Going to the Doctor

The world sure has changed.

When I was a child, there was one doctor you saw for everything that ailed you. Dr Kamp delivered me, treated me for everything from chicken pox to taking a BB pellet out of my ear to cleaning up a cut on my knee that I got from kneeling on a piece of broken whiskey bottle in an old village dump behind my grandparents.

Well, ok, Mom had a bone doctor. Dr Clark was as much a part of our lives as Dr Kamp was. We saw Dr Sarya for our orthodontist, Dr Ross for our dentist. My grandmothers both went to Dr Willoughby. But, we didn't have an ear, nose, and throat specialist, or a dermatologist. Dad did go to an open heart surgery pioneer when he had his bypass surgery, and that was over in Milwuakee. That guy gave us thirteen extra years with Dad, and I am very grateful for that. That in mind, there is certainly a need for specialists.

I used to think that a doctor's work day was more similar to a workday you or I am familiar with, with the earnings based on production or care given. I had no idea what being a doctor really meant. To this day, I don't have a clear understanding, but I am getting a pretty good picture. It really made me angry at what I perceived to be the doctor's wage for visit. So much money for ten to fifiteen minutes of his or her time!

What I didn't realize is how much work a doctor is actually doing.

1. Today's doctors need to do a lot more paperwork than ever before. Due to insurance changes, HIPAA, legal requirements, new medications and changes in how medications can be prescribed, there is a whopping lot a doctor has to do on paper or on computer. If he or she doesn't create the paperwork, they need to find if paperwork has been completed historically, such as medication agreements. Doctor's also have to do prior authorizations, or at least have their nurses do them. Some insurance requirements make providing care a nightmare with the burden of proof of the patient's needs resting on his primary care physician.

2. Due to the internet, patients come in with information that may or may not be correct and healthy for them. The doctor is constantly challenged by a patient's "education". Add in pharmaceutical advertisements on TV and in magazines, and popular opinion, and this can be a pretty good mine field for a doctor to maneuver through in order to provide correct and healthy treatment for the patient.

3. A doctor is constantly interrupted. He spends time listening to the patient during the appointment and has to chart this visit. But there are prescription refills to address, appointment requests, calls from other doctors or health care providers to discuss other patient cases, and more. And always it seems that just after a patient finishes his appointment, he remembers that he forgot two or three important things he needed to ask the doctor about.

4. Patients do not follow orders.  There are people who actually get huge kicks out of not following doctors orders and  how daring that is. Then they come back, complaining about the same symptoms and blame the physician for not taking care of them. I am just as guilty of non-compliance: I am overweight, and have been told by years by my physician that I need to address this. I am still overweight and getting more health issues as time goes by. It is within my power to gain health, but it is so much easier to ask the doctor for a simple remedy. Self discipline is just too hard..

5. Some patients are just lonely or needy. Seeing the doctor may be their only social event. They spend a lot of time talking with the doctor, asking to talk to their doctor, demanding to get appointments for this or that, and being traumatized when the doctor can't see them.  These folks take a lot of the doctor's time as well as the office staff's time. This is just a fact.

6. Doctors have feelings too. A doctor can't stop taking his or her appointment's for the day when they hear a friend or family member has passed away or other bad news. Sometimes, patients will take out their bad day on the office staff and the doctor. A doctor can't take this personally: Sick people are not at their best. Frightened people may lash out too, when lab reports or diagnostic imaging gives bad news.

7. Doctors have had a lot of schooling, and are continually learning. They have a lot to remember. I went to school for four years to become a medical assistant. I took some classes twice because I didn't get it the first time around, and I didn't want to risk other's health because I didn't understand what I was learning. This wasn't all that long ago, and I have already forgotten terminology and techniques. I am in an administrative position, and glad of it. I  had a two-year program that took me four years. How long does it take to become a doctor? And how long does it take to pay off those student loans?

How can a patient help his PCP have a more productive visit?

Seek care when you need it. Understand what is an emergency and what is not an emergency. If your situation is not clear, call and talk with a nurse about your symptoms. Listen to your doctor. Take medications as directed. Don't save antibiotics for later. Understand that your PCP sees many people. Be involved with your care and aware of your symptoms. Have an annual wellness exam. Don't take your bad day out on your doctor and his staff. Do make sure your insurance and address and phone number are up to date in your chart. Specify where you want prescriptions to be sent.  When you call your doctor's office, please identify yourself and please state what you are calling about clearly. Don't expect your doctor to address fifty issues in a ten minute time span. Don't bring family members in to your appointment to be seen for a problem they are having. They need their own appointment.

My mom used to bring all of us kids in to see Dr Kamp when one was sick. It made sense as a mom, but was really hard of Dr Kamp. He finally told her she couldn't do that anymore. Sometimes we just don't think. It is hard to remember that you are just one of many patients, particularly when you are really sick. You are important! So are the other patients.

Drug Abuse, step one:

When you think of drug abusers, what comes to mind?

Now, think again about drug abusers, and substitute the image you visualized with a grandmother, a teacher, a minister, college student, or even yourself.

I used to think that marijuana was THE gateway drug. Now I think it is pain relievers, starting with harmless little old aspirin. We have been taught for years to take a pill and the pain will go away. So convenient! Now that I am in my fifties, I am noticing that there is a lot more pain and a lot less time so it’s a Tylenol here and an Aleve there. If I don’t take too many and have a variety, that is better, right?

This is me normally as a teen. Honest!

So, plain old over the counter pain killers are commonly abused.

These are the gateway drugs, if you ask me. It was in high school that I first heard of a way to get high with aspirin. Just take it with a Coke, on an empty stomach is best. This was when aspirin was still ok for kids to take. Reyes Syndrome was not a new notion in those days, and in truth a school mate had died from Reye's Syndrome. But it was not a firm theology to avoid aspirin yet then.

The other issue with aspirin, Tylenol, ibuprofen and similar drugs is that we do not think of them as being drugs, not really. A drug is something like Tylenol three or Percocet. But anything that is medication consists of drugs, a fact to keep in mind. Also, too much of any of these meds is bad for your body. Do you really want to have issues with bleeding ulcers or liver damage?

Do not exceed the prescribed dosage on any medication. This is not a good idea.

It is also a very good idea to check your other medications for interactions. I was prescribed a medication for restless legs. I got a headache, and thought nothing of taking an aspirin for it. Big mistake! On that particular medication just about any and all other medications interacts badly! I stopped that medication pronto. It was too scary. Read those drug inserts, folks, they can save you a lot of grief!

The thing is, our brains are tricky manipulative little buggers who figure out that if one pill helps the pain, another would help more.  Like Pavlov’s dog, an ache or pain is the bell that calls for a reward of pain relieving bliss. Instead of physical activity such as stretching or walking we baby the pain with pills. Instead of quiet rest with a cold compress on the eyes, we keep reading or working on the computer or driving. We of this current culture, with all its gizmos and doo-dads and time-consuming things, do not know how to rest.

Read the label and the package insert for safe use of medications

This is all basic stuff. What do I mean by drug abuse?

Taking more than the prescription reads, or more than is suggested on the package of over the counter medications, is drug abuse. You have a doctor written prescription for pain medication. You only use it when you need it, it is to help you. But if you take more than the doctor has prescribed, that counts as drug abuse. That means your prescription will run out sooner than it is written for and you will be shocked by the fact that the doctor will not do an early refill for you.

Say your sister has a migraine medication. You get a migraine. She gives you one of her pills. This is illegal. It is also unsafe. Say your sister is a heavy person and you are thin. The dosage is designed for her, and you may actually receive an overdose. Never take a drug that has not been prescribed for you.  You wouldn’t borrow someone’s prescription glasses would you? Prescriptions are not one size fits all.

Taking or using medications in a way other than they were prescribed is drug abuse. For instance, crushing an extended release pill is not how it is prescribed. It is designed for the medication to be released over time. When a pill like this is crushed, the medication is felt all at once. Don’t cut pills that are not designed to be cut. Don’t open capsules. If swallowing pills is difficult for you, tell your doctor or pharmacist. There may be an alternative method for that medication.

I am working hard on developing good habits with medications. This includes reading the insert that comes with prescribed medications and sticking to the suggested dose on the packages. Before I became a medical assistant, I was pretty ignorant about these things. If you cannot read or understand the inserts, ask your pharmacist. They can also tell you about possible interactions with other medications you may be taking.  There are also drug books that are easier to read for people without medical degrees, and websites that help.