I frequently hear of the worst situations and stories of patient suffering, medical mistakes, and just plain apathy (also known as misfeasance) from health care providers. However, I also hear the most inspirational and helpful stories as well. Today I am going to talk a bit about the first kind, and this one is first hand.

I recently had a fall that resulted in a grand laceration to my leg. I went to the local Emergency Department and as we all too often hear, it just did not work out for me. Here is what happened:

I fell hard on a sharp rock and landed on my shin, a spot on the body with very little flesh, so the cut went almost to the bone. As a boisterous fellow I am not unfamiliar with cuts (some serious), sprains, strains, etc., so just another trip to the Emergency department to get some stitches and antibiotics. Here is the problem – I requested antibiotics and that request was denied by my ED physician, even though my fall took place in shallow water on a local river, that also happens to be notoriously polluted. Subsequently I developed the serious infection I thought I would less than 36 hours later which took me out of work for two weeks, left me unable to walk due to a big red tree trunk where my lower leg previously had been, and required six separate physician follow up visits to properly treat the infection.

We are still waiting to see if we need to reopen the wound (with a fresh incision) to drain the remaining infection and junk, and then we start off from scratch and put in fresh sutures. Never a dull moment.Part II will be coming shortly.

Take care and stay well.

While in my part of the country it does not yet feel like Fall (it is around 95 today), Flu Season is coming up soon and for those of you who do choose vaccination, it is time to plan on getting your shot or blast of nasal spray. Yearly flu vaccination should begin in September or as soon as vaccine is available and continue throughout the influenza season, into December, January, and beyond. This is because the timing and duration of influenza seasons vary. While influenza outbreaks can happen as early as October, most of the time influenza activity peaks in January or later.

The seasonal flu vaccine protects against three influenza viruses that research indicates will be most common during the upcoming season. The 2010-2011 flu vaccine will protect against 2009 H1N1, and two other influenza viruses (an H3N2 virus and an influenza B virus). The viruses in the vaccine change each year based on international surveillance and scientists’ estimations about which types and strains of viruses will circulate in a given year. About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body.

While everyone should get a flu vaccine each flu season, it’s especially important that the following groups get vaccinated either because they are at high risk of having serious flu-related complications or because they live with or care for people at high risk for developing flu-related complications:

1. Pregnant women
2. Children younger than 5, but especially children younger than 2 years old
3. People 50 years of age and older
4. People of any age with certain chronic medical conditions
5. People who live in nursing homes and other long-term care facilities
6. People who live with or care for those at high risk for complications from flu, including:
   1. Health care workers
   2. Household contacts of persons at high risk for complications from the flu
   3. Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

Use of the Nasal Spray Flu Vaccine

It should be noted that vaccination with the nasal-spray flu vaccine is always an option for healthy* people 2-49 years of age who are not pregnant.

Who Should Not Be Vaccinated

There are some people who should not get a flu vaccine without first consulting a physician. These include:

• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to an influenza vaccination.
• People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine.
• Children less than 6 months of age (influenza vaccine is not approved for this age group), and
• People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)

Vaccine Side Effects (What to Expect)

Different side effects can be associated with the flu shot and LAIV.
The flu shot: The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. Some minor side effects that could occur are:

• Soreness, redness, or swelling where the shot was given
• Fever (low grade)
• Aches

If these problems occur, they begin soon after the shot and usually last 1 to 2 days. Almost all people who receive influenza vaccine have no serious problems from it. However, on rare occasions, flu vaccination can cause serious problems, such as severe allergic reactions. As of July 1, 2005, people who think that they have been injured by the flu shot can file a claim for compensation from the National Vaccine Injury Compensation Program (VICP).

The nasal spray (also called LAIV or FluMist®): The viruses in the nasal-spray vaccine are weakened and do not cause severe symptoms often associated with influenza illness. (In clinical studies, transmission of vaccine viruses to close contacts has occurred only rarely.)
In children, side effects from LAIV (FluMist®) can include:

• runny nose
• wheezing
• headache
• vomiting
• muscle aches
• fever

In adults, side effects from LAIV (FluMist®) can include

• runny nose
• headache
• sore throat
• cough

More Information

• Flu Shot: Vaccination Information Statement (VIS)
• Nasal Spray: Vaccination Information Statement (VIS)

Good Luck avoiding the bugs this season.

Source: Centers for Disease Control

1.  Employees have more out of pocket exposure than ever before.  Co-pays and deductibles are up 115% since 2000.    (National Coalition on Healthcare, 2008)

2. 50% of Americans live month-to-month.  74% admit they don’t have an adequate financial safety net.                        (MetLife Study of the American Dream, 2009)

3. 49% agree that they are more concerned than ever about being able to pay every day bills if they get hurt or sick.      (Accelerant Research, 2009)

4.  62% of bankruptcies are caused by injury or illness.  For 92% of victims, high medical bills and out-of-pocket costs contribute directly to bankruptcy.  75% have health insurance, own homes, are educated and have typical middle-income jobs.  (American Journal of Medicine, 2009)

Digest these figures above and I will be back in 2 days to take a look at the health insurance industry and shine some light on a few things for you.

See you soon

Bladder cancer begins most often in the cells that line the inside of the bladder. Bladder cancer typically affects older adults, though it can occur at any age. Bladder cancer survivors frequently require follow-up tests to look for bladder cancer recurrence for years after treatment. The most common symptoms include:

• Blood in urine
• Frequent urination
• Painful urination
• Urinary tract infection
• Abdominal pain
• Back pain

The most common types of bladder cancer are:

• Transitional cell carcinoma. Transitional cell carcinoma is the most common type of bladder cancer in the United States.
• Squamous cell carcinoma. Squamous cells appear in your bladder in response to infection and irritation.
• Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder.

Some common risk factors for developing bladder cancer are:

• People over 40 years of age
  
• Caucasians
• Men
• Smoking
• Chronic bladder inflammation

Most often, treatments include possible surgery to remove the tumor, drug regimines, radiation therapy, chemotherapy, and immunotherapy.

Additional resources can be found at the website: www.cancercare.org

Psychotropic drugs are considered any drug that effect reasoning capabilities, personality, mood, or any combination of these. Let’s take a look at the primary drugs in this class:

Antidepressants are the most commonly prescribed psychotropic medication. CNN.com reports that in 2005, of 2.4 billion drugs prescribed in visits to doctors and hospitals 118 million were for antidepressants. Commonly reported side effects include but are not limited to: dry mouth, blurred vision, constipation, urinary retention, sedation, sleep disruption, weight gain or loss, headache, nausea, agitation, inability to achieve an orgasm, decreased libido and anxiety.

Antipsychotics, like antidepressants, alter brain chemistry. Unlike antidepressants, however, these drugs pose more serious side effects and prolonged usage has been proven to cause permanent damage to the nervous system. Used to alleviate psychosis (auditory and visual hallucinations), these drugs can pose serious side effects such as heart problems, sedation, moving disorders, dystonia (muscle spasms), akathisia (involuntary muscle movements in the legs), Parkinson-like symptoms, and tardive dyskinesia (excessive movement of the tongue, lips and jaw).

Stimulants are another commonly prescribed medication, also known as “psychostimulants.” These drugs are prescribed for ADD, ADHD, narcolepsy and other conditions determined by your physician. In ADD/ADHD patients, these drugs work by stimulating an already stimulated brain creating a “canceling” effect resulting in an actual calming of the mind. These drugs, however, are not without their side effects, such as: anxiety, nervousness, agitation, insomnia, loss of appetite, increased heart rate, vision problems, nausea, heartburn and in severe cases, cardiac problems which may result in the need to discontinue their usage.

Benzodiazepams are another very commonly prescribed psychotropic medication. Benzodizepams, sedatives used for insomnia, anxiety and a wide spectrum of other psychological conditions, cannot be stopped without weaning off them. If stopped abruptly, these drugs cause physical withdrawal symptoms that can lead to seizure. The central nervous system becomes dependant on these drugs and cannot react properly on its own without slowly decreasing the dosage in an effort to discontinue use altogether. These medications are also known to cause excessive drowsiness, dizziness, memory impairment, depression and dependence.

The suicide rate for those not taking anti-depressants is 11 out of 100,ooo. This means about 1 /100 of 1% of people are at risk for suicide in North America. For those taking anti-depressant drugs, the suicide rate jumps to 718 out of 100,000. This is just under 1% of all people taking anti-depressants who are now likely to commit suicide. This equates to approximately 65 times more likely for an individual to attempt (and succeed) in suicidal behavior than if they took no anti-depressants. Additionally, violence is not always turned inward as suicide, but outward to others as well. This is startling and counter-intuitive piece of information – that the very drug prescribed to avoid such drastic behavior actually, on occasion, seems to cause such behavior.

While not everyone on psychotropic drugs commits suicide or uncontrolled acts of violence, the effects of the many other side effects can be horrendous.

Clearly these drugs are extremely controversial and anyone (and their family, partner, trusted friend) considering taking any psychotropic medication should objectively research and perform a benefit vs. risk analysis to determine if proposed medications are the appropriate course of treatment, or if there are other alternatives available.

In our next post on this series, we will provide resources that everyone at potential risk (meaning anyone considering the use of these types of drugs) from psychotropic medications should have on hand for reference.

Until then, be well and question your doctors.

The results showed a significant increase in the number of mind impacting drugs prescribed over these years. The percentage of doctor visits which resulted in two or more medications being prescribed increased from 42.6 percent to 59.8 percent. What’s more, the percentage of visits at which three or more drugs were prescribed soared from 16.9 percent to 33.2 percent. And the median number of medications prescribed at each appointment with a psychiatrist increased on average by of 40.1 percent.

Let us for the sake of discussion begin looking at this information from the perspective that humans are experiencing the same general census of psychiatric illness and conditions throughout recent history (or maybe there is just something in the water these days…).

The combinations of drugs being prescribed with increasing frequency include antidepressants with sedative-hypnotics (the most prescribed combination of psychotropic drugs (according to the CDC) are antidepressants and sedative-hypnotics, antidepressants and antipsychotics, and combinations of several different antidepressants. The significant danger to patients is that these drugs are often not tested in terms of contraindication, the often harmful way in which drugs interact. While all drugs should be carefully tested, a property of the life cycle of psychotropic drugs is that in many cases test periods are truncated and not comprehensively tested for drug interaction hazards.

Combination of psychotropic drugs is dangerous and complicated and should be judiciously scrutinized by the prescribing psychiatrist, the primary care physician (who must always be kept informed of any prescriptions from any care provider of the patient), and most importantly, the patient and / or the patient’s advocate.

The Citizens Commission on Human Rights International has produced an article, an except of which I would like to share here:

[The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is psychiatry’s billing bible of so-called mental disorders. With the DSM, psychiatry has taken countless aspects of human behavior and reclassified them as a mental illness simply by adding the term disorder onto them. While even key DSM contributors admit that there is no scientific/medical validity to the disorders, the DSM nonetheless serves as a diagnostic tool, not only for individual treatment, but also for child custody disputes, discrimination cases, court testimony, education and more.

The DSM is driven not by science, but instead caters to the pharmaceutical industry. With its expanding list of “mental disorders”—voted into existence, not discovered as in real medicine—for each of these a psychiatric drug can be prescribed and insurance companies billed. That big formula spells big profits for psychiatrists and drug companies. And this has been exposed more recently with a U.S. Senate Finance Committee investigation into the APA itself and the fact that about 56% of its $12 million-a-year income derives from drug makers (more below).

“The way to sell drugs is to sell psychiatric illness,” says Carl Elliot, a bioethicist at the University of Minnesota.]

The final item we will address on this post is a look at the practice of drug companies working with the psychiatric professional to repackage and relabel drugs previously prescribed for other diagnosed conditions. From the same article cited above:

[Kelly Patricia O’Meara, an award winning journalist and former Congressional staff points out, “Drug companies pull a mental disorder out of the DSM hat and get FDA approval to use an already existing drug to treat it. Well-known psychiatrists are enlisted to publicly affirm the disorder as a social problem…Voila! Confirmed psychiatric ill and magic pill."]

In 1966 there were only 44 approved psychiatric drugs available, there are now as many as 174, and have been marketed to address virtually every possible emotional, psychological, and psychiatric symptom you can think of.

Our next post on this them will take a look at the sensationalized component of psychotropic drugs, the adverse, sometimes fatal, effects of these drugs.

Be well and remember, we are not always going to be giddily happy, and the cure for that should not be a knee jerk to swallow a pill.

Keep your comments coming – we enjoy the side conversations.

In our first post on the subject of Psychiatry & Psychotropic Drugs we are going to look at the trend of prescriptive psychiatry. A recent poll conducted by Harvard Medical School determined that nearly half of all Americans will suffer a mental illness during their lifetimes. The two-year study, which polled 9,000 adults across the country, varied in age, education level, and marital status. They found that 29 percent of people experience some form of anxiety disorder, closely followed by impulse-control disorders (25 percent) and mood disorders (20 percent). Most cases begin in adolescence or early adulthood, and often, more than one disorder will strike simultaneously.

Following diagnosis, a patient is almost certainly prescribed mood altering drugs and perhaps a once-a-month (or less frequently) brief face to face check-in with the prescribing psychiatrist. If more than one condition is diagnosed  additional  prescriptions are often given, and in many cases patients regularly are prescribed several different psychotropic (mood altering) drugs with which to address, in virtually every instance, the symptoms of the patient. I have spoken to patients who have been prescribed a pill per symptom.

While I bet it is safe to say that every generation looks at the following generations with mixed feelings of hope and disappointment, I cannot find the science to support the notion that teenagers are more prone to mental illness than their fore bearers. Psychotropic drug prescriptions for teenagers skyrocketed 250 percent between 1994 and 2001, rising particularly sharply after 1999, when the federal government allowed direct-to-consumer advertising and looser promotion of off-label use of prescription drugs, according to a Brandeis University study in the journal Psychiatric Services. The problem with these medications is that while they can help manage symptoms (not necessarily the actual disorder, often just its’ symptoms) they are in many cases, life threatening.

Our next post will expand on this specific post topic and also include more on the evolution of the life cycle of psychiatric diagnoses and drug prescription.

For your reference, the chart below lists the top 25 psychiatric medications by number of U.S. prescriptions in 2009.

After a long absence we are back and are focusing on an alarming facet of modern health care – the role of psychiatry and psychotropic drugs. This is a big topic and will be broken down into digestible sections over the next couple of weeks.

We are first going to look at some of the statistical data over the past few decades and examine the explosion of psychiatric diagnoses and prescriptions of psychotropic pharmacology.

Our first post on this voluminous topic will be Tuesday, July 20.

Please tune in and join the discussion. I know there are many people out there with legitimate psychiatric issues, and there are more of you with, in all likelihood, illegitimately diagnosed psychiatric issues – please make your voice heard and send me your comments, stories, and anecdotes.

Watch for our post tomorrow to start off this crucially important topic that effects us all.

Be well and question your doctors.

By LAURAN NEERGAARD, AP Medical Writer – Mon Jun 7, 12:00 am ET

WASHINGTON – More medical care won’t necessarily make you healthier — it may make you sicker. It’s an idea that technology-loving Americans find hard to believe.

Anywhere from one-fifth to nearly one-third of the tests and treatments we get are estimated to be unnecessary, and avoidable care is costly in more ways than the bill: It may lead to dangerous side effects.

It can start during birth, as some of the nation’s increasing C-sections are triggered by controversial fetal monitors that signal a baby is in trouble when really everything’s fine.

It extends to often futile intensive care at the end of the life.

In between:

_Americans get the most medical radiation in the world, much of it from repeated CT scans. Too many scans increase the risk of cancer.

_Thousands who get stents for blocked heart arteries should have tried medication first.

_Doctors prescribe antibiotics tens of millions of times for viruses such as colds that the drugs can’t help.

_As major health groups warn of the limitations of prostate cancer screening, even in middle age, one-third of men over 75 get routine PSA tests despite guidelines that say most are too old to benefit. Millions of women at low risk of cervical cancer get more frequent Pap smears than recommended; millions more have been screened even after losing the cervix to a hysterectomy.

_Back pain stands out as the No. 1 overtreated condition, from repeated MRI scans that can’t pinpoint the trouble to spine surgery on people who could have gotten better without it. About one in five who gets that first back operation will wind up having another in the next decade.

Overtreatment means someone could have fared as well or better with a lesser test or therapy, or maybe even none at all. Avoiding it is less about knowing when to say no, than knowing when to say, “Wait, doc, I need more information!”

The Associated Press combed hundreds of pages of studies and quizzed dozens of specialists to examine the nation’s most overused practices. Medical groups are starting to get the message. Efforts are under way to help doctors ratchet back avoidable care and help patients take an unbiased look at the pros and cons of different options before choosing one.

“This is not, I repeat not, rationing,” said Dr. Steven Weinberger of the American College of Physicians, which this summer begins publishing recommendations on overused tests, starting with low back pain.

It’s trying to strike a balance, to provide appropriate care rather than the most care. Rare are patients who recognize they’ve crossed that line.

“Yet let me tell you, with additional tests and procedures comes significant harm,” said Dr. Bernard Rosof, who heads projects by the nonprofit National Quality Forum and an American Medical Association panel to identify and decrease overuse.

“It’s patient education that’s going to be extremely important if we’re going to make this happen, so people begin to understand less is often better,” he said.

Not even doctors’ families are immune.

A hospital appropriately did six CT scans to check Dr. Steven Birnbaum’s 22-year-old daughter for injury after she was hit by a car. But the next day, Molly had an abdominal scan repeated as a precaution despite having no symptoms. When a doctor ordered still another, “I blew a gasket,” said the New Hampshire radiologist, who put a stop to more.

___

There are numerous reasons that one of three U.S. births now is by cesarean, but Dr. Alex Friedman blames some on an imprecise monitor strapped to laboring women. Too often, he has sliced open a mother’s abdomen fearing the worst, only to pull out a pink, screaming bundle.

“Everyone knows it’s a bad test,” said Friedman of the Hospital of the University of Pennsylvania. “You haven’t done the patient a big service by doing an unnecessary surgery.”

Electronic fetal monitors record changes in the baby’s heart rate, a possible sign of too little oxygen. They became a tradition — now used in 85 percent of births — years before research could prove how well they work.

Guidelines issued last summer, aiming to help doctors better interpret which tests are worrisome, acknowledge the monitors haven’t reduced deaths or cerebral palsy. But they do increase the chances of a C-section. While they should be used in high-risk women, the guidelines say the low-risk could fare as well if a nurse regularly checked the baby’s heart rate.

Later this year, the National Institutes of Health will begin a major study to see if adding a newer technology — a type of fetal EKG already used in Europe — to the heart-rate monitor would better identify which babies really are struggling and need rapid delivery.

___

Undertreatment was in the headlines over the past year as the Obama administration and Congress wrestled with legislation to get better care to millions who lack it.

The flip side, overtreatment, is a big contributor to runaway health care costs. Yet it’s one that lawmakers, wary of being accused of rationing, largely avoided in the new health care law. Included were modest steps — studies to compare which treatments work best, some Medicare financial incentives — to push higher-quality, lower-cost care.

“Physicians get up every day with the good intentions of wanting to do what’s best for their patients,” said Dr. David Goodman of the Dartmouth Institute for Health Policy. “We also live in environments where there are strong financial incentives to deliver certain types of care. We get well-paid for doing procedures. We get paid relatively poorly for spending time with patients and helping them make choices.”

Where you live plays a role. Two decades of research from the respected Dartmouth Atlas of Health Care shows that in parts of the country, Medicare pays double or triple the price to treat people with the same illnesses. The differences are not fully explained by big cities’ higher cost of living or populations that are poorer, older or sicker. How much care someone gets is a main reason, yet Dartmouth’s data shows people in pricier areas don’t necessarily fare better.

Dartmouth’s check of 2005 Medicare data found that during their last six months of life, older adults in Boise, Idaho, spent 5.3 days in the hospital compared with 17 days in Miami.

Fee-for-service care and local habits aren’t the only drivers.

Fear of malpractice lawsuits “has everything to do with it,” said Dr. Angela Gardner, president of the American College of Emergency Physicians, whose members face intense pressure to overtest in the life-and-death chaos of the ER.

Nor is there always clear evidence for one therapy choice over another. It can be faster to give in to a patient’s demand for medicine than to explain why, for example, a child doesn’t need antibiotics for ear pain.

___

Care for the dying is often a powerful illustration of treatment going too far.

Texas author Liza Ely had lined up hospice care for her 93-year-old mother, Verna Burnett, as she lived her last days with Alzheimer’s and heart failure. Yet when Burnett developed an irregular heartbeat, the care provider at her Tyler, Texas, nursing home recommended seeing a cardiologist, to have a tube threaded through blood vessels to her heart to check it out.

“We were speechless,” Ely said. “We asked what could be done if something showed up on the test.”

The response: “Nothing, really.”

Ely said the family refused the “painful, expensive and unnecessary test.”

Congress’ health care overhaul initially included a provision that would have authorized Medicare to pay doctors for counseling patients interested in end-of-life options. The provision died in the hue and cry after Sarah Palin dubbed the effort “death panels,” a charge named 2009 political “Lie of the Year” by the nonpartisan fact-checking organization PolitiFact.

Rep. Earl Blumenauer, D-Ore., said he plans to reintroduce his idea.

“Today there is no guarantee that people will get the care they want when they are incapacitated or in those final stages of life. The default is sometimes the most painful, the most intrusive, the most frightening treatment — whether or not that is what people want,” he told the AP.

___

New efforts are beginning to push back against overtreatment:

_In Minnesota, the influential health cooperative HealthPartners saw use of MRIs and radiation-heavy CTs growing between 15 percent and 18 percent a year. So the insurer began a new program: National radiology guidelines pop up on each patient’s electronic medical record whenever a doctor orders a scan. It’s not a requirement, but a gentle reminder of when such tests are recommended.

In two years and counting, HealthPartners estimates it avoided 20,000 unnecessary tests, preventing dangerous radiation exposure and saving $14 million.

Providing the guidelines helps doctors deal with patients who demand a scan, says medical director Dr. Pat Courneya. He recently examined a young man who wanted a brain CT because of dizziness. Courneya’s physical exam turned up no neurologic red flags like weakness or eye problems, but seeing the guidelines helped reassure the man.

_An American Medical Association journal, Archives of Internal Medicine, just began a “Less is More” series to educate doctors about the risks of overused treatments.

First up: Studies saying more than half of the 100 million-plus prescriptions for the strongest stomach acid suppressors — proton pump inhibitors such as Nexium — go to people who don’t need something that powerful. That puts them at unnecessary risk of side effects, including bone fractures and infections.

_This summer, the journal Annals of Internal Medicine begins publishing American College of Physicians’ guidelines for “high-value, cost-conscious care.”

_To increase patients’ savvy, about a dozen health centers around the country are testing “shared decision-making.” That process uses plain-English guides, often DVDs, to explain the advantages and disadvantages of test and treatment options. Given full information, patients choose a less aggressive approach than doctors initially recommend about 20 percent of the time, says Dr. Michael Barry of the nonprofit Foundation for Informed Medical Decision-Making.

“Where I think no one in the Consumer Reports age would go to the car lot and say, ‘I’m going to let the dealer figure out what car I want or need,’ now we are taking a little of that spirit to the doctor’s office,” he said.

Be smart, be well

We are constantly on the look out for new treatment options, better methods of delivery and more effective medications. Information is power; You need to know about your conditions and your treatment options. My Nurse First Members are updated regularly with cutting edge information specific to their interests and medical conditions. Two excellent sites to begin your own research are: www.nih.gov (National Institute of Health) and www.WebMD.com

Most people shop carefully for a new car or major appliance. It’s an emotional choice and you hope that big purchase will last for a long time.  Why not apply that same spirit when considering choices in your health care providers and hospitals? We keep an extensive matrix of information on healthcare providers and can help you find the care that’s right for you. Remember that every human being is by nature fallible, including health care providers.

We research not only the hospital you may choose, but also the physicians to treat you. Your state’s Board of Medicine/Medical Examiners have information on every doctor practicing in your state. www.HealthGrades.com is an independent site where you can get information about your hospital choices as well.  If possible, choose a hospital that specializes in treatment of your particular condition. No single means of treatment is right for everyone. We are all different, with unique needs, values and beliefs. Research carefully and then choose wisely.

• When facing major illness or surgery, always get a second opinion.  Any highly qualified professional will support your right to do so.
  
• Whenever possible, have someone at your side at all times during hospitalizations.  They can ask questions and help you get the care you need.  The Joint Commission on Accreditation of Health Care Organizations, a federal regulatory body, recommends that everyone entering a hospital have an advocate.
  
• Watch for the simple things:  all health care workers must wash hands prior to all treatments.  Stethoscopes should be cleaned in between patients.  Nurses should be able to answer questions about the medications they dispense.
  
• It is your right to refuse treatment until such time as you understand what is happening.  Ask your doctor about your treatment plan:  what is involved, what outcome can you expect, what medications are necessary.
  
• Ask your pharmacist about your medications and if there are potential interactions.  A very helpful site is www.rxlist.com to discover all you should know about the drugs you are putting into your body.  There is a lot of question at the present time about the safety and efficacy of many prescription drugs:  be safe – educate yourself.
  
• Ask your doctor to clearly mark the site of your upcoming surgery – with indelible marker. Surgeons will frequently “sign their site,” that way there can be no mistake while you are unconscious.

Consider this: When you are under stress, your absorption of information is reduced. Ask every question more than once; as many times as it takes to understand. When you visit a health professional, take along someone to listen along with you and ask other questions. You can take notes or even bring along a tape recorder.

The better educated you are, the better your choices, and, consequently, the more relaxed you can be. A confident and more relaxed patient has fewer bad side effects and heals more rapidly.

Be well