Sunday, July 06, 2008

Ways To Help Your Doctor Help You

“You know your body best, so if you want your doctor to help you even more, you need to tell him your story because you are the expert of your own life,” Margaret Bengzon, Head of the Strategic Services Group of The Medical City tells me one afternoon.

In the Philippines, the doctor’s word is often, God’s word. As parents of an ill child, the norm is usually to just take what the doctor says and go with whatever it is he or she wants done. However, we tend to forget that not everything going on in our child’s life is known to the doctor.

This is the paradigm that The Medical City wishes to break with its new advocacy campaign. One that will hopefully shift the way we Filipinos think about doctors and healthcare. A campaign that will probably resonate with many families who have lived the expereince of caring for a sick loved one whether it be child, parent, or spouse. Bengzon says that at The Medical City, every patient is considered a partner in the healthcare process. In a true partnership, where all things are equal, it is expected that communication flows freely both ways.

However, in a healthcare setting, this is often not the case. I have sat in too many family conferences to know where parents or the chief caregiver hesitates to ask questions or share stories and information, and anxieties for fear of thinking that what he or she has to say is irrevelant. Take for example, a child who is brought to the pediatrician complaining of stomachaches day in and day out. Tests are run and the child is checked but the doctor cannot seem to find anything wrong. Then the mother finally says, at the end of an almost half hour consultation, “Oh by the way, he’s also been complaining about this teacher who has been giving him a hard time in school…” Bingo. Suddenly the pediatrician has this new insight that changes the course or manner by which he or she views the problem. Child stress can be the root of many ills that is often not seen on a medical chart.

Another story, an elderly patient is taken to the doctor by her adult children. She complains of palpitations and vertigo (dizziness). A battery of tests are run to find out what is wrong. Her heart is checked, all clear. She is sent to several specialists and her tests indicate that she is as healthy as a horse. After a couple of consultations, in the course of a conversation, she finally admits to her primary doctor that she has been having sleepless nights worrying about her youngest child who is working overseas as a nurse and has been the subject of wife battery. Again, if the patient had only mentioned this at the very start, then perhaps, a lot of money could have saved and unecessary anxiety over test results should not have happenned.

Some doctors are experts at drawing their patients out. It is a gift, but it is also a skill, I believe that any doctor is capable of learning. However,the reality still is that not all doctors are as adept, and so, as parents of our children, or caregivers to our own parents, we need to ask the questions, to share our stories. Doctors are human beings and not mind readers. Not everything relevant can be seen on a patient’s chart. Yes, numbers and test results are significant, but definitely, in many cases, there are many significant issues about one’s life that need to be shared with your doctor. Questions are another issue. One needs to be pro-active. Research on what it is you or your loved one has and don’t be afraid to ask. Is there a better way? Are there alternative treatments? What is the best possible outcome if we do this or that? How much is this going to cost us?

Your doctor can help you best if you also help yourself, tell him or her what is on your mind and share what is in your heart or what it is that is going on in your life. We pay very good money to get the best health care. A doctor will appreciate it if he sees that you are open and interested to know more about your illness. Do not hesitate to share your fears. The best of doctors will not pooh pooh your concerns. They take the time to listen and show you compassion. Even if there is a whole gaggle of patients coming after you, the good doctor will not make you feel that you are being rushed. A CNN report suggests some ways how a patient can better help his or her doctor –

© Bring in a complete list of your medications. This list includes all the prescription and non-prescription medicines that you are taking and any and all health supplements and vitamins that you have been drinking. Write the name of the drug, the dosage and how often you take it. My personal practice is that whenever any of my children are ill with fever, I make a chart so I can track down the highs and lows of the fever (especially if it has gone on for a couple of days) and beside it the times I give the medication. Whether or not my doctor asks for it, I am ready with the information.

© Come armed with your personal health history. It always pays to know what illnesses you have had in yoiur bloodline. Do you have a history of cancer, heart disease, diabetes, hypertension, mental health problems? If your grandparents and parents are still alive, I suggest you sit down with them and find out what sickness has plagued them through generations. Some families have a genetic predisposition towards certain types of cancer, heart disease and even mental illness. If you have had a parent who died from a heart attack before the age of 50, your risk of having a heart attack yourself is higher than the general population. Having that knowledge will encourage you to hopefully be more careful aqnd vigilant about what you eat, how you exercise and taking care of your heart.

© Make a list of your concerns and share them. The reason you are seeing a doctor is because there is something bothering you about yourself or your loved one. However, sometimes, when you are already at the clinic, or in front of your doctor, fuzzy thinking sets in. The CNN report quotes Dr. Dana Frank, an internist as Johns Jopkins who says that she appreciates the patient who is ready, “like a boy scout” and is not afraid to ask the questions. If you also feel that something is not very clear to you, don’t hesitate to ask your doctor again – “Could you please run that by me again, doc?” Yes, doctors are busy people but it is a ptient’s right to get the facts straight and very clear. Write notes when necessary. It is best to be clear about your doctors orders, than coming out of the clinic and wondering for the rest of the day if you got it right.

© Don’t be afraid to ask questions. Even at the risk of sounding silly, do not hesitate to ask questions of your doctor. Clarify the points that are not very clear to you.

© Know your doctor and find the right fit. In this day and age of HMOs it is hard to be picky about doctors. But here’s the trick, often, I first research and find out the list of MDs that the HMO has in a particular hospital. Once I have the names, I go around and ask colleagues, if they have tried out this doctor, or better yet, if I know someone from that hospital. I try to find out a little about this doctor that I am about to see. That way, I already have an idea about what to expect. In certain instances, for whatever reason, you may not be happy with your first doctor or with what he/she has to say. Remember that you have every right to seek a second opinion, and even a third one, especially, if what you are considering is a major procedure. Work with the doctor you are most confortable with. Only you will be able to tell who the right person is for you or your child. After all, it’s your body, and you know its quirks and idiosyncracies best. At the the end of the day, it’s your decision on whom you want to help you care for it.

Published in my Roots and Wings column in the Philippine Daily Inquirer, 6 July 2008

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