September 13, 2004

Neither traditional medicine nor doctors seem to be what they used to be, and many people are working hard to find alternatives. There are literally thousands of therapies, medications and practitioners. Some are very well prepared and helpful, and many are unqualified, selling myths and nonsense. Some are truly dangerous. Of course, this applies equally to those who practice Western medicine and all of the "alternatives". I hope you are not, however, throwing out the baby with the bathwater. While there is plenty to complain about, and they are far from perfect, modern western medicine and many of the alternatives still have a lot to offer if you are a responsible part of the health team and not just a limp sponge.

Most of the people who are victimized by the con artists and bad practitioners seem to think that government is able to weed out the bad apples and they shouldn't have to do anything but show up for their appointment. Nothing could be farther from the truth. A "license" doesn't mean anything at all except that the person who has it paid the money to the proper government bureau to get it. Anybody who just accepts everything that is suggested for them, or ignores everything they are told without real participation deserves all the bad care they get, whether it is standard western medicine or any other kind.

OK, but how do you participate? Most doctors won't give you any opportunity to say much and don't seem to listen when you do say something, so what's to participate in?

That is exactly the starting place. First you have to find a doctor who WILL listen to you, but you can't expect them to spend all day at it. When you make your appointment, tell them you will need significant time to ask questions and go over your lists, especially for a first visit. This will help them schedule your visit with sufficient time. He has quotas and pressures from those who are paying the bills, so unless you are doing that personally, don't expect an hour of his time.

If you are not happy with the restrictions and inadequacies of your insurance coverage, maybe it is time to stop paying those outrageous premiums and strike a bargain with the doctor yourself. Many of them are leaving the insurance nightmare as fast as they can, and you might be surprised if you ask the right questions like, "how much does it really cost for a visit... in cash?"

How do you find a doctor or practitioner? Talk to your friends and family. Who do they see? Do they like him/her? Why? There are several other things you can do to determine if this person is trustworthy. Call the local better business bureau and ask if there are any complaints about the doctor or the medical group you are interested in. Call the local chapter of the association for physicians. They have various names, but most areas have at least one. They should be able to tell you if the doctor you are interested in has any complaints filed against him or her. (See the bottom of this page.) Ask the hospital near you if that doctor is allowed to admit patients there. This is VERY revealing because if they are not allowed to admit patients, chances are they have not done a good job in the past somehow. Just remember that some hospitals now have in-house doctors who take care of all the in-patients and they may not have outside doctors come in much, but it is still worth asking.

The first thing you have to figure out after that is just exactly why you need to see the doctor. Put it down on paper. List your symptoms briefly, but clearly. Here are a few sure signs of a need for medical attention (no particular order of importance):

• Bleeding from anything other than an ordinary cut or laceration, or a woman's normal menses. Bleeding from the rectum (especially if stool is black, sticky), aside from small amounts due to hemorrhoids, or vomiting any blood (may look like old coffee grounds) is a sign of SERIOUS trouble. Any small cut or puncture that bleeds a long time, even with direct pressure. This includes bleeding gums or a nosebleed. This is especially important if you take a lot of aspirin, Motrin or any blood thinners.
• Difficulty breathing, serious wheezing, or feeling breathless is a medical emergency. Don't delay getting to the emergency room. If you cough up large amounts of green/yellow sputum, with or without a fever, and/or your chest feels tight and painful, you need to be seen in urgent care or the doctor's office right away. Less serious, but still needing medical attention would be prolonged and frequent sneezes, serious dizziness, or hoarsness of your voice that isn't due to a common cold.
• Serious pain you can't explain, especially anything that occurs constantly and does not respond to ordinary aspirin or Tylenol. Pain is the distress signal of the body and it is never wise to ignore it for long. Pain that starts in the chest - anywhere - may signal a heart attack, especially if it seems to radiate down either arm, up into the jaw or around to the back. The pain usually is described as a severe "pressure", and often is accompanied by shortness of breath and sweating. Click here for a complete description of a heart attack and what to do about it. Young people often die needlessly because they ignore these signs. NO pain is "normal".
• Significant change in weight, especially if it happens quickly. If you are not dieting to lose weight and seem to have little or no appetite, you need to find out what is happening as soon as you can. Some medications can cause a loss of appetite, but this is also a late sign of many serious conditions, including cancer. If you are suddenly gaining weight, especially if you seem to be filled with fluid and "puffy", you need to find out what is causing it.
• Nausea and vomiting without an obvious cause, or reflux that leaves your throat burning. Constant stomach upset or "indigestion". If the usual over the counter remedies don't help, or you find yourself using them constantly, it's time to see the doctor.
• Infections or skin problems that do not respond to ordinary things or that come back over and over again. (Just remember that antibiotics do nothing for a viral infection like a head cold or the flu.) Look at this for information on the difference between a bacterial infection and a virus, plus others.
• A sudden change of your vision, especially after hitting your head or getting something into your eye. Fast action may be required to save your sight.
• Any loss of consciousness except normal sleep. Any seizures or sudden weakness on one side of the body.
• A poisonous insect or snake bite, or an animal bite that breaks the skin, especially a wild animal. Take the dead insect or wild animal, if possible, for identification. (A human bite, other than one by a known child, should also be seen by the doctor immediately. Find out as much as you can about the person doing the biting and take them along if possible. You may want to be tested for HIV.) Any deep puncture wound, especially if a nail or other object goes through a shoe into a foot. Try to make the wound bleed freely if possible, but go to an urgent care or doctor's office right away. Keep your tetanus immunization current. Tetanus is easily prevented, but very difficult to cure after the fact and is often fatal.
• Anything that seriously disturbs your normal activities or emotional/spiritual health. If you find yourself crying a lot and can't say exactly why, for example, you may need to explore this with your doctor. Sometimes physical illnesses or even some medications can cause this kind of problem. Only you can decide whether to see a doctor or a psychologist or religious counselor. If it is disrupting your life and relationships with others, find help somewhere.

Make a list of important questions you want to ask, again staying brief and to the point. If you have several, pick one or two for the first visit, but indicate there are others by name. The doctor may ask you about them instead. Find out as much as you can about these things and the usual treatment for them. The internet is a very valuable tool and you should know at least a little of what to expect. For example: Go to The Mayo Clinic and type, "infection" into the search box (keep it simple - one or two words). You'll get several pages of entries.

Look through them until you find things that might fit your situation and read them. (See the bottom of the page for some other information sources.) You can find things from the most simple to technical material written for doctors. Don't make the mistake of trying to diagnose and treat yourself from this, however. You only have little bits and pieces of the required information. He has the "big picture" and experience to help him decide what is wrong and what you need to do about it. All you need is to find enough to help you understand what he tells you and, perhaps, understand better the risks and variations in treatment available.

If you can't figure out just what is bothering you, chances are you don't need to see anyone in the first place. If even a small part of the population would just stay home and pursue a healthy lifestyle they would immediately relieve a great deal of the "doctor shortage" and reduce the ever growing medical expense for everyone - but I won't hold my breath. Far too many people see the doctor's visit as "free" and can't understand why they shouldn't go as often as they want for any reason, or none at all. Don't ask me why they want to. I HATE to go to the doctor.

Next, make a list of all of your medications. Include all of the over the counter things you use at least once a week or more. Include any vitamins or food supplements and herbs you take. List the name, the amount and the frequency for everything. Include any allergies or adverse reactions you have, plainly marked as such, to any food, medicine or herb. Make a new list if things change. It's a really good idea to carry this with you all the time so medical professionals will have it in case of accident or sudden serious illness. You DON'T want them to find out by trial and error. I make a new list each month and keep a copy in my purse. See this excellent guide to medications and communication with your health care providers.

On the first visit with this list of medications, ask the doctor if there are any that can be eliminated. Most people take far too much medicine in the first place, with at least half of it to "fix" side effects caused by the first half. He needs to convince you that those medications he wants you to take are vital to your health, and if he can't, I'd suggest you simply dump them. Just remember that not all of them are going to make you "feel" any different, so don't use that as a guideline for effectiveness.

There are NO "perfect" medications except time, sunlight and water, so be suspicious of anything else. Medication is fine to help you cope temporarily, but it doesn't replace a thorough investigation into what has gone wrong and the changes necessary to repair the damage, if possible. Unfortunately, most people just go on taking the pills and never even try to work on getting rid of the cause. (More on that later.)

Once you are actually in the room with the doctor, hand him your questions and medicine list. Don't give them to the assistant who takes your blood pressure because chances are he'll never see them. Personally place them into his hands and ask him to READ all of it. Refuse to discuss anything until he has done so. If he won't read it, you need to find another doctor, and you should tell him so. A good doctor is very happy to have the full participation of his/her patients and will welcome both your questions and your lists. Just don't hand him a book to read!

Initially and at least one visit per year, the doctor should do a "hands on" examination of at least your eyes, ears, nose & throat, lung sounds and palpate your abdomen after listening to it with his stethoscope. He should check your reflexes and range of motion. Women need a basic gynecological examination at least every few years. Men should have their prostate examined too. He will most likely want blood tests to establish baseline chemistry and hormones. Ex-rays are called for if there are structural problems such as arthritis or pain in bones. There are any number of other, perfectly legitimate tests and scans that will help the doctor diagnose the problem. Click here to see what a COMPLETE physical examination would include.

Subsequent visits should concentrate on the specific systems involved in the problems you present, but there usually should be some kind of "hands on" assessment, unless you are seeing a psychiatrist. Any medical doctor's office visit where you do nothing but talk is probably incomplete, though that's a vast improvement on the "visit" where he barely sticks his head in the door. It is up to you to insist on a thorough evaluation of your problems and progress toward solutions, not just more pills. If you settle for the quick rip of a prescription pad, it's your own fault. Ask about what you might be able to do that would not involve medications. (We'll be talking about some of those options in future articles.)

Then comes the really hard part: following through with what you are told. That means a lot more than just taking the pills prescribed. I've seen an awful lot of good medicine go down the tubes because people didn't listen to what was said and didn't follow the treatment plan given to them. He needs to convince you that this is what you must do to solve the problems - or at least an attempt to isolate the core issues - but it's all a waste of time and money if you simply ignore everything and go on as you have been. If you show your doctor that you are really willing to take hold of the situation and do those things necessary to repair the damage, I suspect you will find that he will be much more enthusiastic about listening to you and working with you. So many people just go through the motions and are not interested in doing any of the work that doctors get discouraged and lazy too.

Write down what he tells you. Get the blood tests done, show up for the X-rays and scans, follow the preparation instructions for tests and so forth so the doctor has the diagnostic tools he needs to help you. You might not realize it, but if the blood test is supposed to be taken before you've eaten anything, even something like a cough drop or a few swigs of coffee can throw off the numbers and make the test worthless. Even worse, if he makes medication decisions based on that false information, it can harm you badly. That is a sure source for "medication errors" and I've never read a word about how the patient can screw up the works, only about "bad doctors"! Would you expect the mechanic to fix your car correctly if you refused to pull it into the shop and turn off the engine, or lied to him about when you got the last oil change? Of course you want to be as sure as you can that everything ordered is necessary, but once you agree to do it, you are a fool if you don't follow through. You can't have it both ways.

Make the changes to your diet and activity necessary for good health too. This will take time and real effort, but it's the most important thing you can do to get well, and stay that way. Most health problems can actually be prevented. At least in the early stages, most of the things that go wrong with our bodies can be repaired with some attention to the basics of diet, rest/play/attitude, elimination of exposure to toxic chemicals, and avoiding infections. Yes, really. There are medications, surgeries, therapies and a lot of other things that can help, but if you don't have the basics to some real degree you are probably wasting your time.

So, what are the basics? We'll start on them next week.

I'm happy to answer questions and accept challenges. Just write to me using the feedback form below. Include your email address if you want a response.

Notes: The following links will give you information on most doctors currently in practice, along with qualifications and education. Very valuable place to start your search.

AMA Doctor Finder

MSN Doctor Search

American Osteopathic Association

Pediatrics: Find a Doctor

Next week: The Basics Of Health, Naturally

Please send me your comments and questions too! Use the feedback form below. Thanks! Susan Callaway, RN

Other health information resources:

The Mayo Clinic has thousands of pages of information about asthma and almost every other health problem known to man. The information at this site is presented in language that most people should be able to understand. Bookmark this page and use it regularly to find reliable and timely information about any health issues that interests you. Other good resources are listed below.

MedlinePlus is owned and operated by the U.S. Government, so take things here with a grain of salt. Lots of good information here anyway. This is much more technical and is most useful to medical professionals or people who have done a lot of reading about the subject already.

National Library of Medicine. This is also owned and operated by the U.S. Government, but it contains a great deal of useful information on every medical topic imaginable. Unfortunately, most of the medical research in this country is done by government funding, at least in part, so there is not much available that is totally independent. That will only be possible when the free market can be restored and government reduced to its Constitutional limits.

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