TINA: Mr. Hines, good to see you today.
JOE: Thanks. (good naturedly) And call me Joe. Mr. Hines is my father.
TINA: Alright, Joe. So, what's your understanding of why you’re here today?
JOE: Well, ahh… to prepare for my chemo next week?
TINA: That’s right. I know your oncologist reviewed some of this on your last visit. Do you have any specific questions, or would you like me to review a few things with you?
JOE: Uh, I remember some, I think? But a refresher would be nice. It was all a little...much.
TINA: It is a lot of information, so you need to pay close attention this time, okay?
JOE: Oh. Well…. I, uhh….
TINA: This is all for your health and safety.
JOE: (slightly miffed) Yeah. Got it.
JOE THOUGHT: Are you scolding me? My life has been turned upside down, okay? I'm doing my best here.
TINA: Neutropenia is caused by an abnormally low level of neutrophils, and-
JOE: -Neutro-whats?
TINA: Neutrophils, a common white blood cell. A count of less than 1,500 neutrophils per microliter of blood is considered to be neutropenic.
JOE: Uhh... I'm sorry - I'm... not following.
JOE THOUGHT: Can you bring the "doctor-talk" down a few notches? I have no idea what you're saying.
FEEDBACK: Using medical jargon confused Joe. It's important to use plain language when speaking with patients.
TINA: I'm sorry about that. Let me start over. During chemo, your white blood cells can get really low. The fancy medical term for that is called neutropenia.
JOE: That doesn't sound good...
TINA: You're right, it's not.
TINA: Your white blood cells fight infections and when they get low, you're much more likely to get an illness your body can't fight off. That's why an infection during chemo is so serious. It could mean getting sick, a hospital stay, an interruption of treatment, or--worst case--even death.
JOE: Yikes.
TINA: Right. So I want to make sure you know what to do to protect yourself and lower your chances of getting an infection.
JOE: Yeah, me too.
FEEDBACK: Remember not to use jargon like "neutropenia" without first introducing what it means.
TINA: The risk of becoming septic is highest during your nadir period.
JOE: The risk of what when?
TINA: Sepsis... I'm sorry about that. Let me start over.
TINA: During each chemo cycle there'll be a time when your white blood cell count will be the lowest. That's called your 'nadir.’
JOE: Okay...
TINA: Different chemo meds have different nadirs. We'll check the chemo ordered for you so we know when yours is,but generally the nadir starts 7-12 days after chemo treatment and lasts for 5-7 days.
TINA: Your risk for getting an infection is highest during your nadir period.
JOE: Yikes!
TINA: Right. So avoiding infection during chemo -- especially during your nadir -- is incredibly important.
FEEDBACK: Using medical jargon and talking about nadir before you defined it, confused Joe. It's important to use plain language when speaking with patients.
TINA: So, tell me, Joe, what's a good plan for tracking your nadir?
JOE: Well... I'll check with Dr. Collins about exactly when my nadir-thing will be based on the chemo I'm getting. Then... uhh... something about how many days after? I... I don't remember.
FEEDBACK: Providing an example and using simple language would have helped Joe understand and retain the information.
TINA: During treatment--and especially during your nadir--you'll definitely want to-
JOE: -Sorry. I'm... I want to make sure I understand that nadir-thing...
FEEDBACK: Moving on before ensuring that Joe has a clear understanding of nadir left him confused. Try again and make sure he understands the information.
TINA: Try to stick with me this time, okay, Joe?
JOE: (taken aback) ...oh. Okay.
TINA: Again: the first range of numbers 7-12 days, that's the time from the day after your chemo to when your nadir period begins-- when we know which chemo you're getting we'll know your exact start day. The 5-7 day window is how long your nadir will last once it starts. Got that?
JOE: (a bit overwhelmed) Yeah. The numbers confused me.
TINA: You'll need to adopt three main infection control practices during chemo.
JOE: Infection... control... practices?
TINA: Sorry - let me back up. During treatment, there are three main ways we recommend to keep safe. You'll want to wash your hands often, be sure to have gotten the flu shot and any other recommended vaccines, and try to avoid being around people who are sick.
JOE: Okay. Well... flu shot's already done, so... there's that.
TINA: Great!