Medical history - be prepared.

As I noted in my previous blog, the information that doctors collect on your health status is highly structured. They want details on the current complaint, previous conditions and illnesses, all the medications you take and took in the past especially from the last few years and if you are allergic to any of them. They will want your family history. They will also ask a lot of questions on all your "systems" which means your heart, lungs, intestinal tract, joint complaints, skin problems, psychiatric problems and so on.

Below are lists of questions that you can try to answer with as much detail as you can. Of course there are questions that are not relevant to your problem. Just go to the next one.
This is not an exhaustive list of questions because the actual questions will depend on what you have but this is a good start.

Current complaint - In your own words: What is the problem, when did it start, does it hurt, where, when. Is it stabbing pain or pressure or burning. Worse with moving or better if you move. Better lying down, sitting up or standing/walking. What do you do to make it go away and does that help. Have you tried any medicines, how much and how long and have they worked.  If you have shortness of breath tell them how bad. Only if you do strenuous exercise or also when you are just sitting in your chair. Can you walk without getting breathless. Have you had vomiting, diarrhea, bleeding somewhere. Does anybody in your immediate environment have a similar problem.

If they suspect an infectious problem: Do you have a fever or chills? Are you coughing, are you coughing up stuff, are you vomiting, having diarrhea. Is anyone else sick? Have you traveled? Where, when (all locations). Did you get vaccinations before you left or have you taken any pills to prevent getting infected?

Have you seen another doctor about this problem? Did you have any tests? What were they and what were the results? Did they prescribe medications? What did they prescribe? Did you take it? Are you still taking it or any other drugs for this problem?

What medications do you take? Since when? For what problems? Have they been effective? Have you had side effects? Which side effects? Did you stop the medications because of side effects? Has someone told you what the side effects were or do you have some information on it?

Do you have any allergies. Do you take any over the counter medications, supplements, drugs (marijuana, other, including illegal, drugs). Be honest they won't call the cops but they can't help you if you don't tell them everything.

Do you smoke/drink? Have you done so in the past? How much, since when, has it ever impaired your functioning or interfered with your job? Have you ever tried to stop?

Do you/have you had problems with your weight? Been on any diets? Did they work? Do you exercise regularly? How often, what type, since when?

They'll want to know everything that happened in the past. I have copied a couple of medical history forms from the web because those give good detailed lists. You can find these everywhere and you'll recognize them from your doctor's office. These are very similar from one office to another because the information the doctors are looking for is always the same as I wrote in my previous blog. Filling these out at home with the help of others is going to save time during your visit with the doctor and you will therefore have more time to discuss what is your current complaint.

These are not mine and since they are on the web I assume that they can be used freely.

In addition to the information that these forms collect, make sure you write details on your family. That means: Parents and their siblings, your siblings, your children, your grandparents. Your spouse's medical history and current problems would only be relevant if he/she had a contagious infection. They want to know especially about heart disease, lung disease, stomach and bowel diseases, diabetes, high blood pressure, cancer (where, what type, severity when diagnosed and outcome - treatments, survival).

I hope this blog is helpful to you and I would love to see some comments and suggestions on how to improve these.

Cheaper drugs that you buy outside the US and that are just as good as what you buy for too much money in the USA?

I was going to do a blog on this and let you know how I saved money on drugs and how you can do the same thing. For several years now I have gotten my prescription drugs via a Canadian pharmacy. They honored prescriptions from US doctors. The drugs they provided were generics that were manufactured in countries where I know the standards to be excellent such as the UK. I worked for a British pharmaceutical company and I am well aware of the standards in the UK. The price I paid was decent and a fraction of what I was going to have to pay in the US.

Why am I speaking about the past? Because there's bad news. My Canadian pharmacy will stop shipping to the US next month.  They are no longer allowed. Not because they don't want to but because there appears to have been a legal issue. I don't know if that was something against them in particular. I am of course very suspicious that this is a more sweeping move very much in favor of the US pharmaceutical industry. For the moment I have my supplies, I'll have to shop around and see what I need to do. Now that I have Medicare and part D (Drugs) it may not be too bad.

I have seen and heard the stories about the prices people have paid for their drugs and the huge difference it makes to purchase them outside the USA. We spend the winter in a retirement community in Arizona and hear the stories about the difference in price. Drug companies want to offer treatments to improve the lives of patients. At least, that is what they say. Drugs that are not affordable do not improve the life of patients. One of the difficulties the pharmaceutical companies have is that patients do not renew their prescriptions once they have taken a drug for a month. They can't afford it. There is rent, groceries, what not. And people want to travel, go to the theater, play golf. You can spend your money only once. The pharmaceutical slogan rings rather hollow when improvement of life is so unaffordable. Without a drug plan you will pay the highest price because you don't have the drug plan's volume purchase that can knock the price down. And drug consumption increases as we get older and need treatment for high blood pressure and high cholesterol. Pharmaceutical companies will invent some new drug that is marginally better than the previous one. Statistically better doesn't mean that it makes a difference biologically. On the contrary. The newer drug is so much more expensive that it isn't taken continuously. It looks good in drug trials because then the drug is paid for. I've spent a decade in that world, I know what I am talking about.

The debate over health care is far from over. In my opinion health care should be free for all. Drugs should be affordable. Medicare should cover all Americans and the VA could probably be abolished in that model which could easily better the health care of veterans, those people who we thank for their service by making it often really hard for them to get proper care for their wounds of war. I practiced medicine in Canada. It is not a system where people die on wait lists. That is lobbying talk. That is money changing pockets. People in Canada who come to the USA to get certain procedures are not sitting waiting for years as some politicians would have you and me believe. They just are willing to pay more. They stay in more expensive hotels too probably when they are traveling. Canadian health outcomes are the same as the USA and when it comes to pre and perinatal care they are better. Universal health care systems worldwide give top quality medical care. The UK is rated best in many analyses.

And so there is really no use in telling you how you can obtain your medications cheaper when ordering it via a Canadian pharmacy and having it shipped to your address because it seems that it won't be possible any more. To me that is utterly unfair and is once again an illustration that the pharmaceutical industry loves to tout how they take care of patients but what they really do is taking care of their investors and their executives. They take care of themselves and their own.

Pharmaceutical companies develop drugs and that often involves very minor changes in molecules especially when we talk about pills such as cholesterol or blood pressure lowering medications. Any minor change can yield a new patent and with that new and more money. In the USA, unless we are talking about anti-cancer drugs or other life saving therapies,  the companies usually need to show that their drugs work better than placebo, the sugar pill. In other countries especially in Europe they need to show that they are better than what is currently best practice. A much higher bar. And guess what. They are not easily that much better. As I have said earlier, statistically better does not mean that it makes a difference in biology, especially when you are already taking a bunch of other drugs for other conditions. Drug interactions are insufficiently studied. It is hardly possible to do that because the number of combinations with other drugs is huge and simply prohibitive to make such studies relevant or even affordable. So the effect a drug has according to its label is mostly what it does in people who don't take little else if anything. But the hype over a new drug is gigantic. People are having parties and are dancing because they are so happy with the new drug. And they are still dancing while the adverse effects are being listed. You're watching happiness while death is being mentioned in the side effects list. Body language that talks louder than the "big words" of the bad stuff. You're not going to be dancing when you're handing your credit card to the cashier. And you're not necessarily going to feel better when you're on your new blood pressure drug. Because it may not make a bit of difference from what you used to take other than that it is a whole lot more expensive.

In closing I'd be amiss if I didn't mention what happens with anti-cancer drugs and therapies for life threatening conditions. In those circumstances the existing therapy must be continued. Patients would do very poorly if they suddenly didn't get their life saving drugs because of a drug test and so, rest assured, obviously in those kind of circumstances the new medication is not compared with placebo. I am planning a future blog to discuss how pharmaceutical companies do the clinical trials that they need to do to get approval for their drugs.

How to get the most of your doctor's visit.

I am writing this blog to help you prepare for and get the most out of your visit with your doctor. So little time is available for you that it will help you to use it to your advantage. This blog is a bit long. I welcome feedback to make my blogs more useful.

It is common for people not to be in their "normal self" state when they pay a visit to the doctor. After all, most of us pay to visit the doctor even if some doctors give us the impression that we bother them beyond compare as we interrupt their daily work with our tiring list of problems. I hope those are few and far between, I hope yours is great. That said, even in the best possible doctor-patient relationship you can optimize your visit. The key point is to understand what the doctor is actually doing.

First, of course, you'll be welcomed by someone on the phone who would like to know what you are seeing the doctor for. It is a reasonable question because that is how they decide how much time they need to book you for. An answer like "I need my blood pressure checked" or "he asked to see me" or "she is going to do my annual physical" is enough. Or try: "I have a new medical problem to discuss with my doctor." They will want your insurance information, they will want to know if you have seen somebody else for the same problem, that's all OK. It is NOT OK to insist that you tell them what the problem is if you don't want to. All you need to say is: "I would rather just speak only to the doctor about that". After all, who wants to be welcomed by the receptionist with a happy "Oh yes, you are having lots of diarrhea. I'll tell the nurse you are here". And that 'for my doctor's ears only' line is also OK as the only thing you say to the physician assistant who takes you from the waiting room to measure and weigh you and who will take your blood pressure and go through your medications. They do not HAVE to know what you are there for.

Now that you know that you do have control over information you share right away, I want to tell you about what happens when the doctor is in the room with you. I am going to put it in simple terms. Lots of you know this, some of you don't. Help yourselves to whatever piece of information I can share with you.

Doctors have a rigorous system for investigating a medical problem. It is called History and Physical. It may be followed by Tests (X-rays, labs, MRIs, the lot) and by referrals to specialists. If you understand in what form your information is obtained it may be easier for you to get the information in your medical dossier.

In this blog I am going to discuss History. This is the most important part for you to get right. Whatever you don't talk about will not be in your file so if you would rather not have some information in there you are in control. However, you will want to have in there as much information as is relevant to your current condition. It creates a groundwork for the evaluation of your current problems and helps to get more done more quickly the next time you need to consult even if it is for a completely different problem.

History is divided into several parts and your doctors will try to get it organized in this way. The history of the complaint, the previous health history, the family history and the history of treatments, drugs and others, and their efficacy for everything you ever had before.

You can see right away that you could make the list of what you ever had and what treatment you got before you even make your appointment. And you could write down the family history, the list of what all your relatives on your side of the family have suffered from and how they were treated and if that worked or not, if you know. If you do that and give it to the doctor he/she will not have to spend as much time on it and more precious time will be available for your consultation. You won't be spending your time on trying to remember on the spot who had what and what the little blue pills were that you got from another doctor a year ago. Ask your pharmacy for a list of what you are currently taking and whatever you were on in the past while their customer.

So then, as you sit there armed with your list of stuff, the doctor will start with asking what you are in the office for. Try to be clear. If it is hard for you to talk about it, write it down and read what you wrote. Feel free to bring someone with you to the office who can help. But don't bring someone who keeps interrupting you and the doctor. After all, it is your problem and you are seeking the doctor's advice, not theirs. And it is perfectly OK to tell the person that came with you that you would like him/her to go to the waiting room while the doctor is examining you. That is not rude. In fact, it would be extremely polite on their part to offer you privacy.

Describe your complaint. Example: "I have had backaches for 6 months, mostly in my lower back, on and off. Especially when I am standing for a long time such as in the kitchen do prepare dinner. I have tried aspirin and other things like anti-inflammatories (Aleve, Advil, etc). It is not getting better. I have tried exercises, hot packs, my husband has massaged it (wonderful guy, he's a keeper). Nothing really works." If you had it before, some long time ago, say so. Such as: "I had this when I was in my thirties and I was playing a lot of tennis. It would hurt afterwards for hours." Say if you had relief from those pills and potions. If you don't say it yourself the doctor will ask so thinking of this before your visit will make it easier for you to answer the questions.

Then the doctor will ask a lot of follow-up questions. In a case like this: "Does it hurt more if you stand or if you sit or when you lie down, when you bend over, etc, etc.? Does the pain go down when you change position? Do you have pain elsewhere or only in your back? Are you experiencing stiffness? If so, when? In the morning? Does it go away when you move around. What do you do to make it go away and does that work? Do you have other symptoms like tingling or loss of sensation?"

I use an example. The list of questions would be completely different when you come with a different complaint so don't feel that you should have anticipated all these questions. You can't unless you are a medical professional yourself. That said, you may have looked into it using the internet. Don't be shy, tell them you did. They'll help you understand why it is or isn't what you thought from your reading. I always much preferred people who did read about their stuff. For me it made the conversation easier if I could relate what I found to something they had read. If you are wondering if it has anything to do with what you did/didn't do, what you ate or drank, anything you might think, DO ask. Don't you want to know? The saying is that there are no stupid questions. And if your doctor says "that is a stupid question" you need to start thinking if you want to stay with that person. No doctor in their right mind would ever do that.

Once the inquiry of the complaint is done, there will be a "systems review". It means that you are going to get a lot of questions about all the other things your body is supposed to be doing normally. Breathing, eating, drinking, moving your bowels, emptying your bladder, walking, etc., everything.  I am going to do a separate blog on this in which I will put a list you can work on before you come to your visit. The purpose of the systems review is to get any and all information about your health otherwise, from head to toe and anything in between. If there is a problem, say so. If you are seeing a specialist much more time may be spent on this then at the office of the family doctor. They are drilling down further, they are looking for the more uncommon things.

After that piece comes the personal history. Everything you ever had and what happened with you then, what investigation, what treatment, what outcome. Every time you were in a hospital for an illness. Every time you went to the ER for something. The other medical problems you had and have that you didn't go to the hospital for but did get treated for. Accidents, broken bones, and so on. It is a really good idea to write that down beforehand.

Then comes family history. Everything your family members on your side have or have had. That means your parents, grandparents, siblings, children, grandchildren. Maybe cousins if you know. Again, that is a really good thing to spend time on before you even go to your appointment. And no, your spouse is not your side of the family. What he/she has is not relevant for a family history unless you are indeed related.

They will want to know if you do now or ever did in the past drink, smoke, use drugs, exercise, diet, take supplements, etc. Answer honestly. Make a list. It doesn't help you to withhold information. These habits and substances may have helped or aggravated the problem. If the doctor understands what you did in the past he/she will be better able to make the right diagnosis and give you the right treatment.

They will want to know all the medicines you are taking. Can't remember? Go to the pharmacy and have them print out the complete list. It should say when you had what. You can bring that with you. One from each pharmacy you use. Now you know why it is easier if you use only one. Take all your pill bottles and put them in a bag and bring them to the doctor's office.

Does that sound like a lot? It is. Does it seem like an impossible task to do within a 30 minute visit with your doctor? It is just about impossible. So the better you prepare, the more you info you have ready, the more time there will be for your current problem. Maybe give some thought about going to the doctor's office and picking up a copy of the forms they are going to ask  you to fill out. So much easier to do those at home before your first visit.