Hear my interview with Dr. Steve Feldman by clicking on the link below.
Dr. Feldman cares about the quality of your health; he is the founder of www.DrScore.com, an online doctor rating website that doctors nationwide use to get feedback from patients and has authored over 400 peer reviewed medical articles. Much of Dr. Feldman’s work has been compiled for lay people in his book, Compartments: How the Brightest, Best Trained, and Most Caring People Can Make Judgments That are Completely and Utterly Wrong.
Dr. Feldman is Professor of Dermatology, Pathology and Public Health Sciences at the Wake Forest University School of Medicine in Winston-Salem, North Carolina. He directs the Center for Dermatology Research, a health services research center working to improve the care of patients with skin disease. Dr. Feldman’s chief clinical interest is psoriasis. He received a Presidential Citation from the American Academy of Dermatology in 2005 for his psoriasis education efforts and received one of the AAD’s highest awards, the Clarence S. Livingood Lecturership, at the 2006 AAD Meeting. Dr. Feldman also was awarded the Astellas Award (and its $30,000 prize) by the American Academy of Dermatology in 2008 for scientific research that improved public health in the field of dermatology.
Getting Better Health Care – What does it take to be a better patient?
To learn more go to www.savvypatienttoolkit.com
Monday, May 31, 2010
Saturday, May 29, 2010
New Symptoms: Obtaining a Diagnosis – Part I
"Mr. James, I understand you are having problems with your stomach. Tell me what has been going on," Dr. Brown says as he walks in the door.
"Well, I have this pain in my stomach. I'm not sure how to describe it. It started about 2 weeks ago - or was it three or four weeks ago. It comes and goes. I don't know what else I can say," Mr. James replies.
A little exaggerated, but not much - very little for the doctor to go on. He asks questions that may or may not be the right ones and may order numerous tests to make the diagnosis.
What can Mr. James do to increase his chance for a timely, accurate diagnosis?
Document symptoms as they occur. It's simple to do. Why don’t we do it? Laziness? Not necessary - I can remember? Won't help much?
Laziness – probably not, it is more about habit and not having a management system for our medical care.
Memory – if lucky, we’ll remember 50% of the details.
Helpfulness –accurate, complete information is key for an accurate diagnosis, fewer tests and appropriate treatment plan.
Still no diagnosis - take the following steps:
• Obtain copies of all test results & doctor notes.
• Research your chronic conditions and medications. You may find connections to them your doctor hadn’t considered or better words to communicate your symptoms.
Listen to your instincts, it may be time to:
• Get a second opinion
• Ask for a referral to a specialist
• Change providers if you feel he’s has reached the limits of his abilities, says you are anxious or that your problems are all in your head.
To learn more go to www.savvypatienttoolkit.com
"Well, I have this pain in my stomach. I'm not sure how to describe it. It started about 2 weeks ago - or was it three or four weeks ago. It comes and goes. I don't know what else I can say," Mr. James replies.
A little exaggerated, but not much - very little for the doctor to go on. He asks questions that may or may not be the right ones and may order numerous tests to make the diagnosis.
What can Mr. James do to increase his chance for a timely, accurate diagnosis?
Document symptoms as they occur. It's simple to do. Why don’t we do it? Laziness? Not necessary - I can remember? Won't help much?
Laziness – probably not, it is more about habit and not having a management system for our medical care.
Memory – if lucky, we’ll remember 50% of the details.
Helpfulness –accurate, complete information is key for an accurate diagnosis, fewer tests and appropriate treatment plan.
Still no diagnosis - take the following steps:
• Obtain copies of all test results & doctor notes.
• Research your chronic conditions and medications. You may find connections to them your doctor hadn’t considered or better words to communicate your symptoms.
Listen to your instincts, it may be time to:
• Get a second opinion
• Ask for a referral to a specialist
• Change providers if you feel he’s has reached the limits of his abilities, says you are anxious or that your problems are all in your head.
To learn more go to www.savvypatienttoolkit.com
Friday, May 14, 2010
Prevent Hospital Medication Errors
"Mr. Corbett, your doctor wants you to take two new antibiotics," the nurse said as she arrived with one pill in hand. Time passed and no more pills arrived. When the nurse came to do a blood pressure check, I asked, "When will he get the second antibiotic?"
"I'll check," she said and left. The same dialog repeated twice. Finally, she returned and told us, "He had the first new antibiotic at 8:00 am, he will get the original one at noon, and the second new one at 8:00 this evening." She started to leave the room.
"Wait a minute; it was my understanding, when the doctor spoke to us this morning, that he was stopping the antibiotic they gave him in the emergency room and replacing it with two different ones."
"I'll check the chart again, but those are the orders we have." She returned and verified no stop order for the initial antibiotic prescribed.
At that point we asked her to hold his noon dose and double-check with the doctor to verify which antibiotics he was to take and when.
On returning, she said, "You were right. He is to have only the two new antibiotics."
The next morning, we discussed this mix-up with the doctor. "You were right to persist, and it is good that you did," he said. "The combination of the three could have caused shut down his remaining kidney function."
Lessons Learned:
Check and double check before taking medication if you have any doubts.
Don't take for granted that orders in the chart are correct.
Persist respectfully, when there is a difference of understanding or in the face of resistance.
Keep notes of your conversation with your doctor to aid you in resolving differences.
To learn more go to www.savvypatienttoolkit.com
"I'll check," she said and left. The same dialog repeated twice. Finally, she returned and told us, "He had the first new antibiotic at 8:00 am, he will get the original one at noon, and the second new one at 8:00 this evening." She started to leave the room.
"Wait a minute; it was my understanding, when the doctor spoke to us this morning, that he was stopping the antibiotic they gave him in the emergency room and replacing it with two different ones."
"I'll check the chart again, but those are the orders we have." She returned and verified no stop order for the initial antibiotic prescribed.
At that point we asked her to hold his noon dose and double-check with the doctor to verify which antibiotics he was to take and when.
On returning, she said, "You were right. He is to have only the two new antibiotics."
The next morning, we discussed this mix-up with the doctor. "You were right to persist, and it is good that you did," he said. "The combination of the three could have caused shut down his remaining kidney function."
Lessons Learned:
Check and double check before taking medication if you have any doubts.
Don't take for granted that orders in the chart are correct.
Persist respectfully, when there is a difference of understanding or in the face of resistance.
Keep notes of your conversation with your doctor to aid you in resolving differences.
To learn more go to www.savvypatienttoolkit.com
Sunday, April 18, 2010
Six Steps to Take When Confronting a New Medical Condition
You are having symptoms you have never had before. You think it might be becoming serious and worry is setting in. You seek help and receive a diagnosis. What does this diagnosis mean for you? What treatment(s) will you receive? How will it affect your life? The questions go on…consciously and sub conscientiously.
Do you leave it up to the doctor to tell you everything he thinks you need to know, recommend a treatment plan and hope for the best? Or, do you get involved and make sure the way you proceed is right for you? Your doctor will base his recommendation on his knowledge bank about the illness and what he remembers about you, the new information you provide and what works best for most people... unless you give him reason to do otherwise.
Here are six steps you can take as you make decisions in partnership with your doctor:
1. Seek to understand your illness. Become as aware as you can of your symptoms and how you feel. Document your symptoms as they occur, actions you've taken and the results of each action.
2. Be as clear as possible in the descriptions you give your healthcare providers. Learn the most effective language you can to communicate your symptoms and concerns. Doing research can often help you find the right words.
3. Research and understand how the body works, your medical condition / illness and your treatment options. Use reliable resources.
4. Be assertive. Don't be afraid to ask questions. The more you learn, the better your questions will be. If you don't understand the answers or don't get answers that make sense to you, persist with your research and questions until you do.
5. Be actively involved in finding the right treatment plan for you. Be sure to discuss all treatment options, ask your doctor for her recommendation and the reasoning for it, and how the treatment will effect other conditions and / or medications you take.
It never hurts to get a second opinion – some insurance companies require you do so for certain conditions.
You may not realize it, but the key to a timely diagnosis and appropriate treatment plan often depends on you and your willingness to do your part.
To learn more go to www.savvypatienttoolkit.com
Do you leave it up to the doctor to tell you everything he thinks you need to know, recommend a treatment plan and hope for the best? Or, do you get involved and make sure the way you proceed is right for you? Your doctor will base his recommendation on his knowledge bank about the illness and what he remembers about you, the new information you provide and what works best for most people... unless you give him reason to do otherwise.
Here are six steps you can take as you make decisions in partnership with your doctor:
1. Seek to understand your illness. Become as aware as you can of your symptoms and how you feel. Document your symptoms as they occur, actions you've taken and the results of each action.
2. Be as clear as possible in the descriptions you give your healthcare providers. Learn the most effective language you can to communicate your symptoms and concerns. Doing research can often help you find the right words.
3. Research and understand how the body works, your medical condition / illness and your treatment options. Use reliable resources.
4. Be assertive. Don't be afraid to ask questions. The more you learn, the better your questions will be. If you don't understand the answers or don't get answers that make sense to you, persist with your research and questions until you do.
5. Be actively involved in finding the right treatment plan for you. Be sure to discuss all treatment options, ask your doctor for her recommendation and the reasoning for it, and how the treatment will effect other conditions and / or medications you take.
It never hurts to get a second opinion – some insurance companies require you do so for certain conditions.
You may not realize it, but the key to a timely diagnosis and appropriate treatment plan often depends on you and your willingness to do your part.
To learn more go to www.savvypatienttoolkit.com
Friday, March 19, 2010
Hospital Infections - More Superbugs to Know About
We are all familiar with MRSA (Staphlocous), a well-known hospital-acquired infection that is extremely hard to treat. According to a February 26 article in the New York Times, another class of antibiotic-resistant bacteria is causing tens of thousands of deaths each year. Antibiotics to treat them are very old and cause severe kidney damage. In March 2009, I wrote an article about the things you can do to minimize hospital infections. I thought it important to repeat the guidelines to help prevent these infections. If you or someone you know is in the hospital, please make them aware of this and pass these guidelines along to them.
• If you have a choice, choose a hospital where the infection rate is low.
• Prior to admission to the hospital, ask if the rooms, all furniture & equipment are cleaned with Clorox between patients. If not, take a spray bottle of chlorine-based cleanser with you and clean the room or have someone do it for you.
• Be sure linens and hospital gowns are changed daily and the room is kept clean.
• Make sure all staff wash hands or change gloves between patients. Be aware that another deadly bacterium, c.difficile is not killed by alcohol, so the alcohol cleansers may not protect you.
• If a provider is wearing a tie, ask to him remove it or tuck it in and wash his hands again before he leans over you.
• Make sure all instruments such as stethoscopes have been cleanse before they touch you.
• Be sure to wash your hands thoroughly with soap and after using the bathroom.
• Insist that visitors wash their hands when they come into your room and before they touch you and your belongings.
• If a materials used in your care is dropped on the floor, make sure it is discarded and replaced.
• Almost 50 percent of infections acquired in hospitals are bladder and kidney infections, which increase considerably if you have a catheter, even greater if you have a catheter more than two days. Make sure the staff washes their hands before touching you.
• Be you know the proper home procedures for taking care of your wound after surgery.
• Some surgeries have a high probability of post-operative infection. Ask your doctor if your surgery requires pre or post-operative antibiotics and the best time to receive them.
• Body temperature lowers during surgery, which can affect blood flow and your immune system, increasing your chance for infection. Surgical units are usually quite cool. Ask your doctor if they can do something to keep your body warm.
To learn more go to www.savvypatienttoolkit.com
• If you have a choice, choose a hospital where the infection rate is low.
• Prior to admission to the hospital, ask if the rooms, all furniture & equipment are cleaned with Clorox between patients. If not, take a spray bottle of chlorine-based cleanser with you and clean the room or have someone do it for you.
• Be sure linens and hospital gowns are changed daily and the room is kept clean.
• Make sure all staff wash hands or change gloves between patients. Be aware that another deadly bacterium, c.difficile is not killed by alcohol, so the alcohol cleansers may not protect you.
• If a provider is wearing a tie, ask to him remove it or tuck it in and wash his hands again before he leans over you.
• Make sure all instruments such as stethoscopes have been cleanse before they touch you.
• Be sure to wash your hands thoroughly with soap and after using the bathroom.
• Insist that visitors wash their hands when they come into your room and before they touch you and your belongings.
• If a materials used in your care is dropped on the floor, make sure it is discarded and replaced.
• Almost 50 percent of infections acquired in hospitals are bladder and kidney infections, which increase considerably if you have a catheter, even greater if you have a catheter more than two days. Make sure the staff washes their hands before touching you.
• Be you know the proper home procedures for taking care of your wound after surgery.
• Some surgeries have a high probability of post-operative infection. Ask your doctor if your surgery requires pre or post-operative antibiotics and the best time to receive them.
• Body temperature lowers during surgery, which can affect blood flow and your immune system, increasing your chance for infection. Surgical units are usually quite cool. Ask your doctor if they can do something to keep your body warm.
To learn more go to www.savvypatienttoolkit.com
Tuesday, February 16, 2010
New Smptoms: Obtaining a Timely Diagnosis
"Mr. James, I understand you are having problems with your stomach. Tell me what has been going on," Dr. Brown says as he walks in the door.
"Well, I have this pain in my stomach. I'm not sure how to describe it. It started about 2 weeks ago - or was it three or four weeks ago. It comes and goes. I don't know what else I can say," Mr. James replies.
This may be a little exaggerated, but patients' reports to their doctors are often not much better than the above scenario. The doctor has little to go on and then starts with questions he's been trained to ask. He may or may not ask all the right questions and possibly end up ordering numerous tests to try to diagnose Mr. James' problem.
What can Mr. James do to provide his doctor with better information, potentially decrease the number of tests ordered and likely receive a timelier, more accurate diagnosis?
The Most Important Thing
The most important thing Mr. James and any patient or caregiver can do is document symptoms as they occur. It's a simple thing to do. Why are we not likely to do it? Is it laziness? Do we think we can remember the details; therefore, it's not necessary? Do we think it won't help much?
Laziness – it is more about habit and not having an overall management system for our medical care than it is laziness.
Memory – we all think we will remember details well enough to tell our story, but in truth we are not likely to remember much more than 50% of the details including the best way to describe the symptom(s), how we felt or the day / timing associated with each occurrence.
Helpfulness – the more information we give and the more accurate it is the more likely the doctor will be able to make an accurate diagnosis and recommend the appropriate tests, if needed, and a treatment plan.
If your doctor is unable to make a diagnose immediately, take the following steps:
• Obtain copies of all test results & doctor appointment notes.
• Do research; if you have not already done so, on your chronic conditions and medications you currently take. You my find a better way to communicate your symptoms or that your new symptoms are connected to them in a way your doctor may not have considered
In the event you still can't obtain a diagnosis, listen to your instincts:
• Get a second opinion
• Ask for a referral to a specialist
• Change providers if you feel your current provider has reached the limits of his or her abilities, says you are anxious or that your problems are all in your head.
To learn more go to www.savvypatienttoolkit.com
"Well, I have this pain in my stomach. I'm not sure how to describe it. It started about 2 weeks ago - or was it three or four weeks ago. It comes and goes. I don't know what else I can say," Mr. James replies.
This may be a little exaggerated, but patients' reports to their doctors are often not much better than the above scenario. The doctor has little to go on and then starts with questions he's been trained to ask. He may or may not ask all the right questions and possibly end up ordering numerous tests to try to diagnose Mr. James' problem.
What can Mr. James do to provide his doctor with better information, potentially decrease the number of tests ordered and likely receive a timelier, more accurate diagnosis?
The Most Important Thing
The most important thing Mr. James and any patient or caregiver can do is document symptoms as they occur. It's a simple thing to do. Why are we not likely to do it? Is it laziness? Do we think we can remember the details; therefore, it's not necessary? Do we think it won't help much?
Laziness – it is more about habit and not having an overall management system for our medical care than it is laziness.
Memory – we all think we will remember details well enough to tell our story, but in truth we are not likely to remember much more than 50% of the details including the best way to describe the symptom(s), how we felt or the day / timing associated with each occurrence.
Helpfulness – the more information we give and the more accurate it is the more likely the doctor will be able to make an accurate diagnosis and recommend the appropriate tests, if needed, and a treatment plan.
If your doctor is unable to make a diagnose immediately, take the following steps:
• Obtain copies of all test results & doctor appointment notes.
• Do research; if you have not already done so, on your chronic conditions and medications you currently take. You my find a better way to communicate your symptoms or that your new symptoms are connected to them in a way your doctor may not have considered
In the event you still can't obtain a diagnosis, listen to your instincts:
• Get a second opinion
• Ask for a referral to a specialist
• Change providers if you feel your current provider has reached the limits of his or her abilities, says you are anxious or that your problems are all in your head.
To learn more go to www.savvypatienttoolkit.com
Sunday, February 14, 2010
Family Medical History Tree: Six Reasons to Have One
As medical science continues to discover disease-related genetic links, it is important for you to be armed with your family medical history.
The more complete your personal and family medical history, the more clues you can provide your clinicians as you help them piece your story together to make a diagnosis.
A Medical History Family Tree will assist you and your healthcare team in the following ways:
• Helping to make a diagnosis
• Assessing your risk of developing conditions other family members have
• Determining tests needed to monitor for those conditions
• Determining lifestyle habits that are right for you
• Identifying the risk level of other family members
• Determining if you are at risk of passing a condition(s) to your offspring
The most important family members to include are your parents, siblings and your children. By talking with relatives, you can share things you’ve each learned about conditions you have in common. You might even realize you need seek care for symptoms you’ve ignored or to be tested for a condition that is more prevalent in your family than you thought. Talk with your relatives or send them a survey. Once you’ve assembled the tree share it. You never know who or how it might help one of your family members.
To learn more go to www.savvypatienttoolkit.com
The more complete your personal and family medical history, the more clues you can provide your clinicians as you help them piece your story together to make a diagnosis.
A Medical History Family Tree will assist you and your healthcare team in the following ways:
• Helping to make a diagnosis
• Assessing your risk of developing conditions other family members have
• Determining tests needed to monitor for those conditions
• Determining lifestyle habits that are right for you
• Identifying the risk level of other family members
• Determining if you are at risk of passing a condition(s) to your offspring
The most important family members to include are your parents, siblings and your children. By talking with relatives, you can share things you’ve each learned about conditions you have in common. You might even realize you need seek care for symptoms you’ve ignored or to be tested for a condition that is more prevalent in your family than you thought. Talk with your relatives or send them a survey. Once you’ve assembled the tree share it. You never know who or how it might help one of your family members.
To learn more go to www.savvypatienttoolkit.com
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