Let’s Be Honest: Building Trust with Your Doctor

Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts, Dr. Rajay Seudath and former television broadcaster Gina Galaviz, will share information to improve your health and wellbeing. And now here are Gina Galaviz and Dr. Rajay Seudath.

GINA GALAVIZ EISENBERG
Welcome to the award-winning Docs in a Pod, presented by WellMed. I'm your host, Gina Galaviz Eisenberg. Ron Aaron is on special assignment today. I'm so pleased to have you with us today on Docs in a Pod. Our program is available on podcast wherever you get your podcasts and we're on the radio in several Texas cities and Florida as well. Each week we're going to talk about a variety of health and wellness issues that impact Medicare-eligible seniors and others. So, welcome to Docs in a Pod and our co-host, Dr. Rajay Seudath.

DR. RAJAY SEUDATH
Hey.

GINA GALAVIZ EISENBERG
Hello, hello. You're here. This is one topic that you're pretty excited about.

DR. RAJAY SEUDATH
Yes. In between the scenes, I was rip, rearing to go.

GINA GALAVIZ EISENBERG
This is like your tell-all without the names, of course. All right. So, let's talk a little bit about Dr. Seudath. He's a board certified family medicine physician. He's a Tampa native and currently a physician for Optum. He's at the university location in Tampa. He received his medical degree from the University of South Florida Morsani College of Medicine, and he's got a passion for primary care and for guiding his patients to meet their health care goals while maintaining their values. Before his career in medicine, he's had many jobs, but working as an English teacher abroad was the inspiration that led you to the field of medicine. That's terrific. What was it? What was it exactly that drove you to medicine?

DR. RAJAY SEUDATH
In Japan, I taught ages all the way from preschool to senior centers. It was just that spectrum of different people, different stages of learning, different levels of proficiency in learning English and teaching English, that just translated so well to medicine.Ê

GINA GALAVIZ EISENBERG
Right. Also, about health and medical history or health literacy, right?

DR. RAJAY SEUDATH
Yes.

GINA GALAVIZ EISENBERG
So important. Well, all right. We'll talk a little bit more in just a second. Being honest with your health care provider. Now I'm sure all your patients will come in and just tell you everything as it is, right? But it helps you as a doctor to make informed decisions about their care. It also can help build trust with your doctor. Especially if you're an active participant. Telling all why you're there is so important. Our guest today, Dr. Amber Stephens, is here to help us understand why honesty is the best policy when talking to your PCP. Thanks for joining us here today. Before you start, I'm going to just toot your horn just a little bit. You're a board certified family medicine doctor. You earned your medical degree from Drexel University College of Medicine in Philadelphia, Pennsylvania. You completed your residency at Bayfront Family Medicine in St. Petersburg, Florida. You're also affiliated with Optum, the main clinic. You're married. You have two boys, a 12-year-old and a 7-year-old. Two dogs, one cat, a bearded dragon and drum roll please, 130 snakes. You love being a baseball mom and you do a lot of media education presentations for Optum. So, of all your patients, what's the percentage of them that are actually telling you what's really happening?Ê

DR. AMBER STEPHENS
I think the more established a patient gets with you and the longer they're your patient, the more honest they are and the more comfortable they are sharing things about their lives. I think, and probably Dr. Seudath can say this too, is that, when you're first getting to know a patient and that initial visit, you're kind of going through their paperwork. You're trying to get the details. Some people are very comfortable with telling you past histories. Our patient population that we see is mostly kind of geriatric. So, we're getting some of those sixties baby boomers. Some of them were more honest than others about what they did back then. As time goes on and you start talking to people and you've seen them over and over again, sometimes things will come up. I think even more so, there's things that they may not even realize they're omitting that would be helpful. So, there's things like family history. They go, oh, well, I didn't know that was important. Well, yeah, it kind of is, and it does make a difference in what I'm doing. I don't know if that's so much a patient bias or a questioning bias on our end. People interpret our paperwork however they're going to interpret it. When you're going through family history and past medical histories and, what surgeries have you had? What hospitalizations have you been in? I can't tell you how many times I've had women tell me. I say, you've never had any surgeries at all? You've never had anesthesia? Oh, well, I had a hysterectomy, but like everyone had a hysterectomy and they just totally left it off the history because they just assumed that because they were of a certain age, I would assume they've had a hysterectomy. That kind of stuff, tonsils, adenoids, gallbladder, appendix, that stuff gets forgotten all the time. I don't want to say that people intentionally lie because I don't think that's the case. Most of the time, I think it's more of omission without realizing that it's going to be a problem. Occasionally, you'll get someone whoÕs not comfortable yet enough with you to share that they used to have a nice little cocaine history.

GINA GALAVIZ EISENBERG
Right.

DR. AMBER STEPHENS
One person that was worried about insurance, this was several years ago, who failed to tell me she had a history of ulcerative colitis until one day she had to admit that she did because she showed up pooping blood. So, those are the kinds of things that I think about. I think most people it's not that they're trying to be deceptive or lying, it's that they're not sure what information you really need. Maybe they assume you don't need something that you really do.

GINA GALAVIZ EISENBERG
So, it's honestly the best policy with your PCP. We're going to continue that discussion in just a moment, but if you've just tuned in, you're listening to the award winning Docs in a Pod with our co-host, Dr. Rajay Seudath. I'm Gina Galaviz Eisenberg and our podcast is available wherever you get your podcasts. Our expert today is Dr. Amber Stephens talking about being honest with your doc. Dr. Seudath, what are some of the topics patients don't really like to talk about? Would you say smoking, drinking?

DR. RAJAY SEUDATH
Yes, the vices. Things that you're not supposed to be doing. They'll try to bend the truth or paint themselves in a more beneficial light. But oftentimes, it can be in the things that they know they're not supposed to have. So, you get diabetics who will lie about how many cupcakes they had. Thanksgiving just went by, how many slices of pie did you have? I did not have any pie, doctor, none whatsoever. Okay, well, how about the cake? Well, I only had two slices of cake. I'm not lying. It's just, you're not necessarily digging for the truth.

GINA GALAVIZ EISENBERG
But you can kind of tell, right? I mean, if they come in and you see the numbers, I mean, it doesn't lie, does it? The facts don't lie.

DR. RAJAY SEUDATH
Yes. That's correct. You could tell me, doc, I've been eating one meal a day. I'm not eating any carbs. It's only beef broth and spinach and your A1C went from 7 to 13. I can tell there's something you're putting into your body that is a carb.Ê

GINA GALAVIZ EISENBERG
Yes.

DR. RAJAY SEUDATH
They may not realize it, but there are some people who are ashamed. Part of that is working with your provider to have that trust. A lot of times when I first meet patients and I know their numbers are bad and they know their numbers are bad, they say, you're really going to yell at me. Or, oh, you're going to be so mad at me. I get the sense that maybe their previous provider yelled at them, maybe they berated at them, so they felt they had to lie in order to kind of save their self-respect in order to not get brow-beaten for that. Like Dr. Stephens said, when they've been coming to us for a while, they tend to be more truthful. That's typically because we've shown them that we care. That we're not doing this to make me feel good. I'm doing this to make you feel good.

DR. AMBER STEPHENS
Absolutely. It's not about us.

GINA GALAVIZ EISENBERG
Right. Dr. Stephens, is there a checklist, if you will, that maybe new patients should maybe think about, write some things down before they come see you?Ê

DR. AMBER STEPHENS
Well, I think with a brand-new patient, we're giving them a fairly extensive new patient handout, at least in our office. Then that includes any past medical diagnoses and a lot of stuff that we include with stuff. There are checkboxes. So, maybe things they wouldn't even think about as reminders, triggers for them to remember to say they have. We that includes medical history, our social history. We're going to ask them about smoking and drinking and smokeless tobacco, chewing tobacco, drugs, alcohol. We'll be asking them surgical history, hospitalizations, family history, medications. There are patients that'll come in and they'll say they don't have any medical problems, but then you look at their medication list and they're most obviously a diabetic with high blood pressure and cholesterol.ÊOh, by the way, it looks like maybe at some point in time, they got a cardiac stent done too, because they're on a blood thinner. So, sometimes the medical history, you start putting it together because you see other things that they provided. I think the bigger thing to remember though, as a patient, is when you go in is not to assume that something isn't important. An aisle of patients, they'll be like, why does that matter? And I'll go well, because we're talking about this and in a medical situation, this actually is connected to this, and they don't realize it because it's an educational point. Or, you were saying Dr. Seudath, you had people who would have an A1C that went up really high. Well, I've had patients and they're like, well, I'm not eating any extra carbs. I said, okay, we'll tell me what you eat in a day. They start listing through their meat, and half of what they're eating is carbohydrates but they didn't know it.

GINA GALAVIZ EISENBERG
I'm having pasta.

DR. AMBER STEPHENS
Right. Okay. Well, that's not candy bars, but it's still carbs. So, getting the education points, is a big part of that. I would say don't assume that something isn't important. Overshare versus under share. Most of us have been overshared at some point beyond what we needed, but we're not going to sit there and make the patient feel bad about that. That's not why we're there. We're there to help them. I think probably some of the more dangerous things that people leave out are in our patient population because they're older, they tend to have more arthritis. They have more pain. I do find that sometimes my patients will come in and they'll say, well, I'm just having a lot of pain, and I'm wondering if I can get something for my pain. Then you do a drug screen, and you realize they're already positive for something, and they don't realize that that was going to pop. It turns out that they've been taking their friend's hydrocodone. I don't care what you do. I tell patients, I really don't care if you want to go out and snort cocaine and do marijuana, like, I don't care, but I need to know, because if I give you something that's going to interact with that or cause you to stop breathing because there's a drug interaction, that's a really big deal. Now, on occasion as patients get more comfortable, I will have people come in and be like, well, I don't want it written on my chart, but I've been having a lot of pain in my neighbor down the street let me borrow a Vicodin, and it really helped. It's like, okay, are we going to do that again? No, but okay we can talk about it. I think it is a comforting thing, but also, don't assume that you're going to get yelled at for doing something. I hate to say that people aren't going to get yelled at because some doctors obviously have bedside manners different than what it sounds like we do.

GINA GALAVIZ EISENBERG
Right.

DR. AMBER STEPHENS
Oversharing is always better than under sharing.

GINA GALAVIZ EISENBERG
We're going to talk more about oversharing in just a moment. But we're going to take a short break. I'm Gina Galaviz Eisenberg along with Dr. Rajay Seudath and our guest, Dr. Amber Stephens. We'll be right back.Ê

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GINA GALAVIZ EISENBERG
Thanks so much for staying with us on the award winning Docs in a Pod. I'm Gina Galaviz Eisenberg. Let's continue our discussion on honesty with your PCP. Oversharing and assuming. We can't just assume because a new patient comes in, maybe they're 65, the end of the baby boomers, and we just can't assume that you can tell just by looking at us, everything about us.ÊDon't be grumpy when, as a patient, filling out all the information because that's only going to help you help us.

DR. AMBER STEPHENS
Exactly.

DR. RAJAY SEUDATH
One of the things I do whenever I meet a new patient and they've got that big thick packet in front of them, I always congratulate them. I always say, thank you so much because this is not a five-minute document. This is a 20-minute document. So, thank you so much for going through that. I always make a concerted effort to flip through it with them as I do it. Because one of my pet peeves is I go, and I fill that thing out and the doctor's asking me all these questions and he didn't even open it. And I'm like, if you open it up, you're going to see a lot of those answers in there. So, show them that, yes, I'm validating your efforts. Thank you so much for doing that.

GINA GALAVIZ EISENBERG
Are patients filling that out before we get there? Is that the best thing? Fill it out online so that way you can kind of take a look at it before. That's the importance of that.

DR. RAJAY SEUDATH
Absolutely.

DR. AMBER STEPHENS
Yeah. I think online or in the mail.

GINA GALAVIZ EISENBERG
Or in the mail, too? Okay. So, what are the things that you look for when you're reading through that?

DR. RAJAY SEUDATH
So again, just the histories that they've written down. If there's anything that's a little vague, you know, ah, I've had some back pain, or I think I have diabetes. Those kind of things we're looking to clue in on and make a little more information on, pull that out during the interview. One of the things that I wanted to go through, and I remember this almost as a kid, but there was a campaign, an ad campaign called Questions Are The Answer. I distinctly remember these commercials. There was one, and you can look on YouTube. If you go on YouTube, just type in Questions Are The Answers. There was one, it was a lady, she was in a restaurant, and this waiter comes up and she's just giving him all these rapid-fire questions. She's like, what kind of soup do you have? Oh, it's like a Mug of Tani. She's like, okay, does it have croutons? Does it not have croutons? She's just chitter chatter, chitter chatter. They edit it, so it's so many questions all at once in like a ten second span. And then it cuts to her, she's wearing the gown, she's sitting on the table, and the doctor goes, well, do you have any questions? And she's just like, no, nothing. Then it says questions are the answers. Talk to your doctor. If you have questions, bring them up. That's actually why I was so excited about this is because when I was in med school, I did an international elective in Japan to compare and contrast asking questions over here versus over there. You would think it's a quieter culture. You would think that because they pretty much listen to their doctors. There's not a lot of this mistrust of the medical environment over there. I thought that was because the doctor would just tell them what to do and then they would just do it. But in actually doing it and logging the visits as a first-year medical student and coming and looking at all these questions, they would do what the doctor said, but they would have a lot more questions asked to their provider about that. Not because they were mistrustful of him and they wanted to make sure he was doing a good job, but just that they wanted to have their information brought out. That was one of the things that I remember distinctly was that commercial and that led me to make that project. So, I think any way that you can get around the embarrassment of asking questions or the shyness as a patient yourself, there may be a way you have to change your thinking about it. Oh, well, I've been having this ache or I've been having this issue. It's not that important. That's not what we're here for. Right. Kind of getting past that. This is your time and one of the things that you can do for that is making your own list. That first visit, like you said, what are we looking for that in that first visit? Oh, that's all standard stuff. I love it when patients have their own list or they have their own agenda because when I walk through that door, I've got my agenda. Your A1C is high, blood pressure is high. I don't want you to have a heart attack or stroke. This guy just wants Viagra.

GINA GALAVIZ EISENBERG
Right. ThatÕs why heÕs there.

DR. RAJAY SEUDATH
And we'll do a whole 40-minute visit, and I'm ready to leave. My hand goes on that door handle. Hey, by the way, I've been having some chest pain, and I need some Viagra. That's a conundrum, right? I got chest pain, and I want Viagra. Those are kind of mutually exclusive until we do some testing. So, you having your agenda and making sure we get to your agenda. That's one of the things I say for first persons before we even get into that document and say, I'm Dr. Seudath. Before we enter, before we exit this thing, is there anything that's burning on your mind you want to make sure I go through you make sure I hit before we end this visit. And they'll say, oh yeah, yeah, yeah. You can kind of see their eyes light up like, wow, I really wasn't expecting it I thought you just had to go through this stuff.

GINA GALAVIZ EISENBERG
What if you get a new patient who's just now at that age level and can become a WellMed patient and they're not on any medications and their health is good? I mean, they're going to come in and say, well, really I'm healthy. I'm not on any meds. What are you going to be asking us? I mean, hey, does your father have heart problems? Most patients say, well, there's nothing really wrong with me, but I'm here because I need to be here. Are you trying to set a benchmark then for like years down the line?

DR. AMBER STEPHENS
Definitely. Especially if you have someone that's coming in with almost a blank slate, which I feel like is a very rare situation, but if they are coming in and truly have that blank slate, nothing's really going on, you're just creating your benchmark. You're saying, okay, this is where we're at right now. You're not on any medicines. We're going to get some baseline blood work done. We've gone through your history extensively. I know you've not been in the hospital at all. You haven't had any surgeries, and you didn't do anything you would deem as problematic. I mean, no alcohol history, no smoking, no drugs. So, in those cases, yeah, it's absolutely here's the benchmark. The way we practice medicine at Optum and WellMed is that we want to be the first call for our patients. I make a point to talk to every single patient of mine at their first appointment and say, if you wake up, something's not okay, you feel sick. I don't want you waiting until you've been sick for a week or two to call me. I want you to call me on day one because maybe I'll tell you we just need to take a decongestant or something, but I want to have the opportunity to make sure that's all we need to do. I like how you're feeling well, and I want to keep you feeling well, and if we wait and let it progress, it may be something that maybe you think is not a big deal, but it could be something much more dangerous. Then you do end up in the hospital or, you know, oh, I've got a little lump in my groin, and I really don't think a whole lot of it. I think it's just a hernia, but no big deal. Well, you know what? I'd rather deal with that hernia as an outpatient where you're in and out for a surgery than wait until it's trapped and incarcerated and dying and now, you're in the hospital with emergency surgery and you're super sick. So, if something is not normal, I want to know right away. I think that's coming alongside of asking those questions. I'm not going to sit there and say that every patient I've seen along the line has gotten along with me. I don't think that that's the case for any doctor out there. We all have a personality. Obviously, I think if we're doing this topic, then we're probably more likely to be interested in talking to our patients. If you're listening to this podcast and you're thinking, wow, I don't think I could have a conversation like that with my doctor, then find a new doctor. It doesn't mean that your doctor is a bad doctor. It's just that that's not the doctor for you. Just like not every therapist is the right therapist for a patient. There are personalities that mesh better than others. Maybe it's a gender thing. I have some male patients that are really comfortable telling me things that I don't think all male patients would be comfortable telling me things. Same with female patients. A lot of female patients want female doctors. That's okay. I don't feel judged or anything like that because I don't have the parts that make me who I am. We want the best for our patients. We want them to get the best care possible. Feeling comfortable to have those conversations with your doctor is a really big part of that.Ê

DR. RAJAY SEUDATH
Building on what Dr. Stephens, said I don't want you letting this go for ten days, two weeks or something. That kind of brings back to the idea of being honest with your doctor, right? I don't want to cause a fuss, so I'm going to be quiet about it. That's not necessarily lying, but it's not necessarily being forthright.ÊSometimes if I know there's a patient who's like that, I will give them a hard number. IÕll say, if you are sick for three days, you are going to call me. And I give them the leeway. You can do whatever you want on day one when you are sick. You can do whatever you want on day two while you are sick. You can get some voodoo. You can get some black magic. You can rub oil on your ears. You can put some hairspray in it. You can get some Windex. Whatever you want to try, you can try. But if you're still having symptoms by day three, I want to know about it. If it's bad, I want to know on day one or two.

DR. AMBER STEPHENS
Right. Exactly.

DR. RAJAY SEUDATH
I'm not going to come here on day 14 and pull you back from the pearly gates. In some cases, from the lake of fire.

DR. AMBER STEPHENS
I usually tell my patients if you've called me on day 14, we're two weeks into this, and I could have dealt with on day two or three, then you're going to get to see what an upset Dr. Stephens looks like. Because I'm not happy because you're still sick and I couldn't help you.

DR. RAJAY SEUDATH
Absolutely. Another thing is, with our service Optum/WellMed and with other services, there's always a 24-hour on call service. Don't feel that you can't call those people. You've got a doctor; you've got a provider in your pocket 24-7. Utilize that.

GINA GALAVIZ EISENBERG
Use it.

DR. RAJAY SEUDATH
You're paying for this. You're paying for Medicare. It's coming out of your Social Security. Use it.

GINA GALAVIZ EISENBERG
Use it. That'll be our final word because we've run out of time. Thanks so much for joining us today on the award winning Docs in a Pod. Thank you to Dr. Amber Stephens for joining us. I'm Gina Galaviz Eisenberg along with Dr. Rajay Seudath. And this is our last Docs in a Pod for 2024. Thank you so much.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod, presented by WellMed. Be sure and listen next week to Docs in a Pod, presented by WellMed.Ê

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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