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Red flags: When the doctor is at fault, and what you can do

February 21, 2016 by drjaffer

Yep, you read that right. Sometimes it’s the doctor’s fault. We’re not perfect. Sometimes we’re in a hurry to get to the next patient, and we go too fast during an exam. Sometimes we don’t remember everything from a patient’s medical history. Sometimes we’re just having a really bad day and we’re less pleasant than we should be.

And sometimes, the doctor is actively sabotaging the patient’s medical care.

As a patient, you have a right to adequate healthcare from the people you are entrusting with your life. If the doctor is not respecting the patient-doctor relationship, you have a right to demand change – and to take action if that does not happen.

Today we’re going to discuss when the doctor is at fault. We’ll look at some of the most common failings in bedside manner that can sabotage the patient-doctor relationship, as well as what you, as a patient, can do to exercise your rights to receive proper care.

When your Doctor Doesn’t Know the Meaning of “Bedside Manner”

Rudeness, aggressive behavior, argumentativeness. You know that if you behave this way, you’re going to receive less-than-stellar care from your doctor. But what if they’re the one treating you poorly? The fact is they have no right to do so, and you have a right to demand the same respect from your doctor than you give them.

The problem is that patients often feel powerless against their doctors. This is a serious concern when people entrust medical professionals with their health and welfare. It is an easy trap to fall into. Patients need their doctors to help them make sense of scary, often life-threatening situations. But this is no excuse for a doctor treating you poorly!

Your doctor can be firm with you. They can tell you bluntly when you are hurting yourself by skipping antibiotics or eating poorly. But if they resort to rude behavior, shouting, insults, or other aggressive practices, you should consider filing a complaint to the facility or office manager.

Most importantly, you should consider finding another physician, someone who respects you. (You’ll probably notice this piece of advice come up again and again in this article)

Always Running Late

This is a tough one. Your doctor is, to a large degree, at the whim of his or her schedule. If previous patients arrived late, or if their treatment necessarily took extra time, your doctor is going to run late, and there’s very little they can do about it.

On the flipside, your time is valuable. You have a right to express when chronic lateness is an issue, and at the least to inquire about the reason for it. A doctor who is chronically late may be so poor at managing their own time that it makes sense for you to change physicians. The ability to manage time properly is an important skillset for a doctor to have, and if they lack it, you have a right to find someone who will not waste too much of your time.

Sexual Harassment and Drug/Alcohol Abuse

There is little worse than being betrayed by the person entrusted with your health and welfare, but some doctors do just that. Sexual harassment by medical professionals is absolutely, 100% unforgivable. It is absolutely imperative that you terminate your relationship with a doctor who makes you feel uncomfortable or who makes sexual advances toward a patient.

Many people find it difficult to file a complain in the event of sexual harassment. It can be an intensely personal, embarrassing, and traumatic experience to prolong and relive through the process of reporting. However, if you can bring yourself to do so, filing a report can help prevent future episodes like what you have experienced. The choice is yours, but no matter what, do not let yourself feel preyed upon by someone you should be able to trust.

Drug and alcohol abuse is more common, but often harder to identify and address. Most of us know someone who has struggled with this problem, and we may have sympathy for them – but a medical professional, who is responsible for many lives besides their own, cannot be allowed to perform their job while intoxicated, high, or hung over. There is simply too much at stake.

If you ever come across a physician with alcohol or drug issues in a clinical setting, immediately report this to your nurse or insist on discussing this with a hospital administrator. Lives may be saved by your action.

Trouble with Hygiene

Finally, it’s important for your doctor to stay hygienic. This isn’t just for appearances! A doctor needs to stay clean to help prevent infection and maintain a sterile environment. On top of that, if your doctor is coming in disheveled and unwashed, it is likely a sign of other problems, such as alcohol abuse. Regardless, if you notice a problem, your best bet is to report it to the office manager and consider seeing a different doctor.

Hopefully these things never come up, but if they do, the tips above should help you identify any potential issues and what you can do to exercise your rights. If you haven’t already seen it, check out this article I wrote on how you, the patient, can hold up your end of the bargain to ensure a great patient-doctor relationship.

How to get better care from your doctor

February 21, 2016 by drjaffer

Not everyone receives the same medical care. It’s true, if unfortunate. But what many people don’t realize is that several individuals, seeing the same doctor, with the same insurance coverage, and with the exact same ailments, often receive different qualities of care!

As it turns out, doctors (and other medical professionals) are only human. They have likes and dislikes, good days and bad days. Some doctors are responsible and ethical and try their hardest to treat every patient the same. Others… not so much. All these things can impact your quality of care, for better or for worse. And when your health is on the line, that can be a big problem.

As a patient, it’s important to know what you can do to improve your chances of receiving optimal health care. In this case, it’s all about managing the patient-doctor relationship. Your job is to receive the best possible health care; in order to do that, you should strive to make things as easy on the doctor as possible, while also understanding your rights and how to identify when your doctor is not treating you with the respect and care you deserve.

Today we’re going to talk a little about how to be a good patient. Or rather, let’s talk about how to be a bad patient, and why it results in getting worse health care.

Ditch the Rude ‘tude

Rudeness, aggressive behavior, argumentativeness. We’ve all been there, maybe even with our doctor. Perhaps she ran late. Maybe we’re feeling terrible and we’ve had to sit in the waiting room for an hour and a half. Maybe he seems like he’s glossing over the real problem and we’re getting frustrated.

The problem is that doctors will often respond in kind. They’re busy, behind, dealing with dozens of sick and upset people at the same time, all while managing staff and their own schedules. Even worse, they might simply try to rush you through the exam in order to process them quickly. This is terrible for everyone involved, but especially for you!

Of course it isn’t your job to manage your doctor’s mood or make sure they have a bright day. But if you want to receive the best possible care, it’s worth your while to make the best out of a crummy situation.

Be on Time, and Don’t Miss your Appointments!

This one might seem self-explanatory, but what people don’t realize is that when you run late or have to be re-scheduled during a busy time, the doctor has less time to perform a thorough examination. That means in many cases you’re getting sub-optimal care right out the gate! There are only so many minutes in the day, and if the doctor is rushed, they are simply not going to do as good a job as they could given more time. And they can’t simply push back every other appointment to give you more time (though they are likely going to have to push back their appointments at least a little, anyway).

On top of all this, medical facilities keep detailed records of your appointments and cancellations. If you become known for skipping appointments without notice or showing up late, you may receive sub-optimal care simply because you’ve drawn the ire of the doctor and nurses. You may have trouble getting scheduled in due to your poor record, and many offices will stop accepting you as a result of habitual missed appointments. Avoid this at all costs! If you have to cancel, make sure to give as much notice as possible – and show up on time, every time.

Be Knowledgeable, Be Honest, Be Compliant

This is the simplest rule of all. If you have existing medical conditions, know what they are, what drugs you are currently taking, and any important details about your condition. If you don’t know your own body, your doctor is not going to know how to treat you.

Be honest with your doctor about these conditions, and in answering questions about yourself. If you lie to your doctor or hide information, even information that doesn’t seem important, your doctor is going to reach false conclusions, and may overlook critical parts of your condition or treatment.

Be compliant with treatment instructions. Otherwise your visit is wasted, and you may actually do more harm to your body than good! Follow the exact instructions when taking drugs or undergoing treatments. Don’t stop early because you feel fine, or because it’s too much of a hassle to complete the treatment. You only get one body. Don’t waste it!

Be Clean

Last, but not least, be clean. This might seem like it goes without saying, but ill people especially may come into a clinic with very poor hygiene. It can be tough to tell when your nose is stuffed up or you’re otherwise preoccupied with being sick. But trust me… your nurses and doctors can tell. Take the extra 10 minutes in the morning to make sure you’re clean. You want to make sure your doctor is comfortable spending as much time as possible in close proximity to you to make sure they perform a thorough exam.

In a future post, we’ll talk at length about the red flags that indicate it may be the doctor who is sabotaging the patient-doctor relationship – and what you can do to exercise your rights.

When gun violence is a medical problem

February 17, 2016 by drjaffer

With the rise in high-profile shootings across the country, the potential for gun violence is becoming an integral part of the patient’s healthcare in both screening and prevention. The White House has recently issued a statement requesting doctors to protect patients and communities from gun violence. Physicians have traditionally addressed socio-personal issues relating to illicit drugs and alcohol use, seat belt use, depression, sexual history, domestic violence, and mental health in the clinic. Now, many doctors are coming around to the belief that discussing gun ownership habits and certain red flags are correct to discuss with willing patients as well.

While there are no mandates requiring doctors to talk with you about gun ownership, many doctors have begun doing so of their own volition. This screening process typically involves a set of short questions which are designed to asses common risk factors regarding gun ownership. These risk factors include availability of unlocked firearms, past threats made involving firearms, and the mental health of people with easy access to firearms.

These questions were designed to be uncontroversial while still helping identify potentially dangerous situations involving guns. For example, there is near-universal agreement that firearms are dangerous in the hands of people with certain mental illnesses, or those who regularly abuse drugs. Likewise, most responsible gun owners understand the need to keep firearms locked up in the presence of children.

Obviously, you are under no obligation to answer these questions. But your doctor is asking them for a reason. Many gun-related deaths are preventable. Many happen after a long history of threats or other red flags. Still others happen because of untreated mental illness coupled with easy access to firearms. While doctors cannot prevent all these tragedies, they can in many cases help identify dangerous or life-threatening scenarios before they happen.

There is no easy solution to gun violence, and certainly clinical screening is not going to fix it entirely. But the hope is that by asking the right questions and helping patients better understand potential risk factors in a household with guns, doctors will be able to prevent deaths and help patients lead longer lives – which is, after all, their business.

I hate being sick: The Fundamentals of Preventive Medicine

February 15, 2016 by drjaffer

Getting sick is awful. Even a common cold can ruin your week; being laid low for a single day still leaves you sluggish and tired, sets you behind on work, and can easily snowball into a weekend of stress and helpless catch-up. More serious illnesses are obviously even worse – from a lengthy sinus infection all the way up to life-threatening illnesses and afflictions.

Our society has traditionally focused on Reactive Medicine – curing and treating diseases after they are detected. But with every passing year, more and more attention is paid to Preventive Medicine – preventing illnesses before they occur through early detection and healthy living. The argument for preventive medicine is simple and convincing: preventing diseases is often cheaper and more effective than treating them. In many cases, prevention is the only option for diseases that are otherwise fatal! The good news is that you obviously can’t die of a disease you never get.

Prevention seems simple on the surface, but there are many factors that go into it. Most of us receive vaccines as children and adults, and perform common preventive techniques such as washing our hands, trying to eat healthy, and avoiding dangerous carcinogens such as tobacco smoke. This is known as primary prevention: preventing diseases before they actually occur. When a doctor takes your blood pressure and makes recommendations for keeping it under control, he or she is practicing primary prevention.

Most people are familiar with common screening tools such as blood tests, Pap smears, x-rays, and other medical exams designed to detect the early signs of diseases. This is known as secondary prevention. By detecting diseases at an early stage before symptoms have begun, doctors can treat these illnesses more effectively and with much higher rates of success. A disease that is detected early may have close to a 100% 5-year survival rate, meaning people who have the disease treated during this early stage tend to live a normal life span. The very same disease detected late may have a dismal 15% or less 5-year survival rate if detected during the late stages, meaning most people who are diagnosed late will likely die within 5 years.

The final piece of the puzzle is called tertiary prevention. This involves preventing the adverse effects, including the recurrence and complications, of existing diseases. A simple example is the use of aspirin to prevent heart attacks and congestive heart failure in patients who already have coronary heart disease. Another example is the use of the drug tamoxifen to help prevent the spread or recurrence in patients with history of breast cancer.

So when is preventive medicine most effective? The answer boils down to risk, cost, and potential complications.

The patient and doctor must always ask themselves: What are the risk factors for the patient that make this disease likely and worth screening for? In many cases, a disease is more likely based on family history, sex, or lifestyle factors. In these cases, certain tests should be considered and certain preventive techniques should be undertaken. In other cases, a patient is at such low risk for certain illnesses that screening is more likely to result in a false positive test or undue hardship than to provide a benefit, and should be viewed with skepticism.

The cost of screening and prevention often goes hand in hand with the risk factors. One of the goals of preventive medicine is to reduce the overall cost in healthcare, and in many cases it is significantly cheaper to prevent diseases than to treat them reactively. However, this is not always the case, especially when considering the countless number of potential tests and procedures that exist to detect illnesses. It is important to weight the benefits of a test against the likelihood of the patient actually being at risk, as excessive testing can create unnecessary financial burden. The good news is that while screening can be expensive, many preventive measures can be taken by the patients themselves cheaply or free of cost. It costs nothing to avoid smoking, to avoid excessive sugar and alcohol, and to exercise daily, for example.

Finally, the potential complications of any preventive procedure must be considered. Some procedures are invasive or stressful, and in many cases false positives can lead to additional stress, invasive follow-up procedures, and time/money lost. It is important to focus on procedures that are most likely to contribute toward a long and healthy life without causing undue hardship.

It’s important to discuss all these factors with your doctor, as well as to research them for yourself. In a future post, I’ll be detailing some of the most common preventive tools and the ages you should start scheduling certain procedures with your doctor. Preventive medicine is often the best tool for staying healthy – but it requires you to know your body and your options better than ever!

Why the new breast cancer screening guidelines matter

February 15, 2016 by drjaffer

In October 2015, new breast cancer screening guidelines were published by the American Cancer Society. At the time, we were halfway through the publishing process for our new book. We immediately threw on the breaks and started all over again in order to rewrite the chapter on breast cancer. Even though the ACS is one of several organizations that propose breast cancer screening recommendations, their recent data provides strong evidence that screening too early for breast cancer can do more harm than good.

It may seem like a minor change to have pushed back the starting date for mammograms from 40 years of age (the previous recommendation) to 45 years of age, along with decreasing the frequency of exams after age 54, but the change represents a significant shift in how doctors are approaching early breast cancer detection. [1]

Most people are not aware that 1 in 8 women will develop breast cancer over the course of their lifetimes, and are unfamiliar with the progression of the disease. Breast cancer is a serious life-threatening condition, though the difference in life expectancy between early-detection and late-detection can be enormous. Finding breast cancer early is key… but doctors and medical data have often disagreed on the best way to do it.

While many doctors still recommend breast self-exams, and perform breast exams in the clinic, there is no longer scientific consensus that these tests are effective at detecting early cancers. I’ll be discussing the reasons behind this in a future post, but for now it’s important to understand that the most important and accurate test for breast cancer remains the mammography.

There are several reasons for these changes in recommendations. The most significant is that while mammograms are reasonably accurate tests, they do sometimes result in false positives, and the test performs poorly in young women. The younger you are, the less likely you are to have breast cancer, and the more likely you are to have a false positive test. New research has shown that a large percentage of positive mammograms performed on young women are false positives, and a relatively low frequency represent actual cancers. [2]

A false positive can result in enormous amounts of stress and mental anguish, as well as medical costs, time, and invasive procedures. Unless you are a high-risk individual (in which case starting your screening early is advised – speak to your doctor about this), pushing back the screening start-date should help alleviate the frequency of these false positives while continuing to detect early and potentially fatal cancers.

A review of the new guidelines for women of average risk follows, from the American Cancer Society’s website:

Women with an average risk of breast cancer – most women – should begin yearly mammograms at age 45.
Women should be able to start the screening as early as age 40, if they want to. It’s a good idea to start talking to your health care provider at age 40 about when you should begin screening.
At age 55, women should have mammograms every other year – though women who want to keep having yearly mammograms should be able to do so.
Regular mammograms should continue for as long as a woman is in good health.
Breast exams, either from a medical provider or self-exams, are no longer recommended.

It’s important to keep abreast of changing screening recommendations, especially with something as common and potentially deadly as breast cancer!