient more effectively.
2. What are the greatest challenges facing patients in the health care environment that we have today?
We all know the whole system is broken and we know that different people are doing different things to try to fix it. One challenge is if everybody suddenly becomes insured there’s going to be a doctor shortage because we’re going to have so many more patients seeking care.
I think one of the biggest challenges that people have that they don’t realize is the challenge of becoming a savvy patient. If they don’t manage their own care, their care will be substandard regardless of what is coming down the road regarding insurance.
People don’t have the awareness of the importance of being involved in their care in order get the care they need. Until people realize that they’re part of the system and they have a part to play, the system will always remain broken for them.
Doctors can only do what they can do with the information that they’re given. Lots of time the patient has the missing pieces that would lead to a timely diagnosis and they don’t even realize that a particular symptom that they or another family member has is even related to what they’ve got, so they don’t tell the doctor about it. They don’t have the knowledge to be able to connect things.
3. A recent CDC study found that the average amount of time a patient spends with a doctor is 22 minutes. How can the patient and the doctor make the most effective use of that time?
The patient deciding to get involved in their healthcare, being very knowledgeable and learning how to tell their story will make a huge difference from the patient’s side. They have the capability to set the tone for the appointment. Patients don’t realize that the doctor is a paid consultant and that we should be leading that appointment. The doctor is there to diagnose and act as an educator and consultant to us but we need to learn to be the leaders and coordinators of our healthcare team.
On the doctor’s side they need to be very good listeners and some aren’t. They should not assume that the patient doesn’t want to learn. In the past, doctors have been put upon a pedestal and looked at their patients as if they don’t know anything about medicine, so they assumed that there were a lot of things they didn’t need to tell them.
If doctors would meet people as equals with equal respect and put themselves in more of a role as an educator, they would find that a lot of patients would get a lot more engaged in their care. I know the doctors get very frustrated because a lot of patients seem not to care; it seems all they want is a pill and to go home. But they could reach more people by the way they interact with the patient.
4. If someone were about to undergo a complicated procedure like a heart bypass, what advice would you give that person?
I have a critical question series that I’ve developed so that patients have most of the questions they should ask at their fingertips. If the doctor tells them something, they can flip open to the page and have the questions right in front of them.
Examples of questions to ask when told you need surgery are: what are the risks and benefits? Is it a short-term fix and do the benefits outweigh the risks? How will my other health conditions affect my surgery, the anesthesia, the recovery time or the overall risk? How do the risks of the surgery compared to the risk of any potential alternatives?
When you are asking your questions in the context of the surgery the doctor usually is willing to answer the questions. If the doctor is not willing to answer the questions, I wouldn’t want them to do the surgery on me.
5. How does your system fit in with the new electronic medical record systems being developed?
I see them interacting very well. Having just moved here to North Carolina, every doctor that we have met with since we came here is just blown away. When we leave our first appointments they have our complete medical history – the details they need to know about our chronic conditions, our family medical history, medications and more- they have everything they need to know about us and they say, “I wish all my patients would come with this kind of information.”
I’ve been involved with the nonprofit CareSpark, as well as a national team providing the customer’s perspective on a medical record system. So, I have a very good insight into what is being done and what the challenges are with electronic medical record systems.
One of my biggest concerns is that the patients are going to think that everything the doctor needs to know about them is going to be in that system, so they’re going to be more likely to think that they can be less involved with their care. Going to the doctor even less prepared than they are now – to me that’s the biggest disadvantage.
The medical record system is going to be as good as the information that’s put into it and as good as the way the doctors use it. All of a patient’s information will not be right in front of the doctor when he comes in to see you. Is he going to have time to go through your entire medical records before your appointment? Of course not. Is he going to have time during the appointment to be able to access all the details of your information? Absolutely not. The onus is still going to be on the patient to remind the doctor of their medical history, their family medical history, the medications they take and so on and be knowledgeable enough to help tie the pieces of his story.
It’s going to be a double-edged sword. The biggest benefit is that it’s going to give the doctors the basic information they need and provide missing items such as test results ordered by other physicians. It is not going to be the panacea that will fix all the problems of the medical system, which is what it’s being touted as.
6. Do you see any changes in terms of education in the way doctors and nurses are going to be trained with respect to patient care?
It’s my understanding that the medical schools now have gone toward more effective communication and listening skills than they did when I was younger and the medical schools trained the doctors more as technicians, like a car mechanic, in the technical aspects of being a doctor. They didn’t worry too much about interpersonal relationships but I know there’s been a lot more emphasis on that.
7. What kind of changes do you see that will directly impact patients during the next couple years?
As mentioned before, the biggest one that I see is the impact if we have some type of universal health care. If everybody is covered by insurance we’re going to have a tremendous shortage of doctors and difficulties getting appointments and tests. We just don’t have the infrastructure to support a flood of people who haven’t been in the mainstream system. The good part of that is that people will be insured.
8. If you could use just three words to describe yourself, what would they be?
Ambitious, tenacious and passionate.
9. If you could wave a magic wand what would you wish for?
When I meet people and show them this [the Savvy Patient Toolkit], they say, “This is unbelievable, this is great, this is exactly what we need.” I would really like to spread the word.
The second edition of the Savvy Patient Toolkit came out last year. Last fall I also developed the Savvy Patient School, and this January I started offering audio recordings of the class. They are on my website. It’s about an 8-hour audio course with eight modules. People pay and have lifetime access to the course; they can go in and listen at their convenience.
10. Is there anything else you would like to share with our readers?
I wrote this book for people with chronic conditions and for those who are caregivers either for children or for an elderly parent who really is having difficulty with Alzheimer’s or just can no longer care for themselves.
The one thing that most people don’t do is take someone to their doctor’s appointments with them. An advocate is one who accompanies people to their doctors’ appointments, helps them and is with them when they’re in the hospital.
One of the most useful forms in the book is the Provider Consultation Form. The advocate would have that form on in their lap and would be prepped so they would know what the patient wants to talk about, the questions they want to ask. They can act as a prompter during the appointment if the patient forgets. This frees the patient to totally concentrate on interacting effectively with the doctor. The advocate takes notes. My husband and I do this for each other and it’s been very very effective. Studies show that you forget 50% of everything that was said in an appointment the minute you walk out the door. With appropriate documentation, the patient will be able to access details of appointments to refresh their memory and answer questions from other caregivers.
Learn more about the Savvy Patient’s Toolkit and the Savvy Patient School by clicking on the links below. Your purchase through the links below helps to support this blog.