Speaker 1: Okay, well good morning everyone. My name is Jane Seip and I'm a registered pharmacist. My background is that I went to Purdue University and I got my degree in pharmacy and then I worked for a hospital and as a hospital pharmacist, then I worked at a retail chain, an independent pharmacy, and then I worked in pharmaceutical industry for a couple of decades. And now I own my own consulting pharmacy business. So I really try to help patients manage their medications. And that's what I'm currently doing. So I'm glad to be here today and I'm going to talk to you a little bit about navigating health care. Now that's a big term because there can be a lot of things about navigating health care. But I'm going to choose a couple of presentation points for today. First off, I'm going to talk about how to prepare for a health care appointment, whether it's with a physical therapist, a doctor, a nurse practitioner, etc. I'm going to talk about expectations of the health care professional at your appointment and your own expectations. I'm going to talk about what happens after an appointment, next steps. And then I'm going to talk about calling for help in navigating the health care system because none of us can go through navigating the health care system without calling for help. And I'll give you a few resources and then we can talk about other things as well. But the biggest thing is I want to make sure that everyone knows that your health is your health. You take charge of your health. You are your own advocate and make sure that we all want to be on the same page with our health care team, but we are in charge of our own health. So let's start with the first point of how can I prepare for a medical appointment. And I say prepare in quotes because most people don't think they have to do anything to get ready for a medical appointment, but you really should do a few things in preparation. First off, ask someone to come with you. Even if you're young in your teens or you're in your 20s or 30s and especially as you age, you really need to have someone to come with you. This should be an advocate that is patient, understands your lifestyle, something about you. It doesn't necessarily have to be a medical person in your family. It doesn't even have to be a family member, but someone should be coming with you to your appointment. Also before your appointment, you should make a list of concerns. If you have a medicine concern, I don't feel very good in the mornings or I wake up in the middle of the night with a stomach ache, I have leg cramps at night, I mean all those things should be on your list. You think you're going to remember them, but it's really hard when you see that physician or that person in a white coat, something happens to our brain. So it's really important to actually write down a list of what you want to accomplish, any concerns or issues. Also you want to have a preparation of a list of medicines, surgeries, contact information, and any pharmacy preferences. Let's talk about what to expect when you're at an appointment with a physician, again a nurse practitioner, whatever kind of specialist or primary care you might be seeing. First off, expect for you to be listened to and if you feel like you've not been listened to about your concerns with a doctor, pick a different doctor. And I know that sounds maybe a little harsh, but it's important because you're in charge of your health, remember? So you need to make sure that you are being listened to. So expect that. Expect the healthcare professional to be busy, so try to be concise and to the point. That's why writing down and having someone with you helps you do that. Think ahead of time of what you do want to say to them and if you do that, I think that will help with their busyness. Even though they are busy, you should still expect them to be attentive to you. And again, if you've come out and you feel like you haven't been, select a different physician or a different nurse practitioner or whatever it may be. Ask your questions that you've prepared and expect to get answers. And if you don't get an answer, that's okay, but make sure that you have someone that will help you get that answer. Take notes. Take notes. Again, you think, and you don't ask the patient necessarily, but the advocate that's with you should be taking notes for you. You think you're going to remember things, and I know I've done this with family members, I think I'm going to remember it. I'm in the healthcare business, I'm going to remember something, but guess what? It's really hard to do that. So take notes. And you'll realize later that that was a good idea when you thought, oh, I forgot they said that. So take notes. Do not ask your physician to record the conversation. I know a lot of people with cell phones and things now think, well, I don't have to take notes, I'll just record it. But it's very uncomfortable as a healthcare provider to have someone record you. And it's not really necessarily for legal reasons, it's just confidentiality, HIPAA, all those kinds of things that are in place, good guidelines in place to protect patients. So I always say that's why you should take notes and have someone with you. It really feels uncomfortable for people to record the conversation. So some physicians are fine with that, but overall I would say that might not be the best option to do. And then at the end of the appointment, make sure that you ask what are the next steps. Do I need to do more lab work? Do I need to take more medicine? Do I need to have an x-ray? Do I need to call someone else? All those things you need to ask them what are the next steps. If you came in with a complaint of I'm waking up in the middle of the night with stomach upset, do you have the answer of what you're going to do differently when you walk out of that office? That's navigating your own health. So that's just something that I would expect that would happen at the medical appointment. And then let's move on into the next steps after the medical appointment. Make appointments for any follow-up tests while at the office. And I say that, it sounds kind of obvious and it makes sense, but it's really easy if the doctor has especially delivered some sort of news that you weren't expecting to walk out and not have made the CT appointment, the CT scan appointment or the blood work or whatever else you need to have done. And when you walk out of that office and you don't have that done, you have to call back and it's a lot longer to get that done. If they can help you and assist you and advocate for you while you're in the office to get that done, that's what I would suggest. Inquire about any pre-authorization needed for your insurance. If you are going to have to go and get another x-ray or a CT scan or anything, ask about your insurance while you're in there. They have insurance specialists in the office and that's what I would make sure that you would get that, inquire about that and take care of that. Also make sure that you do make your next appointment with your healthcare professional. Again, it's really easy to walk out and not make that next appointment. Most of the time they catch you, check out and ask you, but if you're making scan appointments or you're getting blood work and those kinds of things, it's really easy to not get that done. So just make sure that you've done your little checklist and that you know to make your appointment. And then make sure you pay your deductible or whatever insurance charges are required and I think that's common sense. So we've talked about preparation for the appointment. We've talked about what to expect during the appointment. We've talked about next steps. So now let's talk about asking for help. Because especially when you, as we age and get older, but really at any age, there's a lot going on in healthcare right now. A lot of things that go on and things that we don't understand. So we have to be able, we can't be afraid to ask for help when we don't understand something. If we don't understand what one of our medicines is for, we need to ask. And if it's not that physician that prescribed that, ask your pharmacist. And your pharmacist is, and of course I'm a little biased in this, but your pharmacist is really your drug expert. It's the person that you can go in and have a relationship with in the pharmacy. Now unfortunately, as we age and our insurance for almost everyone now is through a mail order pharmacy. So you don't always necessarily get to talk to someone about your medicines as they come and arrive at your front door. But you can still go into your local pharmacist and ask them about these medications or you can just call them on the phone. And again, it's the same thing with the physician. If you find someone that is really helpful to you, write their number down, write their name down and always make sure that you go back to that person so you have that relationship. So when you find somebody that's really good for you, keep them. Keep them on your team. And that's one of the things that I have here is get the names of the people who have helped you and can help you before you leave the office. But same thing with the pharmacy. If you find someone that's really good, make sure you take their name down and that's who you ask for when you call back to the office or to the pharmacy. In navigating your own healthcare, you've got to stay positive and it's really hard at times. It's really hard. It's hard for me and I'm in the healthcare business, right? So we've got to stay positive because most of the time you're going to get a lot more done when you can stay positive with people who you're talking to. And we've got to show some patience because, again, patience is a virtue but it's not an easy thing to have in navigating your own healthcare. So as you're talking to people on the phone, you might have had to wait for 20 minutes at an insurance company, still try to be patient and be positive when you talk to them. When you go to make the appointment or when you're going to call someone, give yourself that time so that you're not hurried and you can't be patient and positive. So that's just a piece of advice that I have found that works well and when people call me and it maybe takes me a little bit of time to get back to them because I'm with other clients, when I talk to them and they're pleasant and patient and positive, it just makes for a much better interaction and I feel like I can help them better too.

Speaker 2: So how can family members appropriately or legally be able to ask to speak on the loved one's behalf? So, for example, if a patient is heavily medicated or if you're in a situation where a family member has Alzheimer's?

Speaker 1: The best way to deal with this is to be proactive and I know that's not always the case so we'll talk about when that's not. But if someone has a living will, which a living will is and has a durable power of attorney or their healthcare representative, if they have that set up legally ahead of time when they're feeling well, that's the best thing. Because a living will basically will tell your wishes as a patient. Do I want chest compressions? Do I want to be resuscitated if my heart stops or my breathing stops? So those are all questions that are hard to ask people and they're hard to ask people that you love. So if they can have that set up ahead of time when they're well, then I think that's the best way. Now, let's say that that doesn't happen and they don't have a living will and you're an advocate for someone or you're a daughter or brother, sister, son, then it is more difficult but most of the time, a physician can act using his professional judgment that if you're the daughter and you're here and you're compassionate and you're helping this patient, then they will trust your relationship and give you some of the information that you need to know and be able to help you make decisions. Legally, you need to have a durable power of attorney.

Speaker 3: I heard the term AmeriCare pharmacist and it's kind of like you, so what exactly are they?

Speaker 1: I'm guessing, I'm not sure exactly what, my guess is AmeriCare is a term that is used for a home health care company that has like an integrated system of health care team members. So it's mostly trying to keep people at home, kind of like the home instead, but just trying to keep people at home and it's an integrated system of pharmacists, nurses, home health nurses, physicians, nurse practitioners, physical therapy, respiratory therapy and so that would just be the pharmacists that work for AmeriCare would be part of that integrated team. So they would be in charge of the medicines for those patients.

Speaker 3: So how do you interact with them?

Speaker 1: Well that's a good question, again, asking questions, finding out and I would ask them if it was my family member or me, I would ask that pharmacist if they were, you know, had to start to develop a relationship and I would just ask them, will you look at my medicine list, they most likely would be doing that anyway, do you see anything on there that can, you know, could be taken away, can be reduced dosage, are all of these doses, are all of these medications I'm on within recommended dosing levels, does anything interact, is there anything food-wise that should not be taken, I would ask all those questions and a pharmacist is more than willing and that's their job and that's what they're trained to do so they would be more than willing to do that. I think the biggest thing we need to just remember is when we're interacting with people is it's okay to ask questions. Don't assume that they know about you. So and don't assume when you go to a physician and you're seeing an endocrinologist that they know what your primary care physician said to you last time because they don't. They could probably read into the notes but to get to that on the computer takes a while. So make sure that you can tell your story and maybe share with the pharmacist or the physician what has currently happened and where you're at, any concerns and questions that you have, ask and that's the biggest thing I think you can do with any healthcare medical provider is just ask the questions and tell them your story.

Speaker 2: Anything else? How do you best manage with tools and resources out there for medicines or medical conditions?

Speaker 1: Well the big thing I would say number one to that question is again ask so that you are your biggest resources because if you ask the questions or if you go, you can go online just stay away from sites that are not medical related. If it's medicines, I like drugs.com. We use a different, there's a professional that has all the medical terminology that you know would be put some people to sleep so you don't have to do that part but drugs.com, RxList, those are some things that you can use for medication tips and information on medicines. I also like to say when you are a mail order prescriber for your medicines, a lot of times you'll get a generic that looks different this month than it did last month. So let's say you're on Warfarin which is a blood thinner and last month it was a little white round pill, this month it's a little white orange pill that's square. I'm just putting that out, I mean I'm making that up but it could happen that your generic looks different. So just to confirm that you have the medicine that you need because it looks different than it did last month because it's made by a different generic manufacturer. What I would do is I would go into pill identifier, that's what it's called, it's called pill identifier on your online and you can put what the tablet looks like. Is there a number on there, is it an N029 or is it white and round and you can actually put that in there and they will tell you what that pill is.