Becoming better patients
Many well meaning people have not seen a doctor in years, primarily because they do not want to be a hypochondriac like …. Fill in the blank with the name of whatever family member who nearly drove the rest of the family to madness complaining of their real or mostly imagined symptoms and illnesses.
Patients have the greatest responsibility for their own health. No one else has more to lose. This is not being a hypochondriac. Good health is so often taken for granted, until it is not there.
As an occupational medicine physician, I have done many pre-employment physicals. These exams are generally on healthy people who have been offered a job contingent on passing the physical. Most of the time, they are fairly healthy. But on occasion, I will find new-onset diabetes, hypertension, skin cancer, poor lung function (usually due to a history of smoking for more than 10 years) or any number of other problems. I tend to find most of the patients with positive findings do not have a personal physician or have not seen a doctor in years. When asked why, they generally say “I am healthy,” or “I don’t want to be a hypochondriac like…” More goofy family members have stopped patients from getting preventive check-ups and early diagnosis than any lack of health insurance.
Patients have an obligation to themselves to have a periodic preventive health examination as recommended by the US Guide to Preventive Services Task Force (USPSTF).[1]
The … [USPSTF] is an independent, non-governmental panel of experts in prevention and primary care that is convened by the Agency for Healthcare Research and Quality (AHRQ)…[It] conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications… [evaluating] the benefits and harms…in healthy populations based on age, gender, and risk factors for disease and …[making] recommendations about which preventive services should be incorporated routinely into primary care practice. In making its recommendations, the USPSTF assesses the quality of evidence supporting a specific preventive service and the magnitude of net benefit in providing the service. [2]
You can find those recommendations by plugging in your basic health information into its Web site.[3] There is also information on what those tests entail if you click on the “Tools” section. These tests have been shown to be of value in finding and maintaining health. Your physician may have reason to order additional tests based on your history and physical examination, but you need to make certain you get the healthcare you need. This is not being a hypochondriac; it is taking charge and being responsible.
Going to the doctor
It is odd that we spend probably a year or so in grammar school studying health, including the food pyramid and learning where our spleen is, but no one ever teaches us how to be good patients. This is the most important thing we could learn in such a class!
Having worked in the former Soviet Union, in Russia, Georgia and South Ossetia, I cannot say much good about their healthcare system. The book, Cancer Ward, by Alexander Solzhenitsyn describes a typical Soviet facility quite accurately. However, the one thing the Soviets did manage to do exceptionally well was to teach patients how to give their doctors a good medical history, in a logical and orderly way. Even working through an interpreter, it was easier to take a medical history there than it is here.
Most people can tell you they are sick, but it takes forever to get them to tell you when it began (sometimes who else in the family or at work got it first), what they tried, what worked, what didn’t, etc. They generally only answer the questions asked and do not tend to volunteer any information they think might be important because the doctor didn’t specifically ask for it. Then there are invariably the small but significant number of patients who when asked, “What brings you in today?” say “I don’t know.” In fairness, sometimes a person just feels poorly, and there is not an easily identifiable cause like a cold or backache. But at least try to verbalize what doesn’t seem right to you and pinpoint when you first noticed it. Physicians will sometimes ask a patient what exactly they are feeling only to be given an even more obtuse answer like “That’s for you to figure out.” Inevitably, this will occur when you are running behind or just starting to catch up with your schedule. You cannot help but think to yourself, “You are not going to make this easy are you? A little cooperation might get us to an answer a whole lot faster.”
Know why you have gone to the doctor, and try not to be vague, if you can help it. You will help yourself by helping your doctor help you. If we taught our children and adults how to be good patients, it would take considerably less time to provide better care. More patients could get to see their doctors, and people would waste less time sitting in waiting rooms because their doctor had been held up by such a patient. Patients could get in, out and on their way back to good health.
[1] Electronic Preventive Services Selector, Agency for Healthcare Policy & Research Web site http://epss.ahrq.gov/ePSS/introduction.jsp [Accessed 6/21/09]
[2] Electronic Preventive Services Selector, Agency for Healthcare Policy & Research Web site http://epss.ahrq.gov/ePSS/about.jsp [Accessed 6/21/09]
[3] Electronic Preventive Services Selector, Agency for Healthcare Policy & Research Web site http://epss.ahrq.gov/ePSS/GetResults.do?new=true [Accessed 6/21/09]
No comments:
Post a Comment