Teaching Your Doctor – Health Care Tips You Need to Know

As patients, we all like to think our doctors are on top of their game — they know everything there is to know about our particular health problem. We like to think this because we are putting our health and our lives in their hands.

However, what we really should be thinking is how can doctors stay current on all the new developments, knowledge and recommended treatments available? After all, there are so many new medical findings/reports given everyday it is impossible for any one doctor to stay current in all areas of medicine. It is even a challenge for a doctor to stay current in one specialized area of medicine.

Yes, doctors are required to take continuing education classes, but the number of hours required per year is minimal compared to all the new medical information available each and every day. To stay current, doctors need to make a concerted effort to learn what is new in their particular practicing area. Doctors who are expert lecturers even hire full-time staff to review all the available new medical information. That is how they stay current and can be considered experts.

The point of sharing these thoughts with you is, no matter how good your doctors are there may come a day when they cannot answer your specific questions. They may not know about a particular new treatment, may not know about a change in the current standard of care. You, the patient, may find yourself educating your doctors about something you have read. Think this is not likely to happen, then think again! This happens much more often than we like to admit. Here is an example of a real-life situation a friend recently shared with me . . .

Sarah (not her real name) recently told me she had been feeling very tired and was gaining weight. Her doctor was running some blood tests and was checking her thyroid function. She would know about her test results in a few days. A few days later she told me her blood tests came back fine, within the normal lab ranges. I asked her what her TSH value was and she said it was 4.8. Her doctor thought they could repeat tests in about 3 months.

I was shocked to hear her doctor thought a TSH of 4.8 was normal. I thought she was probably becoming hypothyroid. I explained to her that the American Association of Clinical Endocrinologists (AACE) established new guidelines in 2003 for the TSH range and the new normal range for TSH is now 0.3 to 3.04. Using this narrower range, Sarah would be considered hypothyroid (not enough thyroid hormone) and would be given thyroid supplements.

I suggested Sarah visit the AACE website [http://www.aace.com/newsroom/press/2003/index.php?r=20030118] or Mary Shomon’s thyroid column at http://www.about.com to learn more. (Mary Shomon is the guide for thyroid issues and she provides patients with a great deal of helpful thyroid information.) I encouraged Sarah to speak with her doctor now and not wait three months. Sarah’s doctor was following old standards and most likely did not know about the narrower TSH range. Her doctor was just reading the range the laboratory provided instead of following the new guidelines.

Sarah’s situation is just one example of a doctor not knowing the latest information. In case you find yourself in a similar situation, here are some helpful tips when educating your doctor:

  1. Do your health homework. No matter what doctor you see, you need to verify and discover information yourself. Go to reputable medical sources on-line and print out copies of information you want to discuss with your doctor. Reputable medical sources are sites run by well-known doctors, organizations, or universities like http://www.webmd.com or http://www.americanheart.org. Avoid sites written by unknown individuals merely express an opinion and not verifiable facts. For rarer medical information, visit medical libraries and ask the librarian for assistance in finding answers to the questions you have. No matter how you do your homework — have a hard copy to show your doctor.
  2. Ask your doctor for some time to answer your questions and show him or her printed material. They may want to see the specifics for themselves before they can comment. One of several scenarios should then follow: The best scenario would be for your doctor to already be aware of the information you are providing and for you both to have a thorough discussion about it. The next best scenario would be for your doctor to be unaware of the information and for him or her to be willing to look into if further for you or refer you to someone who is more knowledgeable in that area. Perhaps the worst scenario would be for your doctor to be unaware of the information and be unwilling to take the time to discuss it with you.
  3. Smart doctors will react to information a patient presents by either already knowing the information or by wanting to know more about the new information. Smart doctors know they can always keep learning and they are not offended by patients asking questions and providing information. They are often grateful for patients who bring important issues to their attention because it may help them treat other patients better in the future. You should seek out doctors who are willing to discuss information with you and have a true partnership relationship when it comes to your care.
  4. On the flip side, you should avoid doctors who are unwilling to discuss new information with you. If they are too busy to answer your questions, then you don’t need them. Stay with them only long enough to find a new doctor who will have a quality doctor-patient relationship with you. You need a doctor who has your best interests in mind. Remember in the end, it’s your or your loved one’s health at stake.
  5. Doctors are human beings too. They genuinely want to help people. That is why they went into medicine in the first place. Just like you, they have many time pressures on them and in this fast-paced world it is not easy to keep up on everything new in medicine. Give your doctors the opportunity and flexibility to help you before you decide to move on. If they are willing to spend time answering your questions, but ask to do so at an alternative time or by an alternative means, then try being understanding and work with them. Some doctors have a time during the day when they are more easily able to speak with patients by phone or some will even communicate with patients via e-mail. The best solution is to find a way to get your questions answered that works for both you and your doctor.

Mature Age Students: The New Generation Our Health Care Sector Needs?

The mature age student is studying because they choose to. Often they have come to a point in their lives where, through experiences both good and bad, they have found themselves, their passions and desires and are now ready to commit to doing something with those drivers. Generation X is not your typical mature age student. They are commonly men and women who are no longer under their parent’s roof, and are making a life for themselves with little assistance from common avenues of support. Many are raising children single-handedly.

The mature aged student frequently juggles multiple jobs, children, a standing in their community, a social life, their studies, and a never ending thirst to be better, to do more and to make their lives worth something greater than the individual.

The women are not pursuing marriage as a mechanism for material security and well being. They are out there doing it for themselves and often alone. The men are also doing it hard, trying to find their place in a society which has emasculated them since the feminism movement took root. They have kids, but not necessarily living under the same roof.

So where is the support for the mature aged X Gen who have played hard, defined themselves through experiential means, who have burned themselves out on striving for achievements, money, fame, fortune, professional prowess, and recognition. These ‘X-Genners’ have risen like the proverbial phoenix out of the fires of oppression known as the traditional husband/wife scenario and into the world of self support and fierce independence. But with this independence there comes a price. Our freedom has set us loose from our support networks of parents, wives, husbands, partners and we find ourselves disconnected from each other and more problematic, from ourselves.

Often our gypsy-like nature has resulted in unstable living arrangements, high debt and little assistance to help facilitate a life change into the next phase of self development. Our quest has been to live hard, learn much and at the end of it all, we find ourselves thinking… there has to be more to life than this. We are ready to step into our power and pass on what we have learned to our communities.

The X Generation is the new movement in health care of this nation. In recent years there has been a massive influx of X-Genners returning to formal and informal studies, many of us have not before completed an undergraduate degree, and we are commonly turning to fields of studies that are completely unrelated to our previous lives. Amongst the students I cross paths with through my mindfulness and meditation training is aspiring nurses, social workers, psychologists, bio-med and education. These progressive and open minded students are intent upon affecting healing change upon the world. They are the souls that will guide our next generation of children and teens into a peaceful, healing and authentic society. Interestingly, their drive to healing pursuits comes from their own direct experience with trauma, illness and major life disruptions that have forced a different view, a new way of being.

And what a great place for them to direct their attentions. They are perfectly suited to the health care industry. These students are well traveled, have a wealth of personal first hand experience of how tough the world can be if in a weakened or dis-empowered position in society. They have developed a deep emotional intelligence, understanding and compassion for their world and they have grown to know themselves intimately. Many of them have moved from being cared for, to being the carers of children, parents and grandparents.

Yet, the admirable qualities of tenacity, resilience, motivation and passion that the mature aged student possesses along with their multi-skilled and learned talents seem to have no support from government or other organisations to support their transition into this new era.

The government desperately needs the mature age student. The severe shortage of health workers is becoming an epidemic of mythic proportions. Government is throwing money at education facilities in the form of scholarships and bursaries, discounted health care programs, commonwealth supported undergraduate degrees and Austudy. And yet, we are faced with a post-study debt that continues to make study a financially debilitating endeavour.

Most of the Government subsidies such as Austudy are aimed at school leavers, many whom are still living with parents or have financial support from family members, This subsidy doesn’t even cover the rent for most mature aged students, in fact moving from Newstart allowance to Austudy in order to study full time, rent assistance is removed entirely. Why is it assumed that if you are an older student you no longer pay rent?

Centrelink Newstart offers marginally more financial support, but only if you are looking for full time work whilst studying. Working full time precludes full time study if either is going to be of any worthwhile quality. Part time study requires part time work, but this is no-mans land and there is no support at all, and yet this is the reality for the majority of mature aged students with family commitments thrown in.

The Commonwealth supported placements in health care have helped, certainly, but does the government understand how expensive the educational costs such as books, equipment, uniforms, extracurricular requirements such as vaccinations, CPR certificates, travel to placements, etc. are for the student in a health related undergraduate degree, not to mention the ancillary costs like day care and days of work lost due to placements, residential schools, lectures and tutes. It’s astronomical.

Educational Institutions are trying, but still falling short in helping mature aged students to make ends meet and raise their families whilst noses are in the books. Many Universities have grants and equity funding for financial hardship situations, but these programs are not promoted. Flexible, online and distance education is becoming a very efficient and do-able method of learning offered by many Universities and this intelligent use of technology is to be commended. I would like to see more educational institutions offering crèche or day care services with government or student services subsidy to assist parents to get to lectures, libraries and allow study time on campus. This would greatly ease the pressures of juggling commitments around family responsibilities.

In these trying financial times, when managing the cost of living has raised beyond the reach of most single income families, it seems remiss for the government to leave the financial assistance to independent charities and welfare organisations such as the Salvation Army and the Smith Family. But for many, turning to welfare assistance has become a depressing and humbling reality… ‘Thank God for the Salvos’ has become a common catch cry.

I am a single, white, female who doesn’t own my own home, who stands independently from her parents, with two toddlers who require full time focus and attention, and who has experienced the pain and suffering of the world alongside the wondrous and exciting. I have trialed all that life has to offer, and now I wish to give back via the health care industry. Am I a minority? No. I am the archetype of the next generation of health care workers. I am an example of the type of student the education system needs, the type of worker the health system needs – desperately. I am at a point in life where, through first hand experience, I have learned what it is to care for self and others, and I have honed the skills of commitment, self motivation, compassion and responsibility with which to succeed at my goals.

There is a myriad of support for the under-privileged, uneducated and inexperienced, but virtually nothing for those in the world who are older, and trying to do it for ourselves, who are following our passions despite the challenges and road blocks… and we are ready to help others. We have paid our taxes, we have worked hard, and we are now changing directions. The government and educational institutions need to keep up and lend a greater hand.

By Kristy Lee Rackham©2011
Author of Head Space-Meditate Your Way to Study Success

Three Examples of Reducing Patient Wait Times at Health Care Sites

The third habit of Stephen Covey’s The Seven Habits for Highly Effective People is Put First Things First. The basic premise is that for many there are a lot of things competing for our time and attention. Some are important; some not. Some are urgent; some not. Covey emphasizes that we should prioritize our time to concentrate on the important but not urgent. To achieve this goal requires some reflection and decision-making skills, as well as some trial and error.

In many healthcare settings I think many believe that it would be a luxury to able to actively decide what is important and what is not urgent and focus on these things. There does not seem to be enough time to get the important things done. Many if not most tasks seem urgent. Consider a visit to the primary care physician. The standard seems to be that a patient will get a 15 minute visit. Spending more time would not produce enough income. Even if it is important that a visit be longer, affording the time seems impossible. This is just one example. I am sure that each of you can recount many daily situations where finding time to get the important things done is next to impossible.

Fortunately there is an approach to finding more time to get the important things done, so that the urgent become much less so. The path lies with taking the approach of the Toyota Production System of identifying wasted time and eliminating it. Wasted time in the TPS is one of the seven types of waste. Since most in healthcare are not trained to recognize wasted time or effectively change it when we do recognize it, we end up delivering less effective care than we would like at times. Consider the following examples of wasted time:

A. A surgery scheduled in a hospital is delayed or postponed because a vital piece of information such as a test result does not show up in time. Delays in scheduled surgeries are all too common in some hospitals because the right information such as test results cannot be found or a member of the surgical team is delayed in arriving.

B. There are long waits in the emergency department for most patients except the critical ones. There just does not seem to be adequate staff to meet the volume of service demand. With the increase of patients due to the increasing number of uninsured, the problem seems only to be worsening. These delays affect the bottom line of the hospital as patient throughput drops.

C. Patients at primary care sites have to wait past their scheduled appointments or have to wait for weeks or longer to schedule appointments for noncritical care. The Institute of Medicine identifies timeliness of delivery of care as an important goal for the primary care site in Crossing the Quality Chasm. Not doing so can cause serious problems. For instance, a patient who cannot get an appointment within a day or two of calling may experience a complication of a problem which would otherwise could be treated simply. Having patients endure long waits for scheduled appointments can lead to stress and ill will towards the health team at the site. In any other service market, such as financial products markets, such treatment of customers would not be acceptable. The customer would undoubtedly find a better service provider. Although healthcare patients seem to accept delays as inevitable, physicians are most likely losing patients, losing income because of lower throughput of patients, and experience more difficulty interacting with patients who feel neglected.

These delays and many like them can be overcome. More time can be found to get the important things done. It will take changes in culture and thinking, changes in communication, and learning the use of new tools and approaches to accomplish the changes.

Let me illustrate what can be accomplished and what it takes to achieve them with some examples. In one emergency department there were often long delays in providing service. A lean quality expert studied the activities of the triage nurse. The quality expert in mapping the movements of the nurse with a tool used in Lean production-a spaghetti diagram–found that the nurse was walking approximately 10 miles each shift. At a normal walking pace that is four hours of walking, time not accomplishing the tasks he or she should be doing. With a team of representatives from the ED that time was cut down considerably and patient wait times decreased significantly. Patient throughput increased.

At Virginia Mason Hospital delays in surgery were considerably lessened using the pull system and takt time from the Toyota Production System. The ideas behind the two concepts is that all the necessary tools, personnel, patient and information arrive at the right time for the surgery to begin on time and proceed without delay. The timing of the flow of personnel, patient, instruments and information is carefully measured over many occasions, identifying bottlenecks and waste as measurements are taken. Teams then work to eliminate the waste and unblock the bottlenecks. By eliminating wasted time, eliminating bottlenecks, and coordinating flows, delays are mostly eliminated. To accomplish these changes at Virginia Mason it was necessary to change the culture of the hospital. Leadership had to learn and understand the Toyota Production System and actively support it. Staff needed to learn new ways of working together in teams to identify and eliminate waste and bottlenecks. The changes did not come easily or quickly. Much of the experience of change at Virginia Mason Hospital is described in John Black’s book The Toyota Way to Healthcare Excellence.

Primary care facilities can overcome many of the patient delays with open access scheduling. With open access scheduling, time is left open in patient scheduling so that patients can call in for an appointment and be seen either that same day or the next day. Using open access scheduling not only decreases delays for the patient it also improves patient throughput. The number of no-shows for appointments decreases, thus improving throughput. Implementing open scheduling is not easy. It requires patience, much effort by the staff working as a team, and often a change in focus to become more patient-centered.

As Stephen Covey points out, it is very necessary to focus on how we spend our time so that we can be highly effective. Time seems to be a precious commodity at most healthcare sites and always in short supply. Using approaches and tools to identify and eliminate wasted time-a hallmark of the Toyota Production System-can dramatically improve patient outcomes and financial outcomes. To achieve these goals requires a new ways of working together and active involvement by leadership in guiding the necessary changes. The task is not easy.

American Patients See Mexico As a Better Health Care Alternative

Plastic surgery in Mexico is getting a bit more organized. Due to the demand for lower plastic surgery cost and consumers still demanding savings for medical care, affordable plastic surgery in Mexico is again on the hype.

Two weeks ago, Grupo Angeles, the parent company of Mexico’s largest private hospital group, Hospital Angeles, signed a contract with Health Travel Guides (HTG) to provide the technology infrastructure for managing its medical tourism operations. Another leading medical tourism agency, GoSculptura, now provides excellent but affordable plastic surgery packages in Mexico. GoSculptura now includes Mexico in its network of medical vacation destination and now has more than 500 satisfied patients and a 97% satisfaction rate. Other agencies such as Healthbase also chose the country to be part of its health care network and provide U.S. patients satisfactory plastic surgery in Mexico.

The overwhelming plastic surgery cost and the long wait to get medical treatment are two of the top reasons why American patients travel to other countries to receive medical and dental work. Whether a good new hip and a nice new face, you might have to dig deep into your wallet or wait several months before receiving the medical or dental care that you require. In 2006, more than 50,000 Americans go abroad to acquire affordable plastic surgery and dental work. According to the National Coalition on Health Care, year by year millions of patients from all places go to Mexico, Argentina, India, Dominican Republic, Brazil and Costa Rica. The reason – to evade the trauma of plastic surgery cost, to acquire affordable plastic surgery with less time to wait and experience inclusive vacation package and recuperation activities. These countries are top notch medical destination places where health care, medical facilities and surgeons are comparable and may exceed the quality of health care of the U.S.

As of now plastic surgery in Mexico is at the height of fame, thanks to medical tourism agencies. Mexico offers the same medical care quality as the U.S. but goes out with rock-bottom plastic surgery cost. Although the medical care in Mexico may not be as inexpensive as the ones in some Asian nations, the proximity to the U.S. is a big advantage to patients. Some U.S. companies are now sending employees to Mexico for their annual checkups. Some expert also find Mexico as a definite answer to treat the aging and under-insured Americans at a time when the retirement of baby boomers will further tax the U.S. health care system. An estimated 43 million Americans, about 15 percent of the population, are uninsured, according to a Census Bureau study.

The growth of medical tourism in Mexico and how the country will mature in terms of health care will determine the future of most American patients. According to Peter Maddox, Christus Health senior vice president for business, strategy and corporate development, “Our country will go broke unless we find a health care alternative”. He sees Mexico as a wonderful alternative with incredible potential.

Dog Health Care for Pet Owners

As pet owners, we all want to improve the health and well-being of our family dog. Dog health care makes both animals and owners more pleased. It can certainly be a little difficult understanding problem dog health signs and symptoms, however it’s also fun and helpful to you and also your own family dog. Healthy and balanced dogs are usually content dogs and makes for a wonderful companions!

Understanding about various types of signs and symptoms, as well as just how to take care of your own family pet in a normal and also nurturing method will give you a much better lifestyle for your friend. As you handle your dog and make its health better, a closer connection is formed. We now have a few tips to assist you with dog illness diagnosis and also to give a more natural health for any dog which will totally strengthen your friendship with your furry friend.

1) Oral health and nutrition is of the utmost of importance to your dog’s overall health. If a pet dog doesn’t have strong teeth, then it can’t eat properly. For nutrition, one can consult a dog breed guide, as differing breeds have different food needs. For the teeth, there’s regular old cleaning or perhaps dental food products that can help.

2) What food you provide (or don’t provide) your pet, both people and dog food will go quite a ways in the direction of ailment avoidance. Fresh fruit similar to grapes is just not good for the dog. Another rule is that most vegetables are great for your pup. Look for additional info from your local veterinarian in case you are unclear. Dogs are usually omnivorous along with a blend of vegetables and necessary protein is wonderful for them – simply check to be sure which ones.

3) Do not provide the dog chocolate. It’s not really good dog care to begin with, but chocolate contains Theobromine. Keep on hand a few wholesome alternative snacks that they can enjoy. You can even find unique bakeries for most dogs today.

4) Arthritis can be quite a discomfort in the important joints for both pet dogs and humans. Needless to say, medications and therapy are very different with animals and humans. A veterinarian will make good quality suggestions if the medical diagnosis suggests arthritis. You will find nutritional vitamins, supplements, prescription drugs, as well as special pet food which supports your dog’s arthritis.

5) Physical exercise. This can be a easy and free of charge method to boost the health and fitness of your pet. If your dog is actually obese it can lead to most of the identical pathologies humans may build up. Exercising your pet is a symbiotic relationship as you’ve got to do a similar thing your dog is performing (for example walking or even jogging) so that you may also experience the benefit!

Take your pet to regular veterinary appointments, take care of him or her your self on a daily basis, and ensure that you workout – both of you, that is! Continue to keep a journal for your own dog and this may really help the vet if a thing critical arises.