The Patient-Doctor Relationship in Family Practice

In the office of my family practice, hidden from the view of patients, is a sign along the edge of the counter for my staff to see each day. “Treat every patient like family.”

It’s at the heart of our daily work: to give every individual the care and consideration we would want for a best friend or family member.

If you’re seeing unfamiliar healthcare providers and worry that they may have rushed to the wrong diagnosis, ask two questions. What else could it be? What’s the worse thing it could be?

This may open clinical minds prematurely closed with the pressure of time.

If you’re not sure about the management of your concern, ask, “What would you recommend to your mother (brother or child)?”

This might remind the healthcare provider what should be obvious – that you are a precious individual – someone else’s best friend and loved one.

I remember the moment I knew I wanted to be a doctor.

I was in grade 6 and hospitalized for a painful flare up of rheumatoid arthritis. On the pediatric ward of Burnaby Hospital, I felt that the caring nurses and doctors were treating me as a whole person and not just my condition, and I knew I wanted to do this work when I grew up.

The doctors seemed to have the easier job and it seemed that everything the doctors ever told me I had already read about in my family’s medical encyclopedia. That’s how I chose medicine.

I chose family practice though I considered paediatrics, obstetrics and psychiatry.

Family practice is a unique specialty. We don’t treat particular diseases or organ systems for a limited period of time. Rather we treat the whole person over many years. The family doctor sees the medical condition only in the context of the rest of the individual’s life including their important relationships.

I expected it to be a more satisfying calling, nurturing my relationship with each patient over time while working together in attending to that individual’s wellbeing. Guiding and advocating for my patients through health, illness, the ups and downs of their personal lives, we earn trust and confidence over many years.

I spend many hours each week counselling my patients through the challenging times in their lives. My clinic and sleep schedules are still interrupted by the delivery of babies. It is gratifying guiding patients I have known for years through the most exciting times in their lives: pregnancy, childbirth and the adventure of parenthood.

Family doctors specialize in the care of you, the whole person in the context of your life and relationships over a lifetime.

At 7 pm on Monday, April 29th, I’ll be presenting, “The Patient-Doctor Relationship: Getting the Most Out of Every Visit” at the Bob Prittie (Edmonds) Branch of the Burnaby Public Library. This free talk is part of the Burnaby Division of Family Practice’s Empowering Patients public health education series. I’ll discuss tips on how to work with your doctor to achieve your goals, the key information you need to know about every prescription, test and treatment, what you should know about your medical history, and the key screening tests adults should have at different ages. As space is limited, please register online bpl.bc.ca, at any BPL information desk or by phoning 604-436-5400.

Dr. Davidicus Wong is a family physician. His Healthwise Column appears regularly in this paper. For more on achieving your positive potential in life, read his blog at davidicuswong.wordpress.com.

Your Brain on Emotions

Your amazing brain is the product of evolution but still contains the vestiges of more primitive species.

The brainstem reflects the reptilian brain that is mainly concerned with survival. The midbrain or early mammalian brain is emotional, and the cerebral cortex represent the higher primate brain from which we can plan, reflect and manage our emotional states.

When life and limb are threatened, the reptilian brain takes over.

When we are overwhelmed by emotions, such as anger, anxiety or depression, our normal rational thinking is restricted and our thoughts both reflect and perpetuate our emotional state.

For example, when angered, our thoughts obsess with how we have been threatened, insulted or harmed. It is much easier to see the negative aspects of the other person than our connection to them. If we continue this line of thinking, our anger continues to brew.

When we are overwhelmed with anxiety, our minds exaggerate the enormity of the challenges we face and minimize our strengths and resources. We may start thinking that we are going to die, fail or lose control when our rational minds know we really can manage.

When our brain is shaded by depression, we may only see the negative aspects of our reality. The triad of depressed thinking includes negative thoughts about our selves, our situation and the future.

We can move out of a depressed state by thinking about the very opposite – our personal strengths and accomplishments, the positive aspects of our situation and the people in our lives, and the positive potential of the future.

In Homer’s Iliad, the Sirens’ irresistible singing would lure sailors to their deaths as their ships crashed onto the rocky shores. Odysseus wanted to hear their beautiful songs without destroying his ship, so he commanded his crew to tie him to the mast and cover their own ears, ignoring his commands when he was in an altered mental state.

We could all use an Odysseus app – in our brains or smartphones – when we are overwhelmed by difficult situations and our emotional states. At those times, we need to see our reality from the perspective of our more rational and compassionate minds – the cerebral cortex.

From this perspective, we accept those aspects of our situation over which we have no control while recognizing what aspects we can positively change. What are the positive aspects of this situation? What resources do we have? In what other areas of life are things going well?

At these times, we need to be reminded of our personal strengths, our greatest goals and values, our connection to others, our best relationships, and the likelihood of a positive future.

This is when we can call upon special family members and best friends who can bring us back and remind us of who we really are and how we are loved, bring us to our senses and shine a fresh light on our perspective.

In an upcoming column, I’ll talk about what you can do when you can’t speak to a friend when you need one: what to pack in your emotional first aid kit.

Dr Davidicus Wong is a family physician in Burnaby, British Columbia. His Healthwise columns appear regularly in the Vancouver Courier, Burnaby Now, Royal City Record and Richmond News.

What You Need to Know About High Blood Pressure

Tommy Douglas Library

Thursday, October 4

7:00 pm to 8:30 pm

Dr. Davidicus Wong, popular Burnaby family doctor and Burnaby Now columnist, will present a talk on high blood pressure.

Dr. Wong will cover the following topics:

• What is hypertension (high blood pressure) and how is it a silent cause of heart attacks and strokes?
• Are you at risk?
• What can you do to prevent high blood pressure?
• What do you need to know to effectively manage your blood pressure and remain healthy?

This free presentation is provided by Burnaby Public Library in collaboration with the Burnaby Divisions of Family Practice.

Free, but seating is limited. Please register by phone at: 604-522-3971, in-person, or online.

If you cannot attend the program, please contact the Library so someone else can have your spot. Thank you.

What you need to know about high blood pressure

On Monday, August 21st at 7 pm, I’m presenting “What You Need to Know About High Blood Pressure” at the Tommy Douglas Metrotown Library in Burnaby. This free presentation is sponsored by the Burnaby Division of Family Practice and the Burnaby Public Library. Because seating is limited, please register by phone at 604-436-5400, in person at any branch or online at http:// http://bpl.bc.ca/events/what-you-should-know-about-high-blood-pressure-0

Do you have high blood pressure?

If you’re an adult, you have a one in five chance, and your lifetime risk for developing hypertension is 90%. Your risk may be even higher if you have a family history of high blood pressure, heart disease, kidney failure or strokes.

Blood pressure is the measurement of the pressure of blood inside your blood vessels, specifically, the brachial artery of the upper arm. A normal blood pressure of 120/80 (“120 over 80”) represents a systolic pressure of 120 mm Hg (when the heart contracts) and a diastolic pressure of 80 (when the heart relaxes).

But blood pressure is more than just a number.

High blood pressure damages the delicate inner walls of arteries throughout the body, including the kidneys, brain, heart, eyes and extremities. Over time, it contributes to atherosclerosis (narrowing of arteries), manifested as progressive kidney failure, loss of circulation to your feet and legs, dementia, loss of vision, erectile dysfunction, heart failure (weakness in the pumping of the heart) and angina (chest pain due to impaired circulation to the heart muscle).

The catastrophic end results are premature heart attacks, strokes, blindness, kidney failure requiring dialysis, amputations of toes and feet, aneurysms (the expansion and rupture of blood vessels in the chest, abdomen or brain) and end stage heart failure.

Unless you have it measured, you won’t know your blood pressure. Most people with high blood pressure feel perfectly fine. That’s why it’s recommended that all adults have their blood pressure measured “at appropriate medical visits.” I recommend at least once a year.

High blood pressure may be caused by medical conditions such as kidney disease or an overactive thyroid, by medications including ibuprofen or an unhealthy lifestyle; however, 95% of people with high blood pressure have essential hypertension that is often genetic. Blood pressure also increases with age.

White coat syndrome is a real condition wherein a person’s blood pressure is much higher when taken by a doctor or nurse than at home. For this reason, many clinics now rely on automated office blood pressure machines. The operator sets it up, leaves the room and allows the machine to take three measurements. I ask my patients to measure and record their home blood pressures with a reliable machine (that we compare to our office equipment).

If blood pressure is never high at home or work, we don’t prescribe medications. However, some people have significant rises in their blood pressures with stressful situations, including their work. If the blood pressure is high at least 8 hours/day (i.e. at work) in addition to the medical clinic, it should be treated.

I coined the term “White Collar Syndrome” when I discovered that my patient – an accountant – had the highest pressures when he was at work.

As a physician, I want my patients to maintain safe blood pressure levels and avoid long-term complications. Medications have a potent effect in lowering blood pressure but they are not addictive and don’t make the body dependent any more than before they are started.

I have many patients who have been able to reduce the doses and numbers of medications they take through major lifestyle changes. Some now have normal blood pressures without any drugs.

These potent lifestyle changes include quitting smoking, limiting or stopping alcohol, increased physical activity, weight loss (if overweight), eating more fruits and vegetables and less red meat, and limiting sodium (salt) in the diet.

On Monday, August 21st at 7 pm, I’m presenting “What You Need to Know About High Blood Pressure” at the Tommy Douglas Metrotown Library in Burnaby. This free presentation is sponsored by the Burnaby Division of Family Practice and the Burnaby Public Library. Because seating is limited, please register by phone at 604-436-5400, in person at any branch or online at http:// http://bpl.bc.ca/events/what-you-should-know-about-high-blood-pressure-0

Dr. Davidicus Wong is a family physician. To learn more about upcoming health education events, see the BDFP website at divisionsbc.ca/burnaby.

The long term relationship that’s vital to your heart . . . and every other organ in your body

During the month of Valentine’s Day, many of us think about our most significant relationships. Young couples think about grand and romantic ways they’ll express their passion; married couples think about the money they’ll save by dining at home.

But the relationships that are more often taken for granted are those you share with your physicians, and of course, the most significant of these is your relationship with your family doctor – a long term relationship that’s important not only for your heart, but every other organ of your body and your wellbeing as a whole.

It is my relationships with individual patients that originally drew me to family practice. The practice of medicine can become cold and clinical without the emphasis on the human connection. Nothing can match the potential depth and breadth of the patient-family doctor relationship.

As physicians, we must earn our patients’ confidence – to trust us to keep private their medical history, their deepest secrets and their greatest values and to have the faith that we will be their advocates and do our best for them.

In exchange, we are privileged with the sharing of our patients’ personal stories – the good and bad things they may have done, the great and awful things they have lived through and how they make sense of it all.

Over the years, we become a part of our patients’ stories. Sometimes, life can be overwhelming and each of us could lose our sense of control. When we feel helpless, we feel anxious. When we feel hopeless, we feel depressed.

When needed, physicians can help shape patients’ stories with more positive, empowering perspectives. Though patients may present a number of problems, I encourage them to verbalize and visualize their goals.

One of the greatest gifts I can give to patients who see themselves as hapless victims of bad luck, relationships and health is the transforming perspective that they can be agents of positive change in their own lives.

Though we may not have chosen the canvas of our lives nor the colours on our palette, we can choose how we see this life and what we will create with it.

On Tuesday, February 16^th at 7 pm, I’ll be speaking at the Metrotown branch of the Burnaby Public Library on “The Patient-Doctor Relationship: making the most of the every medical visit.” I’ll offer some tips on improving communication and working together to achieve your personal goals. I’ll cover the key information you should know about medications and other treatments and the key screening tests we need at different stages of our lives. For more information, please phone the Metrotown branch at (604) 436-5400 or register online at http://www.bpl.bc.ca/events.

Empowering Patients with Knowledge

When you think about the work of your family physician, you probably envision the one-on-one care he or she gives to each individual patient. It may be a clinic, hospital or – more rarely – home visit.

That still remains the priority of virtually every family physician: the wellbeing of every patient in his or her practice, but you might be surprised to hear that the circle of care is expanding. More physicians in our community care about the health of the entire community.

The Burnaby Division of Family Practice is a non-profit organization founded in 2011 and funded by the General Practices Services Committee. Its members are the family physicians who serve our community.

With the other founding board members, I wrote our organization’s vision and mission statements. Our vision for the Burnaby community: patients and physicians achieving health and happiness. Our mission: to engage, support and mobilize family physicians in co-creating a network that will support the wellbeing of all members of the Burnaby community.

Although I’ve recently stepped down from the board of directors, I continue to lead the Burnaby Division’s Empowering Patients public health education program. Recognizing that the public receives confusing and often incorrect medical information from the media, we sought to provide unbiased information

Our vision is that by raising general health literacy (public knowledge about healthy living and how best to use the healthcare system), we can improve the health of our community. We may be able to reduce the burden of chronic disease in the future.

Since we started the public education program in October 2014, we’ve delivered 11 public presentations in our community’s libraries, schools and community centres. The topics have included healthy eating, healthy relationships, emotional wellness, healthy physical activity, patient-doctor communication, making the most of your hospital stay, medical ethics and common chronic health conditions, such as diabetes.

Summaries of each of these presentations is available on the Burnaby Division of Family Practice’s website https://www.divisionsbc.ca/burnaby/empoweringpatients. There you will also find the dates for future talks in the series and links to our videos on emotional wellbeing, making the most of a hospital stay and important symptoms for which you should seek medical care.

I’ll be speaking on “Making Sense of Symptoms and Screening Tests” at 7 pm on Tuesday, December 8th at the McGill Library on 4595 Albert Street in North Burnaby. Growing up in North Burnaby, this was my “home library” close to the Eileen Dailly Pool and the Confederation Community Centre. I’ll go over the “review of systems”, the questions that physicians include in a complete physical examination. Because no one gets routine physicals anymore, most people are never asked these questions about the symptoms that may indicate important medical conditions.

When patients receive episodic care at drop-in clinics, they may not be aware of what tests they should be having and when. For this reason, I’ll also review the key screening tests that are recommended at different ages.

To register for this free talk, please contact the McGill library at (604) 299-8955 or http://www.bpl.bc.ca/events

The Power to Change Your Brain

Instead of buying a new computer or smart phone when your old one can’t keep up with your needs, wouldn’t it be great if it had the limitless ability to upgrade its own hardware and software to meet the demands of the moment?

Your own brain already has this ability.

At birth, we are born with approximately 86 billion neurons and as they die, one by one, they are not replaced.

This has lead to the common assumption that our brains and therefore our capacity for thinking and remembering decline throughout adulthood. Associated with this assumption is the belief that we are less capable of change as we age. That’s the way the majority of adults think and behave. With time, we get stuck in habits of behaviour and thought; it gets harder to change our routine and how we see ourselves.

Although the actual of number of neurons (nerve cells) does not increase with age, up to adulthood, the human brain can increase to five times its size at birth. The increase in volume is due to myelination (the outer insulation of nerve fibres) and the growth of connections (or synapses) between neurons.

The principle of “use it or lose it” applies to your brain as well as your body. We know muscles that aren’t challenged will atrophy and become weaker. If we don’t move through a full range of motion, we become stiff, and if we limit our activity, we lose our agility and balance.

How your brain adapts and evolves over a lifetime, depends on how you use it because the brain is capable of creating new synapses (connections between neurons) at any age. Frequently used connections are reinforced and become stronger and more efficient. Seldom used connections are lost.

This creates habits of thought, which beget habits of behaviour and habits of feeling.

If we reinforce habits of drinking, smoking or using drugs when we are stressed or in response to particular situations, those habits become more entrenched over time as we strengthen the corresponding synaptic connections.

But if we stop the cycle, try out a new and healthier pattern of behaviour, and repeat that pattern repeatedly over time, we can reinforce an alternate neural pathway. The more we travel along this new connection of neurons, the more we strengthen the synapses until we have adopted the new and healthier habit.

The same principle applies to how we think about our selves, others and our world. It’s simpler and more efficient to hold onto assumptions and beliefs about others and our world, but too often it doesn’t keep up with the reality of change.

If we think of ourselves as being stuck in our ways, addicted to our attachments or incapable of positive change, we will live this self-fulfilling prophecy. Too often we limit our capacity for growth and happiness by our prejudices and unexamined assumptions; we see only evidence to reinforce our beliefs and are blind to evidence that show them to be false.

Certain patterns of thought reinforce particular emotional states, and once in these states, those patterns are reinforced. Thoughts focussed on negativity, judgment, blame and hopelessness reinforce feelings of anger and sadness. Thoughts of appreciation, personal empowerment and a positive purpose beget happiness.

With a healthy brain that can literally change itself, each of us is capable of positive change. Which free upgrades will you choose?

At 7 pm on Tuesday, September 22^nd, I’ll be speaking on Emotional Wellness at the Bob Prittie Metrotown Library in Burnaby. I’ll talk about the key emotional health skills we all need to cope with life’s ups and downs; managing stress, difficult thoughts and feelings; recognizing the symptoms of stress, anxiety, depression, mood and other psychological conditions; and where to find help.

This free presentation is provided by the Burnaby Public Library in collaboration with the Burnaby Division of Family Practice as part of our Empowering Patients public health education series. As space is limited, please register by calling (604) 436-5400 or online http://bpl.bc.ca/events/emotional-wellness

What you need to know about confidentiality and your doctor

Confidentiality is crucial to the patient-doctor relationship.

Without the assurance that whatever you tell your physician will be kept confidential, there would be no trust, and you would hold back important information that your physician may need to give you the best care and most appropriate advice.

In turn, your physician trusts that you provide all the information needed to understand your situation and make a correct diagnosis.

Physicians are taught to accept without judgment all that their patients share, including excessive drinking, smoking, the use of recreational drugs and other risky behaviour. Of course, we are rooting for them to make the best choices for their health and prepared to offer support for them to make positive changes.

Be aware however, that our profession requires us to appropriately document all important information even if you would prefer it to be “off the record.” Your medical record must be complete.

Doctors cannot reliably remember everything you tell them, and information about your history and habits impact on your risk for potentially dangerous drug interactions and serious conditions such as sleep apnea, hypertensive crises, strokes, cardiac arrhythmias and heart attacks.

In your usual medical care, who else may see some parts of your medical record?

The nurses or medical office assistants who assist your physician may access your records but are also well versed in confidentiality. They will look at those portions of your record necessary for them to perform their work. If a family member inquires on the nature of your recent visit, they will not disclose any information without your permission. In fact, they understand that they cannot even confirm with parents the recent appointments made by mature teens.

When teens are capable of making their own health decisions, doctors should have a frank discussion with the family clarifying respect for the mature child’s confidentiality and autonomy. If this is not clear, parents may continue to make inquiries about their teen’s health without permission and teens may attend a walk-in clinic instead of their family physician’s office.

Other physicians who share in your care may have access to a portion of your records. This includes the physicians who belong in your doctor’s call group, doctors who are covering when your doctor is away from the office and specialists to whom your doctor refers you.

When you are injured in a car accident or applying for insurance, you may sign a consent for the release of your medical records. You should read carefully and ensure that you understand what information has been requested.

If you are injured at work and have a Worksafe claim. Medical information pertaining to this may be released to Worksafe. The same applies to ICBC claims.

There are two cases where confidentiality may be breached without your consent. If you were suicidal or homicidal – at real risk of harming yourself or others, your physician may inform others (e.g. police, family, psychiatrists) in order to protect the life of yourself or another. The other exception is a court order – where a physician is required by law to produce your medical records.

With these facts in mind, you can trust that your physician will respect your confidentiality, and you may share crucial information about your health with confidence.

On Monday, June 2nd, I’ll be speaking at the Metrotown branch of the Burnaby Public Library on “The Patient-Doctor Relationship: making the most of each visit with your family doctor.” For more information, please phone the Metrotown branch at (604) 436-5400 or register online at http://www.bpl.bc.ca/events.

Dr. Davidicus Wong is a family physician at PrimeCare Medical. His Healthwise column appears regularly in Now newspapers and the Vancouver Courier. 

 

The Gift of Words (Part 2 of 2)

My childhood hours spent lost in reading in the Burnaby Public Library, changed my life.

I would later discover the enduring value of perspective shifting and empathy – in my personal life, in my role as a father and in my vocation as a physician.

Today, having taken formal courses in cognitive therapy, I teach my patients to manage their worries, frustrations and sadness by trying on different perspectives. We can learn to transform how we feel by challenging our beliefs, questioning our assumptions and changing how we think.

Empathy has helped me see my patients’ health within the context of their whole lives and how they experience them. It has helped me understand how they cope with illness, injury, loss and chronic conditions.

My childhood home was filled with words. My parents had many magazine subscriptions, including The Reader’s Digest, National Geographic, Children’s Digest and just about every women’s magazine in the 70s and 80s. We all read the newspaper daily.

There were books in every room. In fact, we had a dictionary beside the kitchen table that we referred to regularly to settle disagreements about a words spelling, meaning or usage. When I think back, I can’t recall any vantage point in our home from which I would not see a book.

My life was so enriched by books – the shared perspective of many writers and, on a number of occasions, transformed by great books.

As a child, I hoped that one day I could do the same for others – that through words, I could bring inspiration, comfort, hope and a new perspective to someone else.

The Gift of Words (part 1 of 2

Growing up in North Burnaby, I would go to the McGill library every week with my mom and, like her, I would borrow a dozen books at a time. The library was a door to another dimension – a greater universe.

Each book – fiction or nonfiction – was a window to another world of knowledge and experience. In great fiction, I would assume the perspectives of the characters and see different worlds through the lenses of others’ eyes.

I didn’t realize it at the time but what I learned in reading widely and voraciously enriched the networking of ideas in my own mind. Over time, this helped me see connections, patterns and analogies in my personal life and in the greater world.

Concepts in one field of knowledge could be applied to other quite disparate fields. For example, some of the concepts in the business classic From Good to Great would prove relevant in guiding a young person in finding their personal, spiritual or vocational calling.

The principles and techniques of mindfulness meditation, most closely associated with Buddhism, have practical relevance to human psychology and medicine. They are now recognized as beneficial in mainstream medicine.

Immersion in the great works of fiction not only gave me a taste of other places, eras and cultures but also new perspectives on my own life. I wasn’t just being entertained and learning facts. I was learning cognitive and emotional flexibility. I was discovering how to look at my world from multiple angles. I was also learning empathy.

Next: How childhood reading influences life today.