Wednesday 16 July 2014

"Ask Me Three" - A Simple Resource for Talking to Health Professionals

This great video shows how asking these three simple questions can cut through confusing medical language


Though I have previously featured a few good resources to help you get the most out of your visits to doctors or specialists, you may have found that they did not work for you. This may have been because they involved too many steps; too many things to remember; or just "weren't your style".
 
The National Patient Safety Foundation has worked with doctors to work out the main questions patients should ask: Ask Me Three.
 
1. What is my main problem?
 
2. What do I need to do?
 
3. Why is it important for me to do this?
 
These questions are short, easy to remember, and are in everyday language. This is a great place to start when making sure that you and your health professional both clearly understand the situation and the plan of action.
 
 

Tuesday 15 July 2014

Health Professionals: These Are the "Words to Watch"

 
 
The National Patient Safety Foundation in America has recognised that many problems arise when communication breaks down between patients and health professionals. They have made a list of types of language that health professionals use which may be confusing or offensive to patients; and which risks alienating them.
 
You can download a PDF about this research here: Words to Watch.
 
The Prolapse Information Project has previously highlighted the importance in language choice when discussing prolapse here: Prolapse After Childbirth: Common Not Normal.
 
If you have a busy practice it may seem like you don't have the time to police the language you use. You may also feel as if you shouldn't have to 'coddle' your adult patients. However, good communication is vital to an effective health practice; and taking into account the way your words will affect the person you are speaking to is a cornerstone of good communication.
 
A manageable approach may be to concentrate on one area of language at a time: medical words, concept words, category words, or value judgement words. Look at the list and see if you use some of the words on there, and try to use the suggested alternatives instead. You could even ask you patients for feedback about the clarity of your communication.
 
When talking specifically about prolapse, here are some terms to consider:
 
"Take it easy"/"Don't overdo it" - these are both very ambiguous. Consider using more specific language like "Don't lift anything that makes you strain to pick it up", or "Take a rest by lying down for 15 minutes if the feeling of pressure becomes too strong".
 
"Weakness" - women are often told that they have "vaginal weakness" or "pelvic floor weakness". While you mean this in a medical sense, remember that to your patients this is a negative value judgement. Consider instead explaining the condition in terms of an injury, or by saying that a stronger pelvic floor might help them manage their symptoms.
 
Reconsider using the phrase "nothing can be done" (usually when referring to a mild or moderate prolapse), when you actually mean "Unless you have bothersome symptoms, this degree of prolapse doesn't require treatment."
 
Using specific, emotionally sensitive language will help to foster better relationships with your patients and make them more involved in managing their health conditions, including prolapse.
 

Monday 14 July 2014

Learn About Managing Prolapse Through Lifestyle Changes on MD Conversation





 
MD Conversation provides online presentations that can be used instead of information pamphlets by doctors and specialists. While this is a subscription service, the introductory presentation on Pelvic Organ Prolapse (POP) is available free online here: An Introduction to Pelvic Organ Prolapse.
 
This presentation is very detailed, and includes moving diagrams that may help you to understand pelvic anatomy and POP.
 
The best feature of this presentation is that it clearly states what the goals of POP treatment are, and then compares the available treatments against this list of goals. It also goes into much more detail about lifestyle changes (such as quitting smoking) than most other resources.
 
The presentation can be paused, and you can review individual sections as many times as you want.
 
Please note that the Prolapse Information Project is not affiliated with MD Conversation, nor am I necessarily suggesting that you subscribe to this service. I am only directing you towards the free portion of this service.

Sunday 13 July 2014

A Resource to Help You Get Informed Post-Surgery and Have the Best Chance of Recovery





Prolapse Repair Surgery is a big step to take. It is major surgery, usually with a fairly long recovery period. Added to that is the relatively high rate of failure, which makes it all the more important for you and your surgeon to work as a team for the greatest possible chance of success.
 
However, it can be difficult to be a team if you do not have a clear method of communication. Often, information about how a procedure went, and what you need to do to look after yourself post-surgery, is given to you in the recovery room or in the days following the surgery while you may still be disoriented or overwhelmed.
 
The National Patient Safety Foundation in America has recognised this, and has created a tool to help you and your surgeon clearly record your discharge information. It is a PDF, and can be downloaded here: Post-Discharge Tool.
 
This excellent resource includes spaces for you and your surgeon to record:
  • Follow up appointments, including a plan for what you need to bring and ask at each appointment
  • A clear diagnosis
  • A checklist of important steps during your recovery
  • A medication list, including detailed information about doses, and the reason you need to take each medication
If your medical practice includes post-surgical care, distributing this resource to your patients may improve your surgical outcomes, and field fewer phone calls asking for clarification of your instructions.
 
Everyone involved in managing prolapse, both patients and health professionals, benefits from improved communication.  
 
 

Friday 11 July 2014

"Healthy Women's" Tips for Talking to Your Doctor



 
Healthy Women is a non-for-profit organisation that aims to provide accurate health information for all women.

They recognise that sometimes it can be difficult to talk to your doctor about women's health issues, such as prolapse. To help you approach your doctor, and get the most from your consultation, they have created the following webpage: Tips for Talking to Your Healthcare Provider.

The tips are very practical, and include:
  • Specific questions to ask at each appointment
  • A few sentences you can use if you feel uncomfortable asking your doctor to clarify what they have said
  • Letting your doctor know if you have trouble reading, so they can give you information in another way
  • When to change doctors
The second page of the article discusses some ways in which you can use email to stay in touch with health care providers, and save you unnecessary appointments.
 
Speaking up, even when you are in an intimidating situation, is a great way to improve your level of medical care.
 
 

Thursday 10 July 2014

Australian Women: You May be Eligible to Receive Some of Your Prolapse Treatment through Medicare



 
Medicare is the Australian system of free healthcare for all citizens. This system has many good features. However, it can still be difficult and expensive to manage a long-term health condition such as prolapse if you need the support of a health professional such as a Women's Health Physiotherapist.
 
There is a little known Medicare entitlement called the Chronic Disease Management Plan. Despite the name, it can be applied to any health condition, including prolapse, that has been going for more than six months.
 
Once a GP has written a Chronic Disease Management Plan and Team Care Arrangement that involves at least two other specialists (such as a Women's Health Physiotherapist, a Continence Nurse or a Urogynaecologist), you may then be eligible to claim a rebate for these services from Medicare. This plan also helps to coordinate your care between your specialists.
 
If you are an Australian citizen and do not have private health insurance, a Chronic Disease Management Plan may enable you to access all the services you need to manage your prolapse effectively.
 
For more information, go to the following website: Chronic Disease Management Plan.

What the National Guideline Clearninghouse Says About POP May Surprise You




Ever wondered just what your doctor or specialist was thinking when they recommended a particular treatment for Pelvic Organ Prolapse (POP)? The US National Guidelines on POP may help shed some light on their thought process.
 
The National Guideline Clearinghouse is part of the US Department of Health and Human Services. Their recommendations about Pelvic Organ Prolapse summarise all of the research on the topic until 2011 in a single page of dot points. You can read these guidelines here: Pelvic Organ Prolapse: Recommendations.
 
The most interesting part of these guidelines is the difference between the guidelines from good-quality research (Level A evidence) and the guidelines based on 'professional knowledge' from health care providers who treat POP (Level C evidence).
 
The agreement between healthcare providers is that women with POP who were asymptomatic (had no symptoms) or who had mild symptoms required no treatment. Many women with 'mild' POP, who perhaps experience discomfort or mild pain and incontinence, may be familiar with this view; having been told by health professionals that they do not require treatment.
 
However, there is no evidence from good-quality research that mild POP should go untreated. In fact, the National Guidelines state that a pessary would be appropriate for most women regardless of the degree of their prolapse.
 
We often assume that health professionals are acting based on the most up-to-date scientific evidence, but it is worth remembering that they are also using information that they received during their training, or impressions they have formed during their career.
 
If you have mild prolapse, have seen a health professional who believes you do not require treatment, and can not change health professionals, then it may be worth printing out this section of the guideline while trying to demonstrate to them that you need treatment.
 
Remember that at the Prolapse Information Network I recommend that you continue to seek medical help until you receive it. You are entitled to receive evidence-based, appropriate treatment for your prolapse.

Wednesday 9 July 2014

Pelvic Organ Prolapse on Medscape




Medscape is an online resource for health professionals.
 
Their page on Pelvic Organ Prolapse (POP) can be found here: Pelvic Organ Prolapse.
 
As with all of their pages on health conditions, it includes an overview, workup and treatment guide. All of these are very detailed, and based on up-to-date information.
 
If you are a GP, you may not have traditionally made screening for and treating POP part of your practice. It may not have been a large focus of, or even a part of, your training. However, as awareness of POP grows, you may find an increasing number of women seeking treatment for the condition - after all, it effects up to half of your female patients who have given birth.
 
This resource is a great place to start your professional reading about prolapse.

Tuesday 8 July 2014

Get Informed about Pelvic Organ Prolapse at "Healthy Women"




 
Healthy Women is a not-for-profit organisation that aims to empower women by giving them accurate information about their health conditions.
 
The section of their website about Pelvic Organ Prolapse (POP) is much more detailed than the average information sheet. You can find it here: Pelvic Organ Prolapse.
 
It has separate pages on the following topics:
  • Diagnosis
  • Treatment
  • Prevention (particularly useful for pregnant women)
  • Questions to ask your health professional
  • Answers to common questions (including some questions I haven't really seen addressed on other websites, such as "My doctor says I have some bladder prolapse, but I don't have any symptoms. How is that possible?")
  • Organisations that can offer help and support (mainly in the US)
This is a great place to start your in-depth reading about POP, once you have taken a look at a few information sheets.

Sunday 6 July 2014

Free Multilingual Patient Information Leaflets about Prolapse and Many Other Bowel and Bladder Issues



 
As a GP, it can be difficult to find accurate, easy-to-understand information for your patients about prolapse and continence. You may also feel that you do not have the time or resources to find and print off a pamphlet for each female patient who has bladder, bowel or prolapse symptoms.

The International Urogynecological Association has created an extensive library of patient information leaflets that can be found here: Patient Leaflets.

There are leaflets on many conditions and treatment options, including:
  • Pelvic Organ Prolapse (POP)
  • Types of POP repair surgery
  • Constipation
  • Urinary Tract Infection
  • Pelvic Floor Exercises
These leaflets are available in a number of languages, including English, Mandarin, Italian, Spanish and Arabic. They are in question and answer format, and include clear detailed diagrams. These leaflets download as PDFs, so you could save them to your hard drive if you do not have consistent internet access in your clinic.  

It is well worth your time to print off the relevant resource for your patients who are suffering from any of these conditions. When your patients are more informed about their health problems:
  • They are less likely to suffer undue anxiety due to misunderstanding their condition and treatment
  • They are less likely to get unscientific information from non-reputable sources, such as websites with commercial interests in the condition; and therefore less likely to undertake unproven treatments that could make their condition worse
  • They are more likely to follow your instructions for care if they truly understand them and understand how they will help
  • It will build better communication and more trust between your and your patients
  • This will in turn make your patients more likely to return to you for help, rather than turning to unproven alternative therapies
If you are a woman with a prolapse, you can also access these resources directly by using the link above.

Saturday 5 July 2014

University of Chicago Information Sheet

This series covers information sheets about POP from professional health organisations. These pages, though they don't necessarily go into a great deal of detail, are a good place to start. They help you gain a clear understanding of POP.

The University Of Chicago Medical Center


The University of Chicago Medical Centre has created an information sheet on prolapse which can be found here: Female Pelvic Organ Prolapse.
 
The strengths of this information sheet include:
  • A methodical approach that clearly outlines the types and causes of POP
  • Information with a good scientific basis
  • Detail on a variety of management options, including biofeedback (which is not often featured on information sheets)
One weakness of this information sheet is that it refers to diagrams that are not included. However, it is well worth reading, particularly for women who want an introduction to what is involved in biofeedback, and how it might help them.

Friday 4 July 2014

Tips for Talking to Your Doctor About Prolapse




Speaking to a health professional about the symptoms of your prolapse can be difficult. We are taught not to discuss bodily functions, sex, or our genitals, and it can be hard to overcome this even with a doctor. It can be particularly difficult have that first conversation where you disclose your symptoms.
 
The American Association of Urogynaecologists has created a really useful document to guide you through that first conversation: Tips for Talking with Your Doctor.
 
It has two parts.
 
On the first page, there is a questionnaire for you to fill in and take to your doctor's appointment. It covers most of the questions your doctor is likely to ask if you tell them you are experiencing symptoms that could be caused by a prolapse.
 
On the second page, there is a list of questions that you might like to ask your doctor in an initial meeting, to help you get a clear diagnosis, and a pathway towards further medical care.
 
It is really important to go into medical appointments as prepared as you can be, to make sure that your concerns are heard. If you are getting a friend or family member to act as an advocate, they might be able to help you fill in the questionnaire, or ask questions during the appointment.
 
Doctors, you may like to get your female patients to fill in the questionnaire on the first page in order to help you screen for women who are experiencing prolapse or other pelvic floor dysfunction. This is a great way to begin a conversation with your patients about a topic they might be desperate to discuss, but that they feel unable to talk about with you.

Thursday 3 July 2014

"Any Old Prolapse": Support on Mumsnet

Please note that the Prolapse Information Project does not necessarily endorse the views expressed by members of the support communities I link to. As always, I encourage you to do your own research and use evidence-based treatments.  


Often being diagnosed with a prolapse can be a very isolating experience. Many women don't have anyone to talk to about prolapse in their day-to-day life, or they may feel uncomfortable even bringing the topic up.
 
This is what makes online support communities so valuable.
 
Many online parenting communities have a lot of threads about prolapse, but often these threads are calls for help from people who have just been diagnosed, and usually they receive few replies. These threads often lack a 'voice of experience', who can answer questions based on having gone through the same thing.
 
The "Any Old Prolapse" thread on Mumsnet is unique. It has been running since 2009, and is very active. There are new posts almost every day, and often more than one, so if you post there you can expect a reply fairly soon. There are also many members who have been there a long time, and have a lot of experience to share about managing prolapse. You may also be able to share your experience. This community is very welcoming.
 
You can find the latest part of this thread here: Part 8.
 

PubMed: A Place to Get Medical Information, Not a Drink




 
PubMed is a free online database of medical studies, that includes the research published in almost all of the reputable medical journals. When you see information on PubMed, you can be relatively confident that it has been carefully reviewed by medical experts.
 
You can access PubMed here: PubMed database.
 
Accessing PubMed may seem a bit intimidating, particularly if you are not used to this style of writing. There is a good introduction to how to use this database here: An Introduction to PubMed.
 
Here are some terms that you might come across while using PubMed:
 
Research - an experiment or study of a topic, that follows very specific scientific rules to make sure that the results are as accurate as possible
 
Paper - a report about a piece of research
 
Journal - a specialist magazine where scientists publish the results of their research
 
Abstract - a short summary of a research project, that states the method the researchers used and the results of their research
 
You can search PubMed using keywords like "pelvic organ prolapse". Papers are listed in chronological order, which means the most recent are first.
 
PubMed is a great research tool for women with prolapse, their supporters, and health professionals. It is the main source of information about medical research that you read about here on the Prolapse Information Network.
 
As always, I encourage you to be informed about your prolapse, and about any treatments that are suggested to you. PubMed is a great way to access the latest scientific evidence to help you manage your prolapse.

Managing Your Pessary

Two common types of pessary
 

Inserting a pessary is a common way to manage prolapse symptoms. It is a device, usually made from silicone, that is inserted into the vagina. It helps to support the pelvic organs, and for many women can help to relieve prolapse symptoms including discomfort and incontinence.
 
Many women are unsure about using a pessary, as they are concerned about how it will feel, or if it will fit. Pessaries come in many different sizes and shapes, and most women can be fitted for one that they will find comfortable by a qualified health practitioner. Once a pessary has been correctly fitted, many women can manage it themselves, including removing, cleaning and reinserting it.
 
Cambridge University Hospital System has created an information page to inform women about pessary as an option, and to help them learn how to manage their pessary.
 
In includes a very informative video, which can be found here: Managing Your Pessary.
 
This video includes:
  • A quick explanation of prolapse
  • An explanation of some of the benefits of using a pessary
  • Demonstrations of how to insert two types of pessary, including the ring pessary (one of the most commonly prescribed)
  • Information on cleaning and replacing pessaries
One of the greatest features of this video is real women speaking about their experiences of using a pessary. As always, it is very useful to see the perspectives of women with a prolapse, alongside the scientific information.
 
This webpage, as they state in their video, is not intended to replace visiting a health professional. It is very important that a qualified practitioner fits you for a Pessary, and monitors your use of it at the beginning.
 

Wednesday 2 July 2014

The Best Evidence for Prolapse Repair Surgery





In previous posts, I explained how you can use Cochrane Reviews (a summary of recent medical research) to get the latest scientific evidence about each treatment option for prolapse. You can read the reviews here: pessary, oestrogen and conservative management.
 
The Cochrane Review for prolapse repair surgery can be found here: Surgical management of pelvic organ prolapse in women.
 
Because of the vast number of surgeries available, and the controversy surrounding many methods, this review cannot be quickly summarised, and needs to be read in its entirety.
 
I strongly recommend that you at least look at the section about the type of surgery that you are considering, or that your surgeon has recommended. This is not necessarily because you should not go through with the surgery, but it will help you to be informed about the risks and ask the right questions at your specialist appointment.

Tuesday 1 July 2014

Pelvic Floor Disorders Network: Working Together to Research Prolapse


 

 
The Pelvic Floor Disorders Network (PFDN) is an American group trying to improve the quality and speed of research about conditions such as prolapse.
 
It is made up of eight American research hospitals working together. This enables the PFDN to research more quickly, and to include more participants in their studies. This is very important, as the more people there are in a study, the more likely it is to produce results that will apply to a wide variety of women.
 
Currently, their research projects relating to prolapse include:
  • A comparative study of uterine prolapse procedures
  • Examining the durability of prolapse repair surgery
  • The position of the bladder, bowel and vagina in the years following prolapse repair surgery
 
You can read more about these research projects on their website: Pelvic Floor Disorders Network.
 
Much of the research about prolapse in the last 10 years has been produced by the PFDN - to date their members have published 79 papers. They should be acknowledged for their contribution to our understanding of prolapse, and improvements in treatment.