Saturday, June 13, 2009

What's the Secret?

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In addition to the Comments attached to to the tail-end of every Blog entry, a lot of folks contact me directly via email ( veeduber@chuggers.net ) In response to my last Blog entry ('Good News!' ) I received several email messages. One of them sounded a bit forlorn... and failed to provide a valid email address, making it impossible to answer them directly. What they wanted to know was the 'secret' of receiving good medical care.

I don't think there is a secret. But I think a lot of people have failed to understand the realities of modern medical treatment and a good way to prove that is to take a look at medical treatment in the past. You know the ones I mean.... where the Hero gets sick and ends up in the hospital attended to by the modern-day version of Florence Nightingale, where the All-Knowing physician apparently lived in a room just down the hall. The Hero's medical record -- magically reduced to a single sheet of paper attached to a clip-board hanging on the foot of the bed -- contained everything doctor might want to know.

You can get a good laugh out of some present-day hospitals, the ones where the nurses don't even speak English and the physician might only come around one day per week. My case will give you a nice example of modern-day medical treatment, where the patient becomes their own hospital.

As most of you know, I have Multiple Myeloma, a form of blood cancer for which there is no cure, although it can be treated. The fellow who wrote me is apparently dealing with medical problems of his own, wondering what's the secret to getting a bit of good news.

Although I don't believe there is any secret, the difference between my treatment and his could very well be the quality of the hospital he uses, which is a play upon words since, as I've said above, in the modern day we often become our own hospital.

See that clip-board hanging on the foot of the patient's bed? Back in the Good Ol' Days... whenever that was, that was the patient's 'Vitals Chart' and listed the patient's pulse-rate and temperature, recorded however often the doctor requested it, with every four hours being typical. Nowadays your vitals usually present more data, such as blood pressure and the oxygen content of your blood. Being my own hospital, I collect & record my own vitals, generally using modern electronic instruments. As a pilot I already had a Nonin (brand name) blood-oxygen instrument, and the electronic thermometer seemed to arrive along with the kids. But I had to buy an electronic blood pressure device (less than $20).

I usually take my vitals every day. The data is recorded in a notebook and again into a computer file. The notebook makes the data portable, allowing the physician to see it, should they ask. But most doctor's offices prefer to record your vitals themselves.

I also record my weight, usually after my shower.

My pills follow a four-times-per-day schedule. There is a listing that shows what medications I take, how much, and when they are taken. There is also an 'Origination List' showing which physician prescribed which pills, what they are for and when they were prescribed. Making sure this list up to date is a basic chore each time we visit any of the five doctors. Since my ailment is being treated by a team of physicians, it's up to me to ensure that all are made aware of any change to my mediations, especially when there is the possibility of any drug interaction.

Many cancer patients say the cure is often worse than the disease. I've got a hunch they need to spend more time talking to their physician because a slight change in dosage or frequency can eliminate many of the side-effects which give rise to such claims. (In my case there isn't any cure, but that doesn't mean it has to be fatal.) Working with the physicians over the past year has resulted in a nice balance of medications which has reduced the side-effects to little more than a nuisance. That doesn't mean a full recovery -- the tumor has caused too much damage for that. But neither does it have me puttering about in a wheel chair. In either case, each of us is the master of our fate. For someone to feel that good medical care involves some secret is more likely to cause others to doubt the person's perceptions than the quality of their physician. On the other hand, over the last few years there has been enormous strides in medicine and some physicians have failed to keep pace. If the cure is indeed so terrible it would seem logical to seek a second opinion.

Personally, if there is any secret it probably has to do with the cooperation between the physicians and the patients, with the patient playing the major cooperative role. Physicians simply have too many depands upon their time. From the outset of my treatment Dr. Bessudo, my oncologist, insisted upon a team approach, calling upon other physicians as needed. He also said that I would be a part of the team but I didn't realize what that role entailed. Looking back on the past year it is now obvious that much of my progress was due entirely to the roles played by my wife and myself. While that may sound self-serving I can swear it is not.

In effect, my hospital covers about 200 square miles (!). In the past year my wife has never failed to deliver me to the proper physician, on time and suitably attired. (Indeed, she uses a check-off list to ensure I have wallet, cell-phone and so forth -- ten items, all tolled.) Nor has she failed to procure my medications, and to dole them out in the proper frequency, from once a day to once per week. I suspect support of this nature is not considered much of a secret when in fact it forms the very foundation of my treatment.

A recommended change to my medication appears automatically on the other physician's computers, supported by an often cryptic email. Often times a recommended change will produce a flurry of emails before the matter is resolved, often based on economic factors. (You won't believe what some drugs cost!) New drugs come on the market every day and if your ailment matches the intended purpose of the drug you're liable to be used as something of a lab-rat. Before trying something new, if you are being treated by more than one physician, it's a good idea to make sure they are all aware of the new drug and any possible side effects. This kind of information is available in the Physician's Desk Reference (PDR) and from the company offering the new drug. The key point here is that you... YOU need to devote some time to your treatment. As I've said, physicians are busy people. Your treatment must be a cooperative effort.

Baffled by all those medical terms? Then write them down. Now go look them up on your computer. Learn how to pronounce them properly. Write down any questions you may have. Rehearse your visit to the doctor. Be concise! Don't waste her time. (Nor his.)

Are these things secrets? I don't think so. Indeed, I've a hunch your physician will appreciate your enlightened interest.

-R.S.Hoover
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