Listen to your "Inner Doctor"

- Tea and pumpkin bread while waiting for my car to be finished.

 

     Driving my car on the highway, I feel a cresendo/decresendo vibration with the left front tire.  I brought it into my local Sears Service Center (cheap) to save money worn tires while checking out suspension they said everything is ok but you need new tires.  Went on with my new tires and got back up to 55mph and here comes the shake again.  Need a "higher" level of experience so brought it to my Volvo dealer (expensive).  No problems seen, suspension checks out even with a local test drive.  Ok.....all in my head.  Get back on the road, shake is worse.  I jack it up and get under the car.....check out bushing, shocks, brakes, every thing looks good.  Pull on the tie rod (little metal connector that connects wheel to steering) and the thing is about to fall off.  Bring it back to Volvo and rejoice in my discovery, mechanic gets it in the air, I get called back and he says-"theres nothing wrong, what exactly are you worried about?"  Proud as a peacock, I estutely go straight for the tie rod and say, "is this normal?"  Oh sh_t, says my mechanic and they begin work.  I was thankful they at least allowed me to walk into the garage, under the car and check things out. 

     Today a study from Denmark (Cochrane Review) was released saying wellness check ups didn change the overall odds of death.  As docs, we hope to impact the health of people we see.  One of the most sacred times to establish and develop rapport and trust is the coveted annual check up.  Patients who see me know my preference is to rely on history taking to figure out a plan to optimal health.  As I have pointed out in previous blogs, my job is to get you from point A (now) to point B (optimal health, with minimal suffering).  In my heart, I feel the road blocks to point B will not be obvious.  Certainly if cholesterol or blood pressure is high -easy..... work to bring things to normal human levels.   But if all "looks ok", still have to extract that crucial bit of information from the patient/the driver about how things feel in day to day activity/driving?  What is the reaction to stress/driving fast?  What exactly are the average activities/driving habits that may speed up death/mechanical failure?  This takes a keen ear to comprehend how the patient/driver is relaying the story, a creative architect to construct a plan to change, a politician to softly suggest change without insulting the masses, and a coach to know what will probably work in fighting disease with the strengths and weakness of the individual.  Economics will always have to play a part and in todays insurance based health care model, reimbursement for being a good detective is not rewarded.  In fact, production line medicine is probably the only way to keep an office afloat considering malpractice insurance, price to maintain EMR (electronic medical records), salaries for staff needed return phone calls, discuss results, attain authorization for MRI's/PT/Prescriptions. 

     People coming to see me, want to make a change but also want to stay within the constraints of "what insurance pays for".   I have to always bring the bad news; "your insurance will not pay for being healthy, but it will pay for your medicine and surgery once you get really ill!"  I used to be able to send patients with high blood pressure, high cholesterol or obesity to my registered dietician when I worked for Central DuPage Hospital and I would work with her and make some "baby-step" changes to point B.  Now I have to encourage folks to pay out of pocket to see RD's that used to be the first line in treating the above diseases (times are tough so its a hard sell).  Way too much bad information on the internet to do it properly on your own.  [Had a guy come in with cholesterol issues and said adding fiber may help/he said he did that last year with no change in blood tests.  When asked how he did it, said he started eating 1 bowl of oatmeal daily and that was the extent of it- I said that was a good start- now just eat about 16 bowls of the oatmeal and you would have reached true suggestions for proper intake-people need customized programs from knowledgable professionals!]

     Dont be confused with the information being released now.  The person trained to sniff out medical disease is good at what s/he was trained for.  The caveat is even when the tests seem normal, if there is something you feel is off with your average daily activities, express yourself as best as you can to a person that knows you and has the patience to listen.