Monday, October 31, 2011

Building Your Health Team – Where to Go for the Best Advice

Building Your Health Team – Where to Go for the Best Advice

So here you are, a vibrant, active, plus size woman. You are smart, you have the resources to make choices, and you have added healthful activity as part of your life. You are doing all the right things!

But unexpected things interrupt life. Are you ready? What will you do when you encounter pain that just won’t go away?

We talked to two respected and experienced health professionals, both of whom take a holistic approach. This approach is not always common in our tightly segmented healthcare world, so it was inspiring to talk with them both. One is a woman who practices family medicine, and the other a man and doctor of chiropractic medicine. Perhaps not so surprisingly, given their broad views and customer-centric approaches, they had some similar advice.

#1 Top Tip: Be Your Own Advocate
Good people in medical roles ARE NOT afraid of you doing your own research, online or wherever. They invite your participation in your own health and they know that means you will have a better chance of good outcomes because you are invested in the results. HOWEVER, understand their time constraints. Most appointments are scheduled for 20 minutes in an insurance-driven world. Come prepared, come focused. If you get grief for your questions, seek another practitioner. If you later don’t understand something, call back and ask the doctor or the nurse. You deserve to understand completely.

Tip #2: Bring a Second Set of Ears
To get the most out of your appointments, bring along a good listener and note taker. You’ll be amazed how much information you’ll get very fast from your docs. You can’t take notes and listen well at the same time, and if you are in pain you probably won’t be hearing much of anything.

Tip #3: Match Your Need to the Right Specialty
In the past, the family doctor did it all. This is no longer the case. Many specialists receive no training in family medicine. It’s understandable given the high degree of specialty information and technology these specialists need to know. But starting with a top-level specialist may not get you the best result, and may cost you a lot more and take a lot longer. Let’s walk through three pathways to resolving your pain.

Specialist First Pathway
You have a very painful hip that developed as you started a walking program. You might think you should see an orthopedic specialist. But you should know that they do not receive family medicine training to become an orthopedic surgeon. Your sore hip may not need surgery. The Orthopedist will likely reach the correct conclusion after some pretty expensive testing. What then? Probably a referral to Physical Therapy to eliminate the hip pain.

Alternative Treatment Pathway
Because your sore hip is connected to the spine you might consult a Chiropractic doctor as they specialize in back pain relief. A series of treatments may be suggested to bring the pain under control, through adjustments and/or massage. Many chiropractors also bring a sports medicine approach to their practice, working to strengthen the muscles to reduce pain, based on a careful analysis of posture and structure. If your chiropractor tells you that you will need a series of 50 appointments, something is very wrong. This is not the right person for you. Good practitioners will define success as getting you back on your walking program and pain free. If they cannot, they should be referring you to someone who can.

Generalist Pathway
Let’s take a third route. If you had a well-qualified, trusted family practice doctor as your “medical home” it might look a little different. The family practice doctor would consider the possible reasons for your pain with a broader view. Knowing your history, and viewing you as the budding athlete you are, there would likely be less duplicate tests and a quicker assessment of the most likely possibilities causing your pain. Instead of an immediate referral to Physical Therapy she might send you to a sports medicine doctor. (Sports medicine doctors are trained first in family practice, then in sports medicine. You can also approach them directly without referral as they are also primary care doctors.)

The sports medicine doctor would focus on things like gait analysis, orthotic support for your feet, and advice on balancing muscles groups with strengthening to avoid further injury. They may also recommend different shoes, different walking surfaces, walking poles, or other ideas that will support you as an athlete. There may still be a referral to Physical Therapy but it will be more specifically tailored to your injury, for pain elimination and future injury prevention. If the injury is a stubborn one, they may also refer you to alternative therapies such as therapeutic massage, electronic nerve stimulation or acupuncture.

Which Pathway is Best?
All routes correctly diagnosed the problem and all took care of the pain. All were successful in the short term. However, the generalist-to-specialist route in this case would provide you with the most information for your very particular problem, increasing your odds to prevent the pain in the future so you can continue walking. It would also eliminate the most future cost, including doctor visits and time lost, because you would be engaged in finding a permanent solution to your hip pain.

But to follow that path you need to find a great medical home for yourself BEFORE a crisis happens.

Tip #4: Find a Trusted Medical Home
It might take a little work to find a primary care person you click with. But keep trying. Draw up a list of what is important to you. Write it down. It is your list, and nobody else’s. Ask friends and family for doctors that fit your list. When you find a candidate, review their profile on their clinic website. See if their approach matches yours. Then make an appointment. Bring your written questions, and perhaps your “second set of ears.” And if it just doesn’t click – try again. Remember, you are the customer.

Tip #5: Think holistically (and ask your medical providers to do the same.)
There are many health professionals and more specialties every day. Some are inside the traditional western system, some outside. Keep an open mind about what might work for you. If your primary care doctor is open-minded, you should seek their frank advice and let them serve as your health care coordinator. Reports from specialists and alternative therapists should always be sent back to your primary doctor so you have one complete set of records. And you should keep a set of records, too! Always ask for your test results and track them over time. Be involved in your own care, and you’ll get the most for your medical dollar, and feel great to boot!
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