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Patient satisfaction doesn’t mean you’re getting good care, by Dr. Zach Levine, Er Physician, MUHC

BT Montreal | posted Wednesday, Aug 29th, 2018

by Dr. Zach (www.drzach.ca)

Are you satisfied with your doctor and medical care?  It might not be good for your health

In 2004 RateMDs.com was established.  It is a website that allows patients to rate their doctors.  Similar sites exist for rating dentists, psychologists, hospitals, and teachers.  It is an example of how the internet allows people to share information, and opinions.  Whereas in the past one might tell a friend about their experience with a doctor, this allows people to share their experience with anyone interested.  The concern for doctors is that those people who are satisfied may write nothing, whereas those with an axe to grind may be more motivated to share their negative reviews.  But when studied the majority of ratings are positive.

There are a couple of issues with such ratings sites, such as that there is no way to know who is actually writing the reviews and that some have a business model that allow paying customers to have some effect on their rating.  But that is not the point of this article. The point is that we all have opinions about other people, including our doctors, and now people have a way to share those opinions. The question is — do patient ratings of doctors and healthcare correlate to better doctors and better care?  The answer, from a few studies, seems to be no.

A study published in JAMA Internal Medicine in 2012 looked at almost 52,000 adults between 2000 and 2007, their satisfaction, healthcare usage, and mortality.   It found that “higher patient satisfaction was associated with greater inpatient hospital use, higher overall health care and prescription drug expenditures, and increased mortality.”  Yes, those who were more satisfied with their care had higher rates of death.

Some points made by the study authors:

Research has shown (see references, below) a tenuous link between patient satisfaction and health care quality and outcomes.

Patients tend to be more satisfied when they get more testing and treatment, aka “discretionary testing and treatment” (when they think they need it), and doctors are more likely to do this testing or treatment when their pay is linked to patient satisfaction.  But more testing may lead to harm. Other studies have shown that more intense healthcare (more testing and treatment) is associated with increased patient satisfaction but with increased mortality and no improvement in the quality of care.

Several other studies (see below) have found that patient satisfaction is not well correlated to better outcomes.  So what does this mean? It means that what people think they need may not be what’s best for them. However, there is good evidence that a doctor taking the time to communicate properly with a patient, including why in their medical opinion a certain test or treatment is not warranted, results in better patient satisfaction.

We are all human and we have a right to our opinion about other people.  Doctors have a responsibility to do what’s in the best interest of the patient, though it is not always exactly what the patient initially thinks they need.  A good doctor is someone who knows their stuff and will do what is best for the patient, regardless of pay, or pressure. A doctor who communicates well will explain why she or he feels that a certain test or treatment is needed, or not.  But doctors are human, and often feel rushed, and sometimes get frustrated or stressed, and they can feel pressure.

It is not easy to find a doctor in many places in Canada.  And most doctors in Canada are excellent. But doctors are human and our system is stretched.  It is important to be an advocate for yourself or your loved ones’ health care. You need to understand what is happening with your health in order to do everything you can to optimize it.  It is also important to work with your doctor to choose the best investigations and treatments for your specific case. You and your doctor should work together to make the doctor-patient relationship work, and communication is key.  Find a good doctor and ask questions of them. It is worth your time.

Ideas for helping the doctor-patient relationship and improving satisfaction:

  1. Think about visit before, be realistic about what will be covered
  2. Choose top issues
  3. Bring a list of you important past medical issues
  4. Bring a list of your medications
  5. Read about it
  6. Be an active participant in your care
  7. Be open and honest
  8. Everyone deserves good care
  9. Keep in mind that you have a common goal with your doctor — to maintain or improve health








Schneider EC, Zaslavsky AM, Landon BE, Lied TR, Sheingold S, Cleary PD. National quality monitoring of Medicare health plans: the relationship between enrollees’ reports and the quality of clinical care.  Med Care. 2001;39(12):1313-1325

Rao JK, Weinberger M, Kroenke K. Visit-specific expectations and patient-centered outcomes: a literature review.  Arch Fam Med. 2000;9(10):1148-1155

Sequist TD, Schneider EC, Anastario M,  et al. Quality monitoring of physicians: linking patients’ experiences of care to clinical quality and outcomes.  J Gen Intern Med. 2008;23(11):1784-1790

Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending, part 2: health outcomes and satisfaction with care.  Ann Intern Med. 2003;138(4):288-298

Back to school tips from Dr. Zach, E.R. Physician, MUHC

BT Montreal | posted Wednesday, Aug 15th, 2018


by: Dr. Zach

Back to school is a busy and stressful time for both kids and parents.  It takes some time to get back into the school rhythm. Start preparing yourself and your kids for school early, so you are ready for day one.

Top 5 Back to School Health Tips:

  1. Get your kids’ sleep back in order
  2. Get your kids’ diet in order
  3. Backpack wisdom
  4. Phones and digital devices/screens
  5. Anxiety


Extra – checkups/vaccines, transportation safety


Get sleep schedules back on track.  Good sleep is essential for growth and optimal school performance, as well as mood and energy level.  In summer sleep schedules may shift and be less regular. Get ready for school by getting back in the habit of going to sleep at a decent hour and waking up early enough to get to school (if they’re sleeping until 11am they won’t fall asleep at 9pm).  Kids between the ages of 3 and 5 should get 10 to 13 hours of sleep a night; ages 6 to 13 need 9 to 11 hours of sleep; and teens 14 and older should get 8 to 10 hours of sleep a night. Avoid caffeine and stimulation at bedtime.


Pay attention to diet.  Start the day right with a healthy breakfast.  Model healthy eating. Don’t use food as a reward.  Limit added sugars. Have fruit, not juice. Healthy snack.  Balanced diet. Brown>white (for pasta, bread, rice). This will help maintain energy level and avoid post-sugary-binge crash.

Encourage breakfast, fruit, fibre, vegetables, protein.

Healthy eating in childhood sets good habits that kids will carry with them for life, hopefully protecting them from illnesses such as heart disease, stroke, and some cancers.


Get backpacks that fit well and make sure they aren’t carrying too much weight.  Kids carry more and more books as they get older, often more than they should.  International guidelines says children should carry no more than 10-15% of their bodyweight. Girls are often smaller than boys, but carry the same weight of books and homework. Recent research showed that 31% of boys carried overly heavy bags, compared to nearly 42% of girls.  The further one walks, and the less well-fitting the bag, the more pain it can cause. So get a well-fitting bag, wide, with padded shoulder straps and a padded back, use both shoulder straps, and limit the weight of the bag, but keep on walking because it’s healthy. Consider a rolling bag if there is no option but to carry a heavy load, if allowed by your school.  Back, neck, shoulder pain. Those who experience it in childhood are more likely to experience it as an adult. See more backpack recommendations below.


Phones and digital devices — if your kids have them there need to be limits on how much and what they use them for.  There are rising rates of loneliness, anxiety, and depression in youth.  Cell phones and screens aren’t clearly causing this, but they aren’t helping either (see article below).

Need to talk to your kids about using their phones responsibly.


Some use is ok, and there is peer pressure to play games with their friends, but remember it is not really being with other people.  And if they’re on their phones they are not outside running around, or really interacting, or reading, or creating.

Talk to them about safety from online content and from other people online.  Consider a program to limit their use and limit which sites they can access.


See cell phone rules, below.


Talk to your kids about what you worry about and what they are worried about.  For example, bullying, strangers, what to do in case of emergency.  Open the door for them to talk to you.

Kids can sense parental anxiety and it can make them more anxious.


Back to school Anxiety and Worries:  having friends, fitting in, clothes, teacher, schoolwork, bullying.

This may manifest as physical symptoms (abdominal pain, headache)

It’s crucial that they attend so as not to enforce avoidance and not to make things worse.  Most feel better once things begin. At school they learn not only schoolwork but also social skills, a chance to learn and master new skills, for success and mastery, to make friends.

Strategies to help – tired and hungry kids deal with stress less well.  Good sleep and eating routines, healthy snacks.

Encourage them to talk.  It is normal to be anxious — everyone is.

Work together on problem solving strategies

Talk about what they’re looking forward to

Involve the teacher if necessary

Kids should have some extracurricular activities including physical activity, which helps combat anxiety and depression.  This will also teach them life lessons about balance.


Take advantage of the time to get regular check-ups with the doctor, dentist, and optometrist.  And get vaccines updated.  Most of us are lucky enough to never have witnessed the devastating effects of the illnesses that we now prevent with vaccines.  Examples include polio, measles, mumps, and rubella. Vaccines are covered at your local CLSC.

Also, teach them good hygiene — wash hands and/or use hand sanitizer after using the restroom, after touching shared surfaces, avoid bringing dirty hands to eyes, nose, or mouth.


Other things to think about:


Review transportation safety — street crossing, car/bus/bike/walking safety

Homework – regular routine

Physical activity is important


Other than a reasonable weight, other things to consider when choosing and using a backpack:


  • Lightweight material, such as nylon instead of leather;
  • Padded double straps, to distribute the weight evenly across the shoulders (avoid one-strap, cross-body packs);
  • A belt that connects the two straps, or a waist belt, to transfer the load more evenly throughout the back and pelvic region.

If your child has a growth spurt, reassess the bag to make sure it still fits and is not too short or small. For some kids, especially older ones who have to lug heavy books, a rolling backpack may be more appropriate.

Using a Backpack Properly

Choosing the best backpack will go only so far in preventing injury and pain; kids also need to use it correctly:

  • Keep the load as light as you can. When possible, using two sets of books—one to keep at home and the other at school—may help allay some weight issues.
  • Always use both shoulder straps. They should be tightened symmetrically; not one loose and the other taut.
  • Position the pack properly. Make sure the straps fit the shoulders and chest snugly so that the bag can hug the back and not sag too low.

Some straps may loosen over time. When you first fit them, indicate with a permanent marker where the straps should be and then check them every couple of weeks to see if they need to be readjusted.


Cell phone rules from ahaparenting.com

  1. Remember that everything you send can become public. Never write a message or forward a photo or text, that you wouldn’t want forwarded to everyone in your school, plus your principal and your parents.
  2. Always ask before you forward a text or photo.  Be respectful. How would you feel if someone forwarded an unflattering photo of you?
  3. Always ask before you take a photo or video.  And even once someone has given you permission to take a photo, ask before you post it.
  4. If someone asks you to send a sexy photo… …remember that even with Snapchat (which “evaporates” the photo), the picture can be copied and forwarded to others. Anyone could see it — every kid in the school, your teachers, your parents. It happens all the time to great kids. Just don’t send it. And talk to your parents about it.
  5. If you receive a sexy photo…. immediately delete it from your phone, tell your parents, and block the number so you can’t receive more. Possession or distribution of sexual pictures of people who are under-age is illegal. If the person who sent it to you asks why, just say “It’s illegal. Let’s talk instead.”
  6. Never post your cell phone number…on Facebook, or broadcast it beyond your friends (because it leaves you open to stalking.)
  7. Never broadcast your location…except in a direct text to specific friends (because it leaves you open to stalking.) Don’t use location apps that post your location.
  8. Never respond to numbers you don’t recognize.
  9. If you receive an unsolicited text, that’s spam. Don’t click on it. Instead, tell your parents so they can report the problem and have the caller blocked.
  10. Don’t download apps without your parents’ permission.
  11. Don’t spend your baby-sitting money all in one place.  You don’t need more ringtones. Get unlimited texts so you don’t have to worry about budgeting.
  12. Don’t wear your cell phone on your body…and don’t use it if you can use a landline. Cell phones are always looking for a signal, and that means they’re sending out waves that you don’t want going through your body. Cancer? Maybe. We don’t know enough yet. So why not just be cautious?
  13. Leave your phone at a charging station in the living room overnight…so your phone is not in your room at night. It’s too tempting to respond to, and sleeping near it is bad for your brain.
  14. No cell phones at the dining room table.
  15. No cell phones out of your backpack while you’re in class.   And of course turn the sound off.
  16. Have a life.  Don’t feel obligated to respond to texts right away and don’t text until homework is done, during dinner, or after 9pm.
  17. L8R – Later! If you’re driving, turn off your cell phone…and put it in a bag where you can’t reach it in the back seat. (Make sure you have directions before you start out.) Cars kill people.
  18. Nothing replaces face to face talk.  If a “friend” sends you a mean message, take a deep breath and turn off your phone.Talk to them the next day, Face to Face, about it. Never say anything via text that you wouldn’t say Face to Face.
  19. Monitor your phone usage to prevent addiction.

Our brains get a little rush of dopamine every time we interact with our phones, so every text you send or receive, every post or update, feels good. Why is that a problem? Because it can distract us from other things that are important but maybe not so immediately rewarding, like connecting with our families, doing our homework, and just thinking about life. Research shows that people who use social media more often become more unhappy, because it causes them to constantly compare their lives to others, and to worry about whether they are being left out of things their friend group is experiencing.  To prevent addiction, make sure you block out time every day — like while you have dinner and do homework — when your phone is off. Also limit the number of times you check social media accounts. If you feel like that’s too hard, talk to your parents about it and ask for their help. There are programs that prevent your phone from being used at times you designate.

Depression does seem to be increasing in youth but no clear evidence that smart phones are fueling this trend.  They probably aren’t helping though.  http://fortune.com/2018/04/06/teens-youths-mental-health-smartphones-addicted/

Head over to www.drzach.ca for more info!

Hack your way into a healthy September, by Kathleen Trotter

BT Montreal | posted Monday, Aug 13th, 2018

It is possible to stay on your health horse while transitioning back to “real life” after summer — all you need are a few “back to real life” health hacks. Yes, transitioning back to school or work is often stressful, busy, and overwhelming, BUT the changeover does not have to undercut your health and fitness goals!

“Health hacks” are innovative ways to fit exercise into a busy schedule AND motivate yourself to actually do the exercise! (It is one thing to know how to fit motion in — it is another thing to actually do it. You know what they say, “if knowledge were enough we would all be billionaires with rocking bodies.”)

Hacks are always a useful, but they are especially useful in times of stress and transition. Getting yourself and your family back into the swing of “real life” qualifies as both stressful and a “time of transition.”

Remember, the more stressed you are, the MORE important the workout! Yes, finding the time is challenging, BUT finding the time is also critical. You will be a healthier, happier, and more productive version of you if you stay active!!

Instead of ditching your workouts in times of stress, use a few hacks!


Kathleen-approved “back to real life” hacks!!


Turn “back to school” chores into a workout

For example, do fartlek intervals as you walk the malls for school supplies. To do fartlek intervals simply pick random intervals — like the shopper 3 stores ahead of you — and speed walk towards them! Other options: always take the stairs, park far away from your destination (parking lot X vs A), stand on one leg as you wait at the cashier, do a few biceps curls or shoulder presses with books and other supplies in lines, or do 10 squats before you get into your car.


Make exercise a game with your kids and family

The options for this hack are endless. A few examples include setting up a family challenge (eg, track who can fit in the most steps the week leading up to “back to school”), racing your kids to the end of the block, challenging your family to a push-up or squat competition in front of the TV, or practising your kids’ sport with them.


Stop associating working out with the gym

Your workout doesn’t have to be in a gym to be worthwhile. Thinking it does simply gives you another excuse to be inactive. If the gym is not convenient, find an alternative. We all have enough reasons to skip a workout; don’t make convenience one of them.

For example, set up a home gym. Buy a few inexpensive pieces of fitness equipment — a band, the Pilates circle, the Glider, the TRX, and maybe some rotating discs. Train at home. Just commit to something realistic — anything — and do it!


Reward yourself (and/or reward your family)

Set goals and non-food-related rewards: a hot bubble bath, a new workout outfit, or a movie with friends. Don’t let yourself have the reward if you don’t reach your goal.

Get your family involved. Have everyone establish an exercise goal and a non-food-related reward. Prizes could be “the winner gets to pick the movie for movie night” or “the winner gets to pick the music on the next family car trip.” Get everyone to establish a goal and track their progress!


Find someone who inspires you … and learn from their experiences!

This could be someone from your real life or someone on social media. For example, talk to the mom or dad you know who seems to be able to stay fit and in control of their life. Ask how they do it.

Or start a Facebook chat.

Or try sending a message to someone on social media you admire. Ask them how they manage and/or overcame obstacles. Then extrapolate and apply their experiences to your own life.


Exercise at work

Walk as you take conference calls, invest in a treadmill desk, always take the stairs, do 10 squats before you sit in any chair, bike or walk to work, or go wild and crazy and dance around your office.

Another option is to bring a few pieces of equipment to work — such as a SITFIT and a band — and do exercises at your desk.


Couple exercise with something you enjoy

Watch TV or listen to a podcast, an audio book, or music as you work out. Better yet, have a program you are only allowed to listen to or watch when exercising.


Have an internal hashtag or a pep talk ready to go

We all have moments of low motivation. I love exercise and I still sometimes want to bail on a workout, but I don’t. When I don’t want to train, I use self-talk to convince myself to move.

I say, “Kathleen, you always feel better when you move. Your health quest is something you are doing for YOU. Moving is not a punishment; it is a privilege. If you don’t want to do your entire workout, fine, but you have to do something. Something is always better than nothing. Just start.”

Or I repeat simple internal hashtags. My current favourites are #IamWorthyOfSelfCare, #TheWorseYourMoodTheMoreImportantTheWorkout and #PerfectionIsTheOppositeOfDONE.


Get a fitness buddy

Friends make everything more fun. Plus, you are less likely to skip a workout (even if you are REALLY busy) if you are meeting someone. Meet your buddy and do fun fitness classes, go for a walk, do fun partner strength exercises at the gym, or simply meet and do cardio on side-by-side machines.


Create unique strategies for success

Working out in the morning? Sleep in your exercise clothes. Have an unpredictable schedule? Always have a gym bag packed and ready to go. One of my clients gets up and puts her sports bra overtop of her night clothes and then hops on her treadmill. She knows that if she stops to change she will skip her workout. Adopt the mindset that motion is a “non-negotiable.” Then, create a unique plan that works for you.


Create friendly competition

Figure out what drives you. If you care about saving money, pay yourself every time you train. When you reach a pre-established amount, splurge on something you normally wouldn’t buy. If competing with others is more your jam, sign up for ClassPass or a virtual activity tracker; compete with friends on how many classes you attend or how many steps you take.


Create visual reminders of your success

Have a calendar on the fridge and place a sticker on it every time you exercise or create a spreadsheet or graph and record your workouts.


Two last things to keep in mind

First, pick hacks that serve your personality. For example, if you hate being social, don’t try to make fitness a social activity. Maybe listen to music while you run instead of while you sit and eat potato chips.

Second, always have a growth mindset; recognize what has and has not worked for you. Capitalize on what has worked. If buying fitness clothes motivates you, then do that. Learn from what has not worked. If you aim to work out in the morning, but consistently snooze the alarm, figure out why you are tired (do you need to go to bed earlier?) or decide to work out at an alternative time. When you fall off of your fitness horse — it will happen; you are human — get back on a more informed rider!