Have an appointment with the doctor? Tips show what to ask

Good general info for anyone of any age, no matter what symptoms or disease you may have.

 

by John Beale

Good communication between patients and their health-care practitioners is essential for good care. To help older adults better communicate with their health-care providers, the American Geriatrics Society's Foundation for Health in Aging has released a new, easily understandable tip sheet.

 

The tip sheet, "How to Talk to Your Healthcare Practitioner: Tips on Improving Patient-Practitioner Communication," outlines steps older adults and their caregivers can take before, during and after a visit to a practitioner. These steps help ensure practitioners, older patients and their caregivers get the information they need. The tip sheet is available online at: http://www.healthinaging.org/public_education/communication_tips.php.

 

Before visiting a health-care provider, the tip sheet advises older people to, among other things, make a list of any symptoms or health problems they have, as well as past health problems, any treatments they've undergone and any adverse reactions to treatments they have had.

 

Bring medications

It also encourages older adults to put the medications, supplements and other remedies they're taking in a bag and bring it to their appointment. That way, their practitioner can see what they're taking and at what doses - important information, since medications may interact and some may affect medical test results.

 

The tip sheet also advises older adults who don't speak English as a first language to consider looking for a practitioner who speaks their native tongue, bring along a bilingual buddy to translate or call the office and request a translator ahead of time.

 

The tip sheet encourages older patients and their caregivers to answer all questions frankly, to request explanations when needed and to ask follow-up questions, such as "Are there any risks associated with this treatment?" and "Are there any alternative treatments?"

 

Understanding is vital

It also suggests patients and caregivers repeat back what their providers tell them about their health and treatments to ensure they've understood correctly.

 

After an appointment, the tip sheet advises older patients to contact their practitioner's office if they don't feel better, if they have an adverse reaction to a medication or other treatment or if they realize they've forgotten to mention something important that's relevant to their health.

 

Other easy-to-read health tip sheets for older adults and their caregivers cover such topics as cold and immunizations, falls prevention, emergency planning, and joint replacement surgery for older people.

 

Anyone who does not have online capability may call the Office for the Aging at 845-486-2555 for tip sheet copies.

 

From http://www.poughkeepsiejournal.com/article/20090629/COLUMNISTS06/906290301/1005/LIFE

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How to Talk to Your Healthcare Practitioner: Tips on Improving Patient-Practitioner Communication

The list mentioned in the article from http://www.healthinaging.org/public_education/communication_tips.php

 

Good communication between you and your healthcare practitioners -- the physicians, nurse practitioners, nurses, physician assistants and other healthcare professionals you see -- is essential to good care.

 

It's important that you give your practitioner the information about yourself and your health that he or she needs to provide quality care. And it's important that he or she explain what you need to do to stay as healthy as possible, in a way that you understand.

 

Here's what experts with the American Geriatrics Society's Foundation for Health in Aging (FHA), suggest:

 

Before your appointment

Make a list Visiting a healthcare professional can be stressful -- particularly if you're not feeling well -- and stress can make it harder to remember what you need to tell and ask your practitioner. So make a list and bring it to your appointment. Write down any health problems you have had or do have, and any surgery or other treatments you've undergone. Write down the names of any medications you've taken that have caused unpleasant or dangerous side effects. If you're sick, write down all of your symptoms.

 

And don't forget to write down any questions about your health that you might have. You can find comprehensive lists of questions that older adults should consider asking their healthcare practitioners - organized by subject - on "Aging in the Know" (www.healthinaging.org/agingintheknow/questions_trial.asp), the FHA's free senior health website.

 

Bring your medications, vitamins, and other remedies to your appointment Before leaving for your visit, put all of the prescription drugs, over-the-counter medications, herbs, vitamins, and other supplements you take in a bag. Take them with you and show them to your healthcare practitioner. This way, he or she will know exactly what you're taking, when, and at what doses. This is important because some drugs, herbs and supplements can interact with medications your practitioner might prescribe. They might also affect the results of certain medical tests.

 

Pack paper Bring paper or a notebook to your appointment so you can write down what your healthcare professional tells you. If you have trouble remembering later on, you can look at your notes.

 

Consider asking a buddy along A family member or close friend who goes with you when you see your healthcare professional can offer your practitioner information that you might forget or overlook. He or she can also help you remember what your healthcare practitioner says. If you want to discuss something with your practitioner alone, you can always ask your relative or friend to leave the room while you do so.

 

Call ahead to request a translator if necessary If English is not your first language, you might seek out a healthcare practitioner who speaks your native language. Other options include bringing a bilingual buddy with you to your appointment, or calling your practitioner's office ahead of time and asking if staff can supply a translator.

 

During your appointment

Answer questions honestly It's essential that you answer all of the questions your healthcare practitioner asks you, even if he or she asks about topics that might make you uncomfortable, such as mental health problems, drinking, and sex. There's nothing to be embarrassed about. Your practitioner needs complete information to provide proper care. And everything you tell him or her is confidential.

 

Ask questions If you don't understand what your healthcare professional tells you during your visit, ask him or her to explain it. You need to -- and have a right to -- understand what your practitioner says. It's particularly important that you understand any treatments he or she recommends. You should ask if there are any risks associated with treatments, and if there are any alternatives.

 

Mention any cultural or religious traditions that might affect your care If your healthcare practitioner recommends that you eat foods that your religion prohibits, for example, or if you need to fast at certain time of the year, tell him or her.

 

Repeat back After your healthcare professional explains what you should do to stay healthy, or to treat a health problem, repeat this back to him or her using your own words. You might start by saying, "So, you're telling me that I should…." If you've misunderstood his or her advice, your practitioner will realize this, and clarify.

 

Ask for written instructions If your healthcare practitioner puts his or her advice in writing, you can refer to the written instructions at any time.

 

After your appointment

Call your practitioner's office if you don't feel better, have a bad reaction to medications, or realize you forgot to mention something If you don't feel better after your visit, or seem to be having a bad reaction to medication your healthcare professional prescribed, call his or her office immediately. You should also call if you realize, after leaving the office, that you neglected to ask a question or provide information about your health, or didn't understand what your healthcare practitioner said. Ask to speak with your practitioner as soon as he or she is available or ask to speak to another healthcare professional in the office who can help you.

 

Communication between you and your healthcare practitioner is an ongoing process. The simple tips above can help improve communication. Improved communication means better understanding, diagnosis and treatment.

Addison's Disease and two of its famous sufferers

From http://www.abc.net.au/rn/science/ockham/stories/s18569.htm

with Robyn Williams
on Sunday 31/01/1999
Addison's Disease and two of its famous sufferers
Summary:
John F. Kennedy and Jane Austin both had Addison's Disease. While John F. Kennedy survived the disease, Jane Austin died from it.

Transcript:

Robyn Williams: This week Ockham's Razor is presented by one of its great stalwarts: Dr Jim Leavesley, a great expert in the indispositions of the famous. He's now retired in the beautiful Margaret River south of Perth. Jim.

Jim Leavesley: It is not now fashionable in medical circles to call diseases by their eponymous names. To do so is said to be confusing to those not in the know. So pathologically descriptive names are used, the Greek or Latin bases which are supposed to be universally understood.

For we old fogies, the passing of a named disease is a pity, for not only do we honour the person who first described the condition, but eponymous names are often much more mellifluous than dry descriptive tags. For instance, it is much more satisfying to say someone has Charcot Marie Tooth syndrome, or von Recklinghausen's Disease, rather than the politically correct peroneal muscular atrophy or multiple neurofibromatosis.

But one or two have slipped through the net. Meniere's syndrome, Alzheimer's disease, Parkinson's disease, spring to mind as well as the one I wish to look at in conjunction with two of its victims, Addison's disease.

In 1795 at Long Benton, a village just outside Newcastle-on-Tyne, in northern England, the wife of the local grocer, Joseph Addison, was delivered of a second son. They called him Thomas.

A bright lad, he went on to Edinburgh to do medicine and qualified in 1815. From thence to Guy's Hospital, London, where he became an assistant physician in 1824 and the full works in 1837.

He was a contemporary of Richard Bright, of Bright's disease, and of Thomas Hodgkin, of Hodgkin's disease. What a trio.

Anyway, whatever mental jousting went on, it did not lift Addison's mood, for he was a chronic depressive. He made several attempts on his life until in 1860, he retired to Brighton, disturbed enough to have need of two constant attendants. Despite the care, within months he managed to elude them, flung himself down a stairwell and died of a fractured skull.

But let's go back a bit. On 15th March 1849, Addison had read a paper to the South London Medical Society entitled 'A Remarkable Form of Anaemia'. He cited three cases of increasing lethargy, but made no mention of those characteristic features we associate with his disease, skin pigmentation and low blood pressure. He didn't know how to measure that, anyway. He did note, however, that at post mortem there was a disease of the suprarenal glands, situated just above the kidney.

He did not connect the anaemia and suprarenal condition and said he had stumbled on a second condition, which he called 'melasma suprarenale.' It is this we now call Addison's disease. However, it did show for the first time that the adrenals were necessary for life, and it has been said that the whole of endocrinology dates from 15th March, 1849.

He did not publish until 1855, by which time he had separated the two anaemias, one he called 'pernicious', later known as Addisonian anaemia. The other he associated now with bronzed skin and suprarenal pathology, true Addison's disease. Publication produced no fanfares, no royal honours and his fame has been mainly posthumous. In any case, he was too late for our first famous patient with Addison's disease, who was that model of sense and sensibility, Jane Austin.
Like its houses, its chairs and its coffee pots, 18th century England has managed to convey to us a society which was at once both sensible and elegant. It seemed to manifest good manners, piety, and cultivated discernment.

At least it did if you were of 'the gentry', which was the case with Jane Austen, one of the greatest writers in the English language. It was a lifestyle which provided the ideal ambience in which her genius could flourish.

Daughter of a clergyman, the seventh of eight children, she led a life of gentility and ease spent entirely in the quieter rural southern England. She drew her characters from her own circle and never strayed from the world in which she moved.

Further, she was much too well bred to let her own name grace the title-page of her novels. All her books were styled as being written, 'By a Lady', as indeed they were.

Her towering reputation is based on only six works of fiction written between the ages of 34 until her death at 41. They have never been out of print in 175 years, and have flourished even more during the last decade or so.

She never married, and it appears the creative impulse, then customarily fulfilled by the task of being a wife and mother, was in her attained through her art. She took considerable pains to conceal from her friends and visitors the nature of her life's work, and wrote on small pieces of paper, the more easily to slip under a blotter or into a drawer if chanced upon. She said her books were her children and she was later remembered as the caring wit of the family.

Jane Austen was born 20 years before Addison, in 1775, into a closely-knit family in which she led a sheltered home life, interspersed with occasional visits to Bath to take the waters, or to the nearby houses of her elder brothers.

It all sounds like a rural idyll, and so it was, until June 1816, when at the age of 40, she had an attack of nausea and vomiting and low backache.

In July she was depressed and felt weak. This was put down to her dissatisfaction with the book, 'Persuasion', which she had just completed. Two months later it was noted she tired easily, had uncharacteristic mood swings and further back pains. She improved and life progressed in its customary premeditated way.
In December she declined an invitation to dinner, saying 'The walk is beyond my strength, though I am otherwise very well.'

The following months she wrote to a friend that she was stronger but felt 'bile' was at the bottom of her nausea and malaise.

All pretty vague so far. Then in March 1817 Jane wrote to her favourite niece, Fanny, and in it gave the clue which could lead us to the likely diagnosis. She wrote, 'I certainly have not been very well for many weeks; I have a good deal of fever at times, but am considerably better now and recovering my looks a little, which have been black and white and every wrong colour. Sickness is a dangerous indulgence at my time of life.'

She wrote to a friend two months later, recounting details of recurrent vomiting, concluding, 'My chief sufferings were from feverish nights, weakness and languor.'

We know the slightly built Austen was bright eyed and had an olive complexion, certainly not 'black and white and every wrong colour.' A visitor in May observed the author was looking very pale and spoke in a weak, low voice.

A concerned family moved her to Winchester to be nearer expert medical help. It was of no avail. Over a six weeks period she became progressively weaker and had a number of fainting fits, until on July 18th, 1817, after several hours of unconsciousness, Jane Austen died in the arms of her only sister, Cassandra.
So what did she have? Well I don't think she died of boredom, as someone unkindly suggested. The story is one of unimpaired intellect but increasing languor and intermittent backache, fainting attacks, gastrointestinal disturbances, and fever, especially at night. Night sweats are a well-known feature of tuberculosis. Added to all that, and crucially, is a darkening of the face. The delicacy of the era regrettably precludes us from knowing about skin changes elsewhere, especially the vagina, in the mouth or where pressure was applied to the skin, at the waist, for instance.

A number of conditions come to mind, but probably only one fits the whole scenario.

The lassitude could have been due to a rare neuromuscular condition, myasthenia gravis, but there seems to have been no speech or swallowing problems. Maybe the heart could be implicated with an infection of its valves, or bacterial endocarditis, but fainting crises are not a feature of this. Perhaps cancer of the stomach with anaemia from the slight but persistent blood loss which characterises the condition. The digestive problems did not seem either very great or progressive.

Skin discolouration occurs in a number of general diseases: the rare so-called bronzed diabetes, or haemochromatosis, but the other symptoms do not fit; chronic inorganic arsenic poisoning with its raindrop pigmentation and abdominal symptoms, or indeed poisoning from any of the heavy metals, lead especially, possibly from medication or water pipes. But the other history is inappropriate and no other family member was affected.

No, none of these seem right. From the admittedly rather thin records, coupled with the melancholy fact that living in the country she did have ready access to almost certainly tubercular contaminated milk, the most likely diagnosis is Addison's disease due to TB of the hormone producing suprarenal glands.

As we have seen, it was not until 1849 that Thomas Addison first described the malady. It's best known features are weakness and skin discolouration which he described as 'various tints of deep amber or chestnut brown.'

One alleged feature was not displayed. My old forthright chief used to claim, rightly or wrongly, that tubercular patients, possibly due to their low grade persistent fever, were almost always more sexually charged than the general run of the population. No hint of sexual impropriety in Miss Austen has come down to us.

Whatever her private life, we know from her books that Jane Austen was a consummate writer whose genius was tempered with gentle humour and a subtle insight into the nature of humankind. It is better we remember her thus, rather than someone who suffered from an uncommon and debilitating medical disorder.

Until the mid-20th century, tuberculosis was the prime cause of Addison's disease. Now it is likely to be an auto immune reaction, as was believed to be the case in that other famous sufferer and quite different personality, John F. Kennedy.

I have spoken before in this place about Kennedy, so will not burden you with the details again. But briefly, during the 1960 Presidential campaign, a Republican questioned the candidate about an article in the November 1955 edition of the American Medical Association's Archives of Surgery, and which was concerned with operating for one reason or other, on sufferers from Addison's disease. The questioner wondered if JFK was one of these cases.

The piece was entitled 'Management of Adrenocortical Insufficiency During Surgery'. Of the three listed cases, one told of an unnamed man in for a bone fusion, and insertion of a metal plate who had had Addison's for seven years, and who was managed by desoxycorticosterone pellets every three months and 25 milligrams of cortisone daily by mouth.

It was a typical bread and butter piece for that journal, but suddenly became hot political property when at the end of the piece the authors inserted a quite unnecessary throwaway line which sparked off the question. They simply wrote, 'The operation was accomplished on October 21st, 1954.'

Now on October 11th, on page 39 of The New York Times, it was reported that 37-year-old Senator Kennedy was entering hospital for spinal surgery. On the 21st it wrote he had undergone the operation that day. On February 26th 1955 it saw fit to record that the plate had been removed.

Now you don't need much nous to conclude that two people of the same age, with the same spinal condition, having undergone similar surgery in the same hospital and who returned on exactly the same day four months later to have the plate removed, were in fact one and the same. So we know for certain John Kennedy had Addison's.

His treatment was successful, but in those days, dosage of cortisone was chancy. Accumulating drug gave a fullness of the face, a so-called moon face, which in the President gave him those boyish good looks and appearance of rude good health which made him the darling of the chattering classes.

It increased energy and JFK's well-known bedroom athleticism may have been enhanced by the treatment, though his back will have suffered.

Kennedy did not die of the disease, Jane Austen did. Treatment was relatively unrefined in one and non-existent in the other. The basic cause in one was probably tuberculosis; in the other, an auto immune reaction. The victims had widely differing personalities, but both had one thing in common, and something which indeed they shared with Thomas Addison: they touched the lives of countless people in all corners of the globe and have gone on doing so long after their deaths.

Robyn Williams: Jim Leavesley, in forensic mood, as always. His book is called 'What Killed Jane Austen, and Other Medical Mysteries', published by Harper Collins.
Next week, Sue Taylor has trouble with elephants. I'm Robyn Williams.
Guests on this program:

Dr. James Leavesley
Margaret River
Western Australia
Author of the book: "What killed Jane Austen and other Medical Mysteries", published by Harper & Collins