Some people seem to cleave to a bad diagnosis. The worse it sounds, the more they marry it.
They love to banter about all their “itises.” Arthritis, bursitis, sinusitis and a recent bout of appendicitis may round out any random conversation. In great detail they may recount symptoms, the current course of action for each and the details of life with so many “itises.” > More
Some people just seem to cleave to a bad diagnosis. The worse it sounds, the more they marry it.
They love to banter about all their “itises.” Arthritis, bursitis, sinusitis and a recent bout of appendicitis may round out any random conversation. In great detail they may recount symptoms, the current course of action for each and the details of life with so many “itises.” Woe to be them.
The rest of us count wellness among our greatest gifts.
The Internet hasn't helped with the number of armchair clinicians. The Internet, with its ever-growing boon of information, puts self-diagnosis only a few mouse clicks away. Websites give vast amounts of information, sometimes with an unexpected result: anxiety and a brand new patient.
I've seen my massage-therapy clients insist they have everything from spinal arthritis to sciatica to hormonal problems based on what they've read on the Internet. The thing is, they may have none of these, but armed with the information, start living like they do.
I've seen clients become increasingly sedentary when they believe a serious back condition plagues them. It may only be deep muscular tension that needs movement, stretching and circulation.
I've seen patients stop exercising altogether when they become certain they have inherited a heart condition, without any real evidence. The palpitation they felt may well have been the triple-dose coffee they drink daily.
Overdiagnosis of illness often creates not only needless anxiety and sometimes more-threatening lifestyle changes, such as Couch Potato-hood, but may also lead to unnecessary medical testing, treatment or the self-administering of non-prescription supplements.
Do I think medical websites are bad? Of course not. Understanding wellness is a key to maintaining it, and many medical sites, including Health News Florida, offer valuable consumer information. It's when we shut out the real people and start making medical decisions based on the limited capability of the online databases that we find trouble.
There's also the matter of those who seem to love to receive a diagnosis. I would suggest some among us embrace the “patient” label with great ease, somehow relishing that they are “different,” and in need of personalized attention.
I don't run to my doctor for every little ache and pain. I believe in the body's ability to heal itself in an effort to return to balance, and I won't go if I don't need to.
Just for fun, I took a 30-plus question survey online. Turns out I could have diabetes (I don't) or hypothyroidism or maybe just a bum mattress. Guess if I really want to know, I may have to visit my family doctor.
“I’m feeling better now doc. I’d like to go home.” Bill G. uttered these words to me less than 24 hours from the time he was admitted through the emergency room with chest pain. He had not sustained a heart attack, but he had a weak heart muscle and heart surgery in the past.
“I’m feeling better now doc. I’d like to go home.” Bill G. uttered these words to me less than 24 hours from the time he was admitted through the emergency room with chest pain. He had not sustained a heart attack, but he had a weak heart muscle and heart surgery in the past.
“I don’t know Bill,” I said. “Your pains could have been your stomach but then again it might be your heart. Why don’t you stay in another day for some tests?’
“Oh come on now. I know it was just indigestion. Can’t we do the tests as outpatient?” Since I first met him, Bill and I had a stormy relationship –– he thought I was too controlling, and I thought he was too demanding.
Over the next several hours he would pace around the nursing station, badger the nurses and had them call me several times. Busy at another hospital, I finally relented and discharged him. Within six hours of his release he had severe chest pain, suffered a cardiac arrest and died on the way to the hospital.
This is every cardiologist’s nightmare. It happened to me over 20 years ago and I will never forget it. Bill’s mind and ego denied the obvious, and in a moment of inattention and over-busyness, I bought the lie, too. Not wanting to strain our relationship further, I let him leave without making him sign out against medical advice. His son, who was a trial attorney, later sued me for malpractice, and ultimately my insurance company settled for a few thousand dollars.
Since then I have learned to listen more closely to what my patients tell me. I now realize that it is of utmost importance to separate their symptoms from what they think might be the cause. Some patients fear the worst in everything, but many others downplay and deny what is truly happening. Their minds are lying to them constantly. It is my job to get objective clarity about their condition and not buy into their delusions as well.
We all lie to ourselves sometimes, and most often it is to cover up an addiction, admit fault, or shame. My mind tells me this all the time.
“I can have two cookies today because I exercised.” Or, “I can drive home safely because I only had one drink.”
I’m sure you recognize the thoughts, because most of us have had them.
My goal is to achieve less ambiguity when my mind, or that of my patients, is lying to me. This takes some work, patience, and practice. However, the rewards are enormous.
David Mokotoff, M.D., is a St. Petersburg cardiologist. Check out his blog at www.davidmokotoff.com.
I’m glad to see that the Council for Responsible Nutrition is continuing to identify itself as a trade group representing dietary supplement manufacturers when it takes a stand on public issues, as it recently has.
There’s nothing wrong with trade groups making points for their members, but it can be confusing when such a group takes on a name that glows with independent objectivity. CRN unquestionably has such a moniker. > More
I’m glad to see that the Council for Responsible Nutrition is continuing to identify itself as a trade group representing dietary supplement manufacturers when it takes a stand on public issues, as it recently has.
There’s nothing wrong with trade groups making points for their members, but it can be confusing when such a group takes on a name that glows with independent objectivity. CRN unquestionably has such a moniker.
Years ago, as a young reporter, I fell into the trap of not fully investigating the source I was quoting. That’s a mistake I won’t ever make again.
It involved CRN and its stand promoting supplements. I took its position at face value. Justifiably, I was lambasted by a sophisticated reader who also happened to represent another Washington-based agency that took the other side on the CRN issue.
So, now, when I see those initials pop up, I check to see that the council correctly identifies itself, as it did in a recent statement. The statement was in response to the recently released draft report of 2010 dietary guidelines being circulated by the United States Department of Agriculture.
Those guidelines take a controversial stand.
They state that “a daily multivitamin/mineral supplement does not offer health benefits to healthy Americans. Individual mineral/vitamin supplements can benefit some population groups with known deficiencies, such as calcium and vitamin D supplements to reduce risk of osteoporosis or iron supplements among those with deficient iron intakes. However, in some settings, mineral/vitamin supplements have been associated with harmful effects and should be pursued cautiously.”
These are fighting words. And it is not surprising that the CRN has responded, calling these proposed guidelines a “step backward, without scientific justification, when it comes to vitamin and mineral supplements, by failing to recognize how the multivitamin can address dietary inadequacies for nutrients.”
The CRN also notes that the draft report, which is available at www.cnpp.usda.gov, recognizes that there are multiple “nutrient shortfalls” but “in effect says that living with (them) is preferable to filling nutrient gaps with reasonable dietary supplements.”
Look for those promoting the new guidelines to answer back. And I’m sure many other agencies will offer comments on the draft report, as well.
We should have at least as much interest in how the government views our eating habits and its suggestions for improvement as do those who make big bucks on what we pick up at the grocery or pull out of vending machines.
We should educate ourselves about this debate and know who stands to profit when the final guidelines emerge. Ideally, it should be the public.
Frustrated with the health-care system? Don’t know where to turn for help? Want more on the human side of health care? We’ve got you covered.
When less is more
After 30 years in medical practice, there’s very little left that will shock or surprise me.
Two recent hospital encounters caused me to reflect how too often we physicians are occupied with doing things “to” rather than “for” patients.
Mrs. A was a fragile 83-year old nursing home resident with a bit of dementia. She was sent to the hospital emergency room because of a sudden change in her behavior and was found to be having a stroke. A medical brain specialist, or neurologist, was immediately consulted, who after examining her and doing a CAT scan of brain, decided to administer an intravenous “clot-busting” drug.
After initially improving, she took a turn for the worse later that night and was moved into the intensive care unit. That is when I was asked to see her for an abnormal EKG.
Glancing at the squiggly lines of her heartbeat, I instantly knew she was having a heart attack. Since she was given the clot-busting drug the day before, she was not a candidate for more of this or any other blood thinners, as she might bleed into her brain. As interns and residents raced to place her on a breathing machine, I noted in her chart a living will and do-not-resuscitate order.
I quickly called her guardian, who confirmed that the family did not want her on life support. Rising quickly from my chair, I halted the training doctors just before they inserted a breathing tube in her throat. She died later that day.
In the rush to do as much as possible to save her life, not one of her doctors had called her family to ask about the patient’s wishes and advanced directive. At any age, a heart attack and a stroke within 24 hours has a very small chance of survival.
***
Mrs. B was recently placed on kidney dialysis. Although mentally sharp, she had many heart and medical problems. I was asked to see her for chest pain and an abnormal heart rhythm. Committing someone to dialysis is always a serious decision, but I was stunned to find out that she was 96 years old! This seemed to be clearly out of the range of common sense for me.
I wondered if her kidney doctor, the surgeon who placed the port in her arm for dialysis, or her family physician ever talked to her about the implications.
As reimbursements for procedures decline, physicians and surgeons become increasingly competitive. There is a common perception that if they don’t do what the family doctor wants, a competitor will.
I see these as cautionary tales. They remind me that although we have taken an oath to protect patients, sometimes our actions prolong the natural process of dying, rather than just adding days or months to living.
We’ve collected a list of resources for you, including federal and state agencies and private associations. This is a free listing, without paid advertisers. Read More
Government site outlines new health-care law
A new government site, aimed at individuals, Medicare recipients and small employers, explains how the new health-care law works for the consumer as well as for seniors on Medicare. Click here to visit.
FDA site lets public find drug safety info
The Food and Drug Administration launched a website where patients and health-care professionals can find safety information about recently approved drugs and vaccines. Click here to access.
Florida sets up oil spill info line
Florida has set up a toll-free telephone line to provide residents and visitors with information about the Gulf of Mexico oil spill. When you call 888-337-3569, operators will answer questions about the state's response activities, volunteer opportunities and health, safety and protective tips.
Complaints against licensees now online
Public administrative complaints filed against licensed health-care practitioners are now available on The Florida Department of Health Web site. Consumers can see if a public complaint exists for any health-care professional licensed by DOH at this site.
Consumer Reports looks at reform
Consumer Reports has a guide to health reform, with videos, Q&As, viewpoints and in-depth papers. Access it here.
Online resources for information on health reform
The Washington Post has compiled a handy list of guides to the new rules. Access it here.
Summary of new health-reform law
Here is a summary of the provisions of the Patient Protection and Affordable Care Act (adjusted by the reconciliation act that followed.
The Kaiser Family Foundation has updated its Medicare primer that explains key elements of the program. It describes characteristics of the Medicare population and how much people pay out-of-pocket. The updated 2010 Medicare primer is at www.kff.org/medicare/7615.cfm.
Consumer health information
The FDA has created a partnership with Everyday Health to deliver FDA's consumer health information to the 30 million users who visit EverydayHealth.com each month. EverydayHealth.com/FDA will offer health information from FDA on food and medical product safety as well as prevention and wellness topics.
A national group that seeks to inform the public about this type of cancer lists environmental risk factors in Florida.
State offers flu hotline
The Florida Department of Health has launched a toll-free hotline, 877-352-3581, to provide public health information and updates on the H1N1 "swine" flu.
It is open from 8 a.m. to 8 p.m. daily. Information is available in English, Spanish and Creole.
Information can also be found at the department's website, doh.state.fl.us.
New consumer guides
Spanish-language consumer guides are now available from the Department of Health & Human Services's Agency for Healthcare Research and Quality for consumers and clinicians. To access the guides in Spanish as well as English, go to effectivehealthcare.ahrq.gov. Audio versions of many guides also are available.
Suspect insurance fraud?
Call Florida's Fraud Fighters Hotline at 800-378-0445. It's operated by the Insurance Fraud Division of the state Department of Financial Services.
Helpful hint
Did you know the state offers a Web site where you can quickly find the best price in your local area for the drugs you take? The Drug Finder can save you money.
Some people seem to cleave to a bad diagnosis. The worse it sounds, the more they marry it. 
“I’m feeling better now doc. I’d like to go home.” Bill G. uttered these words to me less than 24 hours from the time he was admitted through the emergency room with chest pain. He had not sustained a heart attack, but he had a weak heart muscle and heart surgery in the past.
I’m glad to see that the Council for Responsible Nutrition is continuing to identify itself as a trade group representing dietary supplement manufacturers when it takes a stand on public issues, as it recently has.
