5 things that I want my patients to know

Today’s healthcare consumer is constantly barraged with conflicting information. Does wine prevent or predispose to cancer? Should I eat certain foods or avoid them? Is this new medication going to hurt me or help me? Many issues are still controversial, but there are some things that have a large amount of evidence behind them.

1. Antibiotics will not help the common cold. Colds are caused by viruses, and antibiotics kill bacteria, which is a whole different type of organism. All of us have been through colds. We know that they are unpleasant–lots of sneezing, coughing, body aches, fever, feeling run down. All of us also know that colds will go away on their own. Some patients will swear that taking antibiotics will help them, but we know scientifically that this is not true; the cold is self-limited and was going to go away on its own anyway. Much better than taking a pill that doesn’t work is to strengthen your immune system, and prevent the cold from happening in the first place. Get adequate sleep. Eat a healthy diet. If you do have a cold, drinking lots of fluids and taking Tylenol and ibuprofen is key to your recovery–not antibiotics.

2. A CT scan will not help a headache. Having a headache, just like catching a cold, is unpleasant. Your head throbs. You might feel that you can’t concentrate and go about your daily activities. While there are potentially serious causes of headache, the vast majority of them are due to tension headache or migraine. These will go away with time. Again, over-the-counter medications like tylenol and ibuprofen can help, as can rest in a quiet, dark room and lots of fluids. A CT scan will only show what you DON’T have, and, in the vast majority of cases, will not help make your diagnosis–and certainly won’t make you feel better.

3. Every test has potential side effects. Patients often ask their doctors for tests to figure out what’s wrong; in the same way, doctors often rely on tests to save them time of speaking to patients to make the diagnosis. The problem is that tests can only tell you what you DON’T have, and not what you actually have. Studies have shown that actually sitting down with the patient and talking to her will much more likely yield the diagnosis than any test. And every test has potential side effects.  CT scans involve radiation, and studies have shown that each individual scan increases your lifetime risk of getting cancer. Some CTs and MRIs involve administering contrast dye that could cause kidney damage. Even the simple blood draw can lead to complications like infection and bruising. This is not to say that you should never get tests done; it’s just a reminder that tests are not always the answer, and that you should make sure you know ahead of time what the risks and benefits are of every test.

4. Lifestyle changes make a huge difference. Study after study show that the single most important contributor to decreasing your risk of heart disease, for example, is your lifestyle. You can take pills to decrease your blood pressure, lower your cholesterol, and control your diabetes–but even better is to eat a healthy diet with low saturated fat and exercising. Similarly, the single biggest risk to health that is preventable is smoking. Within even a few months of stopping smoking, the risk of cancers and heart disease begins to decrease. Don’t get me wrong: it’s not easy. Working on your lifestyle requires far more investment in your time and energy than popping a pill. But it’s the most effective way to really make a difference in your health.

5. Aspirin is one of few medications that’s been definitively shown to help you. Big pharma would like us to believe that the newest and greatest drug is the best thing out there to prevent heart attack and stroke, but actually aspirin is one of very few medications that’s proven its weight. It reduces the risk of hear attack and stroke, and some studies are demonstrating that it may even be preventative against cancer. People who experience chest pain get aspirin first, before they get anything else, because it is the one thing that helps them if they are already having a heart attack. Not everyone needs to take aspirin, and there are some for whom it may be harmful (all medications, just like all tests, have side effects), but this is one more reminder that the newest and greatest isn’t always the best; sometimes it’s the tried and true that you need.

Leana Wen is an emergency physician who blogs at The Doctor is Listening. She is the co-author of When Doctors Don’t Listen: How to Prevent Misdiagnosis and Unnecessary Tests.  She can also be reached on Twitter @drleanawen.

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  • http://www.facebook.com/jwcoppin Jonathan Coppin

    Good article. You rightly point out that doctors have stopped relying on history taking skills and listening to the patient and have started using tests as a crutch. However, you make a blanket statement that tests can only tell you what you don’t have. This is true of some tests in some instances, but there are tests that can reveal a diagnosis and this should be correctly stated.

    • http://twitter.com/DrLeanaWen Leana S. Wen MD

      Jonathan: you’re right–what I mean to say is that tests should be done
      with a specific goal in mind. Otherwise, they only serve to tell you
      what you don’t have.

  • Kari Ulrich

    5 Things I want my Doctor to Know

    1. I do look healthy on the outside and for decades my symptoms have been dismissed. There are many “invisible illnesses” that are under diagnosed and dismissed.

    2. Prevention is the key to a better quality of life. I take an active roll in my health because there are so many things I have yet to accomplish in life. If I bring you an article on my disease, or ask you a question about something I have read don’t roll your eyes and dismiss it. Please take the time to consider the possibility and lets discuss the pros and cons.

    3. If you are not familiar with my diagnosis I am not going to be upset. I would appreciate if you would take the time to learn about it so that you can treat me properly. I know not every disease is covered in med school, nor do I expect you to be up to date on the latest findings. Please let me know you are interested in learning more so we can work together.

    4. I am a complex patient, I understand that your schedule only allows 15 minutes appointment times. We both know that is not enough time to cover someone with a complex disease. Allow me to have a 45 minute appointment time. Indicate on my chart that you need more time so the person scheduling my appointment will not argue with me.

    5. I appreciate when you tell me that you have a plan for me, even if all my test results come back negative. I need to know that you will not abandon me and give up. I also know that you do not always have an answer, and it is OK to say you just don’t know. I appreciate when I am given options for my treatment and care. I know medicine can be trial and error.

    I was diagnosed with Fibromuscular Dysplasia and EDS after 2 decades of symptoms. Along the way I have learned how to advocate for myself. Thanks to my team of doctors at Mayo Clinic I learned that I can be a partner in my care. I know not every patient is able to be in a health care system like Mayo. It is very difficult for both physicians and patients when there is limited appointment times, and that the specialist patients see are across many health care systems. This make communication and continuity of care difficult. It is imperative that physicians and patients work as a team.

    • azmd

      Great post, Kari, and it is good to see that after what sounds like a long struggle, you were finally able to find a team of doctors with whom you have been able to build
      an effective partnership in your care. Just out of curiosity, and because I always wonder this when I see patients mentioning that they need extra time with their doctor, do you expect to be billed for that time? Or are you under the impression that your insurance company pays the doctor extra when you are seen for an extended appointment?

      • Kari Ulrich

        I expect that it would be billed time. A complex patient should generate more RVU’s for the doctor. I personally would be more than happy to pay out of pocket for extended time with my physician team. I understand the amount of extra work I generate for my team of doctors, and much of that time is not compensated. The phone calls, the messages and the correspondence between my physicians is not billable, but it should be. The communication that goes on in between my appointments is just as important as my actual appointment time. My disease affects my life daily. My symptoms wax and wane, some I can tolerate others affect my life greatly, therefore my treatment can be very complex. Communication with my team of physicians is very important to me and my care.

    • http://twitter.com/DrLeanaWen Leana S. Wen MD

      Kari, this is a really amazing post. I would love to be able to share your writing on my blog, The Doctor is Listening http://whendoctorsdontlisten.blogspot.com/. Is this is something you would be amenable to? Thank you for considering.

      • http://www.facebook.com/profile.php?id=1379526991 Kari Muth Ulrich

        Thank you Dr. Wen. I would be honored to have my post on your blog. Thank you.

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