Shannon Garrett, RN, CHLC, CNN
Thyroid Nation

 

How to Talk to Your Thyroid Doctor

 

 

Like most thyroid and autoimmune patients, it took me a very long time and

several doctor visits before I received an official diagnosis. In my case, it was eight

years and nine doctors before I finally found physician #10, a highly qualified and

compassionate doctor who I credit for saving my life. I was diagnosed not only with

Hashimoto’s thyroiditis, but also celiac disease and pernicious anemia, yay! Prior to

those diagnosed, I had been diagnosed with interstitial cystitis which today is

viewed to be closely linked with autoimmune disease. I was relieved and perplexed

at the same time over my diagnoses after eight years because it validated that I

wasn’t crazy after all, which was how I felt for such a long time as I searched for

answers. It was frustrating to feel so intimidated and mocked by various

healthcare practitioners along the way who missed my diagnoses altogether. As

of today, my autoimmune thyroid disease and interstitial cystitis are in remission

and I feel and look better than I have in years. I discuss my journey in detail in my

eBook Hashimoto’s: Finding Joy in the Journey soon to be released July 2015.

The most important thing in communication is hearing what isn’t said ~ Peter Drucker

Unless you are one of the lucky ones, you have experienced frustration during and

after your doctor’s appointment. I know personally that I have walked away many

times thinking “what the heck just happened”, when the appointment did not go the

way I had expected. You know the routine…the doctor listens to your complaints of

an inability to lose weight or gaining weight, feeling cold all the time, hair falling

out, nails peeling/splitting, constipation, extreme fatigue, muscle & joint pains,

inability to sleep, and more. You’ve shared your most private emotions and

communicated in much the same way you would talk with a trusted friend. The

doctor nods his head, smiles, and steps out leaving you with the impression that

just maybe you’re making headway, only for him or her to return to the exam room

with a prescription for an antidepressant along with a recommendation that you

should exercise more & eat less, and learn to deal with stress! What?? Did this

doctor not hear a word?

 

Well, the short answer is no – the doctor did not really hear you. You see, although

they are supposed to be trained in the art of assessment and patient

communication, our medical system has changed. Doctors have very little time

in their daily schedule and must meet requirements for patient care quotas

making it a challenge to process patient’s verbal reports of symptoms and to listen,

assess, diagnose, and speak, etc. Essentially, the amount of time we as patients

have at best to communicate our issues is less than 10 minutes during the standard

20-minute appointment. When we do not quantify our symptoms or make them

measurable, the physician hears what is perceived to be a situation of depression,

stress or anxiety in our tone and verbiage. Not to defend their shortcomings in not

diagnosing us properly…but they are human and they hear these same sort of

vague symptoms that apply to many health conditions almost continually all day,

every day. It is of utmost importance that we don’t communicate our symptoms

to them in the same way we do our girlfriends!

 

There must be a better way to communicate with my doctor…

I can remember thinking to myself “okay, I am an integrative nurse and thyroid

& autoimmune wellness nurse specialist for goodness sake, and I know how to

talk with doctors professionally in the clinical setting whether it be about

patients or private clients – so why do things change when I’m the patient?

Even though finding the miracle doctor I did, that was only the beginning. Then,

it occurred to me that if I were to use SBAR during my own appointments, we

might begin to see “eye-to-eye” on my issues. It was a win/win for us both!

 

Introducing

 

I want to share with you a cool way to communicate with your thyroid doctor.

SBAR is a unique and simple yet effective form of communication that is

typically reserved only for use by healthcare providers. For example, SBAR is

used when a nurse is calling a physician, when nurses are giving reports

during hand-off and when nurses are transferring patients to other facilities

or other levels of care. It is also used for doctor-to-doctor communication.

SBAR was originally developed by the US Navy as a communication technique

used on nuclear submarines and was introduced into the healthcare setting in

the late 1990s. Since that time SBAR has been adopted by hospitals and

healthcare facilities as the gold standard for standardized communication

between HCPs. Believe it or not, you too can adopt the principles of SBAR to

prepare for your appointment (every time) as a better way to communicate

with your doctor especially for thyroid or autoimmune issues and ultimately get

the care you need and deserve out of your visit. I’ve shadowed some of the best

functional & integrative medicine practitioners out there…and believe me when

I tell you that they are overwhelmed with autoimmune & thyroid patients. One

reason is simply the reality that their time with each patient is limited. Another

reason, as it applies to those of us who have a thyroid disorder as one physician

stated, “thyroid patients carry a lot of baggage.” He did not intend for this to be

derogatory, but rather it was his way of recognizing that we are in fact, very

unique individuals with complex issues and symptom descriptions that are

often ambiguous to them rendering the process somewhat of an obstacle. The

truth is we’re not their typical primary care “in & out” patient for sure, and these

circumstances overwhelm them. All the more reason to be armed with targeted,

concise, quantified (when applicable) communication. SBAR communication

fosters a greater potential for thyroid patients to feel empowered and underscores

their credibility as a respectable and contributing member in their own health care.

 

SBAR will allow you to get the most out of the time you have with your doctor. I’m

serious when I tell you that the first time I used SBAR as a guide to communicate

my main points, my doctor’s ears perked up! And it makes so much sense when

you consider that this is the primary form of communication they are trained to

understand and actively use on a daily basis. SBAR is actually their primary form

of communication all day most days of the week; however, it really doesn’t matter

who it is with or what the topic is about – effective and direct communication

applies to all important conversations – it’s not exclusive for healthcare providers.

 

Confidence is preparation

Preparing for your appointment by applying SBAR principles: I teach all my clients

to prepare for their doctor’s appointment in advance. It’s so easy to forget details

when we are not feeling well (foggy brain, anyone?), scared, worried, anxious,

emotional, or trying to think of everything at the last minute. Even if it is only a

simple follow up visit, establish the good habit of preparing for your medical

appointments each and every time. I believe that taking the time to prepare is

one of the most important investments you can make for your overall well-being

and it’s one of the most important tasks you will ever do. Think about it…you

prepare for other important events in life, like dates, meetings, events, and

presentations at school or work. Preparing for an appointment, a meeting about

your overall health, mind-body-spirit and emotions is no less important and you

are worth it! If this ever seems like too much of a task, ask a trusted friend or

family member to help. One of the most valuable services I offer my clients is to

attend physician appointments with them to advocate and speak on their behalf,

if needed.

 

The first step in preparing for your appointment is:

1. To reflect upon what it is you hope to gain from your visit. Whether it is your
initial visit or a follow-up appointment, you will want to make a basic plan as
a rough draft.

2. Make a list of the things you want to discuss and give some thought as to how you
are going to describe your symptoms by quantifying them.

• “I’ve been feeling cold and my basal body temperature has been 95.0 to 96.7
  for the past week.”
• “I’m gaining weight despite eating healthy and exercising, I’ve gained 1.5 lbs
  every week for the past month.”
• “I’m losing more hair than ever before, and I’m counting 50-60 strands of
  hair in the drain when I shower.”
• “My bowel movements have changed and I’m constipated – I used to go
  every day, and now I’m only having one BM every 4-5 days and it’s very
  uncomfortable.”

3. Assess yourself and how you really feel – and your emotional well-being

4. Put your concerns in order of importance so you are sure to address the most
important issues first.

5. If this is a new patient visit, be sure to document your allergies, food sensitivity/
intolerance issues, and other pertinent history.

6. Despite completing this information on your new patient intake forms, note
these on a separate sheet of paper and hand it to the doctor in person (trust me on
this!).

7. Ask your pharmacy to print out a list of your medications instead of listing
them yourself and include it along with a list of nutraceuticals and herbal remedies.

8. Summarize your objectives and then rewrite them in SBAR format to take to
your appointment. I like to write things down on index cards, one for each SBAR
letter and in order.

Then, I simply read them to my doctor. Don’t laugh – this really works! It may feel

awkward at first but you will get comfortable with it when you see how effective it is.

 

Below is an explanation of SBAR, and you always want to communicate your issues

in this exact order:

S = Situation: This refers to “why” you are visiting the doctor. Example: “I’ve been

experiencing significantly more fatigue & I’m also feeling colder than usual.”

B = Background: This refers to details in support of the Situation. Example: “I

used to take daily walks in my neighborhood, approximately 1 mile. For the past

month I can’t even make it past the stop sign at the end of my street which is less

than ¼ mile, I get very tired and have to stop. Also, I’ve been checking my basal

body temperature every morning and it’s always 95.0 to 96.7. I understand that

is low.”

A = Assessment: In the case of patient-to-physician communication, this

refers to your intuition and research as a non-medical person for what you have

learned or discovered with respect to your symptoms. Example: “Based on what

I’ve read via ____________ (cite a credible source) I believe I may be experiencing

thyroid-related issues.”

 

R = Recommendation: This refers to your opportunity to state what you want

done…lab tests, ultrasound or other imaging, referral to a thyroid wellness coach,

nutritionist, bodywork or massage therapy. Example: I would like for you to order

thyroid labs for me (FT4, FT3, RT3, TPO & TGB antibodies, TSH, Ferritin,

Vitamin D3, 25-OH, & a full CMP, saliva testing for adrenal function, stool analysis

testing, vitamin/mineral testing, etc., and a prescription for massage therapy.

Side note: Notice that emotional comments are left out of SBAR communication.

Be concise, specific, to the point, and quantify the Situation in your Background

statement as applicable. Using individual index cards for each SBAR topic, you

should be able to read all the details in a matter of a few minutes. Your doctor will

appreciate this and so will you.

Remember to take the rough draft you made in the preparation phase and

finalize it by reformulating it into SBAR format. I’ve been using SBAR for years now,

and I’ve taught it to more clients than I can count. I have the index cards with me

and I literally read them to my doctor – he not only listens better than ever before,

he respects my efforts to proactively prepare and we both get more out of the

short time we have together than we would have had I gone in totally unprepared

and sharing vague to mixed emotional symptom statements. SBAR has fostered

a new level of healthcare and one that has truly elevated my quality of wellbeing.

I’ve established a more solid partner-relationship between me and my doctor

and I value that. I want this for you too!

 

Another idea I love is to keep an SBAR “journal,” as your own history of what you’ve

communicated along the way. If you are having any difficulty whatsoever

understanding how to apply SBAR in your own unique thyroid situation, no worries,

Contact me HERE, if you need

guidance and I’ll help you to get started.

“I saw the angel in the marble & I carved until I set [her] free” ~ Michelangelo

What are you waiting for? Starting today, I want you to take an active and assertive

role in your thyroid care. Do everything you can by using your power, wisdom and

insight to get the best care possible. No one is going to care more about your

well-being than you (except for maybe your mother, or your wellness coach!).

About the Author

Shannon Garrett, RN is a thyroid and autoimmune women’s wellness specialist, integrative registered nurse, holistic lifestyle & wellness coach, certified nurse-nutritionist and detox specialist.  She is passionate about guiding and supporting women to discovering optimum well-being; mind, body, spirit, and emotions.  She offers unique wellness programs specific for autoimmune and thyroid issues and works in tandem with your healthcare practitioner or wellness team.  Shannon was recognized as one of the Top Thyroid Clinicians & Health Coaches Directory compiled by Dr. Izabella Wentz, PharmD based on submissions offered by patients. Shannon is the author of Hashimoto’s: Finding Joy in the Journey and its companion guide Thyroid Happy: Tips & Strategies for Abundant Living. She has expertise in over 100 dietary theories, behavioral therapy, societal therapy, anxiety, stress, and emotional well-being.  Although Shannon no longer practices nursing in the clinical setting, she has experience in the following specialty areas: cardiac nursing, oncology, neurology, orthopedic, pulmonary, and clinical skin prevalence study teams.  Shannon attended the prestigious Aquinas College School of Nursing in Nashville, Tennessee and completed her degree Magna cum Laude.  Additionally, she was recently featured as a co-host on Thyroid Nation RADIO. Follow her on Twitter.

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