Advice

I give a lot of advice in the course of the day. One might say it’s how I make a living. Some of my advice is pretty general (try get some exercise every day) and some rather specific (you have a weight goal of 153 pounds). But no matter what I say, I choose my words very carefully and use precise language.

I find that the best way to convey information is face to face. That way, I can tell if a person is following me. I encourage follow up questions and I may ask the patient to teach it back to me. I also like to give the patient some written information, often in a follow-up note. Many doctors are using discharge instructions for office visits, but I find that prewritten templates are too generic and sometimes make no sense. A non-smoker doesn’t like being told to stop smoking.

Telling a patient, “call if you are not better” is not nearly as helpful as, “Call if you have a fever greater than 101 or if you are short of breath.” Doctors tell patients to “push fluids” – but what does that mean? Far better are the instructions, “you should be urinating light yellow urine every two hours while awake.”

I also need my patients to choose their words carefully. It’s always best to use natural language rather than medical jargon. When a patient says she is worried about “osteo,” I have to wonder if it could be osteoporosis, osteopenia, osteomyelitis or a number of other “osteos.” What does IBS mean? Even worse is the made-up jargon used to push pharmaceuticals.

It might be hard to take advice, but my goal is that least the patient will understand it.

Electronic or Paper?

Electronic medical records can be terrific – until they are not.

Paper records are very low tech: paper and a black ballpoint pen. There’s actually a law about the pen but no requirement about the type of paper. Other paper rules: every page in the chart must have two identifiers (such as name and date of birth, or name and patient number) and each entry must be dated and signed. No need for power or an internet connection. We all have heard the negatives: difficult to read, often misplaced and impossible to share. The written information can be scanty and may appear to be written in code. Medication directions are still in Latin.

Electronic records need computers. No power, no chart. Computerized records are easy to read – at least the letters on the page are always legible. The notes are very complete since all background information is dragged in, no matter the relevance to the current problem. (Yup, parents are both still deceased). There are still lots of abbreviations, both standard and not. You won’t see the diagnosis “pneumonia” but rather CAD, PNA or 486.  There is so much information in the note that it can hard to discern the plan. Entries still need to be signed (a multi-step process). In theory, information can be shared.

Electronic records can vanish in an instant. I have seen it happen. Paper records endure. Paper can be salvaged if wet and fire is less likely than a computer glitch. It’s not difficult to locate a misplaced paper chart but can be impossible to recover lost computer data. And how much do we want shared, anyway?

Please Take Your Medicine

Nearly three in four Americans don't take their prescription medicine as directed. Even among those with serious chronic health conditions such as diabetes, about one in three don't.

Patients not taking medicine as prescribed cost the U.S. healthcare system roughly $290 billion a year in extra treatment and related costs, research shows. One study estimated those patients pay about $2,000 a year in extra out-of-pocket medical costs.

There can be serious consequence of note taking medication as prescribed. Patients who don't always take medicines for high blood pressure and cholesterol problems can suffer a heart attack or stroke, causing disability or death. Doctors may believe a drug they prescribed for the patient didn't work and switch to another one that has worse side effects or costs more.

There are a variety of reasons that people don’t take their medication as prescribed. The most common reasons are:

financial problems/lack of health insurance, complicated or confusing medication schedule, forgetfulness, and problems with or fears of side effects. A more basic problem is the belief the medicine isn't really needed. This is common with symptomless conditions such as high blood pressure.

Doctors are not clairvoyant. Let us know if you have concerns or problems There are many ways to treat medical problems: diet, exercise, a change in prescription medications or the use of non-prescription products.

If you are having trouble paying for your medications:

Partnership for Prescription Assistance

Patient Advocate Foundation

Rx Hope

Needy Meds

Patient Assistance Programs

Please be careful when entering personal information on any website. This list is from the AARP website. 

Run or Walk?

Taking a walk offers the same health benefits as a run. The determining factor is the distance covered, not how fast one goes. A runner will complete two miles in one-half the time as a walker but the runner and the walker would end up with similar reductions in the risk for hypertension, high cholesterol, diabetes and heart disease.

According to Dr. Paul Thompson of Hartford Hospital, “the faster you are, the faster the results but slow and steady gets you to the same point.”

Running reduced the risk for hypertension by 4.2% and walking reduced it by 7.2%. Running cut the risk for high cholesterol by 4.3% and walking reduced it by 7.0%. Running reduced the risk for diabetes by 12.1% and walking decreased it by 12.3%

Running cut coronary artery diseased by 4.5%, it was cut 9.3% by walking.

These results show that even modest amounts of exercise improve cardiovascular health. It’s not necessary to run a marathon - you don’t need to push yourself very hard to see benefits.

Lace up those sneakers and get going – your walk will put distance between you and the hospital. 

Triglycerides

When talking about heart disease, the conversation will turn to the blood cholesterol level. In a more sophisticated exchange, the ratio of ‘good’ to ‘bad’ cholesterol will be discussed. The neglected part of the dialogue is the triglyceride level.

Triglycerides are formed when you eat more calories than the body needs right away. Sugars (candy, soda, cake) and simple carbohydrates (bread, rice, potatoes) are major culprits in boosting triglyceride levels. High triglyceride levels are most often seen with pre-diabetes, diabetes, obesity and a sedentary life-style.

Elevated triglycerides, especially when combined with low HDL cholesterol (the ‘good’ cholesterol) contributes to hardening of the arteries. The arteries are the blood vessels that travel from the heart delivering oxygen-rich blood to the tissues that need nourishment. Hard and stiff (in contrast to soft and expandable) arteries don’t do a good job with blood flow and run the risk of causing heart attacks and stroke. Other factors that cause hardening of the arteries are elevated blood pressure, cigarette smoking and age. Age is the only risk factor that cannot be modified: every other risk factor is under our direct control.

Obese children have accelerated aging of their blood vessels. The good news is that children are resilient and embracing a good diet and getting regular exercise can restore health to their blood vessels.

In adults, the combination of high triglycerides and low HDL cholesterol is a portent of impending diabetes. Medication is not the answer here – cutting calories and getting daily exercise is. Make water the beverage of choice. Don’t eat manufactured sweets. Get off the couch. Make the triglyceride level part of the conversation. 

Sinusitis

Especially in the springtime, patients will come to the office with sinus symptoms. Sinusitis is the medical term for inflammation of the lining of the sinuses and nose. The sinuses are the hollow areas within the facial bones that are connected to the inside of the nose. It’s not easy to determine if the patient is suffering from seasonal allergies or has an infection.
 

The most common cause of acute sinusitis is a viral infection associated with the common cold. Bacterial sinusitis occurs much less commonly, in only 0.5 to 2 percent of cases, usually as a complication of viral sinusitis. The correct antibiotic can seem like a miracle cure but antibiotics are only effective against bacteria. An acute bacterial infection can be suspected if the patient has been sick for more than ten days without improvement, has a fever greater than 102 degrees or was initially getting better and then got suddenly worse.

 

Patients who have symptoms for fewer than ten days without a fever should have supportive care. This includes pain relief with acetaminophen or ibuprofen, saline nasal irrigation and fluids. Breathing up steam can be very helpful. Medications to thin secretions (such as guaifenesin) may help to clear mucus. Decongestants are usually not helpful and can have side-effects. Antihistamines only work if there is an allergic component. Nasal steroids (steroids delivered by a nasal spray) can help to reduce swelling inside the nose. These prescription medications have few side effects and dramatically relieve symptoms in most people.

 The vast majority of patients will eventually get better without medical intervention, but we do have products that can make people feel better much faster. Usually a quick exam will point the patient in the right direction.