April 09, 2005

The best way to get good medical care is to prepare yourself to become an active and vital part of the process. Then, no matter what happens to organized medicine and government, you'll have the best chance to find the care you need when you need it. It's going to be a mighty rough ride, but there are things you can do to help yourself prepare.
First you have to get beyond the passive role most people play in relationship to their medical caregivers. The old reverence for the doctor and "doctor knows best" are dangerous dinosaurs. You have to face the fact that it is YOUR body and your life - or that of your family - at stake. You want to make use of the medical profession's knowledge and skills without playing medicare games or getting kissed off with a pill and a bill.

So, what did the doctor tell you the last time you saw him/her?

This is one of the first questions I ask my patients. I need to know what they have been told so that I can begin to formulate my teaching plan. Most of the time they have been told very little and/or did not understand much of what they were told. They usually did not ask questions and the history or background of their problem usually wasn't covered carefully.

Why? Many things contribute to this, but the most glaring is the conflict of interest inherent in the third party payer system that accounts for 99% of the doctor's income. Remember: those who pay the bills call the shots. It takes real time to listen to patient's questions and concerns and make reasoned answers. They don't have the time anymore.
Conflict of interest. This is most obvious when some treatments or medications are withheld because the payer doesn't want to foot the bill. Doctors are routinely told not to offer things that are not covered by the insurance or that are expensive, and this has been documented in the news a lot over the years. But the more subtle practice is actually by far more damaging to the lives of millions of people. The only way this is going to change is for people to take back the power to choose and to go somewhere else if their needs are not met.

But there is another serious barrier to good care. Many people do not want to "bother" the doctor or are afraid to ask questions, don't know what to ask, or expect the doctor to know their fears and questions already. Yes, for real! The other is the attitude and body language of so many doctors that makes people afraid to ask. The doctor comes in rushed, stands there and asks why you came, and his body language tells you he's going to rush right back out that door if you don't come up with something fast! It's terribly intimidating - and it works! The average "visit" time is something like 7 minutes. If he takes longer than that, he's apt to get a reprimand from whoever pays him. How do you describe a complex problem, explore your fears and ask questions in 7 minutes? I sure can't.

Consider, for example, what happens when someone comes in with a complaint of pain - the most common complaint. The usual FIRST action of the doctor is to prescribe pills, often the weakest and least effective kind. Usually that is the ONLY action unless you have a broken bone or something obvious! Pain is the body's signal that something is wrong. Any pain that does not respond quickly to rest, massage or other ordinary measures needs to be investigated, not just covered up with pills. Medication is indeed very helpful for comfort until the cause of the pain is identified, but it should never be the only thing done for it.

When the patient continues to have pain (or any other symptom that is worrisome) and returns to the doctor, the usual action is to change the pills! It can take months or years for a patient to get the real diagnosis of the problem, if ever. How many times have you heard someone say, "if only they had found that earlier..."? With the array of diagnostic technology available, this should be rare as hen's teeth. Most of the time, with persistence and care the proper tests and so forth can be obtained, but it won't happen all by itself.

This cuts both ways, of course. Some people WANT all the latest tests, treatments and pills simply because they are new and they don't have to pay for them.

I feel equally sorry for and frustrated with those who don't want to "bother" the doctor. They were raised in awe of the doctor and think he can magically figure out what the problem is without any input from them. They go to the doctor and when asked how they are doing they reply, "fine". This happens most with the elderly, and results in a lot of misery and poor health care. They don't realize that the doctor can't ask them the right questions and ferret out the problems, even if he wanted to and had the skill. He just doesn't have time for guessing games.

What can you do? Aside from the ideal of paying for your medical care directly so that you would have the most control, the next best thing is to go to the doctor prepared to be your own advocate. If you have an idea what may be the problem, do some research and understand it the best you can before you see the doctor. Make clear notes of your symptoms and problems. Write down a list of questions to ask, and be specific. This way you will be best prepared to understand what you are told and have a chance to know if some things are being withheld.

Be prepared to tell the doctor about your diet, the medications/herbs/etc. that you commonly use. Write down a complete family and personal medical history - preferably typewritten - and give it to the doctor on the first visit. He should ask these questions, but it just isn't going to happen. The trick is to get him to read it. Ask him... and insist - or find another doctor who will. Your health depends on it.

Obviously, and so often overlooked, is the very real challenge we all face to avoid health problems altogether as much as possible. There is a mountain of information available, both printed and on the Internet, about living and eating in a healthy manner to avoid illness and injury. There is a lot of junk in those mountains too, of course, so you have to be careful and not believe everything you read.

Take charge of your life and your health. Here are your tools.

A wire bound notebook. Write the personal and family (your parents and siblings) medical history for each family member in as much detail as you can. Ask parents, siblings and other family members for details you may not be clear on. I have mine typed and stored on a floppy disk, updated from time to time, but anything is better than nothing. If you need to have major surgery or develop a serious medical problem, this history may offer clues that will help you. Otherwise, the doctor is looking into muddy water and may miss things that are vital.

If you get sick or injured, write in detail what happened, when you first began to have symptoms, what they are, when they occur, how long they last, anything you can think of. Just as with the history above, this might give the doctor some clues. He only knows what you tell him, so be as thorough and accurate as you can.

Buy a good medical dictionary/encyclopedia for medicine. Taber's, Miller-Keane, Merck and many more are available. Avoid the dippy "family guide to medicine" books that are too general and have a lot of false information in them. Some of these are now available on CD disks with terrific search features. Learn how to use them and investigate things before you see the doctor. You are not trying to diagnose yourself, of course, but you want to be able to understand what he says and the words he uses. If he uses some you don't know, write them down and look them up.

MayoClinic.com
Medline plus

Both of these sites are reliable and have a very broad range of topics to choose from, but this is just a start. There are many more.

"Alternative" medicine. This is both a gold mine and a mine field. It is especially important to be careful about any alternative medicine advice or products you find. There are a lot of very good ones, and there is an awful lot of junk. One excellent source I've found is a newsletter called "Alternatives". This blends the very best of ordinary medicine, the best and latest findings of honest research, and many of the best of nutritional and supplement advances that won't hit the mainstream press for years, if ever.

Alternatives
Mountain Home Publishing
P.O. Box 61010
Rockville, MD 20859-1010
1-800-219-8591

This has a money back guarantee and a lot of extras. It isn't cheap, but I saved the price of the subscription getting rid of just one pill that wasn't helping me! You have nothing to lose. (I'm not selling this and receive no compensation for promoting it.)

Please send your feedback and let me know if you've found other good sources for information on traditional or alternative health care that is backed with clinical trials and solid science. No snake oil, please.

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An Invitation To Participate

For Her Safety

The Valley of the Shadow of Death

Are We All Wasting Our Time?

Standing By Our Mission

Free State Project - What is going on?

A Gift For Granny

Forced Righteousness?

The Meltdown of Western Medicine part 1

The High Cost of Medicine part 2

Don't look now (is it already too late?) Part 3