Two conversations this week remind me that sometimes what we say isn't so bad, but how we say it can really mess things up.

One conversation took place with a gentleman who wanted to talk to me about a business idea.  We had a loooong conversation - made longer because we disagreed about PHRs.  Except, as it turns out, we don't disagree at all.

PHRs = Personal Health Records - I've written about them, and believe that they are mostly pie in the sky.  In my world, a PHR is a record patients keep for themselves, and are rarely used by, and never fed by their doctors or other providers.  In fact, that's the definition used by MyPHR, too - a non-profit group that is a thought leader in all things PHRs.  The KEY here is that providers don't add any patient records to them;  patients must maintain them themselves.  And mostly, patients just don't.

In fact,  I see so many problems with PHRs, that my concerns almost derailed the conversation until....

Until I realized that we weren't using the term PHR the same way.

He was using PHR to refer to a patient's digital medical record.  One patient, one record.  That shared-with-every-provider standard that the US is working toward.  The one that will contain all our bond fide medical records, that all our providers will feed, and we will have access to.  It's the record that I call (and that the industry calls) an EHR or EMR (electronic medical record or electronic health record) - and thus you can see, that our terminology was different.  No wonder we disagreed!

Once we figured that out, the conversation went swimmingly.

The second misconception came from a point I tweeted, when my tweet showed up on LinkedIn.  A fellow patient advocacy supporter, took me to task because several weeks ago, she and I had that same conversation - that I am not a fan of PHRs.  My tweet had heralded the fact that one of my local hospitals had just pulled the trigger for patient access to their own medical records.  She felt I was being supportive of something I had told her I did not support. Another misunderstanding between PHRs and EHRs - and more explanations needed.  And yes, now we have cleared the air.

So why do I raise this today?  The truth is - these points and misunderstandings about PHRs vs EHRs are really very minor.  Who cares, right?

But what isn't minor is when you and your doctor aren't using the same terminology, or when what she says, and what you hear (or vice versa) are two different things.  Like when she says "three times a day" - and you aren't sure whether that means breakfast, lunch and dinner - or every eight hours.  Like when he tells you you'll recovery quickly from minor surgery, and you think you can go back to work, and he means you're supposed to lay low for a week.

What we learn from all this is to be clear -and to ask for clarification.  Be concise in your conversation - and ask for your provider to be concise, too.  If there could be shades of meaning in something you are told, then ask for more information.  Choose your words wisely, too, so they can't be misconstrued.

Here are some points to consider when it comes to communicating with your doctors and other providers clearly - whether the conversation takes place about your body, or your records.

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Here's a thought provoking post from Kevin MD's blog, written by Dr. Martin Young, entitled Isn't it time for a patient rating system for doctors?

Dr. Young suggests that he understands why he is judged by his patients through doctor ratings sites, but that sometimes its unfair, and sometimes patients behave unfairly toward him. He admits that he makes mistakes on occasion (all human beings do) but he feels as if some of his patients judge him and disdain him long past the amount of time they should. He thinks they should get over it. The ones that don't, he labels as "bad patients."

And the comments to his post ensued! They were made by doctors and patients alike. Some were respectful, some were not. Some are well thought through and make good points, but some shot from the hip without regard to good reasoning or reality.

I should note here, that Dr. Martin lives and practices medicine in South Africa. Yet what a nerve he seems to have struck across the globe!

I have a few comments - removed a distance from the conversation and hopefully a bit more objective and less emotional:

1. Doctors judge patients, and record those judgements, every day. We know there are codes in our records describing who we are and how we behave. We know conversations take place at the nurses' station in the hospital. We know patients are blackballed and dismissed every day. Doctors don't need a rating system for their patients. They are already rating us.

2. Sometimes patients deserve to be dismissed! There are any number of behaviors that drive doctors crazy, but beyond that, there are behaviors that mean that doctor and that patient should not be working together under any circumstance.

3. Dr. Martin claims he has patients who continue to hold a grudge. They continue to see him and continue to voice their disdain. Well, maybe the South African system is different from ours in the US, but if any patient told me that's how she felt about her doctor, I would tell her to find a new one fast. And if any doctor told me he was having that problem with a patient, I'd suggest it was fair for him to dismiss that patient.

Regular readers know that I am not a fan of doctor ratings sites. Well, I'm not a fan of the idea of rating patients either. It would be a little like Match.com allowing dates to rate each other. Way too subjective!

The right doctor-patient relationship is like a good marriage, or a good partnership. And - as Gramma used to say - there's a lid for every pot. There are better ways for patients to figure out which doctors they want to see. And sometimes there are reasons to dismiss those patients who doctors don't want to treat any more.

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Hey y'all!  Paula Deen's got type 2 diabetes, didja hear that?

Of course you did.

Regular readers know I am not a fan of celebrities telling us how to manage our health.  But here comes Paula Deen, the darling of butter, sugar, white flour, marbled red meats and plenty of salt - telling us that diabetes IS manageable.  Yes it is!

It turns out that Paula was diagnosed three years ago with type 2 diabetes and kept it under wraps.  That's where it should have stayed, if you ask me.  She decided not to say anything before now because, as she told the Today Show's Al Roker, "I'm not your doctor!"

But it turns out that MONEY can make her say something!  Yes it can - and Novo Nordisk, makers of diabetes treating drugs, was willing to pay her enough to talk about them on TV, online, probably on the radio, too.  So maybe she's not our doctor - but yes, she can still be bought.  And her message makes it sound like we can still eat all those foods that clog our arteries and put fat on our bones to our heart's content because, well, Novo Nordisk wants you to know that diabetes is manageable!  Not to mention that her entire cooking show would go out the window if she dared confess that maybe her fatty, sugary diet had anything to do with it.

(Oh - by the way - manageable really means you can inject yourself with THEIR drugs 2-3 times a day - or more - because your pancreas is shutting down.  It also means you need to keep getting your feet checked because you're at risk of getting them amputated, and your eyes checked because you're at risk of going blind....  yesseree - manageable!)

Once again we have a case of someone well known and beloved by many, endorsing drugs in the media.  WRONG!  Don't listen.  Let Paula go back to cooking her delicious, if deadly, concoctions. Cook one for yourself once a month if you must.

Smart patients know that professional cooks are not the ones to be giving us medical advice.  Like other celebrities telling us to "ask your doctor," they are simply shills for drug companies.

And a simple note to Paula:  oh, Honey. If you had only come clean on your own, without that big Novo Nordisk paycheck, I might have had some respect left for you.

Learn more about celebrities and drug endorsements (think Sally Field, Antonio Bandaras and others, too.)

Here's how to use drug ads to benefit your health (really!)

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Prescription drugs are expensive, whether you pay for them in cash, have to dig deep to cover the donut hole, or have to pony up a co-pay even though you have insurance.

But someday it's possible that the real expense of prescription drugs will have little to do with the cost of their purchase, and everything to do with whether you actually fill the prescription, and purchase the refills on schedule.

Enter FICO - Fair Isaac COmpany - those diabolical business people who invented credit scores to help control whether we Americans can make credit purchases. Now they will tell you that they only cough up a number - that we individuals actually control our own credit scores because we control how well we borrow money and pay it back.  I can buy that.

But now FICO has invented a new score - the FICO Medication Adherence Score.  It will measure how well we fill and pay for our prescriptions - as if that is some accurate measurement of how adherent we patients are, and therefore how well we control our own health.

Seriously?  That's one of the most ridiculous data uses I have ever heard of - and I am not alone. There are so many reasons patients don't fill prescriptions that don't relate to whether we think we should take them. They may be too expensive. We may have an allergic reaction and therefore do not fill subsequent refills. Or maybe there is a shortage - and just how much control does anyone thing we patients have over drug shortages?

Thing is - I have to give FICO some credit. When you read about all the organizations who will pay them for the information and what they will use it for, you'll have to agree with me that the idea is genius.

It's just that it's based on the wrong conclusions and assumptions!  Garbage in, garbage out.  And guess just who will end up paying for it in the long run?  Of course. We patients.

Sometimes the best way to beat a ridiculous idea is to join it - or game it - or intentionally try to mess it up.  So I've come up with some ways to do that. I invite you to take a look, to make smart decisions about affecting your FICO Medication Adherence Score that won't have a negative effect on your health, and to join me in doing our best to send FICO back to the drawing board.

•   What Is the FICO Medication Adherence Score?

•   How to Control Your FICO Medication Adherence Score

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