Scalpel’s Edge

Healthcare is not a battle

// January 30th, 2009 // 4 Comments » // Health

This article is part of a patient education series that I previously published elsewhere. Explanation is here. If you have already read this article, please accept my apologies.

I’m sick of the fighting

Healthcare doesn’t have to be oppositional. In fact, a doctor and patient should be acting as partners to reach a common goal. Although I am sure it will be unpopular, I have to say some of this is about patients behaving like a customer.

Some doctors have issues with patients who stand up for themselves, demand to be understood, or who ask lots of questions. However, your health is more important than any consumer product you might buy. If you would jump up and down to get your entitlements when your iPod breaks, you should be doing it about your health. But a better analogy is your prized vintage car. You choose a trusted mechanic, and you make sure you understand what is going on. You take control. If you feel in control of your health, your relationship with your doctor will benefit.

It’s all about the relationship

Problems in healthcare occur when the patient or doctor (or both) don’t understand what is going on.

Being a patient is sometimes difficult, humbling and embarrassing. However, dealing with doctors can be easier, if you are a smart consumer. You can improve your healthcare, and get more out of your experience, by using smart strategies.

There is a lot of information available on the internet on “How to Be a Good Patient”. The articles seem eerily similar - health-care providers giving patient’s tips on how to behave in an appropriate manner. This advice seems, to me, more about the provider than the patient, “Behave like this and I will find you easier to deal with and therefore have more energy to sort out your problem.”

But the answer is more simple. Create a relationship with your health. Work to understand what is going on. Find a useful doctor, who you can trust. Even when you are healthy, this can help smooth out the bumps of illness. For example, if you lost a prescription, you’re working uphill to get it replaced by a doctor on holiday, but it is much easier with someone who has met you before.

What about the doctors?

In my experience, doctors sabotage healthcare relationships, too. Usually, it is not intentional, but tiredness, unrelated stress, frustrating patients and staff conflict can make us into poor communicators. A short consultation seems even shorter, and less satisfying with a grumpy doc. It’s a trite comparison, but I behave this way with my kids when I am stressed and tired, as well. I know what I should be doing and saying, but I just can’t manage it.

What’s the solution?

I am no expert on this. I don’t have great answers. But I think part of the process is recognising the difference between the doctors/patients we should and want to be, and the way we actually are. Once we find real relationships in healthcare, then it becomes easier to cut through the daily static. Once we make connections, we can approach success.

Tweeple are funny

// January 28th, 2009 // No Comments » // Uncategorized

Twitter is a microblogging service where users share their lfe 140 characters at a time.  Here is a collection of some of my favourite “recent” tweets.  The timeline works back to front - the most recent updates are at the top.

	darthvader The bad news is we had to let go of about 8,000 clone troopers today. The good news is it really only counts as 1. about 1 hour ago from twitterrific
	PhilBaumann More people might be interested in Twitter if the question was changed to “WTF are you doing?” about 4 hours ago from TweetDeck
	grahamwalker Just got a nice call from a partner of a young patient who we coded and ultimately died. Thanked me for being there for him. Nice to hear. 11:53 AM yesterday from web
	danielpunkass When I was eight, my dad tried to explain the theory of relativity to me. I laughed hysterically for several minutes. So it must be true. 10:57 AM yesterday from twitterrific
	Geek2Nurse Social worker note says Pt expecting call from Heaven. RNs exchange knowing looks. Phone rings. Pt’s friend Heaven asks to speak with him. 9:32 AM yesterday from web
	atariboy Movie concept: ‘Prams on a train’. It’s a horror. 2:16 PM Jan 25th from Tweetie
	badbanana Any rational economic stimulus plan should include blowing up Mount Rushmore in search of the City of Gold. 11:10 AM Jan 25th from web
	tjstaab Why is it I’m the only one still smelling like chlorine. The joys of being a mum. Everyone else showers first and no hot water left for me. 5:51 AM Jan 25th from TwitterFox
	pyknosis Not sure she realizes it is impossible to have more than 2 biological parents regardless of how fucked up your family otherwise is. 5:09 AM Jan 25th from Tweetie
	pyknosis Shot a quizzical look when the instructor ventured out of bounds saying some ppl have >2 genetic links “in era of artificial insemination.” 5:07 AM Jan 25th from Tweetie
	pyknosis Wouldn’t that make a phenomenal holiday season movie? A one-legged toddler who trains like Rocky I, overcomes the odds, and wins the race. 3:57 AM Jan 25th fromTweetie
	doc_rob Writing is the only profession where no one considers you ridiculous if you earn no money. - Jules Renard9:17 AM Jan 24th from TweetDeck
	jpoh Wish I had a ’spinning beachball of death’ tshirt cos I feel like that right now. Someone force quit and reboot me pls9:17 AM Jan 24th from Tweetie
	drlori71 Family Bingo night tonight for my son’s school. Bingo - where B4 is really just B4 and not “before” 7:58 AM Jan 24th from web
	badbanana New York pushers are selling ‘Obama’ brand drugs. Personally, I’d rather have whatever Palin was smoking.7:05 AM Jan 24th from web

How to choose a medical specialty

// January 26th, 2009 // 4 Comments » // Links, Surgery

I like this. Just think of me as a mean, hardworking and sane. That does all the right things for my ego.

Inspired by my interactions with residents training in all major specialties, I have created an algorithm to guide students’ choice of specialty on the basis of their personality characteristics. Boris Veynsman

Image by Veynsman BMJ 2005;331(7531):1529 (24 December), doi:10.1136/bmj.331.7531.1529

Five easy ways to live longer

// January 23rd, 2009 // No Comments » // Health

This article is part of a patient education series that I previously published elsewhere. Explanation is here. If you have already read this article, please accept my apologies.

I am sure most people know that you can live longer by giving up all your vices and exercising regularly. I am not going to talk about that, as those methods aren’t really easy ways to live longer.

Instead, I am going to give you five straightforward ways to improve your health. Most of these things will take a bit of time, so consider them as time investments. These investments also have compound effects - the earlier you think about your health, the better your outcome will be.

1. Get a doctor you are happy with and trust.

Your health is much better served by having regular check ups. People who lurch between “disaster appointments” can only keep substandard health. Furthermore, we are not that great at picking when we are getting sick. If you have a trusted primary doctor, you are more likely to ‘fess up to embarrassing problems, or even problems you are not sure about. If you are unhappy with who you have, try someone new.

2. Visit your doctor often - everytime you feel like it

The human body is a magnificent machine, and tends to look after itself. It is very uncommon to get so sick that you suddenly keel over. So, illness is usually detectable far in advance. Visit your doctor regularly to take advantage of that.

For example, instead of running out of a prescription and having to quickly call in to get a repeat, plan for it. When you get your pills, figure out when they will be finished and write it in your diary. Then you can ring up a week ahead to get a real appointment. If you plan, you will get in. So you rock up and get your prescription.

For the price of being organized and 30 minutes waiting, you and your doctor get a unique opportunity. Your doctor will probably take the time to look at your health as a whole. They could:

• Check your blood pressure, blood sugar, or similar. Lots of tests are important to preventative medicine, but get missed when people are in a hurry.
• Read through your notes and make sure you haven’t missed any test results. Results sometimes are missed, and we see the bad consequences in the news a lot. God forbid it should happen to any of us, but couldn’t things be completely different for those people if they had of seen their doctor two weeks later for an unrelated reason?
• Talk about your family history (see below)
• Talk about your future plans. Doctors love to see people before they go overseas to offer them immunisations. Doctors also love to see people before they start trying to get pregnant, as they can help prevent some familial diseases, and advise about doing things to make your baby fitter, such as taking vitamins, or helping you quit smoking. Doctors love to see people before they try to get fit, so they can check their cardiovascular system out. All these things make you a healthier person.
• Give you an opportunity to vent about your life, and possibly even offer some support, either by recommending a counselor, or home help services, or letting you know about a support group.

If you and your doctor are not having time to look at your overall wellbeing, you are not seeing them enough, and you are not getting value for your health.

3. Examine your family history

A lot of medical conditions are not random. Heart disease, breast cancer, asthma and allergy are all inherited diseases.

Talk to your surviving parents or grandparents about what conditions they may have had in the family. Through my Gran, who was a family history freak, I know that polydactyly (being born with more than 5 fingers) runs in our family. So it wouldn’t have caught me as much by surprise if that happened to one of my children. Luckily, it seems to not be an ongoing trait. More commonly, people often know of uncles or parents who were diagnosed early (before 60) with heart disease or cancers. Some of these people should have extra screening at an earlier age.

It is important to note that previous generations felt very secretive about their health. There are some conditions that are still considered to have a stigma associated with them, especially in some cultures. For example, mental illness in our culture is still treated like a dark family secret. So it is important not to assume you are ok, just because you have never been told. Do some family snooping.

If you find out about any conditions that might be familial, discuss them with your trusted doctor.

4. Get outside once a day

It seems so simple, but it is hard to do. Visiting the “outside” works on many levels.

• UV light is good for us and improves mood.
• “Inside air” contains a lot more particulates and microbes, such as skin cells and bacteria. “Outside air” usually contains a lot more pollutants like carbon and soot, but it still makes you feel better.
• People who work inside normally have trouble continuing work outside, so it works as an enforced break.
• Most people exercise more simply by the fact of being outside. There are no lifts or travelators outside, and even if you sit on a chair in the park, you still need to walk to get there, and it is often furhter than you can walk insude your office without looking silly.

5. Exercise and give up all your vices.

OK, so I fibbed. It is important to give up some vices, but try to see giving up as a treatment for a medical condition. If you try to change a long-standing habit, you need to be fully motivated and you need to be doing it for yourself. Tackle them on thing at a time, and make a real effort.

There are lots of people trying to make a lot of money out of getting people to give up smoking, drugs, obesity and any other number of vices. However, it doesn’t mean those techniques are not worth trying. The idea that we need to do it all ourselves is pretty outdated, nowadays. So if you want to do the right thing about one of your guilty pleasures, do whatever it is you need to do and demand whatever help you need.