QUESTIONS, QUESTIONS...

Studies show that patients don’t often ask their doctors questions about their care during appointments. Maybe they have questions they intend to ask, but they forget. Or they only think of the questions long after the appointment.

Why don’t patients ask questions? It’s not because they understand the information they’ve been given. Multiple studies have established the dismal fact that about 50% of the information given to patients is forgotten immediately, and half of what they do recall is incorrect. Those are averages; the numbers are even lower for patients who are older, have lower literacy levels or are in general less educated.

Doctors and other healthcare providers, for their part, may view this situation in one of two ways. First (and hopefully this rarely happens), “I hope they don’t have any questions,” they may think. “I’m an hour behind schedule as it is.” Secondly, they might be frustrated by the lack of questions. Doctors who have been around the block a few times fully realize the truth of the studies referenced in the preceding paragraph. They’ve seen the evidence first-hand a thousand times. So they may be a little frustrated or disappointed by a lack of questions. They know people need to ask questions and get clarification.

What made the difference for me was thinking about my grandchildren who really depend on me now. Our five-year-old granddaughter with special needs will likely need help all her life, and while I know I won’t be around for all of that, I need to stick around as long as I can to help her as much as I can.

What did I choose? I chose life without some of my favorite foods, or at least with them making up a significantly smaller percentage of my diet. I’ve made attempts before to buy back my health, but I never took the two-pronged approach. I’d go on a diet. Or I’d exercise. Or maybe I would diet a little and walk some, but never in a regularly scheduled way for any length of time. Not long enough to make it a habit. As time passed, the novelty of eating better and trading TV viewing and web browsing for sweating, breathing hard, and feeling sore, wore thin.

I was most successful with the diet part of the equation and most of the credit should go to my wife, who would either find or concoct healthy versions of some of my favorite foods. But she too, would tire of that, especially when she would find out that I cheated on the diet anyway. It got to the point where I’d almost rather tell her that I had cheated on her in a marital way (not really, but that isn’t too far from the truth) than on my diet, such was her disappointment when she would find a Little Debbie zebra cake wrapper in my truck or in the trash. Once she saw that I had lost the will to keep the diet up, she would stop supporting me in it.

Will this time be different? Only time will tell. However, this time I joined a gym and I really got into studying what I needed to change about my eating habits to get back to a healthy (or at least healthier) state of

What I found out was that medicines I take for type 2 diabetes (like Metformin), for example, or medicines others take for diabetes (like insulin) aren’t fixing the real problem, but only compensating. My problem is insulin resistance. What does that mean? The best illustration I heard went something like this: If your father is losing his hearing and keeps turning up the volume on his TV, the louder it gets the worse his hearing will get. Eventually, no volume is loud enough for him. It works the same with our cells. Insulin helps our cells utilize sugar, but with type 2 diabetes our cells start becoming resistant to the insulin. In response the pancreas makes even more insulin in an attempt to get the cells to take in the sugar. This is triggered by higher blood glucose (sugar) levels in our blood that couldn’t get into the cells. It becomes a feedback loop, and our poor pancreas works hard to fix it, but it’s actually making it somewhat worse. The excess sugar goes to fat, and it can end up in your liver to the point that you get fatty liver disease, and that is serious. What causes it? They are not sure, but we do know what can potentially reverse it. That is where my focus will be.

Diet plays a big part in managing type 2 diabetes as it does with many other illnesses and conditions. The CDC says we should avoid foods that will cause our blood sugar to rise to levels that will trigger large dumps of insulin, and that is challenging these days with so many foods having added sugars. My doctor stressed the importance of sufficient fiber in the diet and some leading researchers explained this well. It turns out that fiber isn’t just about getting your waste products moving smoothly through your internal septic system as I had thought. Fiber helps the overall health of the bacteria and other necessary components of good gut health. I was told to

Conversely, a 1994 study discovered that primary care doctors attempted to elicit questions from their patients in only 25% of encounters.

Unfortunately, sometimes the question-seeking doesn’t work as well as it should because of the most (seemingly) insignificant details. “Do you have any questions?” sounds okay on first hearing, but when you compare it to the open-ended, “What questions do you have?” the latter is clearly the better choice. Even so, the tiniest nuance could make or break the moment: if a doctor puts her hand on the exam room doorknob to leave and then turns to ask, “What questions do you have?” she probably shouldn’t expect much.

People on both sides of the stethoscope obviously have to do better. Patients have been told over and over again: write down your questions ahead of time. Be sure to ask them. Write down the answers. And doctors: when patients forget to ask you, ask them. And ask like you mean it.