Sunday, May 30, 2010

How to be a Healthier Patient

The list that follows is by all means not inclusive, and if any of you out there want to contribute to the list, please do so.

1) Please inform the doctor if you plan to (a) change the dose of a medicine or drop it entirely, or (b) not see the specialist to whom you were referred, or (c) plan not to do a suggested test.

2) Be aware of your family history. The risk of diabetes increases with age, and even more so if any relative has adult-onset diabetes and you are overweight. The risk for Alzheimer's Disease and coronary artery disease is also inherited. If either parent smoked and developed lung cancer, you shouldn't even think about smoking. If either parent or sibling had colon cancer, you should start colonoscopies at age 40, and have one every 5 years.

3)Feel free to search the internet about your disease, at the same time that you try to ignore the well-meaning advice from family members and friends. They may be angry with you for not asking for a different test, not getting another opinion, not seeing the doctor they recommend, etc.,, but remind them that it is your body, and it is more important to please yourself and feel comfortable with your medical decisions than to please them Discuss the internet results with at most one person. Once you have decided on a treatment plan, try not to second-guess yourself.
Never look up your symptoms, because you may imagine you have horrible diseases, as many second-year medical students do during their course in abnormal human pathology.

4)Be sure you have a signed and notarized copy of your pre-terminal and terminal wishes, and discuss this with your doctor and make sure both he and your medical power-of-attorney have copies.

5) Please make sure that your tetanus, shingles, pneumovax vaccines etc. are received at the recommended time intervals. (Vaccination is discussed in an earlier blog.)

6)You can be the best patient in the world, but sugar, cholesterol, and blood pressure all usually increase with age. By observing your doctor's recommendations, you can reduce the rate of increase of risk.

7)Avoid brand new "treatments" that only one doctor knows about. There are very few secrets in medicine, because all doctors want to cure their patients. If you hear/read about a new medical "development", you should wait for the second published paper. If it is an announcement after a talk at a medical conference, or shown on a TV talk show, then the results probably weren't reviewed at all. (Remember when a "study" claimed to show that coffee drinking increased the risk of pancreatic cancer? Or that lemon in hot tea in a styrofoam cup leached out a dangerous and carcinogenic chemical?) For that matter, they jury is still out on the safety of charcoaling meat, but no one seems to worry about this any more.

8) Please make sure your family doctor gets a copy of ALL your tests, both blood and Xrays, wherever they are done, especially including the emergency room. It is important for your health that at least one doctor has all your health records. (And if you want your doctor to use an electronic record storage system, I have received notices in the past 2 years from 3 Veterans' Hospitals that their system was hacked. Would you trust the fact that you are a married, bisexual, cocaine-using AIDS patient to the security of the internet?)

9) If you can, try to exercise non-stop for at least 30 minutes 3 times a week. The maximum exercise pulse rate is a myth. (Bjorn Borg's resting pulse when he won the French Open was 34, which is also typical of many marathoners.) You should exercise at such a rate that at the end of your workout you feel that you have exercised. Walking is great, swimming is a no-load exercise that shouldn't stress any joints, and if you use a treadmill, setting it on an incline leads to an unusual walking pattern.

10) If you want to lose weight, remember that no one stays on a fancy diet forever. Just use portion control, and be satisfied with a spoonful of chocolate ice cream rather than the whole pint. You burn fat when you feel hungry, so always leave the dinner table before you feel full. You don't even need a scale. Just feel how your clothes get looser. For a man, one belt notch, aka 2" around the waist, is about 10 pounds. If you are more than 100 pounds overweight and a diabetic, the most certain treatment to date seems to be gastric banding, but ask the surgeon how many he/she does a year. Also, remember that your metabolism slows down each year until you are about 75 years old, so if you don't reduce what you eat, you will probably gain 3 to 4 pounds each year. Just recall what you weighed when you graduated high school or college, or before you got married, or before your first pregnancy.

11) As of this date, there is NO evidence that treatment of prostate cancer saves lives (which doesn't mean that it does not, but only that there is no proof of its effectiveness.) However, I have never seen a wife who would let her husband not treat his cancer, so if you believe in "watchful waiting", then don't have the PSA test if you are married.

12) Please tell the doctor the whole truth and any and all complaints, whether the doctor asks you about them or not. Too many patients are embarrassed to discuss certain issues (is sex with your partner satisfying?), or do not raise certain complaints because they fear the possible diagnostic consequences. Too many men minimize their symptoms (men will almost always be macho with other men). Patients rarely discuss habits that they feel are demeaning or childish, or make them seem less than perfect in their own eyes or the eyes of their doctor. Remember that we doctors have really seen it all, both in our offices and in the emergency room, and we are not shocked, censoring, or belittling. We really do want to help you, and it is no longer true that an alcoholic is any patient who has a drink a day more than his/her doctor does.

13) Please only have protected sex. Too many of my college students don't. I tell all my female patients to keep a condom in their purse, don't tell the guy that you are on the pill, and that "if he doesn't put it on, he doesn't put it in".

14) If you are concerned that you may have AIDS or another sexually transmitted disease, then donate a unit of blood to the Red Cross. They will test your blood for AIDS, syphilis, hepatitis A,B,and C, West Nile Virus, and a few other disease, and the tests are run free of charge. Also, the country can always use another unit of blood, and there will be no record in your doctor's office chart for your life insurance company to wonder why you had an AIDS test.

15) Whether or not you have high blood pressure or diabetes, you should review your diet with a competent nutritionist.

16) For what it's worth, there have been at least two studies showing that women (but not men) who drink regular coffee decrease their risk of developing adult-onset diabetes.

17) Lastly, even the government now admits that daily (for men) and thrice weekly (for women) alcohol ingestion decreases the risk of coronary artery disease, heart attacks, and strokes. (See my previous blog for more details about the health benefits of alcohol.)

18) And you should probably see your doctor to review your health and be thoroughly examined once a year, but I know of no studies that support this suggestion.

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