May 4, 2012

Let's Talk Sustainable Medical Habits

I talked about sustainable medical habits at least twice in the past month. What shocked me was I couldn't find a match when I Googled it. So here I am to speak to you about this.
To start, we define "sustainable" as consuming the least resources (manpower, money etc) to achieve a desirable medical outcome.
Now, let's take a look at two scenarios below:

  1. Mr. A had a headache and visits a neurologist in a tertiary-care hospital. After spending 2 hours waiting, he talks to the physician for 3 minutes and a diagnosis of migraine was made. He was charged NTD500 (USD17) and given some pain medications.
  2. Mr. S had a headache and visits his family physician. He was seen promptly and a diagnosis of migraine was made. His family physician educated him on dietary management for migraine and advised him to quit smoking. He was charged NTD150 (USD3) and given some pain medications.
The differences are obvious, and may seem ironic to you - why did the hospital physician charged more but provided less service? Because (in Taiwan, at least) hospital physicians are flocked by patients with minor ailments that could be managed by primary care doctors, eroding time and resources for patients with more severe diseases that required critical attention. Since (in Taiwan) the price difference is trivial, most patients are willing to fork out more to see a "specialist."
I can immediately hear arguments against seeing a specialist for your first consultation - I don't have a primary care doctor; I had one but he sucks; I don't like to be referred here and there for a simple ailment; I just wanted a second opinion etc.
The truth is, tertiary-care hospitals are designed to cater for critical patients. Critical patients. If you live in a Commonwealth country or the US you'd probably know these clinics are by-referral only. If you live in Taiwan, the clinics are open for all. But that doesn't mean it's like shopping.

  1. First of all, start with your primary doctor. The doctor whom you see the most for trivial concerns. It may be your family physician, pediatrician, gynecologist, general internist, or neurologist. They usually have the most time to listen to your concerns and educate you on lifestyle changes. And they charge cheaper, too.
  2. Being patients, you have responsibility cooperating with the physician to establish a diagnosis - personal information like medications, allergies, previous surgeries, trauma, scans or tests from other hospitals, are best provided to save on repeated (and potentially harmful) tests. Nobody knows them better like your primary doctor. Hence, if you plan to go further, discuss it with your primary doctor and ask him for his referral. This would save you some money because hospitals charge less for referral patients (in Taiwan).
  3. If you came for a second opinion, you should request at least the pivotal scan or test from your primary hospital, what the doctor diagnosed, and what treatments are suggested. If unavailable, you should at least provide the hospital's phone number and doctor's name in order for your second doctor to negotiate for the release of your data.
  4. Most treatment strategies are standardized across the nation or around the world. That means no matter where you go, you receive the same medications, radiotherapy, or chemotherapy. Hence, while seeking a second opinion is good when you're uncomfortable with the first, excessive opinion-seeking will only delay your treatment and potential outcomes.
  5. Find a physician you can trust, feel comfortable talking to, and knows your expectations. As a rule of thumb, the most popular physician isn't always the best physician for you - because his time is too fragmented for all his patients. The next time you hear someone boast of how good his physician is, grill him with these questions - how much time does he delegate for you? Does he listens to you without interrupting midway? Does he explains what he is going to do for you? Are you provided with the opportunity to discuss your concerns and expectations?
  6. If the patient is in any way unable to communicate (toddler, stroke patients, dementia patients etc), please bring along his / her primary caregiver during clinics. This may range from the grandma to the maid. Regardless. We feel helpless when you couldn't answer any questions we asked. And you'd probably have to come back a second time. With the primary caregiver.
  7. Be punctual for clinics. We feel sorry you have to wait an entire morning just to see us, but please understand we don't sit around all day waiting for you to show up. A typical physician has 10 to 15 hospitalized patients to visit everyday apart from clinics. When you show up late, you're actually compromising his time for other patients and his family. If you couldn't make it, call. This is common courtesy.
  8. Take your medications as required. It's one thing for us to prescribe, and another thing for you to take them. If you feel uncomfortable taking your medications, you should talk to your physician about it. We assume you're doing all right when you don't report anything out of the blue. And we really feel frustrated when your blood glucose remains high even after using the best diabetic medications. Which actually ends up in your drawer untouched.
  9. We understand you might feel tempted to try other non-medical interventions from yoga to aromatherapy. While we may feel awkward against some, we tend to agree on most. Talk to your physician about alternative therapy. We don't want you to waste money on some astronomical cactus from Timbuktu.
  10. We don't really like gifts because your smile or 'thank you' is rewarding enough. We are forbidden to accept monetary gifts anyway. Food is nice, for medical students. Remember, the nurses work equally hard as the doctors. So never bully them as they can make your life hell.
All in all, sustainable medical habits is about trusting your physician and his team that they will do what's best for you. I don't disagree with the fact that there are some bad hats amongst that try to overcharge or rush you through your decision. However, please have faith that most physicians are honest and warm-hearted human beings. And that you should treat them like how they treat you.