Jewish World Review May 2, 2003 / 29 Nissan, 5763
Drs. Michael A. Glueck & Robert J. Cihak
Although patients are increasingly aware that the United States has the
potential to deliver the world's best medical care, frustration with the
system grows daily. We have previously discussed many of the root causes.
Additionally, many patients tell us that their major annoyance is weaving
through the everyday medical maze. Thus, we feel everyone needs a
quarterback to direct the plays once the patient has decided the basic
goals and strategies. By this we mean a physician who calls the plays in
the huddle, runs, hands off or passes as needed, directs the blocking,
receives feedback from other players, reviews the films and is director of
the medical team.
The most satisfied patients seem to be those who have a decisive internist
or family practice physician who is in the take-charge position.
Out of roughly 650,000 practicing physicians, fewer than 40 percent make up
the "general care primary specialties" plus "primary care subspecialties."
To confuse patients further there are anywhere from 40 specialties to over
The total number of patient visits in the United States in 2000 was
823,542,000, according to http://www.aafp.org/x794.xml. That translates to
billions of diagnostic/therapeutic tests and procedures yearly that must be
sorted and fed back to relatively few primary providers.
As the population, particularly over 65 and 85 increases significantly, has
more chronic illnesses and diagnoses, and requires more treatment and
medications, the potential for problems increases geometrically.
Says Sheila Pinsky, Orange County, Calif., "With all the medications,
over-the-counters, herbs, spices, vitamins, supplements and tests, this
gets pretty confusing for the senior population."
A Newport Beach medical internist who is well liked and respected by her
patients told us: "My job as a well-trained internist is to follow every
questionable finding to conclusion. Most specialists want to treat their
area only but don't want to treat the whole patient." By "conclusion," she
means until the finding is determined to be significant, non-significant or
needing further study or follow-up. In other words, she helps the patient
decide when to get off the medical merry-go-round/treatment treadmill.
We understand. Recently a relative of one of these writers had a body scan
that showed an incidental "cyst" of a gland in the neck. Specialists were
consulted. One specialty examined the neck, another checked the ears, nose
and throat, and a third the thyroid gland. The anecdote has a good
conclusion because the patient's quarterback meticulously reviewed all the
findings and made a decision.
With the above in mind we recommend the following. Very little is brand new
but sometimes going back to basics is the best way to win the game.
- Previously we have suggested that everyone make a list of all
medications, vitamins as numerated above. This includes names, appearance,
indications for usage, doses, schedules and prescribing physician. Remember
also, the pharmacist has an important role in today's medicine. Most have
computers to check drug interactions.
- Now add the names, specialties, addresses and phone numbers of your
consulting physicians. Include the pharmacy you use and phone number. This
vital information taped to your wrist or in your personal notebook will
save you and your providers time and inconvenience and perhaps save your
- Choose your primary care doctor carefully. This means not only his/her
qualifications but whether you like and can relate to each other. If you
don't get along say "So long!" You won't be able to communicate or
coordinate only vacillate.
- In general, most super or sub-specialists are not ideally suited, by
training or inclination, to be your primary care physician. For children
the general pediatrician is a good choice. For women most
obstetrician/gynecologists are too specialized.
- When you decide on a QB, meet and set up some rules of engagement such
as how often to meet, talk and e-mail. Most patients get upset with long
office waits. So make a deal. You will call if you are late for the
huddle and ask that the doctor do the same! Providers and patients
should both practice sportsman-like conduct!
- To best utilize time, think out your message, comments and questions
before entering the doctor's office. In the May/June 2003 issue of The AARP
Magazine's Health Report by Elizabeth Austin, "I'm afraid I have bad news,"
she quotes author Joni Rodgers as saying, to prompt her doctor to listen.
"I need to say something and if you promise to listen without interrupting,
I promise to speak for 90 seconds or less."
- Alert your Primary Care QB when you see a specialist and that a report
will be coming. Report back any new medications prescribed.
Remember that with all the new rules and regulations on the turf, you must
assume partial responsibility for your moves. Don't get sacked in the
medical backfield. Make a medical QB your franchise player.
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Michael Arnold Glueck, M.D., is a multiple award winning writer who
comments on medical- legal issues. Robert J. Cihak, M.D., is past
president of the Association of American Physicians and Surgeons.
JWR contributors are Harvard trained diagnostic radiologists.
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