You are Part of the Solution
Five Ways to Take Action
Now Add Three Rules of Defense
Changing Behavior
Summary

YOU ARE PART OF THE SOLUTION

Figuring out how to stay healthy and get good medical care seems as hard as figuring out how to do your own heart surgery.

Why then are you being asked to take more responsibility for your health and medical care?

The changing role of health workers and the financial strains within the system are getting in the way of good health care. HMOs, doctors, insurance companies, employers, and politicians are hoping that you can help improve the system by becoming a smart consumer.

Will this help? Yes.

Will your involvement solve all of the problem? No.

But you are part of the solution.

FIVE WAYS TO TAKE ACTION

Many doctors feel that they are taking care of issues that were never covered in medical school. And like old dogs, physicians seem to have difficulty learning new tricks. Also, changes are happening so quickly, it is hard to stay current, see patients, and deal with paper work.

Physicians need help to focus on concerns of patients and to provide the best care possible for them.

It probably seems unbelievable that doctors are turning to you for help.

But it is true.

Patients relate to doctors and other health care providers (nurses, social workers, nurse practitioners, physician assistants etc.) on two levels:

the technical level -- ability to correctly diagnose problems, or perform surgery
the communication level - educating and helping you

If you are in a serious car accident or have sudden bleeding into your brain, you care most about clinicians' technical abilities.

For most day-to-day health care issues communication is very important... and it makes a big difference! The best way for you to improve health and medical care is to concentrate on "communication".

How can you help build better communication? Five Ways.

First, Complete the Health Quiz

The "health quiz" is found on our web site at www.howsyourhealth.org The Patient Report is in the form of a letter. The letter summarizes the important issues that you have identified in the quiz and offers methods to manage problems that may be bothering you.

The patient report alone is not enough. The real world of health care is a very busy place where your needs can be easily overlooked. Even if you carefully prepare for an office visit, you may not have the vocabulary and means to communicate what really matters to you.

The advantage of the Action Form is that it allows you and your doctor or nurse to quickly and specifically identify areas in which better communication and education is needed.

When a doctor first uses this approach she or he often say: "I thought I was doing a good job... but I was amazed by how many things I had missed even though I had know these patients for years."

When patients are asked about not being on the "same page" as the doctor they usually say: "I forgot to tell," or "the doctor was too busy," or "the doctor never asked."

When a doctor or nurse is busy and can't deal with all of the prblems on the Action Form in one day, they are reassured knowing that their patients can find useful readings before the next meeting. "This is a 'win' for them and a 'win' for me.

It is always easier for doctors and nurses to respond to a specific problem. The Action Form clearly presents important issues so that they are not overlooked. If you have a medical condition such as diabetes, high blood pressure, or heart disease, you will receive additional, helpful forms, that you may wish to share with a doctor or nurse.

Second, Talk to Your Doctor

"How's Your Health" stimulates productive conversations. In early tests of this approach, we found that about 85% of the patients read the sections assigned to them by the Letter. However, many patients did not make sure that they talked to the doctor or nurse about the information. Those who did not discuss the material did not do as well as those who did.

After you read the assigned information and discuss the Action Form with a doctor or nurse, you are on the path to improve your health and medical care.

Third, Take Advantage of Free Materials

Many health plans now offer (nurse) phone lines to give advice for home/self treatment. Some health plans also give away "self-help" health books to manage demand.

Since many problems can be handled at home, we urge users of "How's Your Health" to take advantage of these phone lines and health books. Internet users should look at theses additional on-line health information sites:

for excellent, general information go to www.medlineplus.gov. This can also be a good link to non-commercial special web sites for special diseases such as arthritis or Alzheimer's.
for an important treatment or testing decision, go to www.cochrane.org and look at the abstracts of cochrane reviews. The language is technical so you may need some help. If your topic is covered, this is the most up to date information about certain conditions and treatments.

In general, do not waste you time on the other ".com health" web sites. They will generally flood you with advertising or place an electronic device (cookie) on your computer. Some may give misleading information because they want you to buy something.

Fourth, Take the Lead for Typical Acute Problems

Acute needs are those that develop suddenly. The five acute needs that are most often seen in the office are 1) the common cold, 2) the "flu", 3) injuries, 4) infections of the throat, ears, and urinary tract, and 5) gastroenteritis (diarrhea or vomiting illness).

When a direct phone line to a nurse is available, more than half of the calls are generally about the five acute needs. You may save yourself a call by reviewing the Tables below. They condense most of the information about acute conditions that is found in "health books." These Tables also summarize typical "red flags" for common problems. When a "red flag" occurs, you should generally contact a health professional.

SERIOUS RED FLAGS REGARDLESS OF THE PROBLEM ARE:

A RESTING PULSE OVER 110 BEATS PER MINUTE OR LESS THAN 50;

TEMPERATURE 103 DEGREES OR HIGHER;

SHORT OF BREATH AT REST (or a breathing rate of more than 25 per minute);

TROUBLE THINKING OR SPEAKING CLEARLY; OR

NEW, SEVERE PAIN UNRELATED TO INJURY.

What happens to the acute problems that don't have red flags? After one week, about 1/3 of the persons with the five acute problems say they are back to normal, about 1/2 are getting better, and the rest are still feeling badly.

Problem

Red Flags

Comment and Home Treatment
( major side effect of treatment)

Cold in head or chest:

Head fullness, runny nose, cough with generally clear or no sputum, muscle aches.

Temperature over 101 degrees; getting worse each day; shaking chills, close contact who has a "strep" throat; foul smelling, thick green sputum from the lungs or the nose; persistent pain in one or both ears; a severe headache or sore throat; a stiff neck; severe pain in the face or upper teeth, often worsened by bending over.

All treatments are designed to allow you to function better while your body clears the virus infection; antibiotics are not needed.

• cough - dextromethorphan is the most effective suppressant (drowsiness); pseudoephedrine plus dextropheniramine (high blood pressure); perhaps zinc lozenges; and inhaled "asthma drugs" for prolonged cough.

• runny nose - chlorpheniramine (drowsiness), neosynephrine spray for 7 days or less (overuse), other decongestants (read label)

• aches/fever - aspirin or naproxen (stomach upset); acetaminophen. Read labels. Take regularly for 2-4 days, not just as needed.

Injuries

Active bleeding; injured area does not function or is deformed; pain persists or worsens after two days of rest; fall on hand causing pain in wrist; direct blow to head; deep penetrating wound.

• Scrapes need good cleaning - hydrogen peroxide - and clean bandage. tetanus shots when dirty or penetrating.

• Cold compress and elevation when possible to injured area in first 24 hours to decrease swelling

• Acetaminophen for pain relief

Diarrhea/Vomiting

"Stomach flu" often has muscle aches and can come on quite suddenly. Loose stools can persist for a week.

Blood in diarrhea or vomit; temperature over 101 degrees; shaking chills; severe abdominal pain; vomiting lasting more than one day; history of diabetes.

Allow the lining of the gut to heal by drinking "clear" liquids such as chicken broth, ginger ale, etc. The more of these liquids, the better.

Pepto bismol may be helpful.

Aches in Lower Back or Joints

Usually follow over- activity or may accompany the flu.

Pain in back worsened by cough or sneezing or shooting from the back to the leg below the knee; pain in joint with redness, swelling or warmth; persistence of the aches more than 7 days.

When accompanying flu, use flu treatment described above. When following obvious over-activity, use standard injury treatment described above; Otherwise, consider the addition of naproxen or ibuprofen (stomach upset) if acetaminophen or aspirin are not effective.

Allergies/Sinusitis

Severe pain in face worsened by bending over; temperature over 101 degrees

Chlorpheniramine (drowsiness), neosynephrine spray for 7 days or less (overuse), other decongestants (read label). If recurrent and persistent, nasal steroids can be quite effective and safe (prescription needed).

Fifth, Avoid Unnecessary Treatments and Medications

Americans use a lot of pills; they are using 50% more pills than they did 10 years ago. Americans spend much more than other countries on pills. But medication use has more than a financial cost. It can also be risky. It is now estimated that medications are the third most common cause for health problems in the United States and cause up to 150,000 deaths a year. In the past 20 years one out of every ten medications newly placed on the market has been withdrawn. They hurt people more than they helped.

Those who have looked at American "pill-popping" identify two causes for it:

"push" and "pull" advertising (read on)
our impatience with the time it takes our bodies to overcome illness

When you have the flu - runny nose, head fullness, aches and fever, how long does it take for you to be back to normal?

The average person will need about 7 days: some will be better in 3 days and some will need 10 days.

For a bad "chest cold" with cough (bronchitis), the average is about 12 days. (A cough that persists may actually be asthma).

If you ask patients about their satisfaction with care, those who are improving quickly are happier than those who are not. Doctors don't like to be "blamed" for dissatisfied customers. Giving a prescription may make a patient feel better because they feel they are getting "something."

Your understanding of this tendency to "over-treat" is important whenever you seek advise from a doctor, a self-help health book or a phone line.

The costs of pills is a serious issue. About 8 in 10 United States doctors are unaware of the cost of medicines they prescribe. Very large, well-done studies have shown that form many common conditions, such as hypertension, using "old" medications gives as good results with no more harms than new "new" medications. The same can be said for most "generic" medications versus trade-branded medications.

If you shop the web for lower-cost medication look for VIPPS - Verified Internet Practice Sites. But it is even better to talk to your doctor and the drug store to find the best choice. When you are going to take a medicine for many years, a difference of even a few dollars can add up.

NOW ADD THREE RULES OF DEFENSE

How do you guarantee that your concerns will be addressed and your medical care improved? Learn these three rules of defense.

Rule #1. Recognize hype -- misleading stories about health and medical care.

This Rule describes a sad situation. Perhaps it is one of the reasons Americans now have less trust in health care than in the U.S. postal service.

This rule is based on four observations:

* (1) Many health announcements come from sources who may have an interest in the story you are told.

* (2) About half of the health information on the web is wrong or has a sales intent. Reminder: www.healthfinder.gov and www.medlineplus.gov are good information sources.

* (3) Recommendations are often political. Who sits on an expert committee can make a difference.

* (4) In the "good olde days", success stories were a popular way to "sell". Now, study results are used to sell. However, well-done, randomized studies are difficult to do well. Some studies can not be randomized -- done by the flip of a coin -- particularly those that examine the harms and benefits of diets, activities, and habits. The result, lots of hype that often does not hold up. For example, tomato sauce prevents prostate cancer, cranberry sauce causes cancer, the list goes on and on.

Best Defense to recognize hype -- misleading stories about health and medical care?

Try to find out the real source of the news and judge accordingly. When you hear about a "breakthrough", wait until it is proven again in another study. On the other hand if the new approach "can't hurt - might help" and is something you would not mind doing, do it. After all, new diets, activities, and habits can be fun. But don't ever take high doses of anything without talking to a doctor or certified nutritionist. List of diet adds

Another way to have fun, is to visit an antique bookstore and look at "healthy" lifestyle and product recommendations over the years. They recycle.

In 1864, Warren's Household Physician said:

"Big muscled men seem to think you can determine health by the tape line... they contribute far less to their longevity by weight lifting than by a daily run".

Over 100 years later we are shown study after study about the benefits of regular endurance exercises. Old news in new packaging.

The Table illustrates some dietary approaches over the years: some are silly, some are dangerous, but all were popular.

Rule #2: Understand "push advertising" and "pull promotions"

With "push" promotions, the public is made to think about a health problem and then "ask their doctor about it". These advertising approaches are very successful and most useful for prescription medications, tests, or procedures that require a doctor's signature. With good planning by the manufacturer, the doctor will feel "pushed" to prescribe a product.

"Pull promotions" are usually "free" services. Many responsible organizations use pull promotions to improve their image or find important new diseases. Although free screenings for high cholesterol, cancer, and high blood pressure can be useful for some persons, the screening can be linked to other things that have less obvious benefits and some costs or harms. Nothing in life is free.

The "push" and "pull" approaches can be combined.

The problem with the "push" and "pull" approaches is that they are so easily abused, worry people, and make people feel sick, ugly, or bad.

Best Defense against "push" and "pull" advertising?

Recognize when you are being "pushed" or "pulled".

Rule #3: You must be able to answer this question: how big are the harms and benefits of the new test, treatment, or approach?

You need to develop a difficult but very important skill to answer this question. So if the information is important to you and you have trouble figuring out the harms and benefits, ask a health care worker to help you. Let's try an example.

Almost sounds like a "cure". Fortunately, the National Cancer Institute wrote their news release in a way that would allow women to begin to ask the important questions.

The Table summarizes the news release. Once you examine the results in the way they are shown in the Table, you have a much better idea about this new treatment. Notice that:

* Among these women who were specially chosen to be at high risk for cancer, cancer deaths were low during the 4 year period (5/6500 versus 3/6500). And the deaths did not differ much at all between the two groups.

* Harms and costs of the medicine are considerable. For example, the drug caused blood clots in the lungs and legs.

* Many women took the medicine for a few to benefit. This is called the number needed to treat (NNT). The NNT to avoid one cancer in five years is about 70 in this trial. In comparison only 3 persons with very high blood pressure have to be treated five years to prevent one death, stroke, or heart attack.

NO DRUG

NEW DRUG

Dummy

Tamoxifen

Women Treated
6,500

6,500

Benefits of Treatment:

Cancers

145

85

% Cancers

2.4%

1.3%

Cancer Deaths

5

3

% Cancer Deaths

0.08%

0.05%

Harms/Costs of Treatment:

Uterus Cancer

14

33

Blood Clots in Lungs

6

17

Blood Clots in Legs

19

30

After thinking about the report using this benefit/harm table, other questions might come to mind.

What would happen if the study went longer?
Would cancer deaths be less in the new drug group?
What about deaths from other causes if lung blood clots result in death?
Is there an even newer, safer drug on the horizon?
Have the results been repeated by other researcher here or in other countries?

What Does This Mean For You ?

YOU ARE PART OF THE SOLUTION

FIVE WAYS TO TAKE ACTION

First, Complete the Health Quiz

Second, Talk to Your Doctor

Third, Take Advantage of Free Materials

Fourth, Take the Lead for Typical Acute Problems

Fifth, Avoid Unnecessary Treatments and Medications

NOW ADD THREE RULES OF DEFENSE

Rule #1. Recognize hype -- misleading stories about health and medical care.

Rule #2: Understand "push advertising" and "pull promotions"

Rule #3: You must be able to answer this question: how big are the harms and benefits of the new test, treatment, or approach?

CHANGING BEHAVIOR

Summary