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Chapter 13: Going
Beyond An Apple a Day: How to Remain Healthy
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A physician is judged by the three As: Ability,
Availability and Affability.
- Paul Rezniknoff
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All of us hope never to fall ill, but this would
be wishful thinking. When we do fall ill, we expect
our doctor to be able to help us to tide over the
crisis. However, it is a sad fact of life that most
of us spend more time selecting a hairstylist than
we do in choosing a doctor! Such an anomalous situation
often results in our being unhappy with the medical
care we receive. Invariably, patients stick to one
doctor, even when they are not very happy with him,
simply because their family has been going to him
for years; or because "he knows my case".
Others select a doctor on the bases of capricious
reasons; for instance, because "he treated
my cousin's friend's case successfully" ; or
because " he is supposed to be the best "
. However, such reasons do not lead to efficient
ways of finding a good doctor.
The perfect doctor would treat you as an intelligent
person, have plenty of time, as well as infinite
wisdom, charge low fees, be totally honest yet compassionate,
have a conveniently located clinic and understand
your emotional as well as medical problems. While
you may never find such a doctor, you need to keep
your picture of your ideal doctor in your mind when
you are looking for the physician of your choice.
First of all, you need to find a primary-care doctor;
i.e., someone who will provide medical care for
your whole family; carry out regular checkups; and
treat common illnesses. Such a doctor is a usually
a general practitioner ( also known as a family
physician in today's trendy world) , or a general
physician . Women may prefer a gynecologist, and
for your children you may choose to go to a pediatrician.
A primary care doctor is trained to recognize common
health problems in the patient as a whole; in other
words, his "specialty" is comprehensive
care of a patient, either on a short or long-term
basis.
choosing a good primary care doctor is perhaps the
most important step you can take to insure that
you get good medical care. A primary care doctor
is much more than a quick fix 'craftsman' for an
acute illness; he can become your healthcare partner
in the long haul...helping you to establish your
health goals and periodically evaluating how you're
doing while treating any illnesses that come up
along the way.
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Ideally, a primary care doctor can offer you the
following benefits:
- A good starting point in the healthcare system.
Whatever your concern or problem may be, your
primary care doctor will either be able to either
treat it or determine precisely when and where
to send you for specialized help. In either
case, you have the distinct advantage of a physician's
expertise, and any trips through the medical
'maze' will be less confusing for you...and
less of a hassle.
- Preventive healthcare. Your primary care doctor
can help you with disease prevention, as well
as prompt intervention during any illness.
- Continuity of care. You and your doctor can
develop and sustain an on going health partnership.
He will get to know your concerns, and you won't
have to repeat your history each time you fall
ill or need treatment. Your primary care doctor
will know you as well as any chronic problems
or potential troubles you may be facing. He
well also be familiar with your family history.
- One stop shopping. You can consult the same
doctor for a variety of conditions, and often,
he can treat both you and your family. Your
family doctor can take you and your family through
pregnancy, childbirth and childcare; instilling
the concept of good health at an early age.
- Lower cost and convenience. Primary care doctors
generally serve large populations of patients,
so they encounter and become familiar with managing
the most common medical maladies. They have
been trained to diagnose and treat a wide range
of conditions cost- effectively. And, in most
cases, it's easier to gain asses to a primary
care doctor than a specialist, since general
practices are usually geared up for maximum
efficiency.
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An assurance of continued health may be the most
valuable benefit of teaming up with a good primary
care physician. Your lifestyle plays a major role
in shaping your health and well being in the long
run. You, in tandem with your doctor, can define
your health goals, analyze your habits and get started
on the basics to maintain or improve your health,
now and in the future. Your working relationship
with your doctor can help prevent serious illness
from developing down the line apart from enhancing
your well-being, the quality of your life, and your
independence for years to come - the biggest benefit
of all.
Your primary-care physician should be someone who
will coordinate and oversee your overall medical
care, referring you to a specialist only if needed.
It is not usually a good idea to consult the "top"
specialist for every problem, though this seems
to be have become fashionable these days- for example,
rushing to a neurologist for a headache such a step
can actually lead to your getting poor care ! Specialists
often order unnecessary tests (which could be expensive
and painful) to rule out rare diseases (after all,
they are specialists, and they cannot afford to
overlook any possibility, however, remote it may
be, while making a diagnosis !).
The best time to find a doctor is when you don't
need one! This statement may seem paradoxical, but
finding the right doctor when you are ill becomes
much more difficult, because of the stress of the
illness - as well as the pressure of time. Ask your
friends for recommendations. A good source of referrals
can be nurses and other paramedical staff. If you
have a friend who is a doctor, seek his advice as
well.
While it is true that many mediocre doctors flaunt
posh clinics, the setting in which the doctor functions
can reveal a lot about him. Is the clinic located
in a decent building? Is public access easy? Has
the doctor bothered to provide the basic amenities
you need ( e.g., drinking water, comfortable seating
)? What kind of reading material is kept in the
waiting area? (Old and torn magazines should qualify
as a negative mark . Patient educational literature
and current issues of health magazines indicate
that the doctor respects your waiting time and wants
to use it to educate you). Are the office staff
member helpful? How do they answer the telephone?
How do they treat other patients ? you can learn
a lot about a doctor and his practice from the personality
of his employees: remember that efficient, caring
physicians tend to hire competent, friendly personnel!
During the first consultation, not only should the
doctor get to know you and your medical problems
by examining you, but you should also get to know
a lot about him. Such a initial assessment is important
in answering the following vital questions: Are
you comfortable with him? Does he explain the details
properly? Does he use relevant teaching aids? Does
he ask for your views? Does he listen to you carefully?
A concerned doctor will organize the clinic and
its functioning so as to minimize your visits- for
example, blood samples can be collected in the clinic
itself, to be forwarded to a reliable laboratory,
so that you don't need to go there yourself. Similarly,
many obstetricians provide the facility for ultrasound
scans in the clinic itself, so that patients need
not run around from one place to another.
While looking for the ideal doctor beware of quacks!
While many of us tend to be overawed by a long list
of alphabets behind the doctor's name, you need
to remember that not all of them are legitimate
degrees. For example, many doctor's will use the
'embellishments' FICA (USA) and FRSH (London) to
give the impression that they have been trained
abroad. These acronyms are not qualifications- they
merely indicate memberships in a society abroad,
which are open to anyone- even a barber- on payment
of a nominal fee, can acquire such memberships!
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Useful criteria to consider while selecting a doctor
are as follows:
- Is the location of the doctor's clinic important?
(in other words, How far do I have to travel to
see the doctor? Is it convenient for me? Is there
parking space?)
- Is the hospital to which the doctor admits patients important to me?
- Are factors such as the age, sex, race, and religion of the doctor important?
- Do I prefer a solo consultation or a group practice?
- Do I have to choose a doctor who is covered by my insurance plan?
- Is the doctor duly qualified and in which field? For example, a patient with a heart problem may prefer to see a cardiologist, rather than a general physician.
- What days/hours does the doctor see patients? Are the timings convenient to me ?
- Does the doctor ever make house calls?
- How much in advance do I have to make appointments?
- What is the length of an average visit?
- In case of an emergency, how fast can I see the doctor?
- Who takes care of patients after hours or when the doctor is away? At this stage, one may well pose the question: what are the attributes of a perfect doctor? In my opinion, a perfect doctor is one who:
- is respectful and treats you with dignity;
- makes you feel welcome;
- treats more than the symptoms;
- recognizes the expertise of the patient;
- listens to you, explains the relevant facts, asks you questions and answers your questions;
- makes home visits if you require them, or arranges for another doctor to visit you after hours;
- uses pictures and diagrams to explain complex medical terms;
- explains everything, including diagnosis, procedures, treatment and what you can expect in the future;
- is easy to talk to and gives you clear - cut information;
- is open to discussion about alternative systems and is willing to refer you to say, a natural therapist;
- is interested in you, is down-to-earth and treats you as an equal;
- prescribes medication that you can afford;
- fits you in if you are really sick despite a tight schedule ;
- is up-to-date with the relevant information;
- refers to various sources (e.g., books, journals, internet )to clarify information;
- refers you to an appropriate specialist when required;
- refers you to other support services or self-help groups;
- phones back when additional information or tests results are obtained; and
- gives adequate consultation time.
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In contrast, a bad doctor
is one who:
- Does not value your time, and makes you wait
interminably on a routine basis
- Is more interested in treating your reports
than in treating you
- Does not spend enough time with you
- Seems to be too busy and rushed all the time
- Orders tests whether or not they are needed
- Does not explain your options to you
- Discourages questions or refuses to answer
them
- Promises too much.
- Makes remarks like "that's my secret."
- Doesn't explain clearly what he is doing during
treatment. Sometimes, if you are a victim of
a rare or complex problem, you may need to find
a " Doctor's Doctor " i.e. the best
doctor in the city, country , or the world for
your particular problem. How do you go about
locating such a doctor?
The best way of beginning the search is by asking
your doctor. To start with, your doctor knows you
and your situation better than any other physician,
also since most doctors are aware of the accomplishments
of "super-specialists" who practise at
large university hospitals or research based facilities
. your doctor can help you identify there experts.
If you can find a book relating to your problem,
then the author (if he is a doctor) is likely to
be a good choice. The other option is to find the
name of a doctor or the head of a clinic or department
which is actively publishing their medical research
in this field ( you can easily do this by doing
a Medline search). This doctor ( or the head of
the clinic) is likely to be an authority in the
subject, and will be well-informed of the latest
advances in the field. Many patients naively assume
that all they need to do to get good medical care
is to make a beeline for the west. However, do not
automatically assume that just because you go to
the USA, the UK or
Germany, you will find a competent doctor - you
need to do your homework thoroughly before making
the trip!
In order to feel good about your medical care, you
should feel good about your doctor, too. In this
context,
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Ask yourself the following
questions in order to evaluate your physician:
- Does your doctor listen to you and answer all your questions about the causes and treatment of your medical problems, or is he vague, impatient or unwilling to answer them?
- Are you comfortable with your doctor? Can you openly discuss your inner most feelings and talk about intimate personal matters , including sexual and emotional problems?
- Does your doctor take a thorough history, asking for relevant factors about past physical and emotional problems, family medical history, medications you are taking and other matters affecting your health?
- Does your doctor address the root causes of your medical problems or does he merely prescribe medicine to treat the symptoms?
- Is your doctor well-groomed ? A doctor who cannot be bothered to take care of how he looks may not look after you carefully either !
- Does your doctor smoke? ( if yes, this should be a black mark against him !)
- Are you satisfied with the doctor's stand-in when he or she is unavailable?
- Do you feel at ease while asking your doctor questions that may sound "silly"?
- Does your doctor explain complex medical jargon in simple terms?
- Are the office staff members friendly? Do they listen to you patiently?
- Does your doctor answer your telephone calls promptly?
- Are you usually kept waiting for a long time even if you have fixed an appointment before hand?
- Does the doctor have hospital privileges at a respected medical institution?
If you are not satisfied with the answers to the
proceeding questions, discuss your concerns with
your doctor. Even after this discussion if you are
still not satisfied, you should consider looking
for another doctor.
changing doctors is never easy, because, over a
period of time you do build up a personal relationship
with your doctor.
However, you should consider
changing doctors if you strongly feel that :
- the doctor is incompetent ( i.e., he has ignored obvious symptoms, missed a diagnosis, prescribed the wrong drug, or can't get to the bottom of your problem);
- the doctor does not communicate with you effectively ( i.e., his explanations are not in lay person's language or no time is given to you to ask questions and bring up related problems);
- the doctor does not pay attention to your needs and concern
- you have lost confidence in the doctor's skill and ability.
- you find the doctor is too inconsiderate ( i.e., he makes you wait a long time for an appointment, he fails to return your phone calls, he does not provide clinic time during evening or weekend hours ); and
- your doctor is too expensive.
There is no single who is Dr. Right for everyone,
and you may need to hunt patiently and persistently
for the doctor who is right for you, depending upon
your temperament, personality, and perhaps age and
sex. Different patients have different expectations-
some need to be told what to do while others want
all their questions answered. Obviously, they will
need different types of doctors. Most people invest
a lot of brain power and analytical skills deciding
which shares or stocks to buy, but doing in - depth
research for finding the right doctor is likely
to pay much better dividends for you and your family
!
In the final analysis, remember that the most reliable
test for a doctor's suitability for you is your
own gut instinct - after all, if you don't feel
comfortable with your doctor, you are not likely
to be able to work well together in your health
care partnership with him ! On the other hand, if
you have faith in his abilities and can trust him
that he will do his best for you, you are likely
to get excellent medical care !
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