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?"