Monday, 5 March 2018

Be your own Health Historian.

  Some time ago I blogged about the value of developing a systematic approach to keeping available your own personal health history, which should be in your possession and available at all times.   This applies to everyone but particularly to active senior citizens, who, like vintage automobiles may be functioning admirably most of the time, but on occasion require immediate attention to keep  running.  I addition, the tendency to forget issues you wanted to address or at least mention during the standard ten minute visit to your family physician is often forgotten in hustle and bustle of a busy office and the anxiety of the moment and needs to be to be added .
   Few people read my blog, (my kids assure me of this quite frequently), so it is particularly gratifying to me, when out of the blue, a friend or acquaintance mentions some aspect of my opinions or suggestions that they deem helpful to them in traversing the vicious medical jungle, that all but the political 'elites' encounter whenever health problems arise.
    Most recently, one of my friends casually mentioned a recent encounter with Health Care Ontario, when his health care interrogation was just beginning, he put his hand into his breast pocket and pulled out the carefully written history he had crafted in response to suggestions in a previous blog and said something to the effect,
    "you'll find it all here!"   
    My interpretation of what he told me was that they his interviewer re-acted with something akin to amazement and commented on the clear and concise history he had written.
   "Can I keep this,?" the astonished  doctor asked.
   "Of course," my friend said.
   " Where did this come from?" he asked .
   ( My friend smiled at me, "Of course, I got it from your blog.")
    "Oh, a friend of mine in the business recommended it as a way to ensure accuracy and save everyone's time."  he replied.
      I interrupted my friend to mention, " I always take three copies with me when I have an appointment for hospital consultations or investigations.  Because everyone I encounter on my way to treatment usually has to take the time to take a history.  I used to get tired repeating the story to the student, to the resident, to the staff physician and anyone else involved when I  was referred for investigations or consultation.
   'Can I keep this', is the question they most frequently ask, because it reduces their work load and everyone wants their work load reduced.  Additionally, they know there is no one more concerned than you, the patient regarding the accuracy of the information.  When I get to the resident or doctor who settles down in front of the computer, ready to start pounding out the necessary details before we can proceed, I present him/her with the documented history.   As a result, h/s can take their eyes off the computer and actually look at me.  Instead of interacting with the computer and trying to type everything into the record in the ten or fifteen  minutes available for our appointment the doctor actually has time to to establish eye contact and to talk to me."

   The sad truth is that even dedicated, caring family physicians have been bullied into practicing medicine based on a ten minute consultation fee.  If your physician spends much more time than that with  you he is subsidizing you and the bureaucracy  at his own expense.      Much of health care has gone the way of the house call. When the people decided that the doctor's home visit is worth much less than the plumbers visit, they sealed the fate of now almost defunct house call.  The miracle is that some physicians will still make house calls when they feel it is in the patient's best interest and if you look at the fee schedule you will realize that this is a charitable act by a caring physician.  So, bearing in mind that a ten minute visit is now the norm, anything that will focus that ten minutes into a therapeutic session is valuable.  The last thing a sick  patient requires is the physician wasting both their time filling in the boxes that the administridiots need to run the health care system as the Health Care Industry.  And that is what much of the interview has become, primarily concerned with collecting the business data instead of being solely focused on patient care.  The physician's forced occupation with the data being entered is not primarily concerned with patient care.   It is concerned with the business of the system, not of the patient.
   I was an early and enthusiastic proponent of the computerized medical record and its benefit to patients.  I introduced the computerized medical record to  the Department of Family Medicine at the Mt. Bridges Family Medicine Unit, the first EMR in the Western Family Medicine Clinics. I am disappointed with the current use of the EMR generally, because the administration has diverted the system from its vast potential as a health care tool, to use for their own benefit.   It has become a distraction from the very purpose it was created to address. 

   To get back to the point, you, the patient must do all in your power to re-direct your ten minute visit into a concentrated patient-physician interview.  Neither you, nor the physician, have time to waste. Not only do  you need a focused, concise history to present to the doctor you are seeing today, (who incidentally may not be the one you are familiar with), you also need to have pre-considered questions you may want answered and to write them down.  It's easy to forget things you wanted to address amidst one's anxieties in the hustle and bustle of a busy family physician clinic.
   Because we are so mobile these days I think a simple inexpensive project could improve health care significantly.  It is so simple and inexpensive and involves so little high tech expense that no one wants to be bothered with it, despite the fact that it may save more lives and money than high tech devices.   Everyone could carry their entire medical history on a card not much larger than one of the many credit cards that most of us carry in our wallets.
   So, in addition to  having your medical history available in a concise and easily accessible form on your person at all times, you need to have a list of the questions you need answered the next time you see your doctor.

If you are interested in learning more about this, or have ideas about how to achieve these objectives, let me know.

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