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Saturday, May 17, 2008

Secrets of Great Doctors

Become a Smart Patient

To be a smart patient, you can't be passive; you need to be a first-rate Sherlock Holmes. Like Holmes, smart patients ask intelligent questions and have the instincts (and guts) to politely challenge things they don't understand. They don't need to know the most esoteric medical details, but they need to put at least as much effort into finding out the basics about their health as they did in getting the driving directions to our office. Ultimately, you are the person most responsible for the success of your health. Here, what great doctors know that great patients can learn.

1. Get your stories straight. Bring your spouse or partner to your doctor's appointment when you're giving your health history or describing a problem; there are a lot of questions that only a partner can answer (such as how many times an hour you stop breathing while asleep). But beware the doc's sixth sense. When you tell us that you rarely tear into the Pringles after 8 p.m. or that you've been taking your cholesterol-lowering drugs with the discipline of a Marine, your spouse will shoot you (or us) a look that says, "Are you kidding me?" We never miss it. And hey, sometimes your spouse wants to blow your cover. It's called love. But if you try to snow us, we might try to trip you up. For example, we'll ask if you're fit enough to climb three flights of stairs. You'll say yes, unless you're over 85 or bedbound. Then we'll ask, "When was the last time you climbed three flights?" You'll say "Maybe a month... " and your spouse will send a look that says, "You haven't climbed three flights of stairs since we voted for Ike."

2. Truth or consequences. We know you bend the truth a little when telling us the good and bad you do to yourself. That's why we at least double, up or down, the most fudged claims. For example:

Patient Says:
Doctor Hears:
I have two drinks a day.
I might drink a case a week.
I exercise about twice a week.
I rarely exercise.
I smoke a few cigarettes a day.
I'm a pack-a-dayer.
I eat about two hamburgers a week.
I eat cheeseburgers most other days.
I'll follow up with you -- I won't forget.
I'll stop back when the kids are grown.


3. Nurses know it all. One way to find a great doctor is to grill the head ER or ICU nurse at the largest local hospital, preferably a teaching hospital. These nurses get a battlefield view of doctors at their best and worst. If you're visiting someone in the hospital, you may be able to swing into the unit. If all hell isn't breaking loose and the nurses have a few relatively quiet minutes, you'll have a chance to politely approach one and make your inquiry. A nurse may say, "Well, to be honest, Dr. Addison is a complete jerk and everybody hates him, but if you're in serious trouble, there's nobody better." Endorsements like this aren't unusual in medicine.

4. Get friendly with your pharmacist. Your pharmacist is the least expensive and most accessible health resource you have. While it might seem easier to forge a personal relationship with one pharmacist at a small mom-and-pop pill dispensary, smart patients can and do establish great relationships with superstore pharmacists too. You can see her anytime you want, without an appointment -- all consultations free. In medicine, that's extraordinary. Your pharmacist has an amazing wealth of knowledge at her fingertips, which means at your fingertips. Many also have access to new technology that can answer questions (such as, Is it safe to take this brand-new medication with this even newer medication?) in a blink. What's more, they get a soldier's-eye view of patients with similar conditions using different medications every single day. They see who improves, and who complains about side effects. And they know which side effects could mean serious trouble. Why do so few people take advantage of this golden resource? It baffles us.

5. Learn the shorthand. When your doctor hands you a script (that's doctorspeak for "prescription"), she knows you can't understand the arcane Latin-y squiggles and abbreviations. Doctors typically write the name of the medicine first, then the form (say, capsule or tablet), dosage, amount (say, 30 tablets), directions for taking it, and finally the number of refills. Here's the medical shorthand:

More Insider Secrets

6. The waiting game. When you're anxious for test results, don't think, No news is good news. It's no news. Too many patients wait for the doctor to call them with results, or they figure that silence means everything's fine. Smart patients always ask when the results will likely be in, and they call the office that day. And the next day, and so on. It's an extra reminder for us to call the lab if it's running behind. A postcard from the lab may have been lost. And in a bustling office, records can sit for a day or two without us knowing. So be a nudge.

7. Get with the plan! If a doctor doesn't accept your insurance, but he is really your top choice, don't give up. Call the insurance company and ask if it would consider adding this doctor to the list. If it won't, ask why. Sometimes, if even just a few patients ask the insurer to add a doctor, and the physician approves, the company will agree. Likewise, ask your doctor if you could persuade him to begin accepting your insurer. And every year when you renew your health insurance (a lovely period, usually in the fall, called open enrollment), call your doctor's office and make sure it intends to keep accepting this insurance plan. When we're deciding which insurance carriers we'll work with, we can be swayed by just a few small factors -- and if dropping a plan will create big problems for two or three regular (and well-liked) patients, that can carry weight. So speak up.

8. Learn from the past. Consider having an autopsy performed on your parents when they pass away. Few are done today compared with decades ago, as it's rarely thought necessary when a cause of death is clear. Although it can be expensive, there's much value in knowing if your 82-year-old father has undiagnosed prostate cancer that had been advancing since his 50s, or heart disease even though it was a stroke that did him in. This is especially useful if the death was due to an accident. Reassure your living parent this doesn't mean that foul play is suspected, there can't be an open casket, or the body will be shipped to a CSI sound stage.

9. Need surgery? Hunt for the specialist's specialist. You don't just want a doctor who is comfortable with performing a particular surgery as part of a wide repertoire; you want the surgeon who is obsessively focused on the exact technique you need done. Today, one surgeon can gain so much experience with one very specific surgery that her patients have fewer complications than the national average. Aside from asking your regular doctor to point you to the maestro of your surgery, doing Internet research can help you locate such a hyper-specialized surgeon. You just have to hope that one works at your hospital (and takes your insurance plan), or a road trip might be in store. And make sure your hospital is Joint Commission accredited for quality and safety. Go to qualitycheck.org to find the best hospital for you.

10. Meet the doc behind the scenes. If you're having surgery in a hospital, you need to meet the anesthesiologist face-to-face and give him some dirt on you, such as the last time you had general anesthesia, exactly how much you drink, what drugs you use and how often. People who recreate with substances can keep their habit hidden from lots of people, but they'd better be up-front with the anesthesiologist, since narcotics and other drugs can increase the amount of anesthesia needed, and you don't want to be wide-awake when the surgeon asks for the knife. The anesthesiologist also needs to know how physically fit you are, any allergies you have, and (for the umpteenth time of your hospital stay) every medication, herbal remedy and supplement you take. What about those nightmarish stories you've heard about patients waking up during surgery? It's rare, but it happens. Talk to your anesthesiologist about this, and ask if a medical device that monitors wakefulness is available and should be used.

11. Customize your living will. The two words living will evoked about as much emotion as life insurance did not long ago. But that was before Terri Schiavo captured the country's attention in 2005. Living wills became a vogue subject, even among people under 40. Yet there's no one-size-fits-all living will. If things should take a particularly unhappy course and you can't speak up for yourself, you can tell hospital staffers ahead of time which measures you do or do not want to receive, such as:

Artificial breathing. No, not via the services of one of the more attractive hospital staff members, we're afraid. Instead, you're placed on the machine called a ventilator, which pumps air into your lungs.

Artificial feeding. If you're unable to eat, you can be given nutrients through an IV or a tube that's inserted into your stomach. Some of our more industrious friends have asked if they could have this procedure done just as a matter of convenience, but we tell them to slow down, take a break and eat a real meal.

Cardiopulmonary resuscitation (CPR). You know, the organized theatrics you've seen in TV shows and movies, when a hospital team tries to revive you after your heart stops beating or you stop breathing -- unless you request a do-not-resuscitate order (DNR). Unlike on television, however, there is not a 99.9% chance that you will be revived successfully and to full consciousness within five seconds by a tanned actor, but we'll try our best.
Original here

Pharmaceutical Drug Companies Killing Middle America Legally while Robbing You Blind

In 2005, the Centers for Disease Control (CDC) reported(1) that drug overdoses killed 33,000 people that year. Roughly 10,000 people died in 1990 of the same causes. In 1999, it was 20,000 people. Are you seeing the trend? In 2005, drug deaths were second only car accidents (44,000 people killed) in the category of accidental deaths.

The category ‘‘drug-induced causes” includes not only deaths from dependent and nondependent use of either legal or illegal drugs, but also includes poisoning from medically prescribed and other drugs.

This huge increase in people dying is not because of a heroin or crack epidemic. It’s not young, black people who are dying either. This increase in deaths is happening in the middle-aged, white demographic. CDC epidemiologist Leonard Paulozzi stated to Congress, “Mortality statistics suggest that these deaths are largely due to the misuse and abuse of prescription drugs.” (1a)

46% of of Americans(2) take at least one prescription pill daily. Do we really need this shit? Are these drugs really solving all of our problems? If so, why is the pharmaceutical industry growing every single year, with some of the biggest, if not the biggest, profit margins of any industry?

If you haven’t seen the drug commercials, you are not watching TV. It used to be the majority of commercials were trying to get you to buy a car. That fact may still hold true, but these days you can’t get through a set of commercials without being pitched the latest in Restless Leg Syndrome medication, or the best new pill to get you to sleep at night. Here’s a tip: Stop being such a stressed out lard ass and get some exercise. Maybe your wife would screw you to sleep if you weren’t so repulsive.

Get yourself a Tivo and skip the bullshit. I’ve never felt better!

How much is spent on marketing prescription drugs?

We all know about the commercials. But that only accounts for a portion of total spend for marketing pharmaceutical drugs. Big Pharma spends millions on commercial email, online marketing, and print. They will spend $1 billion in 2008 on direct marketing to make a return of $10 billion (3). Now that’s profitable!

Despite my best efforts, I cannot find a comprehensive break-down of the total marketing spend of pharmaceutical companies. The best I can do is a study that shows that the, “pharmaceutical industry’s drug promotion efforts … estimate that the industry spent $12.7 billion promoting its products in 1998.” (4)

The resulting estimate of $12.7 billion is high not only in absolute terms but in relative terms, Ma noted, as the pharmaceutical industry ranks 34th among the 200 U.S. industries with the largest advertising expenditures.

That was in 1998. The pharmaceutical industry has grown exponentially since then. The commercials have only gotten more rampant. And I thought drugs were so expensive because of Research and Development!

Shouldn’t drugs sell themselves? Do you get the feeling that you’re being sold these drugs to make you think that you’re sick with something, just so you have to spend an insane amount of money per month on prescriptions? If those advertising numbers piss you off, then you might want to check out this article: Big Pharma Money Spent on Marketing Exceeds Drug Development Costs

Are these drugs we’re swallowing by the pound effective?

Don’t get me wrong. I am not some holistic health nut (although I’d probably live longer if I were). For the sake of disclosure, I do not take any prescriptions drugs. Am I lucky, or do I realize that most of our problems can be prevented or cured with changes to lifestyle?

I do see a place for drugs. Some people get legitimate help from the drugs the take. Some. A good portion of the drugs that make up the multi-billion dollar industry of pharmaceuticals are simply doing nothing, if not making us worse.

A recent study(5) suggests that anti-depressants only work for the severely depressed. If you’re one of those halfway depressed souls, then you might as well be taking a sugar pill.

An analysis of the data showed that patients taking antidepressants fared no better than patients receiving a placebo. This appeared to be the case whether the patients were mildly or moderately depressed. The drugs only seemed to benefit a small group of patients — those with the severest depression when the study began.

Middle-aged women: “Doctor, I’m depressed because I’m fat and I don’t like myself.”
Doc: “Here’s some Paxil.”
Pharmaceutical company: “CHA-CHING!”

Wake Up America!

Drug companies lie to you. Plain and simple. Those drugs you thought were non-habit forming? They are. Those drugs you thought could cure your Restless Leg Syndrome (which has got to be a made up disease), well, it causes compulsive gambling. Those drugs that cured arthritis? Well, turns out they cause heart attacks and the drug companies knew it.

The staggering death rate from accidental drug overdose or use is no accident. We’re taking more drugs than we’ll ever need. We’re turning children into mindless drones because every time a kid jumps off the wall they’re diagnosed with ADHD. (Maybe it was that 100 grams of sugar in their cereal they had in the morning?) Some will cause addiction and will ruin your life, like Percocet or Paxil. Others will simply eat up your income, producing absolutely no results except less money for you to spend on the things you need.

How about stopping the problems before they start? Get off your ass and live your life. Being overweight causes more problems than you can imagine and no pill is going to fix that. Working 16 hour days may bring in more money, but you’re distancing yourself from your family. Don’t be surprised when one of you has to get on anti-depressants, whether its you because of stress or your spouse because of depression and loneliness.

Take a step back and look at your life. Do you actually have problems, or do you only think you have problems because of what some commercial told you during Oprah?

Our bodies are incredibly well developed machines. Our brains are marvels of modern science. We can fix 95% of our problems because they are self-induced.

Original here

Sex disease fears over teenagers

Condom
Teenagers lack knowledge about condom use, the study suggests

Nearly half of all under-25s do not use condoms with new partners, according to a new survey.

The report by the National Aids Trust also found that more than 200 young people questioned rarely or never used a condom.

The finding has prompted the body to call on the government to introduce condom advertising on TV and radio before the nine o'clock watershed.

The Trust is also lobbying for condom awareness to form an essential part of compulsory education in all schools.

The call comes during National Condom Week.

Wake-up call

Deborah Jack, chief executive of the National Aids Trust, said: "In National Condom Week, the British public need a wake-up call on condom use.

"Too many people don't know the basic facts on how condoms prevent a sexually transmitted infection such as HIV.

"Too many people are inconsistent in how they use condoms and too many people give up on condoms in a relationship without a health check-up, thus possibly harming their health or that of their sexual partner.

"We need to educate the whole population in the importance of condoms."

Sexual partner

The Ipsos MORI survey suggests that 49% of Britons don't always use a condom with a new sexual partner.

Some 24% of people questioned who had a new sexual partner within the last two years said they would only stop using a condom once they had both been tested for HIV and other sexually-transmitted infections (STIs).

A further 17% said they would always use a condom.

That leaves over half - 53% - putting themselves at risk of an STI when they stop using condoms in a relationship.

I'm seeing more Chlamydia, Gonorrhoea and infections like HIV and Hepatitis
Dr Anhoushka Hari
Doctors say they're seeing more problems in their surgeries because of this.

GP Anhoushka Hari told Newsbeat she's treating more and more people with STIs and has also seen an increase in accidental pregnancies.

"I'm seeing more Chlamydia, Gonorrhoea and infections like HIV and Hepatitis," she says.

"A lot of these diseases are silent, so you can be carrying and transmitting one without having any signs of it at all."

National Condom Week is taking place until 18 May.

Original here

Don't do this in your car

(AOL Autos) -- It's a familiar scenario. You're on your way to work, maybe running 10 minutes late, and you're trying to make up for lost time.

art.driving.mistakes.jpg

So you put your foot into it a little bit more and also decide to multi-task, perhaps get a head start on email on your BlackBerry.

Before you know it, you've got one hand frantically tapping away on the small keypad, the other on the wheel, and your eyes are working overtime to keep track of it all. Your foot, however, is doing just fine laying heavily on the accelerator. Doesn't sound too safe, does it?

Almost all of us make them, so here's a list of some of the most common and dangerous mistakes witnessed on the road:

Pushing buttons

Car companies and their suppliers jump through lawyers' hoops when developing central information consoles that can include satellite navigation, stereo controls and climate gauges. And with good reason.

Tweaking these devices while driving is a leading cause of accidents and near misses, according to Drive for Life, the National Safe Driving Test and Initiative. Most new consoles won't allow you to plug directions into a sat-nav while the car is in gear, but almost all allow you to play with the stereo. Try to do this when stationary, at traffic lights if you must.

Aggressive driving

Aggressive driving is a factor in about 56 percent of fatal crashes, says the latest study on driving habits from the Surface Transportation Policy Partnership.

Though subject to debate, the study has classified aggressive driving as "speeding, tailgating, failing to yield, weaving in and out of traffic, passing on the right, making improper and unsafe lane changes and running stop signs and red lights." The group says that most drivers admit to making the same mistakes they hate to see other drivers commit.

Mobile devices

As a group, teenagers are more likely than most to take their eyes off the road to concentrate on mobile devices, including cell phones, iPods and instant messaging gadgets.

They are also the age group most likely to impress their friends both with the latest in gadgetry and by taking risks behind the wheel. The National Safety Council points out that traffic crashes are the leading cause of fatalities in teens, accounting for 44 percent of deaths.

Connecticut, New Jersey, New York and Washington, D.C. have banned the use of hand-held cell phones while driving. California is scheduled to ban their use by July 2008. Another side effect of the ever-changing technology? Shorter attention spans, which isn't the ideal trait of conscientious drivers.

Driving while upset

"Well the morning was complete. There was tears on the steering wheel dripping on the seat," lamented cheeky British pop mites The Arctic Monkeys on their new tune 'Do Me a Favor'.

All very well if you, like I did, took an Audi A4 S-line Convertible to see them at this year's Coachella Festival, but what happens if you've had a great, sober festival, but end up in a fight with the wife while driving home (which didn't happen, obviously, as she adored the sporty drop-top)?

Other situations that inevitably distract from good driving habits are fighting over maps and directions or looking for a free parking space. Try to pull over if you feel your concentration is not fully on the road and take a walk to cool off.

As a married man who's terrible at reading maps and spotting parking spaces, all I can say is, "But I told you so."

Turn signals

Here's a harsh lesson learned. When my brother and I rolled up at my sister's wedding in her hubby's Jaguar XKR convertible, we expected a bit of respect and not, well, giggles. My brother was driving and we traveled about 20 miles in convoy alongside many of the other guests.

We had enjoyed the admiring looks and stares from others on the way, figuring it was the fire-red convertible and the two good-looking lads up front.

Only during the groom's speech later did we find out that we'd driven his car the whole way with the left turn signal bleeping, to much mirth all round and conversation about stupid drivers and their habits.

Turn signal errors in my experience are more common in trucks, SUVs and convertibles, when wind and cabin noise can crowd out the click of the signal, leaving the driver oblivious to their error.

Pushing the wrong pedal

In November in California last year, Huntington Beach police officer Brian Knorr was honored for his actions after he rescued an 83-year-old Orange County woman whose car was partially submerged in a water channel.

Uninjured, the driver told a local newspaper she thought she had pressed the brake pedal of her 1999 Chrysler Concord only to find her car accelerating off the road into the water.

She also said Chrysler had not been too responsive in her efforts to find the root of the problem, which she blamed on mechanical failure.

Tragically, this is an all-too-familiar story. In Santa Monica, California, in 2003, an 86-year-old man drove his car through a crowded farmer's market, killing 10. Elderly drivers rank as one of the safest groups, often sustaining unblemished driving records over long periods.

But self-awareness combined with oversight by family members is key to upholding driver safety. Many more elderly drivers report trouble checking blind spots and looking over their shoulders due to physical restraints.

Speeding and tailgating

For Lisa Lewis, executive Director at The Partnership for Safe Driving, it's simple: We drive too fast. "Based on what's going on today, the biggest thing we can tell people [is] to slow down," she tells AOL Autos.

"Governments all over the country raised the speed limits from 55 mph and people are still continuing to drive even faster than these very high speed limits. It's not just the 20-year-old hot rodder, it's mothers, grandmothers."

Lewis says people are also driving too close together, where you see "the NASCAR effect" of bunching. All it takes, she says, is one unexpected move and "you get a pile-up." In fast-moving traffic, Lewis recommends a safe distance of one car length for every 10 mph.

Buckle up

Fatal crashes fell slightly from 43,443 in 2005 to 43,300 in 2006, or just under five every hour nationally. More than half of the fatally injured were unbuckled.

"Bad things happen when people don't buckle up, and no one is immune from the damage and devastation that comes from not wearing a seat belt," Department of Transportation Secretary Mary Peters said on the release of the Department's most recent report last month.

Driving while tired

Beware and make sure that an energy drink crash doesn't lead to a road smash. Take a break. It's that simple.
Original here

How to spot weak arguments

When you’re debating, you’ll come up against many styles of arguing, based on all different levels of arguing. If you’re in the debate to win, you’ll have to spot the flaws in opposing arguments and point them out, or exploit them like a weak spot. Sometimes it’s as easy as listening for fuzzy words. Here are some words and phrases that are easy indications of flaws:

many, all, a lot, every, none, nobody, much, more - Solid arguments use actual numbers with references to their source. These words can indicate implied statistics that show the debater is making up a fact rather than working off real data. Example: “Many Christians disagree”

never, always, usually, tend, trend - These may be blanket statements that imply cause and effect, or assumptions about overall responses and opinions that don’t hold up under scrutiny. Example: “the rich have always been getting richer”

I, I don’t think, I believe - including yourself in the argument can indicate thinking personal experience equals the overall trend. If the debate is not a poll or about individual views, this can be Hasty Generalization.

Here are some examples from CreateDebate:

From: Should the US have seatbelt laws?
Someone who manages to use words from two categories:
“I always choose to wear one”

From: Man vs. Elephant : can you escape?
“I am much more shifty than an elephant and would be able to escape if ONE was chasing me in a large field by cutting and weaving.”

and one rebuttal that found the critical flaw:

“Elephants charge at up to 25mph. Way faster than you can run…”

So next time you’re arguing with friends or proving your point in an online debate, listen in for these hints for weak arguments and when you make your response make it stronger by avoiding the same flaws.

Original here