Healthlines

Just sitting at the Chinese restaurant waiting for my combo fried rice. Was reading "100 ways to motivate people". Some interesting ideas in there... Basically encourages you to stop worrying about being a leader, focus on being a better human being and gaining the respect of ur peers and subordinates through your service of their needs rather than the protection of your ego. A novel concept but I can totally see how it works. I've always believed that leadership begins by being worthy of peoples' respect. Essentially, when people can see what you stand for and respect ur principles, they can buy into what you are selling. Interesting because it suggests that the first barrier to good leadrship is a paltry soul. Makes sense. A good leader isn't afraid to turn his back to his team coz he knows they have his interests at heart just as he has theirs.


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How do you live a Heart Smart Life?

Maintain normal body weight for height
Monitor amount of fat in diet - recommended amount of dietary fat 20% which should mostly be in monounsaturated fatty acids.
Exercise 30minutes a day - variety is the key to continuity....walk, bike, swim...stay in the zone...85% of heart rate 140- age/2.

What about if you are already behind the 8-ball as it were...hmm!!!
All is not lost....first,
are you overweight?
do u have high cholesterol?
Any co-morbid diseases eg diabetes, CAD, had a prior heart attack.
Any family history of early heart disease...in men before age 50, women age 65
DO U SMOKE!!! Ok, Ok, I know you've heard this before...but seriously...all the other risk factors are mostly non-modifiable...HOWEVER, smoking is pretty much the worst offender and get this!!!! THE ONLY ONE YOU CAN CHANGE and it will have a significant impact on your cardiac risk factors, anyway, think about it.

Lets tackle the problem one at a time...what can you do TODAY to change your weight...can you cut out ONE THING from your diet???!!! Lets start with that...what can you give up today that is not good for you? Muffins, chocolate, ice-cream, an extra helping of food a day??? Lets start with that.

Then if you smoke, lets start by HALVING THE AMOUNT you smoke this month...that's right, you don't have to quit cold turkey...baby steps...cut the amount in half...HOW...do not carry your cigarettes around with you. Make it harder to get to them....determine how fast you smoke and increase the length per cigarette. Time how frequently you smoke and double then triple the time between cigarettes...What this will do is decrease your nicotine addiction...then cut down each week by half the amount you are smoking once you have tripled the time between cigarettes.

At the same time, you should be walking at least 15-30minutes a day or doing whatever you have chosen to do for exercise AND you will have cut out your least addictive foods...After you have done this for a month, it will be time to get serious...TIME to get where it hurts..now pick some of your fav foods...are there lower calorie alternatives...how about portion control...slow down the pace of your eating and drink lots of water with your meal THEN after your first meal, wait 15 minutes before you go for seconds...ARE U Still hungry? Then take a SMALL second portion and enjoy...don't worry, ur stomach is learning to shrink already.

You will get there sooner than u think.

To take a history and get clues to what ails our patients, certain basic questions are important to all physicians...presence or absence of the symptoms or pain, it's location, does it go anywhere else, what makes it better or worse, is it associated with anything...food, time of day, place, any behavior and are there any other symptoms...

One of the problems working as a physician and seeing patients is that most patients unfortunately have very little clue about the answers to these questions...

WHY IS THIS IMPORTANT???

Because medicine is a very complex detection game...based solely on our history taking, we have to make a best guess as to what is going on in your body and then follow our deductive reasoning with confirmatory tests...

Just like at a crime scene, it is easy to be misled by inadequate information, conflicting storylines and objects that are out of place...Studies have been done which show that most physicians within 10-15mins of talking to a patient, have a good best guess as to what might be wrong which is 85% right, after the physical exam, that percentage increase to >90%, following this, they order tests to basically confirm their suspicions or in the 10% of cases where they are really not sure, to guide them in their suspicions and rule in or rule out certain diseases...

Because most of the diagnosis is based on the history, you can see how important it is for the patient to give a very detailed history as to what is going on. Any yet, for most people, this is where the medical encounter goes awry...

Medicine being what it is today, doctor are limited by market forces to how much face to face time they can have with patients...it's not a great situation for patients or doctors..however, these are the times...we just cannot afford to spend much more time with patients. We have to do much with little time so what's a patient to do to make sure that that time counts when they do get face to face...Well, given for the fact that most diagnosis can be made in just about that time, the simple thing to do is to MAKE SURE YOU KNOW YOUR HISTORY of illness COLD...

1. KNOW YOUR SYMPTOMS AND THE TIMELINE of occurrence
2. BE VERY CLEAR ON WHAT YOU WANT TO ACHIEVE IN THAT VISIT...
3. MAKE A LIST OF WHATS IMPORTANT and STICK with it. A common mistake patients make is to come with a shopping list of things to talk about...after spending 10 minutes talking about the small stuff, they wait till the last 2 minutes to tell you the BIG TICKET ITEMS...that is shortchanging themselves! There is NO TIME to deal with the major things and do justice to them in 2 minutes....given doctor's time constraints, time is limited and other patients are waiting so most doctors schedule a return visit to discuss the new issues...and patients get VERY IRATE.

Unfortunately, TIME IS AT A PREMIUM...as a patient, if you want to get what you want THAT DAY, the best defense - and a good offense -- is to come prepared to the medical visit with the most important items (2 or 3) and try to get through those things in that visit...anything else can be deferred to another time when it can be combined with other issues.

In the same way that patients shortchange themselves by waiting till the last minute to discuss big issues, the other mistake often seen in practice is patients who bring VERY LONG LAUNDRY LISTS OF ITEMS they want to cover in ONE visit...

Time yoursef. How much conversation can you get in in 15 minutes...if you were talking to a friend, a colleague and having a two way conversation, how much meaningful information can you squeeze into that timeframe...

Once again, remember, physicians are medical detectives...as a patient, you give clues and they try to figure out based on the clues what is going on...Imagine going to a complex crime scene and in 15 minutes trying to decide whodunit???? or on a more mundane scale, imagine taking your car to the mechanic and expecting that in 15 minutes, he would have your car fixed and running as good as new....how long does a plumber take to fix a leaking faucet??? That being the case, patients who try to get the leaky sink, the blocked toilet, the broken gutter, the weird noise in the car, the wobble in the steering and the grinding that the door makes whenever it opens in 15minutes, get NO SATISFACTION....sorry guys, it is just not possible to do a good job with a patient who comes in with a list of 20 things they want fixed in 15 minutes of a back and forth conversation, interspersed with pleasantries and remember whens!

So be a savvy patient.
Save the small talk for the hello's and goodbyes,
Get to the point QUICKLY and DIRECTLY
Know the facts about your symptoms and state them without a lot of embellishments...
Equip your doctor with all the information he or she needs to best help you in that visit.
Generally this should get you the best bang for your healthcare buck and save many repeat visits to try to get to the bottom of what's really wrong with you.

And have patience...SOMETIMES, the crime scene (aka your disease) isn't quite as simple as it seems and it takes some digging up of new clues, following up of leads (testing and testing and MORE TESTING) to figure it out. Sometimes, it takes specialists, a team and much expertise...but you are our best lead in figuring out the dastardly problem plaguing you...

THE POWER is in the patients ability to give the BEST HISTORY possible so we can figure things out quickly. So feel free to write down your symptoms...

One of my patients actually had a history of her symptoms that went back 1 YEAR..she then took pictures of her rashes on her digital camera...thank GOD for that...her disease was so rare that only by tying together all those various strange and seemingly unrelated events was I able to diagnose her disease in minutes...with the AID of her beautifully illustrated history, Before that visit, she had seen several doctors - 1 symptom at a time - and the diagnosis could not be made. Fortunately for her AND me, as luck would have it, she finally came to me with an EXTENSIVE written HISTORY + PICTURES and I was able to diagnose her condition, BECAUSE of the completeness of her history. Today, she is on treatment. Had she come to me with bits and pieces, I too would have been stumped and unable to help...That is the importance of the history patients give.

Remember, most of the medical detective work is done during the initial interview so go in there prepared.