Mean Doctor?

Does your doctor tell you to lose weight or stop smoking?

When I counsel patients about lifestyle issues, some of them are astonished that I would bring up such "personal" issues. Uh, I think that's my job. I am hard core about smoking and advise strongly that patients quit. I offer suggestions and encouragement.
Obesity, as well, is a significant cause of a variety of illnesses and for my patient population of breast cancer patients, it is as important to control body fat and to exercise as it is to take one of the hormonal agents to prevent recurrence of cancer. But the same people who complain about the cost of the medication are the same ones who are baffled by the thought of making some changes in their eating and exercise habits and taking control of their own health. I make all sorts of recommendations about how to make small changes over time. I offer resources, positive reinforcement for the smallest effort and still, in the end, they would rather take a pill.

Making healthcare affordable is possible only when we take responsibility for ourselves and do the best we can each day to live healthy, eat sensibly and exercise.

Need a prescription?

If you are calling the doctor's office or the doctor on call and think you may need a prescription for goodness sake, have the phone number ready!
First of all, you should not be calling the doctor on call for a prescription refill or a routine medication. On call is for emergencies! The fact that you didn't get around to calling the office during business hours does not qualify as a legitimate call. I take and return calls immediately, as most oncologists do, and am frequently in the car or in a place that does not give me access to a phone book. If you call and I need to call in an antibiotic or other important medication, I need you to provide the number of the pharmacy. If it is at night or on a holiday you need to know ahead of time that the pharmacy is open.
When I ask for a pharmacy number, the caller will often say "I use the Brand Name Pharmacy on Elm Street." OK. That doesn't help me. I need the number. Our on call territory covers 10 counties over 3 states and I do not know all of the numbers of all of the pharmacies.
If you are calling for a family member you need their date of birth because the pharmacy will use that as an identifier when filling the script.
Gather this information before you place the call and it will be a much easier transaction for both of us.

Shocking!

I saw a woman in consultation last week for the sudden onset of a blood disorder. Very treatable but requires large doses of steroids. As I was taking her medical history, I asked her how long she had been obese. She was stunned that I would ask, but she told me that she knew she weighed over 400 lbs. 10 years ago but was too large for any scale now so she wasn't sure how much she weighed. She related how she had been a regular size 10 and began overeating.

What amazed me was that she is very intelligent, well groomed in spite of her size, meticulous about tracking her blood sugar ( she has diabetes) watching her blood pressure ( has high blood pressure, too) and has been going to the same doctor for many years. He is an excellent physician. But according to her, no one has ever really talked to her about her weight. She said "You are very brave to bring it up." Brave? I think it is my job. If I did not address a life threatening blood sugar or elevated blood pressure, it would be malpractice and I could very well be sued. But physicians are afraid to discuss weight because it is politically incorrect to point out a personal "flaw". I think we need to address this issue in a non- judgemental voice as we would any other medical issue. But it must be addressed. This is not the first patient to express surprise that I would use the word obese in our discussion. Oprah can talk about it on her show and the audience applauds, but when the doctor points it out to the patient we are labeled insensitive. Let's treat obesity as we do all other medical conditions and stop avoiding a serious national health crisis.

How to pick 'em.

How do you look for a doctor? Whether it is a primary care provider or a specialist, ask some questions. Why does your doctor use this person? Why does your friend like this doctor? Is the office well run? Does the staff and doctor return phone calls ? Do they take email questions? Most importantly- do they accept your insurance plan?

If you have a seious illness that will require a close relationship with the specialist, you want to make sure that you connect with them and feel comfortable with the physician and their staff because you will be interacting with them repeatedly. Do they honestly and thoroughly discuss treatment options? If this is an illness that may eventually be terminal, how does this physician handle late stage disease.

If the recommendation for a doctor is that they have the lowest handicap at the golf course, that isn't really what you are looking for.

You can search Google for a wide range of information on anyone and it is a quick way to gather some specifics on the professional and community activities of the practitioner you are considering.

Great topic?

Americans have an enormous fear of death. In spite of this fear, they have terrible health habits and often refuse to plan ahead for the inevitable.

This blog is meant to be a resource for those interested in their health and life. That should include just about everyone. While I cannot claim to keep you healthy; I hope that readers will ask questions and learn something from the posts here.

I will try not to restate common advice found in multiple other sources, but I will attempt to point out information that is not often discussed. Issues of serious disease management, doctor communication, end of life planning -even for the robust and healthy reader- and a little bit about what it is like to be an oncologist.

Your comments will drive much of the content. Blog away!