The motivation is more important than the reversal of obesity Information

September 7, 2012 by Dr. Val Jones health, advice, opinion

Recently, I found my way to a podcast of interesting NPR via a link to Dr. Ranit Mishori (@ ranitmd) on Twitter. The host of the show interviewed a physician (Dr. Mishori), an obesity researcher (Sara Bleich), and is a family nurse practitioner (Eileen O'Grady) on health care providers how to try (or not) to help patients to manage their weight. Several of the patients and called practitioners participate.

First of all, I found this fascinating that research has shown that the BMI of the attending physician has a significant impact on the question of whether if he or she is willing to counsel a patient on weight loss. Physicians weight normal (those with a BMI of less than 25 years) were more likely to address the subject (and follow with weight loss and exercise of planning with their patients) than doctors who were overweight or obese. Sara Bleich believes that this is because an overweight and obese doctors is recognize the problem to other people who have similar body types or personal shame on their weight makes them feel that they do not have the right to give advice because they do not practice what they preach. While 60% of Americans are overweight or obese, 50% of doctors are also in these categories.

Although it is not entirely surprising that sensation of physicians overweight or obese as they, it made me wonder what could influence other personal conditions based on evidence of the care for patients. Is a doctor with hypertension less able to encourage accession salt restriction or drugs? What is depression, smoking cessation tobacco or erectile dysfunction? Is there some personal diseases or conditions which threaten the good care and treatment in others?

Several calls told negative experiences with physicians, where they have been "read the Riot Act" on their weight. Said overweight woman she handled this by avoiding simply go to the doctor at all, and another said obese man her doctor made her cry. However, the man continued to lose 175 pounds thanks to changes in diet and exercise and said that the "magic" is just what he needed to galvanize action.

Dr. Mishori found that the "Riot Act" approach was rarely useful and usually insane patients. She advocates a more nuanced and more sensitive approach that takes into account the social and financial patient situation. She explained that there is no use advocates personal training of a person on food stamps. Doctors must be more sensitive to the conditions of life of the patients and physical capabilities.

In the end, I felt that the nurse practitioner Eileen O'Grady contributed to some useful observations - it was argued that the factor limiting the speed in reversing obesity is not information, but the motivation. Most patients know what they "do" but just do not have the motivation to start and keep at it until they reach a healthy weight. Ms. O'Grady has dedicated his practice of coaching by phone weight loss, and believes that the phones have a large advantage over in-person visits: patients are more likely to be honest when there is no direct visual contact with their provider. His secret of success, beyond a non-moralistic therapeutic environment, highlights small achievable goals. She said that if she does not believe that the patient has at least 70% chance of success, they should not set this particular goal.

Objectives can be as simple that "find a training outfit suited." As the patient grows in confidence with their success, bigger, wider goals can be set. Intensive group therapy and weight loss training can be more motivating strategy that we must help the Americans to shed unwanted pounds. Apparently, universal service providers working group accepts, as they recommend "intensive behavioral interventions, multi-component" for those who screen positive for obesity in their cabinets.

I think it is unfortunate that most physicians believe that "simply don't have time to advise patients on obesity." Diet and exercise are two medical the most powerful tools we have to fight against many chronic diseases. What else is so important that it is further our time focusing on the "elephant in the room?".  Pills are not the way forward in the treatment of obesity - and we should have the courage to admit it and to better address the problem head-on in our offices and our own lives also.

Tags: BMI, Coaching, advice, education, Information, Motivation, NPR, obesity, BMI, Podcast, nizatidine doctor Mishori, USPSTF recommendations, weight loss

Ultraviolet radiation damage can have long-term consequences for your eyes

July 23, 2012 by Dr. Val Jones in Audio, health

If you have been invited to be part of a nuclear radiation cleaning crew, I'll bet that you do not want to wear protective clothing. Not only the costume of white rabbit of hazardous materials, but gloves, goggles, mask and slippers, right?  But when it comes to exposure to ultraviolet radiation, we often put on "half a costume" as on. We cover our skin with sunscreen (maybe), but we regularly protect our eyes. I don't know why forget us this step, but it is time for serious protection of the eyes.

In a recent interview with Dr. Jeanine Downey, dermatologist and optometrist, Dr. Stephen Cohen, we discussed the long-term damage that UV rays can cause skin and eyes. I hope that you can listen to the full conversation here:

Sun damage of the skin have a familiar appearance - brown spots, wrinkles, thinning and enlarged pores.  UV radiation causes visible damage to the eyes - yellowish horny (the "white" of the eye), scars (called pterygia) and crow feet. Over time, the skin of the eyelid may become cancer from exposure to the Sun, while the eyeballs develop cataracts and macular degeneration (which can lead to blindness). The risk of these diseases and conditions can be greatly reduced with Sun protection measures. And it is not that difficult to do...

Tips for protecting your eyes:

1 Wear a hat to wide to protect your face and your eyes from the Sun.

2 Wear enveloping sunglasses that absorb at least 99 a100% of UVA and UVB rays for maximum eye protection.

3. If you wear contact lenses, ask your doctor to look at if your lenses are UV protection. Contact lenses ACUVUE ® OASYS ® brand offers the highest level of available UV blocking, blocking at least 90% of the UV - A radiation and 99% of the UV - B radiation. While blocking UV contact lenses offer significant additional protection for the carriers, they did not completely cover the eyes and surrounding area and should not be considered as a substitute for the UV blocking sunglasses. For maximum protection, blocking UV contact lenses must be worn in conjunction with quality, wrap, UV blocking sunglasses and a hat to wide.

4 Remember that UV rays are more intense when reflected off the water surface and snowy owl. Just because it is winter time does not mean that you do not need to wear your sunglasses.

So the next time you reach for your sunscreen, don't forget to take your hat and sunglasses with you too! Fortunately, costume rabbit and booties are still optional for protection against UV radiation.

Disclosure: Dr. Val Jones is a consultant paid for VISTAKON ® Division of Johnson & Johnson Vision Care, Inc..

Labels: ACUVUE, Cancer, cataracts, contact lens, eye, macular degeneration, sunglasses, Sun Protection UV, UV radiation, broad-brimmed

Women are more motivated by a Fitness Chubby trainer?

July 26, 2012 by Dr. Val Jones in health, opinion, true stories

I am taken aback by a recent conversation with the owner of a gym. She is interested in encouraging the women to come to the gym for the beginner fitness classes and is considering a strategy meeting for its staff and key clients. I asked if I could join and she said that I was specifically a-invited. A little upset, I asked why it was - after all, I am a rehabilitation physician, who devoted my career to move people.

"You are too advanced." She said. "Beginners concern the way in which you are working, we are really more focused on the creation of a less intimidating environment for women.

"You mean, like planet Fitness ads." Those where the athletes are not welcome? "Confused, I asked.

"I do not like these ads, but the idea is the same." Beginners feel deflated by with people who are in much better shape. They not even want their instructor look too good. »

"You're kidding me." Women really would prefer to work with a chubby trainer? »

"Yes." In fact, I have had some women come to the gym room and request not to be matched with some of our personal trainers, precisely because only they look too fit. "They are afraid that they will be invited to work too hard, beyond their comfort zone."

"Then why they come to the gym in the first place?" I asked. "What is motivating their if they do not want hard work or change their body in the direction of the sport for trainers?

"They are just interested in staying the way they have always been." Maybe they started to put on weight after they hit their 40's and 50's and want to just go back to where they were in their Beardmore. They are not interested in running marathons or lift heavier weights in the gym room. They do not want to be pushed too much, and they prefer the trainers who appear healthy but not extreme. »

Medically speaking, there is an extreme effort to be in good health. Many studies have shown that the regular market is sufficient to prevent certain diseases, and loss success stories of weight (described in the National Registry of weight for example) generally result from adherence to a system of restraint caloric and his commitment in moderate exercise.

In a sense, these women who "want that hard work" are - they do not have to perform extreme feats to be in good health. However, I am always fascinated by the preference for the "medium of research" trainers and apparent bias against athletics. This must be a fairly common bias, although because the national channels (such as planet Fitness) gym took on it and is the cornerstone of their marketing strategy. "Any judgment" - unless you have buns of steel, I suppose.

When I choose a trainer that I'm looking for someone who embodies the best of what the exercise can provide. An athlete who has been their trade through years of sweat and effort... because it is my star in the North. Of course, I can never reach the North Star myself, but I would like to achieve. And that is what motivates me.

But for others, having a professional athlete for a trainer can be a bad state of mind. If your aspiration is to be in good health but not sports, then it is logical to find inspiration in those who embody this attitude and style of life. The important thing is that we all meet the minimum requirements for exercise for optimal health. According to the CDC, this means that:

** 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., walking) every week

and

** muscle - strengthening activities on 2 days or a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms).

How you get there, and with which you arrive, belong you. Chubby or steely - with regard to health and fitness is the best mantra, "what works."

Tags: Athletes, fat body, CDC, Chubby trainers, guidelines of the exercise, Fitness, physical trainer, NWCR, Personal Trainers, Planet Fitness, weight loss, what is good

The Ten Worst Hospital Design Features: A Family Member’s Perspective

July 21st, 2012 by Dr. Val Jones in Health Tips, Humor, True Stories

An ICU Bed False Exit Alarm

I just spent the last 8 days in the hospital, at the bedside of a loved one. Although I squirmed the whole way through a tenuous ICU course and brief stop-over in a step-down unit, it was good for me to be reminded of what it feels like to be a patient – or at least the family member of one – in the hospital. The good news is that the staff were (by and large) excellent, and no major medical errors occurred. The bad news is that the experience was fairly horrific, mostly because of preventable design and process flaws. Having worked in a number of hospitals over the years, I recognized that these flaws were commonplace. So I’ve decided to tilt at this great hospital design “windmill” on my blog – with the hope that someone somewhere will make their hospital a friendlier place because of it.

Most of these design and process flaws have one thing in common: they prevent the patient from sleeping. In some circles, sleep deprivation is an organized form of torture reserved only for the most dangerous of terrorists. In other circles, it is hospital policy. And so, without further ado, here is my top 10 list of annoying hospital design flaws:

#1: False Alarms. Every piece of hospital equipment seems to be designed to beep for a complex list of reasons, many of which are either irrelevant or unhelpful. I snapped a photo of a particularly amusing (to me anyway) alarm (see above). This was a bed alert, signaling the “patient exit” of an intubated and sedated gentleman in the ICU. Not only was the location of the alert sign curious (if you could get close enough to the alert screen to read the text, you would surely already have noticed that the patient was AWOL) but it was triggered by mattress pressure changes that occurred when the patient was repositioned every 2 hours (as per ICU pressure ulcer prevention protocol).

The I.V. drip machines are probably one of the worst noise pollution offenders, beeping aggressively when an I.V. *might* need to be changed or when the patient coughs (this triggers the backflow pressure alarm, leading it to believe that a tube is blocked). Of course, I also thoroughly enjoyed the vitals monitor that beeped every time my loved one registered atrial fibrillation on the EKG strip – a rhythm he has been in and out of for years of his life.

#2: Intercom Systems. Apparently, some hospital intercom systems are wired into every patient room and permanently set at “full volume.” This way, every resting patient can enjoy the bleating cries for housekeeping, tray pickup, incoming nurse phone calls,physician pages, and transport requests for the entire floor full of individuals undergoing the sleep deprivation protocol.

#3: The Same Questions Ad Nauseum. Over-specialization is never more apparent than in the inpatient setting. There is a different team of doctors, nurses, PAs, and techs for every organ system – and sometimes one organ can have four teams of specialists. Take the heart for example – its electrical system has the cardiac electrophysiology team, the plumbing has the cardiothoracic surgery team, the cardiologists are the “minimally invasive” plumbers, and the intensivists take care of the heart in the ICU. Not only is a patient assigned all these individual micro-managing teams, but they work in groups – where they rotate vacations and on-call coverage with one another. This virtually insures that the sleep-deprived patient will be asked the same questions relentlessly by people who are seeing him for the very first time at 20 minute intervals throughout the day.

#4: Inopportune Intrusions. There are certain bodily functions that benefit from privacy. I was beginning to suspect that the plastic urinal was attached to the staff call bell after the fifth time that someone summarily entered my loved one’s room mid-stream. Enough said.

#5: Poorly Designed Tubing. Oxygen-carrying nasal cannulas seem to be designed to maintain a slight diagonal force on the face at all times. This results in the slow slide of the prongs from the nostrils towards the eye. Since the human eye is less efficient at absorbing oxygen than the lungs, one can guess what might happen to oxygen saturation levels to the average, sleep-deprived patient, and the resulting flurry of nursing disturbance that occurs at regular intervals throughout the night (and day). My loved one particularly enjoyed the flow of air pointed directly into his left eye as he attempted to rest.

#6: The Upside Down Call Bell. In an age of wireless technology, where almost every American has a cell phone and/or a flat screen television, it is odd that the light, TV, and nurse call bell control system must be tethered to a short  cord positioned just outside of the patient’s reach. The controller is also designed so that the cord comes out of the box’s farthest point, causing it to remain upside down in the hands of anyone lucky enough to reach it from a chair or bed.

#7: Excessive Hospital Bands. In addition to multiple rotating IV access points, my loved one’s wrists and ankles were tagged with not one but four hospital band identifiers, including one neon yellow band sporting the ominous warning: “Fall risk.” If that little band is the only way that a staff member can ascertain a patient’s risk for falling down unassisted, then one is left to wonder about their powers of perception. In a moment of rare good humor, my loved one looked down at his assorted IV tubes and three plastic wrist bands and concluded, “I’m one stripe away from Admiral.”

#8: The Blank White Board. Sleep-deprivation-induced delirium can be rather disorienting. To help patients keep track of their core care team names, most hospital rooms have been outfitted with white boards. Ideally they are to be filled out each shift change so that the patient knows which activities are scheduled and the names of the staff that will be performing them. Filling out these boards is tiresome for staff members (not to mention that the dry erase markers are usually missing) and so they remain blank most of the time. This has an anxiety producing effect on patients, as the boards boldly proclaim that no nurse is taking care of them, and no activities are scheduled.  I also noted that the size of the board lettering was a fraction smaller than a person with 20/20 vision could make out from the distance of the bed.

#9: The Slightly-Too-Tight Pulse Oximeter. Because being tethered to a bed with IV tubing, telemetry cords, and a nasal cannula is not quite irritating enough, hospital staff have devised a way to keep one unhappy finger in a constant, mild vice grip. This device monitors oxygenation status and helps to trigger alarms when nasal cannulas achieve their usual peri-ocular destination every 30 minutes or so.

#10: The Ticking And Creaking IV Drip. During the few rare moments of quiet, we did not enjoy any sort of blissful silence, but rather the incessant ticking of the I.V. drip machine. My loved one remarked that he felt as if he were trapped in an endless recording loop of the first 5 seconds of the TV show “Sixty Minutes.” And so if the alarms, tethering, interruptions, PA announcements, tubing, or white boards didn’t drive you mad, the auditory reinforcement of a ticking time bomb next to your head could bring you close to tears.

And so, because of all these nuisances (not to mention the ill-fitting hospital gowns, inedible food, and floors covered with various forms of “seepage” that penetrated patient socks on hallway ambulation attempts) we had one of the most unpleasant experiences in recent memory. All this, and no dissatisfaction with the surgical team or the primary procedure performed during the hospital stay. In the end, it’s the little things that can drive you crazy – or make you well.

Tags: Acute Care, Annoying Things About The Hospital, Bells, Caregivers, False Alarms, Flaws, Hospital Design, ICU, IV Drips, Noise, sleep deprivation

Patients have access to the results of prior laboratory tests their doctor examines their?

July 25, 2012 by Dr. Val Jones in health, opinion, true stories

Six weeks ago, that I had a lesion of the skin removed by a surgeon. Approximately 7 days after the biopsy, I received a letter from the pathology laboratory where the sample was analyzed under a microscope. With bated breath, I opened the letter, assuming that this criterion it contained the results, but was disappointed to find a Bill instead. As a physician, it felt strange to be in a position of having to wait as a colleague to give me the results that I have been trained to understand for me. However, I knew that in this case, I was wearing my "patient hat", and that I should trust that I would receive a call if there were an anomaly. I have not yet received a call, and I assume that no news is good news. But what happens if no news is an oversight? Perhaps there was a breakdown of communication between the path lab and the surgeon (or colleagues) and someone forgot to tell me about melanoma? Unlikely but not impossible, right?

Patients feel a similar anxiety with regard to the testing laboratory on a constant basis. In a perfect world, they would receive results along with their physicians, as well as an explanation full of what mean tests. But most of the time there a long time - a delicate period where patients must wait for a call or make a nuisance of themselves to the staff of the Office. Should not be a better way?

The New York Times looks at the issue of "the anguish of waiting for the results of tests", with some tips for patients in limbo:

As patients must wait for the results of the tests, anxiety increases as the slips of time in slow motion. But experts say that patients can regain a sense of control.

Start before the test itself.Because fear can cloud memory during interviews with doctors, take notes. If you can, bring a friend for the capture of the details that you may be missing.

A few questions first:

What precisely is this test reveal? What are its limitations?How long should take results and why? The doctor calls the results, or should I contact the Office?If it is my responsibility to call, what is the best time, and who should I ask?What is advice of the physician to obtain results online?

I think that patients should have access to their results without consideration of their doctor? While my first instinct is to say "Yes", I wonder if more anxiety may be caused by the results without an interpreter. There are so many results that may seem scary at first (for example, a mammogram with a "find" - the term "find", may mean that the entire breast was visualized in the image, or that there was a shadow caused by a layer of fat or - less frequently - it can also indicate that a suspicious lesion was observed). I do not argue that patients do not include the results of tests on their own, but the medicine has its own brand of jargon and nuances which require the experience to interpret.

Consider slight deviations from the average of a series of blood tests. They can be quite normal in the personal context of the patient, but can simply be listed by the laboratory as high or low. This can cause unnecessary anxiety for the patient. And what of smear results are listed as "ASCUS" - of atypical squamous cells of undetermined significance? These can occur if the patient had simply sexual recent and are not necessarily signs of cancer.

""And what about the ambulance"chasing lawyers" there? Will be it additional frivolous right costumes created by the results of laboratory tests reported directly to the consumer as abnormal in some way (when they are really not, taking into account the clinical situation full) and the patients, assuming that their doctor has been neglect reporting does not the anomaly for them earlier? This could happen.

Ultimately, I think that physicians need to all make a concerted effort in the before laboratory (with an explanation if necessary) test results for patients as quickly as possible. But because doctors are those who command the tests in the first place, they do not have the right to see their (before the patient where appropriate)- and the obligation to transmit the information timely and fully explained. This is the value of having a doctor to order a test - expertise in the interpretation of the results are part of the package (and cost). When patients controlling their own tests (and in some cases they can) then we must all first to receive the results.

For my part, I will have to resort to Office staff nuisance to get my results confirmed... like any other regular patient. Oh well.

Tags: DTC, EMR, Laboratory Tests, NYT, pathology, Patient Empowerment, results, expected to Get Patients their Laboratory Test results until their doctor?

In Defense Of Doctors: Why We Act Like Jerks, And How To Handle Us When We Do

July 5th, 2012 by Dr. Val Jones in Health Tips, Humor, Opinion

A Typical Jerk, M.D.

Editor’s Note: This post is meant to be tongue-in-cheek. We sincerely hope that our colleagues are not offended by the use of the term “jerk” to describe physician behavior. If you are a jerk, please feel free to leave a nasty complaint in the comment section of this post. Thank you!

Physicians have a reputation for being, to put it bluntly, jerks. It took me a long time to accept the fact that we are (on average) a disagreeable bunch, and my years of denying that there is a problem has finally given way to acceptance and even some degree of tolerance of “assholitry.” Few of us doctors think that we’re the one with the attitude problem, but I’m afraid that even the sweetest pediatrician can show some mighty claws when backed into a corner.

I didn’t think that I was a jerk until a few days ago when a surgeon made a medical error in the care of my loved one. I won’t go into details here, but let’s just say that evisceration was on the menu. My family member overheard one of the conversations and commented timidly, “I think you’ve probably just successfully alienated yourself from the entire medical community at Hospital X.” Yes, I was a total fire-breathing monster.

But this got me thinking – maybe if I explained all the reasons why doctors have bad attitudes, there would be a little more grace shown to us? Maybe our patients would be less offended and more understanding of our dispositions? I suspect that most people feel that there is “no excuse for rudeness” but I’ll offer a few nonetheless and see if I can’t change your mind. Here are the primary reasons that doctors are jerks:

1. We are afraid.

Being responsible for sick peoples’ lives is a scary thing. There are so many variables outside our control, and yet we believe that we must control the outcomes at all costs. It’s as if doctors somehow absorb the false belief that we can cheat death, and so when our patients don’t experience the optimal outcome from our every action and decision, we engage in some serious self-flagellation or (for those who possess a higher jerk index) we kick the proverbial dog (i.e. you).

Fear of inadvertent medical errors is a real butt-clencher for many doctors, and as science provides us with more insight into disease management we must be ready to do things differently, and to relearn everything we were taught. Keeping abreast of all these changes is very hard work, as there are over 6000 new research studies published world-wide each day. Our fear of failing to know everything we “should” causes many of us to hide behind a veil of toughness. Arrogance is often just a cover for vulnerability, and with so much information that we’re expected to digest, we are at risk for making a bad decision if we aren’t up to date. And when a doctor makes an error, he or she can pay a high penalty, including public humiliation by her peers, loss of her medical license, livelihood, the pain and suffering of legal action, and even confiscation of personal assets and savings.

And then there’s the daily fear of “fire-breathing monsters” like me. At any turn, irate family members, colleagues, hospital administrators, and staff can swoop in and criticize your best efforts.

2. We are hen-pecked.

A Physician With Three Hospital Administrators

The constant juxtaposition of trivial and critical can make doctors seem dismissive and arrogant. This is a subtle point, but one that is really important to understand a physician’s mental state. Imagine that you’re tending to a dying man with a gunshot wound to the chest, and a hospital administrator taps you on the shoulder to ask if you could fill out a form about insurance coding. You would view that request as particularly annoying given the context in which it occurred, right?

This may be an extreme example, but similar scenarios play out in our work days constantly. We are frequently interrupted (in the midst of very grave conversations, for example) with requests for approval of Tylenol orders, coding clarifications for duplicate insurance documents, or updates of no apparent consequence (such as, “Dr. Jones, I just wanted you to know that Mrs. Smith did receive your Tylenol order.”)

The very act of doctoring can make us feel as if we’re undergoing harassment by the hopelessly inane, punctuated by terrifying bouts of near-death scenarios accompanied by the usual fire-breathing monsters. If that job doesn’t turn you into a jerk, then… you probably are a robot.

3. We are exhausted.

Sleep deprivation is a well-known form of torture used by interrogators to extract information from “evil-doers.” It is also used by residency programs to keep whining residents from having the energy to complain effectively or to organize their efforts against their torturers. Then once these doctors-in-training accept chronic sleep deprivation as the new-normal, they carry an expectation of it throughout the rest of their careers. Of course, sleep-deprived people are more likely to be irritable, short-tempered, impulsive, grandiose, and hostile – aka jerks.

4. We were probably jerks to begin with.

Getting into medical school is extremely competitive. Only the very top students make it, and they are generally ranked according to science test scores (not compassion scores or charming personality scores). Successful pre-meds are generally type A personalities with a fierce competitive nature. And what kind of person would sign up for a career where they are harassed, blamed, required to do endless paperwork of indeterminate usefulness, denied regular sleep, and endure hostility from staff, coworkers, family members, and error-prone colleagues? A person with a pretty thick skin and a high tolerance for sadism and/or masochism… also known as a jerk. So, for the few doctors who don’t enter medical school as fully formed jerks already (let’s say they didn’t realize what they were getting into), the work they do will thicken their skin eventually, creating jerk-like personality traits in the end.

A High Jerk Index Surgeon

Is there a jerk scale in medicine? Who are the biggest jerks? Yes, all doctors exist somewhere on the jerk continuum, and you can roughly guess where they’ll be depending upon how likely that an encounter with them will end in your demise. Trauma surgeons, cardio-thoracic surgeons, and neurosurgeons have the strongest jerk traits, while pediatricians, physiatrists, and family physicians are probably on the other end of that scale. There are some exceptions, of course, but actually not many.

What can you do to make the best of having to work with a jerk? At some point, you or a loved one will need medical care (no one gets out of this life alive) so you will probably have to deal with some serious jerks along the way. Knowing that this is in your future, you should probably start planning how you will handle this now. I offer you my do’s and don’ts of jerk management, or how best to ally with your physician:

Don’t:

1. Bring your doctor more trivia. Jerks have a low tolerance for irrelevant details, largely because they are tortured by it daily (such as pages of EMR-generated duplicates of physical exam findings from interns). Think about what you really want to talk about with your doctor and don’t get side tracked with your own personal “hot flash tracker” data or other tangential story that is unrelated to your current problem.

2. Threaten your doctor with legal action or allusions to your “friend the lawyer.” The jerk you’re talking to is already frightened enough about frivolous law suits. If you tap into that fear he or she will just go into self-protection mode and probably harm you with excessive and unnecessary tests, consults, and referrals. Or even worse, maybe they’ll hide information from you.

3. Attack your doctor’s judgment directly. This is a tricky one because your doctor won’t always make the best clinical decision in your case, and you have the right to point that out. The best strategy for getting your way (assuming that you’ve found a true error) is to be friendly about it. Use the Socratic method if you can so that they’ll think they discovered the mistake themselves.

4. Fight fire with fire. You would think that you could get some respect from a jerk by being just as nasty to them as they are to you – and that strategy may work with playground bullies – but unfortunately that rarely helps in medical culture. More likely the physician will become quiet and simply resolve to stonewall you and be extra unhelpful in processing your care needs. You don’t need that.

Do:

1. Be prepared for your visit. Bring a list of your medications, relevant medical history and test results. Write down your questions in advance. Anticipate the questions that your doctor will ask you (if you can) and be ready with focused answers. You will look like a super-star and your doctor will be indebted to you.

2. Be understanding of our lateness. I know it drives you crazy and you feel disrespected by your doctor. But know that lateness can be caused by many things, including ill-prepared patients, really sick people, emergency surgery and golf games. If your doctor is a major jerk and the cause of his/her lateness is golf-related, then at least YOU will feel better if you presume he/she was delayed by a real emergency.

3. Be a “compliant” patient. Once you and your doctor decide upon a care or treatment plan that is right for you, try to stick with it. It’s in your best interest to do so and your doctor will love you for it. Sure, if he’s a big jerk he’ll only love you because your good outcomes make his performance measures (and payment structure) increase, but if he has a conscience he’ll also be genuinely pleased that you’re well.

4. Find another doctor if you need to. Although this isn’t always an option for folks in rural areas, if your doctor is impossible to work with, then you should find someone else to take care of you. Be very polite, get copies of all your medical records, and then take them elsewhere. Don’t be stoic and stick with a total jerk if your care is being compromised by his or her attitude and behavior.

So there you have it. When you have your next unsatisfactory encounter with me or one of my colleagues, please consider that there are some good reasons for our irritability. But being a jerk isn’t always a bad thing, because if your loved one needs a medical champion, then a fire-breathing monster is probably an excellent advocate. You can harness a monster for your purposes if you follow the do’s and don’ts of physician relationship management. I wish you luck with your future encounters with us!

Tags: Arrogant Doctor, Bad Attitudes, Doctor Patient Relationship, ePatient, Jerk, Physician, Surgeons, What To Do, When Your Doctor Is A Jerk

Your Nagging Fitness Questions Answered With Scientific Evidence

July 9th, 2012 by Dr. Val Jones in Book Reviews, Health Tips

I just finished reading a great little book called, “Which Comes First, Cardio Or Weights? Fitness Myths, Training Truths, And Other Surprising Discoveries From The Science Of Exercise” by Alex Hutchinson, Ph.D. I’m very grateful to Alex for patiently sifting through over 400 research studies in a quest to answer (with evidence, not subjective opinion) some of our most nagging exercise questions.

Alex is the perfect guy to do this exercise myth-busting as he is a competitive runner, professional journalist, and has a Ph.D. in physics. His writing is crisp, uncluttered, and bears the understated humor of a Canadian. To be honest, I enjoyed his book so much that I was contemplating blogging about most of his conclusions. However, I don’t want to teeter on the edge of copyright infringement, so I’ll just provide you with some highlights from my favorite sections of the book:

1. Do compression garments help you exercise? I’ve wondered this many times as I jiggled my way down the road on a long run. I’ve always liked the theory behind tight outer-garments, that they reduce unnecessary movement during running, thus making one’s movement more efficient and reducing the bounce and drag on muscles and skin. They may also help with blood return to the heart and reduction in peripheral edema, speeding recovery from exercise. Believing the plausibility of the argument, I have indeed sprung for some rather expensive running tights.

So what does the scientific literature have to say about compression garments’ role in exercise? Apparently there is nothing conclusive yet. Small studies have shown no clear improvement in exercise economy, athletic power or endurance, or recovery from exercise. The only measurable benefits appear to have occurred in those who believed that the compression garments would help their performance. A nice reminder of the importance of the “mind-body” connection in athletic pursuits. Bottom line: if you like how you feel in compression garments, by all means wear them. But don’t expect any dramatic improvements in anything more than your jiggle factor.

2. Will sitting too long at work counteract all my fitness gains? The short answer to this question is: possibly. I was surprised to note that at least one large study found that sitting for more than six hours per day increased one’s risk of death by 18-37% regardless of how much exercise one performed in the other eighteen hours of the day. Long periods of sitting appear to be quite bad for your health, so getting up and moving around every hour or more is important if you have a sedentary job or lifestyle.

3. Does listening to music or watching TV help or hurt my workout? Listening to faster-tempo music can result in increased exercise effort (in many cases completely unconsciously), while TV-watching usually results in a reduced exercise effort. This is because watching videos requires visual attention and subtle changes in balance and movement occur to accomplish it.

4. Will stretching help me avoid injuries? As a person with limited flexibility, I found this section of the book to be quite comforting. As I have blogged previously, stretching has not been shown to reduce the risk of injury or post-exercise soreness. In fact, it can decrease power and speed for certain athletes, though it is important for those who intend to perform great feats of flexibility (such as gymnastics).

5. Should I take pain killers for post-workout soreness? Interestingly, non-steroidal anti-inflammatory drugs (NSAIDs) are not particularly effective in reducing post-exercise pain and can even interfere with muscle repair. NSAIDs block prostaglandins, which are important in collagen synthesis. While NSAIDs are useful in reducing inflammation and swelling in acute injuries (such as an ankle sprain), general muscle soreness isn’t a good reason to pop some ibuprofen.

6. Will drinking coffee help or hinder my performance? I’m one of the few people I know who doesn’t drink coffee, so I was surprised to discover that I may have been missing out on an important exercise enhancer. According to decades of research, caffeine is likely to improve your exercise performance. Studies have shown that pure caffeine (not necessarily in its coffee form) enhances sprint performance as well as endurance activities up to two hours. In 2004 the World Anti-Doping Agency removed caffeine from its list of restricted substances, so expect to see some caffeinated athletes in this summer’s Olympics.

7. What’s the best way to breathe during exercise? If you’ve ever marveled at your own panting, you’ve also probably wondered if there is a more efficient way to breathe – or at least a less embarrassing way. The answer is no. Studies have shown that people who consciously work to make their breathing less labored expend more energy and get less oxygen in the process. So, keep on breathing the way your body wants to… you’re naturally more efficient at it than you think.

I hope that these little tidbits have whet your appetite for more of Alex’s excellent insights. I have fully equipped myself with fast-paced music and a little caffeine, as I move my inflexible, jiggly, panting self down the road on another long run.

Tags: Alex Hutchinson, Book Review, Breathing, Caffeine, Cardio Or Weights, Exercise, Fitness, Myth-Busters, Mythbusters, Myths, Olympics, Running, Stretching, Tips, Which Comes First