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Practical Advice for Medical Patients

Practical Advice for Medical Patients

Find a good internal medicine doctor, to reassure you or fix your problem 70% of the time.

Write a problem list for every appointment. Bring 4 copies. Make them read it.

When you choose a specialist, you have chosen your diagnosis and treatment! Never forget that. Once I had a spine C7 bone bump diagnosed by x-ray. Dr. Smoth, internal medicine, said not to worry, no problem. I said: "Should I see a neck surgeon?" Dr. Smoth said: "IF YOU DO, HE WILL OPERATE ON YOU." Best piece of medical advice ever.

Take Purell with you always. In a hospital bed or the ER, put the bottle on your chest.

Reduce the frequency of screening tests; they lead to many false alarms, following by harmful interventions to confirm alarm is false. The PSA test is fading away, also mammograms, even lung cancer screening.

Until CMS (Medicare, etc.) cracked down on over-screening and over-diagnosis, each speciality set the frequency of screening in their field &emdash; so of course, they say to screen often, because they want more $$$. To understand US medical care, follow the money.

After surgery, you are likely to be dehydrated and also high. The crash will start a day or two later. The second night may be one of your worst nights ever. Prepare for it, remember that it happens to many others, keep hydrated, get a gentle massage, and, if at home, keep your dog near.

For learning about your medical issue, go first and maybe only to these websites: Mayo Clinic, NIH, Wikipedia, and, for detail about your problem once you know what it is, Medscape. Never rely on Google list or the creepy sewer of ads embedded in Google's list.

For something serious, go to best place you can. There is great variability in quality of care and survival. Many will accept Medicare. Scott Simon told me ten years ago: "If you need to have serious surgery, go to Cleveland Clinic."

Five years later I remembered his advice. I fled my local hospital, which ranked 64th, to Cleveland Clinic, ranked first. Cleveland cured my mitral valve problem. The difference between number 1 and 64 was day and night on every single measure.

Upon going for medical care, try to have someone accompany you. They can drive you to the clinic (do not supervise the driver), take notes, keep track of your bag, arrange follow-ups... Upon leaving the clinic/hospital, no matter what, we head straight for pizza or Tandoori, and ice-cold beer.

American medical care is superb for the very rich and very smart. But otherwise it ranks 20th in the developed world on fundamental measures: baby death at birth, death of mother delivering, longevity of life. The other 19 countries doing better all have universal health care.

Do rehab! Stick with it. Medicare pays for lots of rehab appointments. Rehab is not like a regular gym at all; most people go to save their lives. 20% just sit and chat, and I wore my noise-canceling to get them out of my life-saving exercises. ALWAYS bring Purell and constantly use it.

Have a living will, keep it up to date, and say, I want to die at home or hospice. Living wills don't help all that much. The key element is the person you assign to have power of attorney. That is the person the hospital will obey for end-of-life.

Avoid hospitals. You can walk or wheel out any time you want. To avoid a $3,700 "transport fee" to be paid by your heirs, have someone drive you home. Die at home or hospice.

-- ET

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