Thursday, March 31, 2005

Unexpressed fears

I recently saw a very smart educated woman who was worried that her periods had become very scanty. I spent a long time reassuring her that this was not a cause for concern; that a scanty period simply means that the uterine lining was thin, which is why there was not much bleeding when it shed; and that it didn't t have any sinister significance. I thought she was happy with this logical explantation, but she kept on calling repeatedly. I finally had to ask her what her anxiety was, and she told me that she was scared that the fact her periods had become scanty meant that her uterus was decaying as she was getting older , and that she wouldn't be able to conceive. I finally had to do an ultrasound scan in order to show her uterus was perfectly normal, but the moral of the story is simple: your doctor cannot read your mind, so it's much easier to tell him openly what's worrying you, so he can reassure you in terms you understand. And don't worry that the doctor may think you are "crazy" - it's highly likely that he's heard wackier worries before !

Wednesday, March 30, 2005

Asking questions, and not getting answers

Here's a thoughtful email I received recently from an intelligent patient, who was going to the "No 1 IVF clinic " in her city. She wrote - "Though they have an excellent reputation, they did not like to answer questions, they didn't have the time, and they liked to practice "their way", not forming a collaboration with the patient. I ask a lot of questions, I like to understand my body, and the more knowledge I have, the more receptive I am." Rather than continue with the clinic, she chose to change doctors, till she found somneone who was more in tune with her needs. Full marks to her - now she has peace of mind she is doing her best. It does require work and courage to change doctors, but to be fair to yourself you need to do so, rather than go passively with the flow because you are too lazy and then kick yourself later on !

How to choose a doctor

Choosing the right doctor can be a daunting task.
Rather than leave it upto fate, the best way of doing so is to adopt
the following simple 3-step approach.
1. Do your homework about your medical problem
2. Prepare a short-list of suitable doctors
3. Interview the top 3 doctors on your list and choose the one you like the best !
Remember that patients get the doctors they deserve !

Tuesday, March 29, 2005

Medical decisions: your role and that of your doctor

Many patients are quite happy allowing their doctor to make their decisions for them. While this is appropriate in an emergency setting, it's often not the right appraoch in an elective situation. After all, how do you know your doctor will make the right decision for you ? He cannot read your mind, and does have his own biases, which may not be the same as yours ! I always tell my patients - " You need to decide for yourself - you have to live with the consequences of your decision for the rest of your life ! I promise you that I will never let you make a wrong choice, but when there are options, the responsibility for deciding rests on you – you cannot abdicate it to anyone else."

Sunday, March 27, 2005

Some common solecisms

: "Some common solecisms. " Not sure what a solecism is ?
Check this witty guide out ! Not only will it improve your own writing, it will make you cringe when you read some of the rubbish written in medical journals and health articles in the lay press.

What is the most painful aspect of modern medical practice ?

What is the most painful aspect of modern medical practice ?: It is not whether most physicians are up to date in their knowledge or in their techniques, but whether too many of them know more about the disease than about the person in whom the disease exists. The overriding issue before medicine today is one not of proficiency but of humanity."

A simple way to help you make the most of your doctor's visit

Doctors are very busy people, and have little time to talk to you. However, since it's well known that your medical history is the most important diagnostic tool at your doctor's disposal, how can you make sure you tell your doctor all the relevant facts about your medical history ? The answer is simple - prepare a one-page written summary of your medical story and give it to your doctor. Let it read like a story and don't worry about using technical terms - just tell your story in your own words. It's simple - just use the following to guide you.
I am worried about...
I was last completely well ...
The problem started on..
It gets better when..
It gets worse when..
I have tried the following remedies...
This will ensure you don't forget anything important; and will also help your doctor to give you the right treatment.

Saturday, March 26, 2005

Embryo research - the birth of a new era in the UK

Reproductive freedom - allowing patients to choose for themselves: "If you can fertilise embryos in a dish to make babies, what is the role of the state in deciding who can benefit from this technology and what they can use it for ? We decided to take an evidence-based approach, that you shouldn’t tell people what they can and can’t do, unless there is evidence that there is harm to individuals or to society."
This is NOT allowing doctors to play God - it is simply permitting parents the right to choose - personal rights which need to be protected in a democracy ! I wonder why we raise such a hue and cry over the rights of embryos, when we allow parents to send their children to factories to work as slave labour for 16 hours for a pittance.
In India, we do not even have the resources to protect our children , so why do we try to divert them to protect the embryo ? Wouldn't it make much more sense to allocate our resources more sensibly ?

Reproductive freedom - allowing parents to decide

Why the critics got it wrong over 'designer babies': The recent UK report , which allows couples much more choice as to what can be done with their embryos , has raised considerable controversy . In my opinion, this is a well-thought out sensible report. As this author says " Reproduction is generally regarded as a private matter. The state has the right to intervene only when there is evidence of harm. The evidence obtained over the past decades points to an absence of harm. Therefore, there is no justification for interfering with such reproductive choices. Thus, the committee was able to embrace the concept of reproductive liberty: something which is regarded as a positive good. The logical result of this is that decisions about the use of assisted reproduction are a matter between doctor and patient."

Friday, March 25, 2005

Preventing unnecessary surgery

Unfortunately, an apple a day will not keep the surgeon away. The best way of avoiding unnecessary elective surgery is to let the doctor know you do not have the funds to pay for it. You will be surprised how often the surgery is then no longer indicated ! This is why patients in public hospitals often end up getting better care ( translate this to mean less unnecessary surgery) than patients in private hospitals.

Thursday, March 24, 2005

Chest pain = angiography = bypass surgery

We are seeing an epidemic of bypass surgery ( coronary artery bypass surgery, CABG, or cabbages as they are fondly called by cardiac surgeons in the US!) It seems to have become a routine that every patient with chest pain is sent to a cardiologist, who does an ECG and finds "suspicious changes"; advises a stress test, which confirms the suspicions, which then inexorably leads to an angiography, which invariably detects a block, which is then treated by angioplasty or surgery. While this cascading effect is extremely good for a hospital's bottom line, how much this actually helps the patient with chest pain is anyone's guess ! The technology for treating blocks has become fancier and glitzier, with balloons, stents, coated stents and drug-eluting stents; and it's so seductive to fix a block when you see it, that no one bothers to question the logic or utility of doing so. Many of these blocks are benign, of no clinical importance, and could be left well alone, but with the fear psychosis created in patients' minds of "impendig death" around the corner if the block gets clogged up, few patients have the courage to say no to surgery. Relatives are also often bamboozled into signing on the dotted line, because they are made to feel guilty if they don't cough up the money for the surgery. However, few patients know that CABGs don't extend life expectancy, except in a small group of selected patients; or that there are major deleterious long-term effects of bypass surgery on the brain, which no surgeon tells you about ! You need to ask lots of questions before saying yes to a CABG !

What should I ask my doctor ?

A common observation many intelligent patients have is the following - " It's all very well to talk about how important it is to question your doctor, but how do I know what questions to ask ? I am not the subject expert ! " This is very true, and a good way of learning what to ask is by quizzing your first doctor - and then getting a second opinion ! Often you maybe clueless during your first consultation, but by the time you are going in for your second opinion, you should have become better informed !

Monday, March 21, 2005

When doctor turns patient

When doctor turns patient: Excellent first-person account of what doctors go through when they become patients ! All doctors become better doctors after they have had the opportunity to become a patient and experience what it feels to be on the other side of the scalpel !

Thursday, March 17, 2005

5 skills you need to master to ensure your doctor will listen to you

The 5 skills a patient needs to master

What could be easier ? Yet, why do so many of us mess this up ?

Silence Kills

Silence Kills: Studies have indicated that nearly three in four medical errors are caused by mistakes in interpersonal communication. This site teaches you "Crucial Conversation" skills which will allow you to speak up and talk to your doctor, so he listens to you - and doesn't just hear you !

Wednesday, March 16, 2005

Nurstoon Nursing Cartoons - Hospital Time

Nurstoon Nursing Cartoons - Hospital Time A cartoon a day keeps the doctor away !

Making Sense of Medical Jargon

Making Sense of Medical Jargon: Patients often complain that they can never understand anything their doctor says. This usually because doctors use medical jargon --- but you should never get intimidated by this ! This chapter will help you decipher your doctor's medicalese.

Sunday, March 13, 2005

"My doctor seems good but is too busy to talk to me "

I just received this email from a patient who was undergoing an IVF cycle at another clinic and who wanted a second opinion as to whether he was on the right track. He commented, " My doctor seems good but is too busy with patients to talk and explain things."
I was astounded ! How can a doctor who is too busy to talk to his patients be considered to be a good doctor ? It seems patients have very low expectations from their doctors, and this maybe because doctors have bullied their patients into submission, so that they don't waste their time talking to them !

Saturday, March 12, 2005

Making sense of your doctor's answers

Asking questions is easy - but answering them can be hard ! Often, your doctor may have to tell you that we don't know what the answer to your question is. Some patients feel very uncomfortable when their doctor doesn't know the answers, but you need to remember that medicine is a biological science, and there are many variables we cannot control. It's far better for you if your doctor is honest and shares his doubts and uncertainties with you, rather than bluff and provide you with dishonest "answers".
I would give full marks to the doctor who pulled out a PDA to answer a question about the dosage of a drug or who looked up the Net to find out the side-effects of a new medicine. Some patients feel that a doctor who needs to look up stuff is not competent or well-informed, but in all honesty, with the pace of change in medicine today, it's impossible for a doctor to know everything about medicine. A doctor who is honest will look up information in front of you - and this should increase your confidence levels in him - because he is confident enough to not have to hide his ignorance !

Friday, March 11, 2005

Making your own decisions

Often the doctor will offer you options as to what your treatment choices are, and allow you to make your own decision. This can be very hard to do - and very scary as well - suppose you make the wrong decision ? I always tell my patients that it's fine to make their own decisions - they should not be scared to do so. After all, they have made critically important decisions easrlier as well ! Since they need to live with the consequences of their decision, it's best they make it themselves, rather than abdicate this responsibility to someone else. I also assure them that I will never let them make a wrong decision - that's my responsibility ! But when there are choices, you have to choose for yourself !

But my doctor never answers any of my questions !

This is the commonest complaint patients have about their doctors ! However, complaining does not help either you or your doctor. What you need to do is to prepare for your visit by doing your homework before you see your doctor. It's helpful to have a written agenda, so you don't forget anything important during the stress of the consultation.

Monday, March 07, 2005

Infertility cures draw medical tourists to city

Infertility cures draw medical tourists to city- The Times of India: This article highlights the fact that the internet has now empowered patients to look for medical treatments well beyond their own country. I personally dislike the world "medical tourists". These are patients who are looking for medical treatment, so calling them "global patients" or "international patients" or "overseas patients" would be far more appropriate. In any case, this just shows how patients can break the shackles of the limitations imposed by their local medical system, to find the treatment which is right for them. Thus, patients may look overseas for treatment options if treatment is too expensive in their own country; is not available locally; or is not allowed by their local laws. The internet has facilitated this search tremendously, adding considerably to the clout the patient can wield !

Sunday, March 06, 2005

How to get along with your doctor

Have you ever wondered why some patients seem to get along so well with their doctors, while others have such a hard time ? It all boils down to the fact that these smart patients have excellent "people-skills" and a high EQ, which is why they know how to manage the doctor-patient relationship. They respect their doctor and value his time, and this is obvious - and since respect breeds respect, their doctor treats them with respect in turn.

Helping your doctor by asking the right question

It's well-known that your doctor has a limited amount of time to spend with you. There's a lot you can do to make the best use of this limited time - but the most useful tip I can offer is - " Learn to ask the right questions ! " It's a truism that the quality of the answer depends upon the quality of the question, so the better you craft your question, the better the doctor's answer will be ! I am an infertility specialist, and mnay couples ask me - "Doctor, can you please tell me why I am I not getting pregnant ? " I remind them that no one cares about problems - people only care about solutions ! This means the question should not be - "Why am I not getting a baby ?" but rather - "What can I do in order to get pregnant ?" There's a big difference in the two questions - and therefore a big difference in the two answers !

Wednesday, March 02, 2005

Poking fun at quacks

Poking fun at quacks : "The people who are deceived by these quacks are not stupid - they simply do not have the scientific knowledge or even the critical thinking skills to separate truth from nonsense. It is the duty of doctors and skeptics to not only oppose quackery but to educate consumers and patients about what is possible and what is not. " Laughing at quacks and their tall claims is a great way of teaching the public the truth about them.


Quackwatch: "Your Guide to Quackery, Health Fraud, and Intelligent Decisions".
Highly recommended site to help protect you and your hard-earned money from all the dubious doctors out to help you part with it.

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