Wednesday, December 21, 2011

Do mandated disclosure forms like (informed consent, Truth in Lending Act etc) work?

Watch this video, and you might think that helping patients better understand if a coronary stent is going to benefit them might be best accomplished by mandating a better informed consent process.

The use of patient specific, tailored informed consent forms might indeed improve the process of helping patients making treatment decisions that are better aligned with their preferences.

But before you write your congressman requesting that the informed consent process be improved, you might want to consider this interesting paper  from University of Chicago that explains what the informed consent process shares with the Truth in Lending act (hint--mandated disclosures frequently fail miserably to achieve their intended purpose, and have many unintended adverse consequences).

How to address this problem today, if you are having to make a treatment decision?  The DSP blog still thinks this approach is not a bad place to start.

Monday, December 19, 2011

Friends don't let friends consent for a stent uninformed

The DSP blog was saddened when it read this study which asked a simple question:  do patients about to undergo a stent for stable angina correctly understand the expected benefits.  The key finding of this study:  88% of the patients that were getting a stent thought that the stent would "reduce their risk for MI" (myocardial infarction).  Why is this a problem?  Why is the DSP blog exhibiting grinch-like behavior by blogging about this so close to Christmas?  It is a problem because of what this study told doctors about the benefits of stents for stable angina:  the COURAGE trial demonstrated that stents do not reduce the chance of MI compared to medical therapy.

In the DSP's humble opinion, this discrepancy between what is known about the benefits of stents for elective angina, and what patients who are going to get a stent think the benefits are--this is the proverbial canary in the coal mine warning.  If the current system does not facilitate patients arriving at a correct understanding about how a stent for elective angina will and won't do for them, this really signifies a major problem in doctor patient communication.

The DSP blog's recommendation:  Besides reading the DSP blog, if you are pursuing any elective procedure, you better know enough to ask, and ask enough to know.  Asking the right doctors the right questions (see related post on this blog) is a good place to start.

Thursday, September 1, 2011

Is this the future of medicine? Is this the future of doctors?

The DSP's daily commute has been pure bliss this past week because I have been listening to A Whole New Mind.  In a nutshell, Mr Pink asserts that you better figure out how to use both your left brain (analytical, sequential) and your right brain (synthesizes big picture, sees things in patterns).  If you only use your left brain, you are in jeopardy of being replaced by either a computer, or somebody able and willing to do your left brain job for 1/5 of the compensation you require.

What does this have to do with a patient getting in the driver's seat?  Admittedly, it is only tangentially related (I am trying to exercise my right brain here).  But I'll give it a shot:

1)  Skin Scan is an app that analyzes skin lesions before you go to the doctor's office (at this point, it is not intended to replace the physician's visit) going to replace some of the left brain tasks that doctors are doing eventually.  (Consider that TurboTax has likely replaced a lot of accountants.)  This may be a glimpse into the future of medicine.  If Skin Scan disagreed with your doctor's assessment of your lesion, would you seek a second opinion?

2)  It is easier to be a patient if you have a job, and so if you think you are currently only using your left brain in your career, you would benefit from reading (or listening to, if you are an audio learner like me) A Whole New Mind, as it has a primer for developing your right brain.

Monday, August 29, 2011

3 magical questions

The DSP blog has recommended patients consider the Ask Me 3 approach when at the doctor (Ask Me 3). But I think those three questions (1. What is my main problem?  2. What do I need to do?  3. Why is it important for me to do this?) might stifle the discussion a bit.

While I hate to admit this, because it apparently has originated from England, I think some researchers at Cardiff and the Vale University Board (whatever that is) might have come up with 3 better questions:  

1.  What are my options?  
2.  What are the possible benefits and risks of those options?  
3.  How likely are the benefits and risks of each option to occur?

Are you going to the doctor soon and at risk for a prostate exam?  Ask your doctor these questions about your options re prostate screening, and tell me how well they work.    

Sunday, August 28, 2011

Friends don't let friends have a prostate exam uninformed

While I definitely would not let this "doctor"  examine my prostate, I applaud CBS for this educational video for several reasons:  it is almost as funny as this doctor (does anybody know if he's still taking new patients) and is as accurate as this guy (talk about doctors who only use their left side of their brain) without being such a bore.

Dr Schloffengut's message essentially boils down to this: if you're a man over 50, talk to your doctor about whether or not you need a prostate exam.   Is Dr Schloffengut recommending talk therapy for the prostate?  Hardly.  He is recommending that men talk to their doctor before diving into a prostate exam (does that sound wrong), not only because it is always a good idea to talk to letting any doctor plunge a finger into any of your orifices, but because the decision to try to screen for prostate cancer simply isn't a slam dunk.

In a nutshell:  some men may benefit from prostate cancer screening, and some may be harmed by prostate cancer screening, and it is not entirely easy to sort it all out.  Consequently--before men consent to this graceless experience (unless Lou Rawls is your doctor), they deserve to partake in a discussion and share in the decision about whether this will benefit them.  

His recommendation is consistent with that from the United States Preventive Services Task Force recommendation.

Tuesday, March 15, 2011

Who is the Driver's Ed teacher?

In this study, primary care physicians were asked, "How important do you feel it is for patients to be well informed when making decisions about managing chronic conditions?  89% of the doctors felt it was very important.  At the same time, they felt only 15% of patients were well informed when making decisions about managing chronic conditions.  They felt 31% were not well informed.

To keep it real, what does the DSP blog think it for a diabetic to get an A?  In a nutshell, diabetics would need to know:  a) their goal A1C (typically <7%); b) their goal bp (typically <130/80); c) their goal LDL (depends, typically < 70 or <100); d) why they need to get a dilated eye exam once a year; e) why they need to have their kidneys checked for protein once / year.  That's pretty much it.  It seems pretty basic.  And yet the DSP blog would be concerned that most diabetics would not know theses answers.

This begs the obvious question--why so many driver's ed students getting low grades?  Who is responsible for how few patients get an A in this subject,  and how almost 1/3 are getting a D or F?

Obviously, this is a complicated question, and even though the DSP blog completely knows the answer, due to limited space here and the need for me to go to work, it will have to posit some thoughts to get the conversation started (at least that's the idea--come on, people, can you start pushing the comment button a few more times?):

1)  If being well informed translates into better outcomes (and that is a big if--driver's ed students have to be motivated to actually stop at the stop signs, stay within some approximation of the speed limit, for driver's ed to have much of an effect--then the DSP blog thinks driver's ed schools represent quite an opportunity for several key players affected by the high costs of poorly informed drivers.

2)  The DSP blog feels that doctors must take at least some of the blame for the low grades.  Some obviously seem to take a greater role playing driver's ed instructor than others.   The DSP blog is thinking about trying to find one of those kinds for itself.

3)  Patients deserve at least some of the blame for their low grades.  Perhaps Dr Google isn't the most effective way to learn how to drive.

Sunday, March 13, 2011

The Blob that Ate America

When doctors were asked:  "When patients come to you with information they have gathered on their own, are they generally more likely or less likely to end up getting screenings, treatments, or interventions they don’t really need?"

63% said such patients were MORE LIKELY to get unneeded screenings, treatments, or interventions they really DON'T NEED.

Aside from the fact that there are risks to medical treatments and screenings, and that in medicine, "the more you do, the more you do," (quoting one of my best teachers ever--lives in Ann Arbor, MI), there are much greater concerns here:  Patients pursuing unneeded treatments increase traffic on the road, are unable to be perusing the DSP blog, and are missing time in their backyard looking at the birds while listening to the DSP show.

However, the DSP blog was briefly encouraged when it realized a benefit to patients pursuing unneeded treatments--what better way to simplify one's life?  For if you are going down the path of unneeded treatments, your life consists of one of two things, a) arming yourself with info that will lead to unneeded treatment; or b) pursuing the unneeded treatment; or c) talking about it or blogging about it.  I suspect most of the time would be spent in category b, driving all over the kingdom in order to get forms filled out, blood drawn, unneeded surgery performed, resulting in back pain from all the driving around, which would lead to category a...

Because the DSP blog suspects some reading this may be "serious readers" (the DSP blog acknowledges the disturbing possibility that serious readers who stumbled across this blog's clip of Sarah Palin interview may have unfairly put it in the category of total buffoon and decided not to return), it offers the following:

1)  One health care expert, Jack Wennberg, (whom, by the way, the DSP blog met when he visited its professor's house in Champaign, IL, where the DSP blog learned that pistachios are best eaten after the shell has been removed (somehow, I had missed that memo, and had to learn this lesson by putting a handful of these disgusting things into my mouth, and then trying not to appear uncouth while amongst many learned professorial types), and also had the unpleasant experience of eating one of said professor's mom's cookies in front of the professor, only to realize, while it was in my mouth, that some of said professor's mom's hair had been baked into the cookie), has suggested that for many medical decisions, there is no clear winner re the "right treatment"

A perfect example would be prostate specific antigen screening, which the USPTF suggests it is just not clear whether this test should be pursued.  This could result in a situation where a patient gathers information on his ("or her" clearly unnecessary here) own and decides to get the PSA test, which the doctor feels is unneeded.  In this type of case, the DSP blog thinks this is not a horrible outcome at all--in these cases where the right strategy is unclear, if the patient should decides to pursue an intervention that the doctor thinks is unnecessary, does it really matter?  The only truly horrific outcome in this scenario would be the exam accompanying this screening test (the DSP blog formally apologizes for that image now running through your mind).

But alas, the above suggests that the DSP blog has clearly slipped back into its pollyannish ways (except for the part about the exam).

2)  To the extent that "informed patients" increase their doctors' fear of malpractice is driving unneeded pursuit of screening tests or interventions--this is bad and sad, and because I lost an hour last night due to daylight savings time, I don't have the emotional capacity to deal with that right now.

3)  If you just take it at face value--and the DSP blog thinks this might be the best approach--that doctors think (?correctly) that patients are informing themselves into unneeded interventions, then really the biggest take home point is this:

At this current time, patients in the driver's seat (in general) are seemingly looking at the wrong manuals and/or interacting with the doctor in the passenger seat in such a way that they are getting their oil changed too often, getting diagnostic testing they don't need, seeing mechanics they don't need to see, and in the end, this is causing them to spend too much time and money in the car and/or in waiting rooms talking to others about their adventures taking care of their car....

Does getting in the driver's seat affect your care?

It has long been known that there is widespread/geographic variation in rates of treatment for conditions like back surgery, breast cancer, prostate cancer. As this report suggests, the variation may be due to variation in how physicians practice and influence their patients. More is not always better. When treatment for a condition is proposed, ask questions such as, "Is this considered standard of care, or are there other acceptable alternatives?" If the proposed treatment is surgical, ask, "Do you perform the other alternatives?"

The ultimate goal is to get the right physician in the passenger seat, one that is competent, listens to you, and both of you like each other, and to collaborate with the physician to determine the destination and route that make the most sense for you. Probably wouldn't hurt if he's board certified as well. It's a bonus if the guy you get in the passenger seat shares the same tastes in music and/or talk shows.

Saturday, March 12, 2011

Driver's seat patient who failed driver's ed

Although much more could be said, the Driver's Seat Patients blog thinks this video poignantly illustrates a) how patients and doctors are bumbling their way from a paternalistic doctor-patient relationship to one of shared decision making; b) why puppets should never use iphones; c) what happens when doctors pursue puppetry; d) some puppets who might benefit from a plastic surgeon's groupon deal.

The Too Informed Patient from Marketplace on Vimeo.

Friday, March 11, 2011

Getting in the driver's seat of your bank

The DSP blog is stumped and would appreciate your input:

1)  why are the maps to put us in the driver's seat of our money seemingly so much superior than those maps for us in the driver's seat of our health?  (Take a look at Mint.com--it is simply incredible!  and it is leaves health sites in the dust).

2)  of all of the sites you know, which health site comes the closest to Mint.com

Thursday, March 10, 2011

Doctors inviting customers, I mean, patients, via Groupon

Still not convinced that doctors see you as a customer?  One plastic surgery group in Boston used Groupon to get the word out that Groupon ?patients could get laser hair removal for less than 25% of the normal $800 price.  Despite the DSP blog spouse's unfair comments about the ever increasing amount of hair on the DSP blog's back, the DSP blog was not in need of the hair removal offer.  However, it was disappointed that it could no longer by the cellulite treatment ($249 value) for its sisters (deal has expired).

The DSP blog anticipates the situations like this will increasingly force patients to make customer-like decisions with greater frequency.  Those who know best how to evaluate these ads placed under their windshield wiper will best be able to know which ones they should throw away and which ones they should pursue.

Even if you don't subscribe to Groupon, those reading this sentence may finish reading it for 50% off, today only.

Wednesday, March 9, 2011

Like it or not, you're being thrust into the driver's seat

Should patients be viewed as customers?  Is it appropriate to suggest that patients get in the driver's seat?  If billboards are advertising joint replacement, lap band specials can be found on the internet, and you can find out if you're at increased risk for experiencing muscle pain while taking statins, and you can directly access these services without going through a gatekeeper, then I would suggest that to a large extent, you are at the very least being viewed as a customer by many health care manufacturers, doctors, and hospitals.

If so, who do you turn to know whether you should pursue any of these flyers left under your windshield wiper while you're getting the groceries?  Or do you just throw them away?  Wouldn't it be nice if there was a "consumer reports" to turn to?   Interestingly, there is.  Not only that, it helps you sift through the small print that you might have otherwise missed, like the part about what percentage of patients that pursue lap band surgery love it so much that they have the band removed.  (about 1/3 need revision or removal of the band according to this reputable source).

Although Consumer Reports is great,  let's see it for what it is--a great map to have in your glove compartment.  But to figure out the best destination, make sure you have a primary care physician in the passenger seat that you enjoy talking to and will help you figure out which destination makes the most sense.

Sunday, March 6, 2011

Sarah Palin talks about Driver's Seat Patients Blog in embarrassing interview

Okay, so I am engaging in some self-promotional behavior. I was, yeah, just a little surprised, and I must admit, somewhat flattered, when Sarah Palin mentioned this young blog, admittedly during what must have been a somewhat embarrassing situation for her, so, yeah.

Saturday, March 5, 2011

Today's radio show guest: her condition would have stumped House, MD

On today's show, we had the pleasure of learning from Lisa Hall, who talked about her experience navigating her way on a ten year journey to the correct diagnosis and treatment.  Along the way, she was diagnosed with a variety of conditions, including being conflicted about her status as a Southern woman.  Now I'm no psychiatrist, but I'm pretty sure that diagnosis was a bit off.  She talks about how crucial her relationship was with one doctor, and she discusses questions you might consider if you are in the midst of a confusing diagnostic workup.

In addition, some intellectual firepower was brought to the show by cohost Michael, aka, the neighbor.

The DSP blog is indebted to both Lisa and Michael for this great show.

Friday, March 4, 2011

Tomorrow's show

0800 central standard time

Where to go to listen:  here

Call in number:  323-784-3632

Topic:  getting to the right diagnosis, with Lisa Hall

Co-host:  Michael, representing the patient side

Do doctors really want patients to question them?

Dr. Groopman does, and his stories illustrate why.  Short post here, because the value here is in this link.  For a treat, go to link and listen to interview with author of "How Doctors Think".  My hunch is that doctors will welcome the nature of questions Dr Groopman suggests.  The DSP blog is very interested in your thoughts and experiences in this arena!

Thursday, March 3, 2011

The Art of War and Patients in the Driver's Seat

SSSShhhh.  Listen very carefully.  Did you hear that.  No, not Robin Williams.  No, if you listen carefully, you'll hear Sun Tzu, from the 6th century BC?   Sun Tzu, the military strategist and author of The Art of War, wrote:  Strategy without tactics is the slowest route to victory.  Tactics without strategy is the noise before defeat.  

I am quite confident that he was addressing diabetics when he said this.  Why?  What he was saying to diabetics was this:  You must know what your overall strategic goal is (i.e. achieve an A1C of <7%), or you will have no idea if all of the tactics you are employing (diet/exercise/medications) are effective and/or need to be modified.

This applies to any chronic disease:  first step, driver, is to know your strategic goals.

Help your doctor take better care of you by asking this one question

Wednesday, March 2, 2011

Medicine and social media: dangerous intersection ahead

While enjoying a delicious, heart healthy meal at the not what is used to be Walnut Room in Macy's/Chicago, the DSP blog was informed about an individual with multiple sclerosis who had pursued treatment in Poland.  I was told that this individual went over there in a wheel chair, and came back walking.  Not only that, this person saw many other customers pursuing this treatment having the same results.

The current thinking about multiple sclerosis is that something, most likely the body's own inflammatory system, starts attacking the nerves, which results in a variety of debilitating problems such as abnormal sensation, fatigue, depression, pain, lack of coordination, muscle weakness and even paraplegia.  Some people with MS progress rapidly to significant problems, whereas others have a more benign disease course.  For those so severely affected, you can imagine why they would be willing to travel great distances and take great risks to pursue a new treatment that an Italian doctor developed to cure his wife.  

In what is likely a sign of things to come, multiple sclerosis patients interacting on social websites like Patients Like Me became aware of and knowledgeable about this new treatment much sooner than their doctors.  (Scientific American dubbed the treatment, "The YouTube Cure".)

The DSP blog thinks that patients who pursue this without collaborating with their doctor are driving their car recklessly.  My hunch is that most neurologists, once they researched the therapy, would suggest that before dangerous therapy should be pursued, it should be appropriately vetted in research trials, so that realistic estimations of benefits and risks can be properly assessed.  Ideally, the therapy could be compared to the placebo effect (see video--if a small pill can have a powerful effect--consider the placebo effect of having "surgery").  Doctors have seen first hand what patients with a stroke look like, and realize that a patient with MS pursuing this treatment might end up worse off than before the treatment.
Moral of the story--think carefully before being one of the first ones to drive your car over the bridge.

Victor Hugo's message to the DSP blog

The DSP blog's soul was strangely stirred recently while viewing "Les Miserables" in Chicago, when I heard Victor Hugo (the author) sending a strong message to the DSP blog and I'm pretty sure it was intentional, too).  The main character, Jean Veljean, has spent some time in a prison for stealing bread and a few other things.  He is pursued relentlessly by Javert, a police inspector, who sees Jean Veljean as one thing only:  a criminal.  Fortunately for Jean Veljean's sake, he runs into Bishop Myriel, who sees Jean Veljean as a man, not a criminal.  At one point, Jean Veljean says to Javert--"I am a man," (not a convict).  If you are still reading at this point, you are probably seeing the obvious message Victor Hugo was sending to DSP blog readers, but at the risk of offending you, I'll point out the obvious.  I'm pretty sure Victor Hugo was saying, see yourself as a person, not as a patient, and look for a doctor who sees you as a person and is a competent clinician who can offer you a good map.

Monday, February 28, 2011

What one question is should you ask when in the emergency room?

According to Dr. Jerome Groopman, asking a busy ER doc, "What is the worst thing thing this could be?", encourages your doctor answer the crucial question they are supposed to answer before sending you home.  In "How Doctors Think," Dr. Groopman tells a story about a woman with a known history of irritable bowel syndrome was discharged home from the emergency room, only to return 3 days later with a ruptured ectopic pregnancy because the doctor didn't address that question.

Dr. Groopman's book is a must read if you feel you are struggling to interact effectively with your doctor and feeling like your doctor is not listening to you.

Sunday, February 27, 2011

Should you question your doctor?

While the DSP blog recognizes the many nuances of this question, its final conclusion is:  if you are going to question your mechanic about the validity of their diagnosis about your car and their recommended treatment, then maybe you should feel like you are allowed to do the same with your doctor.  However, just as the practice of medicine is an art, the practice of being a patient also is an art.  This is another way of saying, it would probably help you get to be where you need to be if you knew (or at least had thought about) what the right situation is to question your doctor, and what the right questions were to ask.  This site, which interestingly enough I saw a billboard advertising this site while driving through an economically challenged area on Chicago's south side, will go a long way in helping you ask reasonable questions.  If you're doctor doesn't want to answer these types of questions, it may be suggestive of an underlying problem in your relationship with your doctor.

One of the other many issues related to this pertain to how often your doctor is correct about his/her diagnosis.  If he is right all the time, then why question, other than to pursue clarification?  The DSP blog is sad to reveal that while listening to, How Doctors Think, he heard the author suggest that doctors have the wrong diagnosis 15% of the time.  If you're one of those 15%, and you can pose the right questions that will make your doctor realize that maybe she should be a more uncertain of her diagnosis than she is, then you might move into the 85% category of patients correctly diagnosed.

Obviously, way more to the nuanced art of asking the right questions.  Would enjoy hearing your stories about how your questions led to the right diagnosis or treatment.

P.S.  There's no way a post can do justice to that question, so that's why the DSP blog shamelessly invites you to for next Saturday's show where we will explore this question further with Lisa Hall.  In light of the realization of what a boring monologue/diatribe yesterday's show was (note it was so bad, I don't even link to it), I am also inviting a cohost to join me, somebody from the ranks of the patient world, somebody that can a) add some humor; b) keep it real; c) argue when necessary.

P.P.S.  Example of perhaps the wrong approach to questioning doctors, from this enjoyable site:  Doctor:  "The best thing for you to do, is to stop drinking and smoking, get more sleep, and stay away from women."  Patient:  "I want to know all of my treatment options.  What else would you recommend?"

Thursday, February 24, 2011

If you need to have a heart bypass, do you choose the hospital with the biggest building?

The DSP blog is quite impressed by some of the beautiful architecture it witnesses in hospitals.  And sometimes concerned by the food it has eaten in hospital cafeterias.  You may feel like you have no other choice but choose a hospital based on a) their TV commercials; b) architectural transparency; c) hospital cafeteria; d) which hospital you have heard the least horror stories about; e) which hospital you have heard the most success stories about.

Where's the Consumer Reports for hospitals?

This and this is a start.  And it might give you a better basis to choose a hospital than a,b,c,d, or e.

Wednesday, February 23, 2011

Does your hospital get the simple things right?

The professional society (i.e. ACOG) which provides guidelines for obstetricians that say, in a nutshell, that say inducing labor before 39 weeks without a clear indication is simply not a good idea.  The DSP blog was not there when this edict was officially issued, so it has to speculate why ACOG recommends against the practice, but it thinks it may have to do with the minor issues of this practice a) increasing the chance the baby is born before it can breathe using only it's built in ventilator, and b) increasing the chance the baby will have to take a tour through the mom's abdomen on its way out, instead of another, perhaps more natural route.

If the recommendations are so clear about not inducing labor before 39 weeks, then would you want to go to a hospital where this was done more than half the time?  If these hospitals can't deliver on this one simple guideline, how well are they going to deliver on something a little more complicated?  How would a driver's seat patient know how well their hospital was doing in this arena?  You might find yours listed on this list.  The DSP blog found it concerning that not a small number of hospitals reported getting this wrong over 25% of the time (including one hospital that got it wrong 100% of the time).  What was even more concerning was the hospitals that either "declined to respond" or felt that the recommendations apparently did not apply to them.

Clearly, the DSP blog is against patients playing Dr. Google.  But at some level, if you are in the Driver's Seat, and you know a hospital gets this simple directive wrong so often, the DSP blog might start looking at the map for a hospital that was a little more successful getting the simple things right.

Tuesday, February 22, 2011

Upcoming show: March 5: Wheelchair to marathon due to effective driving?

The DSP blog is excited to inform you that, thanks to some cigar smoking, back room wheeling and dealing, Washington's very own Rahm Emanuel will be Chicago's new mayor Lisa Hall will be joining us on the Driver's Seat Patient Radio show, March 5, 2011, from 0800 - 0830.  As told on her blog, The Proactive Patient, Lisa got in the driver's seat and successfully made the trip from being not being able to walk down the driveway due to being able to run a marathon.  This was accomplished with stops at 38 different physicians, including one who apparently realized that her symptoms were due to the internal conflict raging inside her head because she was a southern woman (his diagnosis, not the DSP blog's).  At any rate, her story is quite intriguing, and the DSP blog is looking forward to talking with her about her experience, and plans to ask her just how applicable her experience is to others (apparently some of her symptoms may have been secondary to a lightning strike....).  So please join us here live on March 5, and call in with your questions.

Monday, February 21, 2011

Ask for more than 8 minutes

Unfortunately, too many patients discharged from the hospital make are admitted again within 30 days of their discharge.  While the DSP blog thinks that hospitals are great for cable, decent food, and sometimes a front row seat to quite a bit of excitement depending on who your roommate is or what condition is ailing her, all in all, it seems like a fairly expensive way to entertain oneself in this way.  Although the DSP blog was quite saddened by a number of things in this recent overview of the problem, potentially most distressing was this quote:  "Nationally, nurses spend an average of eight minutes on discharge education -- that time spent on education is probably inadequate for anything."  Eight minutes?  The DSP blog feels that if the guy at the oil change place can spend close to 8 minutes reviewing what they did for my car, and how I can take advantage of their free top-off policy between oil changes, then the nurse at the hospital can spend a little more than 8 minutes explaining a) what I need to do when I leave, including my medications, activity, and wound care, and b) which doctors I need to see and when, and under what conditions should I call for an earlier appointment.  The DSP blog would add that before you leave the hospital, you should have a friend fill your discharge prescriptions and you should make your follow up appointments so any issues can be dealt with before you leave the hospital.  

Saturday, February 19, 2011

Aren't doctors supposed to be in the driver's seat?

If you're a patient, and you don't have a good doctor sitting next to you in the passenger seat, you're in trouble buddy.  Because patients who navigate without collaborating with a doctor are more likely to pursue worthless treatments, instead of pursuing treatments that have been more rigorously evaluated for their effectiveness.  Also--come on now, let's not throw doctors under the bus here--they go through a rigorous training process themselves, and see thousands of patients, and if they care a lick about you, they can help you access the best tools available to achieve the best health possible.

The problem is, your doctor doesn't own your disease.  If your diabetes is poorly controlled, you are going to be the one that is at risk for a heart attack, kidney failure, and and amputation.  And when multiple treatment options exist, who really knows better than you which options work best for you and are most aligned with the way you are made?  And as helpful as your doctor is, they have a thousand other patients they're taking care of.  And let's be realistic--sometimes things fall through the cracks....

The ultimate driver's seat patient

Who is the  ultimate driver's seat patient?  How about this guy:  A 44 year old male who has diabetes.  Because he collaborates thousands of other diabetics almost daily using a social site for diabetics, he is well aware of his what his care should look like, and he has collaborated with this doctor to develop a treatment plan that has achieved these goals for his A1C and his blood pressure.  He explores point of care testing options with his doctor to minimize the hassle factor of having to run around all over creation getting his blood done.  And the icing on the cake:  because he also reads this blog, and is aware of concerns of how his sedentary job is probably making it harder and more expensive for him to control his diabetes, his company has provided him with a treadmill work station as part of a pilot project to study the ROI on creating a virtual indoor walking path for him to use.  Now that's a patient in the driver's seat.