Monday, July 9, 2012

How to be a Healthier Patient

     What can the individual do to extend his/her life? I am not going to talk about the obvious suggestions such as "lose weight", "get more exercise", "stop smoking", etc. Rather, I wish to consider simple modifications of habits that do not involve a life-long commitment, but rather are situational responses.

1) Be sure to finish the entire bottle of medicine. Too many patients stop talking the medicine, especially antibiotics, when they feel better. The problem with this is that the first seven days of a ten day course of penicillin may have only reduced the bacterial load to a level that you do not notice, but there are still enough left to "become fruitful and multiply" and make you sick again.

2) Never ignore blood in the stool.  Too many patients ignore it until it goes away, and then never mention it to the doctor unless specifically asked about it (and sometimes not even then).

3) Tell the doctor all the drugs that you ingest, including vitamins and other over-the-counter products. There may have been a recent article in a medical journal pertaining to your supplement. For instance, there have been at least two published clinical studies demonstrating that taking vitamin E supplements increases your chance of having a heart attack. In this vein ( no pun intended) if you are taking a nutritional supplement, you should bring in to the doctor a list of all the compounds in the supplement.

4) Doctors are not opposed to alternative medicine per se, but to us "alternative" is another term for "not clinically proven to help", which is not to say that you are not benefiting from your particular treatment.  And  we do want to know about any such treatments you are undergoing, because it can impact on your overall health. We are are interested in all your health provider contacts: acupuncture, chiropractor, nutritionalist, yoga instructor, pilates, tai chi, biofeedback,-----.

5) Please also tell us about any illegal drugs you are using, not the least because they may interact negatively with a medical condition you have or with a prescribed or OTC drug you are taking.

6) Never stop or decrease a prescribed drug you are taking without notifying your doctor. Some drugs can cause rebound problems: abruptly stopping some anti-hypertensive medications has caused  a rebound upsurge of blood pressure and a stroke. If you reduce an asthmatic drug too rapidly and get an asthma attack, the old inhaler may not be able to be inhaled to the proper depth in your lungs (because the resistance to the flow of air in your lungs varies inversely as the fourth power of the radius of the bronchioles). If you reduce an anti-depressant drug too rapidly you may need an even higher dose of the anti-depressant to control a recurrence.

7) Almost every patient has at one time or another tried a friend's or relative's sleeping pill or tranquilizer. Please tell your doctor, because whether the borrowed medicine worked or did not work is useful information for the doctor to know. (BTW, borrowing someone else's controlled medicine is probably the most commonly committed drug-related felony in the US, although few people think of it as such.)

8) At your annual physical, if the doctor does not ask, please tell him/her about any sources of emotional stress, especially if it involves your relationship with your spouse or SO, your parents, your children, your siblings, or your boss. Unresolved stress can lower your pain threshold as well as contribute to insomnia and depression. It is easier for the doctor than for you  to see a possible solution to your problem , because your physician is thinking "outside the box" of your relationships.

9) The internet is full of truths, half-truths and lies. I generally tell my patients that it is OK to look up their disease, but not their symptoms. Almost every symptom is listed as a possible symptom of cancer, AIDS,  Alzheimer's Disease, or multiple sclerosis, and reading about it will cause you to worry needlessly. The mind can imagine and worry in unbelievable amounts. Most medical students, during their second-year course in pathology, imagine that they have at least one of the diseases that they are studying.

10) If you are thinking about leaving your internist/gynecologist/dentist/..... but are hesitating to do so because you don't want to hurt his/her feelings, or the doctor is a relative, or a close friend, please leave anyway. It is your body, and the doctor should feel that it is a privilege to treat you. And if the doctor takes it the wrong way or gets angry,  the doctor's ego is too big.

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