Wednesday, 29 June 2016

Mind your Meds.

      Now that the provincial governments are legislating away the annual 'complete' history and physical examination under the pretense that it does more harm than good, you have to look after yourself a lot more than you used to.  Although the cleverly crafted 'Choosing Wisely' program has made some valid points about over-investigation and excessive testing, it has been put together with the purpose of saving health care dollars.  I have commented on this in the past and will do so again in the future. In the meantime, you are going to have to take responsibility for your own care in ways that you have not had to do in the past, if you  were using the system well and wisely. 
      For the most part, with healthy patients, the annual examination was not annual, it was biennial, triennial or less frequently that that.  People, with various health problems for which they needed information, re-assurance or treatment, often used the label so they would not feel silly 'for coming to the doctor for nothing'.  Physicians and nurses of my generation, spent a significant amount of time in educating patients about when to have a health consultation even if one wasn't ill at the time.  It was proudly and often pompously labelled and bragged about as the 'wellness model' by the administridiots who laboured mightily to establish themselves as innovators regarding something that had been going on in the medical and nursing professions for eons.  In any event, the annual exam was a time when many vital exchanges took place whether the patient was ill or not.  It was a time when the doctor got to  know the patient and the patient got to know the doctor.  It was a time when patients had an opportunity to ask doctors many questions and not all of them of immediate relevance.  It was a time when the doctor established a knowledge base that took into consideration medical history, family history, environmental and mental history and many other things that have a significant bearing on the patients personal and family issues.  The administrators don't understand all this stuff: they are not physicians or nurses, most of them have a financial background and not a medical one, and even those who do are usually so removed from medical practice and professionalism that they might as well not have.  They don't understand the conversation between physician and patient, that is a vital part of medical care and particularly the history and physical examination that is its foundation.   They don't understand how much effort it can take to sort out, evaluate and adjust a patient's medications.They certainly aren't going to pay for it.  So you better start preparing to do a lot of it yourself.
      I have previously written about the importance and convenience of preparing your own up to date medical history.  If you haven't read that previous blog, I  would recommend that you do it now, because it leads right into what I am going to  write next.  It is vital  to have an accurate and up to date list of your current medication as well the dose you take.  With our aging population, many people are on many medications (polypharmacy) and it becomes impossible for a physician or pharmacist let alone a patient to carry in their head the number and complexity of side effects possible.  Every drug has side-effects, a drug that has no side effects has no effects.
     So what can you do?
     Well, to start with, you need to establish a complete list of all the medications you are on and the dosage.
     When did you start it, when did you last change the dose?                          
     It really is impossible for you to keep a record of possible interactions in your head, so you have got to have access to appropriate software to examine all the possibilities.  You have three choices:
     1. Ask your friendly family physician to run your meds through whatever software s/he uses and to go over the results and give you a printout.
     2. Do above with your friendly pharmacist.
     3. Get yourself a copy of one of the many medication interaction programs that are available free from the internet and do the job yourself.  Anything you have difficulty understanding you can discuss with your doctor.  (He can still get a modest fee for that, for the moment).
     4. Anything significant that you do find, you can communicate to your physician either at  a scheduled appointment or by mail, just in case it happened to  slip between the cracks.
     Bear in mind that certain foodstuffs can also  interact with drugs.and we will deal with that later.

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