Optimizing your doctor visit

Going to the doctor is not the highlight of your week, and it probably never will be.  You don't want to be there.  We get it.  But there are ways to optimize your visit so that you can convey your message, receive your advice, and leave with minimal confusion.  Besides arriving on time (I know, I know...doctors run late), there are some steps to improving your visit:

1.  Be a good historian.  You have a medical issue and we are trying to diagnose it.  Before any of us ever spoke to a "real" patient, we were taught to obtain the best history possible.  While patients believe that a physical exam is the most important part of a diagnosis, most physicians agree that there is nothing as important as an accurate history.  This is the reason we ask so many questions.  Some of the most common questions are:  How long have you had this?  What have you tried for it?  Does anything make this better or worse?  Has this ever happened before?  What symptoms are associated with it (fever, chills, cough, congestion, sweating, bowel changes)?  The point is, the more information you can give us, the easier it is for us to diagnose it.  We don't need an hourly log for the past six days, but an accurate and concise description is crucial.

2.  Know your medications.  If you're taking medications, know what they are and how often you take them.  If you take a bag full of medications, bring them with you or bring an active list.  Medications and their interactions with each other can be responsible for many medical problems.  This includes over the counter medications, vitamins, supplements, herbal/natural drugs, and cultural home remedies.

3.  Read up, but don't self-diagnose.  A lot of times, a physician will ask a patient what brings them in today and the response they get is "I have bronchitis" or "I have tonsillitis."  This can bias the physician's history-taking, diagnosis, and treatment.  Report your symptoms, have your physical exam, and then ask if it can be a possible diagnosis that you read about.  Most physicians are open to discuss your ideas because in many cases, you may be very well informed of certain medical conditions and can provide valuable insight.

4.  Limit your list of chief complaints.  This one is hard to do, but it is one of the most important.  Most physician visits are limited to a 20 minute time slot.  This includes the process of having your vitals taken by the nurse, the visit, and any paperwork that needs to be done after.  Believe it or not, one chief complaint can take more than 5 minutes to address.  Something like chest pain can take longer due to the many things that can cause chest pain, the most important being heart disease.  If you have a list of 5 or 6 things to talk about, you can bet some things will be brushed off lightly due to time constraints.  If you do indeed have multiple concerns, schedule a follow-up appointment to have your needs adequately addressed.  Trust me on this one, walking in with a list of problems will lead to a disappointing visit for you both.

5.  Be patient.  Medicine is an ever-evolving art.  It does not have a cook book and it will never be mastered.  Sometimes patients and physicians alike want an answer and they want it immediately.  We live in a world of drive-thrus, delivery service, and online everything.  This doesn't work in medicine.  Many office visits are only a starting point, not the finish line.  Medicine requires testing, thinking, formulating, and sometimes guessing.  We as physicians and patients may not get our answer today, tomorrow, or ever.  A 150 years ago, Charles Darwin was trying to figure out genetics by mating pea plants.  Today we have the human genome mapped out.  Some things just take a while.

The ways in which medical care is administered has come a long way.  Long gone are the days of home visits by your neighborhood doctor.  They are replaced by double-booked office visits and self-diagnosing internet sites.  This isn't so much a problem of the patient or the physician, but more likely a product of a distressed health system.  Whether we like it or not, it is here to stay.  So the next time you visit your doctor, empower yourself and have a worthwhile visit.  Your clock starts...now.

Chicken Soup for the...Common Cold

This past weekend in Los Angeles was a reminder of what beautiful California sunshine is all about.  The birds were out chirping, the kids were out running, and my friends were out soaking in some sun at the beach.  I was home.  Coughing.

Catching a cold every year is expected, especially while working in the medical field where dodging a patient's precisely-guided cough is an essential skill.  Unfortunately, most of us have to accept defeat after a direct hit while trying to examine the throat with a tongue depressor.  (Note: when asked to say "aahh," it is entirely possible to do so without coughing.)  After my latest date with the common cold or sinus infection, I found myself bed bound and hopped up on Sudafed and Mucinex.  I'm sure most people can attest to the bad taste medication leaves in your mouth after a couple of days, and I was willing to try anything different.  I had heard a lot about chicken soup as a possible home remedy and the great taste was surely a huge plus as well.  So I tried to find out what was so special about chicken soup, and here it is.

When chicken is cooked into soup, it releases an amino acid called Cysteine.  This amino acid is actually a part of a medication known as N-acetylcysteine that is used to help break down secretions or mucus in the lungs.  Therefore, the cysteine from chicken soup is thought to aid in the process of mucus breakdown during the common cold or sinus infection.  I would say that the whole concept of cysteine seems theoretical but in reality it is actually manufactured into a medication.  This gives it significantly more credibility.

While there probably won't be any studies to back up the finding of chicken soup for the common cold, there also aren't any studies for many home remedies.  At the end of the day, we all know that a viral illness has to play itself out and there isn't much we can do to expedite it.  However, we have to try to treat the symptoms to maintain our own sanity.  So the next time you have a cold and want to keep it natural, head over to the poultry aisle and make some broth.  Cattle and pigs...carry on.

Is 5-Hour Energy the real deal?

When 5-Hour Energy was first introduced, it was primarily in specialty stores and certain grocery stores.  Last week I saw 5-Hour Energy next to the gas station cash register, sandwiched between the Slim Jims and Skittles.  The popular energy shot is now so popular that most people can recognize the small shot-sized bottle.  I assumed that 5-Hour Energy contained some sort of vitamin and herb mixture but I wasn't sure if it was effective.

It turns out that 5-Hour Energy contains some amino acids, B Vitamins, Citicholine (thought to help with memory), and caffeine.  I know, caffeine is the kicker and you probably forgot all the other ingredients after you read that one.  Some people are shocked that 5-Hour Energy contains caffeine and some people are not the least bit surprised.  So how much caffeine are we talking?  ConsumerLab.com did an independent analysis of the product and found one shot to contain 207 milligrams of caffeine.  Putting that in perspective, an 8 oz. cup of Starbucks coffee contains 160 milligrams of caffeine according to cspinet.org.

Okay so 5-Hour Energy contains caffeine and a bunch of other stuff, but does it actually work?  The producer of 5-Hour energy did its own study with 90 participants and obviously found individuals who took 5-Hour "significantly outperformed" those that did not.  There have been no outside studies to date but Consumer Reports states that "5-Hour Energy will probably chase away grogginess at least as well as a cup of coffee."  They also found little if any research that proves to support that Vitamin B and that other stuff give the average person a boost.

The bottom line from all that is that the caffeine content of 5-Hour Energy is likely about the only thing you would be getting to boost your day.  So unless we find out 10 years from now that Citicholine is the difference between appearing on Jeopardy and Wheel of Fortune, I'll stick to my cup of overpriced Starbucks!