TALKING TO YOUR DOCTOR
Read further for helpful guidance on how you can make the most of your next doctor's visit. You can also scroll a bit further down or click here for information about getting a second opinion, and click here if you'd like more information about using telemedicine to consult a physician from home.
One of the keys to success in treatment for bladder or bowel control problems is to first get accurately diagnosed. Your input is vital. You know your body, your routines, and you can identify changes in how you feel better than anyone else. You must speak up. There is no such thing as a detail too small to mention.
Because there are so many different types of incontinence, and therefore, so many different contributing factors, details help distinguish one form from another. This allows your physician to develop the proper prognosis.
Case in point, the NAFC conducted a survey of more than a thousand women ages 18 and older and discovered that 20% of women with symptoms exclusively associated with stress urinary incontinence reported they had been prescribed medication. We know that this was the incorrect treatment because there is no FDA-approved drug for SUI available in the United States. So how did this happen?
Most likely, the physician was acting on inaccurate or incomplete information from the patient describing her symptoms.
So take charge of the conversation with your doctor. Don’t wait until the last minute to bring up the subject. Come prepared. Have as much information gathered as you can. Share your bladder diary or bowel diary with your physician or nurse. It should contain such important information as:
Recorded toilet habits over a 2 day period
A list of everything you ate and drank
Any nighttime trips to the bathroom? How many?
Note the strength of urine flow
Any accidents? What happened to cause them?
If you’re not sure where to start, use the NAFC template to help you keep track of times and events. Print it from our web site and get started. This document will serve as the basis for your discussion about your experiences.
You might discover more than one set of symptoms and thus face multiple solutions. The point is to create a record of all the symptoms in a context that will be helpful to your doctor in reaching a diagnosis.
By keeping a bladder or bowel diary, you are not only educating and informing yourself, you are assuming responsibility for playing a role in getting diagnosed correctly. This includes understanding your own anatomy so you can describe what’s happening. This will also help you discern between what is normal and what is abnormal. The more you know will also help downstream as you will be able to ask meaningful questions about your treatment, understanding the risks and possible effects from medicine or surgery.
Most importantly, it puts you right in the middle of the conversation. After all, this is your body, your life. Ultimately the treatment will only be as successful as you make it. So get in the know!
Not sure if you might have a medical problem with bladder or bowel control? Take our online quiz to get pointed in the right direction.
Getting a Second Opinion - The Value of a New Perspective
It is always a good idea to see a physician expert who is well trained in the problems you are experiencing. But not all experts are equal. Sometimes you don’t communicate well with the practitioner or sometimes you do not feel comfortable with the recommendation. A second opinion is always an option.
If surgery has been recommended to you, a second (or even a third) opinion is an excellent idea. Very few things in medicine are black or white. There are often many different approaches for the same problem and many shades of gray in evaluating and judging what is best for the individual patient. In the present managed care environment, some doctors cannot take the time to fully discuss your situation with you. They may not have the extra training needed to offer the best option. They may not be trained in newer or less invasive procedures. If doctors do not know how to perform a procedure, they may not be equipped to discuss or recommend it to you.
When a new patient comes to see me for a second opinion, I ask them to bring all the pertinent medical records including all the notes from previous doctors’ appointments and any relevant test results. If an X-ray, ultrasound, or MRI has already been performed I ask the patient to bring the actual films, hard copy or on a CD file, as I prefer to look at the films myself so that I can come to my own conclusions about the diagnosis. I can then take the time to explain the test results to the patient.
For an individual seeking a second opinion, I begin with a consultation and a review of the records, and then I proceed to a complete physical examination. Often the patient and I go back to my office to discuss the findings and answer any questions that the patient might have. Medical care should be collaboration between patient and doctor. Together the patient and I discuss how best to approach the particular diagnosis. I often use illustrations, diagrams and 3-dimensional models to demonstrate what the problem and potential solutions might be. At this point I make a list of one or more possible diagnoses and outline the treatment options available for each problem. To be complete, I often include even those treatments that I advise against, and the reason. Together we collaborate and determine which choices on this list best meet the individual needs of each patient, seeking choices that are both medically sound and personally acceptable to the patient.
Family members or friends should be welcome to participate in the consultation. Friends and family members are helpful to make sure all the concerns are addressed and to help the patient remember what is said as a lot of material is covered. Taking notes or having a companion who can record notes of what is asked and how it is answered is also helpful. It is a good idea to then digest the information at home to make the best decision. Patients are encouraged to call back with any additional questions they may have or for any clarification they might require after the consultation.
What If You Decide Surgery Is Right For You?
If you decide that surgery is right for your situation, you will need to choose the doctor to perform your surgery. There are a number of factors that should influence your decision. The first is to choose a doctor who will perform a procedure that fits your particular situation and problem. In most cases you should have more than one option from which to choose. It is particularly important to discuss the risk factors for adverse, or negative, outcomes based on research, associated with each option.
The next concern is the skill of the surgeon. How many procedures does the doctor perform in a month? How many procedures like the one you are requesting are routinely performed? How many of these procedures have they performed in patients with problems like yours? How many and what kind of complications has the doctor had? Studies show that with more surgical experience for a particular surgery, the surgeon performs with fewer complications. In other words, surgeons who perform procedures frequently have lower rates of complications than those with less frequent experience. Many surveys show that some gynecologists and urologists perform as few as one or two major incontinence or prolapse operations a month. Choose your surgeon carefully.
It is important to know something about the training of your surgeon. Did they do any extra training in pelvic floor problems, such as a formal fellowship? Do they teach in an academic program? What is the experience of the surgeon’s support team and the facility where such procedures are routinely performed? What is their track record with respect to success versus failure and how is success defined? What is their track record with respect to complications?
It is also important to feel comfortable with your doctor. Do you get an opportunity to ask questions? Are they answered to your satisfaction? Is the doctor available by phone? Will the doctor be available after your surgery for follow-up and questions as well as support?
If you decide to have surgery, another visit should be scheduled with the doctor you have chosen to go over the specific details of the procedure you are planning. Again, it is nice to have someone accompany you. In my practice, once a decision has been made, we have a conversation called the “Informed Consent”. At this time we go over, in writing, what you should expect from surgery. It includes the details of the operation to be performed, the specific risks of the procedure, the alternatives to the surgery, and the possible consequences if no surgery at all were performed. Basically, this is the time you will hear about all the possible risks and complications that may occur during and after your surgery. This can be difficult and may feel as if it’s the last thing you want to hear, but ultimately it will be quite informative for you. Whatever you sign should be understandable and agreeable to you. Continue to ask questions until you are comfortable.
During the “informed consent” your surgeon is not trying to erode your confidence, but surgeons are legally and morally bound to tell you about things that could happen that might influence your decision to have surgery. Most people’s emotional reaction to this is some fear, which is understandable. Just remember to be sure and hear the optimism in the fact that there are options available to help you.
To summarize, never hesitate to get a second opinion. If this threatens your doctor, you may need a new doctor. Transparency is the key to a good relationship and optimal outcomes. If you are a woman experiencing incontinence and/or prolapse, you have the option to be treated by a fellowship trained Pelvic Reconstructive Surgeon. This subspecialist can be a gynecologist, a urogynecologist, or a urologist. If a subspecialist is not available in your hometown it may be well worth your while to seek one out as close to home as possible somewhere in your region. Otherwise there are general gynecologists and urologists with significant experience in this area, but you must ask questions to confirm adequate surgical experience with pelvic floor surgery. If you are a man with incontinence, urinary obstruction from the prostate, or other bladder dysfunction, a well-trained urologist is the best choice.
TELEMEDICINE - CONSULT A PHYSICIAN WITHOUT LEAVING YOUR HOME
One of the most important ingredients to getting successful treatment for incontinence is removing hindrances in your way. Time, distance, and access to specialists all may pose issues with moving forward. Thankfully, American Well, one of the most trusted names in telemedicine, is using technology to knock down those remaining hurdles.
While Amwell is not affiliated with NAFC, we recognize that they have great expertise and technology to help those dealing with incontinence. Their online medical group is a primary care practice with a national network of US-based clinicians that provides online clinical services. Their 800+ doctors are board certified and licensed to practice medicine in your state.
As a patient, you can get a consultation with a physician very quickly, using the latest videoconferencing technology. In fact, American Well offers live video consultations in more than 40 states around the clock, 365 days per year. More and more doctors offer telehealth everyday. If your doctor is not yet online, give us their information and we can send them information about joining the online care group.
Of course, Amwell is designed to be a private, secure, and HIPAA-compliant tool that allows you to safely and confidentially consult with a doctor online. Better still, healthcare providers are recognizing the value of telehealth. Visit Amwell to speak with a doctor today.