Joseph Cramer, M.D.: Help your doctor to help your health
My doctor has a disadvantage: I, his patient, am his next-door neighbor. But he has one advantage for half the year: I am his next-door neighbor, and I have a snowblower. He doesn’t. Beyond that, I am not sure of any other benefits that accrue to him.
My internist is like the character in Gilbert and Sullivan's "The Pirates of Penzance." Instead of being "the very model of a modern major-general," he is the very model of a modern major, ah, doctor.
He is modern because he practices evidenced-based medicine. He will come up with something that is in one of the thousands of journals and say, "the studies show." Who can argue with the studies? The old-school practice of medicine was individualized. I don’t mean patient-centered individualization of care; instead, the old way centered around what the doctor knew or believed. To be evidence-based means a doctor goes with the science and not with a factoid perpetuated by mere personal habits.
The disadvantage of the proximity of our homes is that when I become ill, he has to fix it. Breathing is everything they say it is. Even though I should know better, it is not easy to give a clear, linear, coherent medical history. I freeze up when he asks me to “explain what is happening.”
It is hard to describe an ache, a weird sensation or a rare, subtle twitch. Even something as simple as “How long have you had a cough?” brings out vagaries. Was it two weeks or two months ago? Then there is the question of qualification, “How is the breathing?” I know it is happening and it is tougher, but to explain it with words or numbers is a struggle.
Try it yourself. There are the calendar whizzes who can pinpoint the second of the first sniffle. For the others who are time-challenged, thinking back a few weeks or months in any accurate fashion is nearly impossible.
It is worse when years pass. When were those three knee surgeries? I draw a blank better than Walt Disney animated mice.
My doc cautions me about taking too many medicines. Self-medicating can be dangerous. Not knowing what we take is also fraught with risks. Clinicians need more detail than just "the funny-shaped tablet."
With so many people with so many ailments going to see so many doctors and receiving so many treatments, it is critical that you let your doctor or pediatrician know what the other consultants are doing. Otherwise, it's worse than chaos; people die. There is the potential of drug-to-drug interaction. One pill undoes what another tablet is supposed to cure, or one capsule makes the other one seem like 20.
Expired drugs, addictive compounds or surplus pills are all potentially dangerous and a waste of good medicine-cabinet space. Worse, they can be the drug abuse cache of family members or neighbors. Don’t be an inadvertent drug lord to your kids and their friends.
We need to get engaged with our health and our care. That means working with our medical providers as a team. Know your diseases. Know your history. Know your medicines, including their names, doses and frequency. Know what to do when there are problems. Write things down. If you leave a doctor’s office with only spoken directions, demand a written plan. If you don’t get it, ask for your co-pay back.
Likewise, if your doctor offers you antibiotics to treat a viral cold, ask him or her where in the world he or she went to medical school. The overprescribing of antibiotics is creating monster strains of germs. If you ask for antibiotics, shame on you. You don't kill viruses with antibiotics.
So take care, and stay healthy. Fuel the snowblower or take out your neighbor's garbage cans.
The lesson is to pick a good doctor or a good neighbor. I am fortunate to have both.
Joseph Cramer, M.D., is a board-certified pediatrician, fellow of the American Academy of Pediatrics, practicing physician for 30 years and a hospitalist at Primary Children's Hospital and the University of Utah. Email: firstname.lastname@example.org
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