What do you do if you are unhappy with your doctor? What if you have not seen a doctor in nearly a decade?
Finding a competent, compassionate doctor can be a daunting task, but not if you go about it in an organized manner. Here
are some key steps:
First, ask yourself why you are unhappy with your present doctor.
Do you often leave the office more confused than when you entered? Is your doctor difficult to get a hold of? Do you often
feel rushed out of the office? Have you not found an adequate explanation for your symptoms? These feelings are all valid
and writing them down will aid in your search for a new health care provider. Similarly, if you have not seen a physician
in several years, why are you going now? It may be that you feel great, but have hit the big 4-0. Or you may have a family
history of a chronic disease and want to know what if anything you can do about it. Again, write these concerns down and refer
to them in your search.
Next, use friends and family. Solicit recommendations and
referrals. Inquire specifically what they like about their doctor. Did she diagnose a difficult condition, or is it his bedside
manner? A colleague's praise of one physician led me to my own gynecologist. If you belong to an HMO, take advantage of
the list of participating physicians. Many physician practices will have websites with detailed physician bios. These bios,
in addition to providing information about educational background, will often include that doctor's main interests. If
your father and grandfather both died of heart attacks in their 50's, you might want to choose a physician with a focus
on preventative medicine. In addition, websites will also allow you to make sure your physician is board certified in his
or her specialty. Keep in mind, also, that older is not necessarily better. While age provides a wealth of experience from
which to draw, younger doctors having just completed their training are often more willing to think outside the box rather
than relying on the old adage common things are common.
If you are thinking about switching doctors, now is the time to start gathering your old records.
Review old records to ensure that office notes, diagnostic test results, and laboratory test values are included. Obtain actual
copies of x-rays and CT scans. Arrange the forms in chronological order. Highlight areas which are confusing to you and ask
your new physician to go over it with you. Finally, keep a copy for yourself. Your new physicians can utilize old records
to determine if repeat diagnostic tests are needed and to compare results of newly ordered studies with old ones. For example,
someone with a long-standing history of heartburn and reflux disease may have had previous endoscopy studies in which a camera
scope is inserted through the mouth to visualize the intestine down to the first part of the small intestine. Office notes
can also detail various medications tried. These notes can provide clarity to your description of "the little white pill"
you first tried that didn't work and the "little purple pill" which seemed to best soothe your symptoms. In
some people who have had cancer or a precancerous condition, slides of the tissue obtained from the biopsy can be obtained
from the pathology department. Specialized cancer centers use this data to determine if a new lump in your breast is a recurrence
of your cancer or a new cancer. Your new doctor may also have your old slides reviewed in cases where the diagnosis may be
equivocal.
Finally, always
bring a list of questions and concerns. Often times, physicians will lead the conversation in a manner that allows them to
get your story efficiently and quickly. This rapid and often comprehensive pattern of questioning can lead one to believe
that everything was covered only to find that a concern went unanswered. A written set of questions before you arrive and
jotted down during your initial evaluation by the physician can help prevent this.
Following these steps will help clarify for you what you are looking for in a doctor.
In addition, they are geared toward effectively establishing an open communication line between you and your physician. Lastly,
it will help you assess if this new doctor is the right one for you.
Quick, have you written your living will yet? In an unofficial ABC News/Washington Post poll performed in March
2005 amidst the Terri Schiavo maelstrom, 87% of Americans stated that they would not want to be kept alive in a permanent
vegetative state. Yet, according to the Living Will Registry, only 10-20% of Americans have documented their beliefs in a
Living Will. Many health care advocates would have you believe that you can safely go mountain climbing or bungee jumping
once this document is set in stone. But just like wills and organ donation, the situation is much more complex. Most people
are unaware that despite indicating your desire to become an organ donor on your driver's license, if your family declines,
you will be buried with all your organs in place. Similarly, the belief of your physicians and family will often dictate your
care far more than a living will can.
This article will hopefully clarify what a living
will is and what its strengths and limitations are. The purpose of a living will is to detail the type of care you wish to
have or do not wish to have should you become incapacitated and unable to communicate. With that in mind, there are four key
points to consider. 1.A living
will does inform your loved ones and health care providers what life-sustaining medical treatment you desire.
This is probably the most fundamental and useful aspect of the living will. The presence of a living will alerts
emergency room physicians that a nursing home resident stricken with end-stage Alzheimer's disease would not want to undergo
surgery under any circumstances. It also informs physicians and family not to commit a comatose terminally ill cancer patient
to expensive heroic treatments. 2.A living
will does not obligate your family to abide by it.
If a person's next of kin such as a spouse or parent insist that maximal therapy be undertaken despite
a living will stating otherwise, physicians are obligated to respect their decision. Many hospitals have an ethics committee
that are designed to intervene in such cases, however, the fear of lawsuits often hinders the amount of influence they can
levy on the patient's family members. In some cases, long-distance relatives with memories of the patient in younger,
healthier days will often insist that everything be done. They will insist that their once vibrant uncle last seen a decade
ago now stricken with brain hemorrhage be kept on a ventilator.
3. A living will does
not obligate the physician to follow it.
Physicians are human as well with their own set of religious beliefs and code of ethics. Some may feel uncomfortable
discussing end-of-life issues with patients and family members and will defer the conversation even if medically appropriate.
Others take it as a personal failure if their patient dies. A physician may maintain a more optimistic view of the patient’s
condition than it actually deserves. In such circumstances, a physician can continue to administer costly intensive unit care
to a patient who has no hope for meaningful recovery.
4.
Determining permanence or irreversibility is not necessarily agreed upon by loved ones or physicians In the case of a warm body "found down" either unresponsive or without a heart beat, most paramedics
will institute life-saving measures right away without a second thought. Whether or not that person is able to gain full consciousness
is directly related to how long their brain has been deprived of oxygen. If the amount of time a that person was unconscious
and not breathing is unclear, all physicians and family can do is wait to see how and if the person recovers. In general,
the earlier the person begins to follow commands and make purposeful movements, the better their prognosis. How long to wait
has long been a matter of debate, for some it may be 48 hours, 7 days, or 2 weeks. Some physicians are more reluctant than
others to declare a patient brain dead or permanently comatose, particularly in the case of young patients.
With these key points in mind, the best way to ensure that your wishes be carried out when you are unable to
communicate is to discuss your wishes within your circle of loved ones. Talk to your spouse, your children, your parents,
and your best friends. Consider appointing a power of attorney, one person who is responsible for all major decision-making
in the event you are incapacitated. Choose someone whose beliefs are in line with yours. My brothers and father share the
same desires as I do which is not to be kept alive in situations with no hope for meaningful recovery. My mother, however,
has a different view. She has stated time and time again that only God can make the decision to take life. If life can be
supported by artificial means, then so be it. Having had this conversation with my mother multiple times, I now know to appoint
either my father or one of my brothers to be my power of attorney to ensure that my wishes are followed through upon and also
to not put my mother in an uncomfortable position.
Finally, discuss your living will with your primary care physician. They can point out any
discrepancies in your living will and discuss scenarios with you to ensure that your living will is as thorough as possible.
In addition, in equivocal situations, your primary care physician can act as an intermediary between your family and your
hospital physicians preventing a David vs. Goliath situation. They can provide a second opinion adding their own level of
expertise and experience regarding prognosis and recovery.
Start the converstion now with your loved ones while you still can.
Leave
all your valuables at home. This includes jewelry (especially wedding bands), watches, and money.
Virtually all surgeries/procedures
require you to fast after midnight.
If you take daily prescribed
medications, ask your doctor which medications you should take the morning of surgery.
Be prepared for a long day. Tell your family members to be prepared for a long day. Anesthesia preparations can take
up to 1-2 hours. Your surgeon will inform you of the average operative length. After surgery, you will be taken to the a post
anesthesia care unit. Your family will not be allowed to see you until after the nurses get you situated in the recovery room.
Take this interactive tutorial provided by medline plus to help you prepare for your surgery and your
recovery afterwards.
When confronted with the need to have surgery, a number of thoughts run through a person's mind. Many want to
know how long they will be in the hospital. Others want to know when they can start weight lifting or get back to their walking
program. The ones that focus on how they should best prepare for their operation will ask if there are any foods or medications
they should avoid. Few ask about smoking. To be fair, numerous studies have shown that the vast majority of smokers state
they quit for health reasons. But unfortunately, a number of them are not told by their physicians that stopping smoking before
surgery provides them with a number of benefits.
Smoking is associated with a number of chronic illnesses including
lung, heart, and peripheral vascular disease; however, smoking has acute effects on the body as well. Active smoking causes
constriction of blood vessels reducing blood flow and delivery of oxygen to tissues. In addition, cigarette smoke contains
high levels of carbon monoxide, an odorless, colorless gas that impairs the blood's ability to carry oxygen. Healing tissues
requires an augmentation of blood flow for the delivery of oxygen and nutrients. Smoking slows down wound healing which can
lead to higher rates of wound separation and wound infection. Stopping smoking approximately 4 weeks before surgery can greatly
improve wound healing.
Smoking also contributes to decreased ability to clear the airways in the lungs, known
as bronchi, of secretions and debris. Small hairs called cilia line the surface of the bronchi. Smoking causes dysfunction
of cilia, preventing its ability to sweep mucous out of the airways to be coughed up. Smoking cessation helps to restore cilia
function allowing for more effective clearance of mucous and secretions from the lungs preventing development of pneumonia.
This begins to occur in as little as 72 hours.
The use of a general anesthetic always carries with it a small risk
of heart attack. The risk of heart attack in healthy individuals is very small, but in people with other medication conditions
and smokers, the risk is increased. In fact, the amount of carbon monoxide exhaled by a smoker has been correlated with an
increased frequency of disturbances in an electrocardiogram signaling decreased blood flow to the heart. Improvements in blood
circulation start to occur two weeks after stopping smoking.
Finally, the postoperative state, 1 to 14 days after
surgery, is associated with an increased risk of developing blood clots in the legs, a condition known as deep venous thrombosis
(DVT). A clot in the lower extremity can travel to the lungs causing decreased ability of the lung to transfer oxygen from
the air to the blood. This is called a pulmonary embolism (PE). A large clot burden in the lung can result in sudden death.
Smokers already have a higher tendency to develop blood clots over non-smokers, even in the absence of surgery. Undergoing
an operation increases the risk of a DVT or PE even further for smokers.
From the chart below, you can see changes
in your body after smoking cessation occur as early as 8 hours. Even 2-3 days of smoking cessation can improve how well you
recover from surgery. The toughest part is setting a date to quit and sticking with it.
Time
since quitting
Beneficial health
changes that take place
20 minutes
Blood pressure and pulse rate return to normal.
8 hours
Nicotine and carbon monoxide levels
in blood reduce by half, oxygen levels return to normal.
24
hours
Carbon monoxide will be eliminated from the body. Lungs start to clear out mucus and other smoking debris.
48 hours
There is no nicotine left in the
body. Ability to taste and smell is greatly improved.
72 hours
Breathing becomes easier. Bronchial
tubes begin to relax and energy levels increase.
2
- 12 weeks
Circulation improves.
3 - 9 months
Coughs,
wheezing and breathing problems improve as lung function is increased by up to 10%.
1 year
Risk of a heart attack falls
to about half that of a smoker.
10 years
Risk of lung cancer falls to half that of a smoker.
15 years
Risk
of heart attack falls to the same as someone who has never smoked.
Table is
from data provided by the American Lung Association 2001.
