E=

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E = EXACT

Health Care is not an exact science.  That’s right.  We want it to be…and I see much frustration, disappointment and even desperation because of this fact, but it’s the truth.  Despite all the medical advances and advertising of drugs that seem to point to the opposite, there really isn’t a “pill” for every illness or a test to diagnose every medical condition.  Sometimes there is no clear cut answer to a health problem, nor a solution.

Medicine and Pharmacy are applied science which means we take science and apply it to people.  We take everything we know about anatomy, microbiology, pharmacology, biochemistry, therapeutics, etc., and apply it to individuals who have their own unique physical, biological and genetic differences (not to mention the social, cultural, and psychological aspects).  From this application of knowledge to each individual situation, diagnosis is made and treatments are decided upon.

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E = ERRORS

This applying of science also means that medical care is not perfect.  Combine that with the speed at which this knowledge needs to be applied to patients and situations, errors are inevitable.  Here’s a quote from Dr. Brian Goldman that had me thinking this week.

What I’ve learned is that errors are absolutely ubiquitous. We work in a system where errors happen every day.  Where 1 in 10 medications are either the wrong medication given in hospital or the wrong dosage…  In this country as many as 24,000 Canadians die  [every year] from preventable medical errors. [which is a gross underestimate]

We all know someone who has had sub-optimal medical care or errors made in their care.  Often there is anger towards the professionals that made the mistake.  I’ve been on both ends of that situation.

There is an expectation of perfection in health care.  As patients we expect our health professionals to be competent, and so we should.  But as a health professional I know we are all human and lack perfection.  We all fall short and can make mistakes.

I’ve made mistakes in my career and will most likely make a few more before I am done.  Fortunately I have never made a mistake that has seriously harmed someone or caused a death.  But I know each time I put my lab coat on it is a real possibility.

cc licensed flickr photo shared by chrisinplymouth

E= e-PATIENT

The possibility for error is why I continually encourage people to be engaged in their health care.   Not because you shouldn’t trust your health providers.  Quite the opposite.  You need to be an active partner so a trust relationship is essential. Working as a team is the best way to ensure optimum health care.  How can you do this?  Get to know your own body, your medical conditions, your medications.  Ask questions. We need you to be as educated as possible.

More and more patients are getting health information over the internet.  (Interestingly, Health Professionals are often divided over this.  Some thinking this is great and others not so much).  I think the more knowledge you acquire about your own health the better.  And this is where the trust relationship comes into play.  Yes, there can be some bad information out there.  So you check it out with your doctor or pharmacist.

Last week I had a patient in tears because she had read on the internet that her diabetes medication could give her seizures and she didn’t know what to do.  Was that good information?  No.  It wasn’t true.  But I didn’t advise her to stay away from internet health information.  I provided her with some reputable sites and encouraged her to learn more about her disease and contact me in a week to go over what she had learned.   As one e-patient says in this video, “When push comes to shove you check with your [health professional]. They’re there for a reason”

Here’s an example of the growing movement of “e-patients.”  As you’ll see, the “e” stands for many great attributes that can lead to a safer, more participatory, less paternalistic model of health care.

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Dr. Oz and the Ruby Slippers

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I really wish Dr Oz would just put on his ruby slippers and go home. Just click those heels three times and retire.

That may sound harsh, and I usually don’t make such blanket statements, but honestly, he’s starting to do some real damage.

Like Oprah, when Dr. Oz speaks, millions of people listen. His level of influence in the average North American household has become almost iconic. Millions turn to him for advice. That would be a good thing if he was a health professional with integrity and his advice was backed by science. The reality is quite the opposite. Here’s my beef with Oz.

Dr. Oz puts profit before people.

When Dr. Oz first started out on Oprah, his information and health recommendations were fairly standard, typical of your family doctor with some Hollywood spin. Over the years, however, he has become more “Hollywood”and less “doctor”. He sensationalizes medicine, often offering quick fixes with unproven therapy. It makes for great sound bites (like the un-workout workout) and it sells, but it’s not based on science. In fact, coming soon is his own product line of unproven supplements. It doesn’t matter that he lacks the science to back up his claims. His name sells and so will his unproven products.

His advice can be dangerous

Diabetes can be prevented with vinegar and coffee. Really? If that were true, I know many of my patients would be reaching for more pie; just add a cup of coffee and it’s all good. Instead, what is proven by science is that weight management and good nutrition can delay Type 2 Diabetes.
If a person needs to lose weight to reduce their risk of having a heart attack or stroke and Dr. Oz says all they have to do is take white kidney bean pills and they can eat all the cake they want…that’s dangerous.
How about having a doctor on his show that believes cancer can be cured with baking soda? Not kidding.

Dr. Oz presents “Pseudo-Science” as fact

Pseudo-science is presenting a claim or belief as scientifically valid without having the scientific supporting evidence. Here’s what we mean by science:

What we mean by “science” is simply rigorous methods of observation. Good science looks at all the evidence (rather than cherry picking only favorable evidence), controls for variables so we can identify what is actually working, uses blinded observations so as to minimize the effects of bias, and uses internally consistent logic. Steven Novella, MD

Are there some studies showing coffee has an effect on diabetes risk? Yes. Can we use these studies to make sweeping statements that affect people’s health? No. That would be irresponsible. All that is proven by a few small studies is that more studies in that area need to be done.

Dr.Oz takes “bad science” or limited science and presents it as fact. That’s irresponsible.

I’ve been in health care long enough to see really good studies point to facts that we incorporate into our practices as health care professionals. But 10 years later (after more studies with larger numbers of people, going on for a longer time), the original studies are proven to be misleading or even point to the opposite conclusion. Studies need to be examined with the eye of a sceptic and there is a science in itself to evaluating the strength and validity of scientific studies.

When people come to me with health concerns looking for advice, they are in essence sharing a trust. Patients expect me to be honest and to have their best interest at heart. They expect that my advice will be based on scientific evidence, not on anecdotes, popularity or profit. Patients should expect that from all their health providers.

Dr. Oz fails on all fronts. So, Dr. Oz, if the ruby slippers don’t fit, perhaps you can take the job of the original Oz behind the curtain. After all, he was a charlatan too.

All I Want for Christmas…

Gratitude.  It was top of my list for Christmas this year.  To feel more grateful for the life I have, to not need more, to feel settled and ultimately at peace.  So while I sit in my quiet house, the chaos of the day having quieted down, the gifts I have asked for have arrived.

Flickr shared by Wolfsavard

The past two months I have had several close friends suffer serious health problems.  All of them went from lives busy with work, kids activities, holiday plans….  then everything in their lives suddenly came to a grinding halt.  When your health fails, that’s all that’s on the plate.  So, I am grateful for my health;  so far my life continues as is, and I wish to not take that for granted.

Working in the inner city once more this week reminded me of how grateful I am for my parents.  I am fortunate that they had no drug or alcohol addiction, no mental health issues or extreme  poverty.  They managed to make things work and keep our family functional and enriched.  It allowed me to develop and grow and have a “normal” childhood, unlike so many in our city.

I am grateful for my education.  My parents somehow instilled in us the importance of furthering our education.  It was not an option for us to learn, our only choice was what to learn about.  It continues to lead me in my career and to passing on that value to my own children.

Lastly, my gratitude falls to those who are closest to me.  There are people in my life who know the good in me and also the not so good in me….yet still choose to love me.  They are the ones who make life beautiful.  You know who you are.

Merry Christmas

Just do it?

Winter is coming. Mornings are cold, and I gotta admit, I am getting lazy.

As the days get shorter every year, my motivation to be active does the same…I become less and less active until Spring arrives.

Part of this is the business of Winter. Hockey starts, school ramps up, my job is busier, too cold to run outside, etc. etc. But if I’m going to be honest, my lack of activity lies in my motivation.

via flickr by Sean Lloyd

The last few weeks I have given a lot of thought to my personal motivation. What has kept me running and working out this year and why do I gear down as the weather gets cold?

I started exploring by asking others what their motivation is.

Whenever I see a patient who has made radical changes in their lifestyle for the good of their health (eg: losing weight, quitting smoking, etc.) I always ask them what motivated them to change. I also asked various pharmacists and physicians what they thought the biggest motivator for healthy changes was. And yes, I asked friends and Tweeted it out as well.

Most responses landed in the realm of three main motivations.

1. Vanity

Undoubtedly the most popular reason people try and stay in shape. We want to look good and be attractive. When I asked Yoni Freedhoff about the motivation of his patients to lose weight, he replied that most say it is for health but he undoubtedly thought that vanity won out.

2- Health

Everyone knows that if you maintain a healthy body weight and keep your heart and lungs challanged with regular exercise you have less chance of developing diseases such as diabetes, high blood pressure, heart disease, and even cancer. I have seen patients come off a lot of medications after losing a significant amount of weight and incorporating exercise and healthy nutrition in their life.  Sometimes this comes as a medical “wake-up call”.  We all desire a long life and often are motivated to change when we truly realize that our lifestyle affects our health and life span.

3-For Others
Each of us have people in our lives that we love and want to be with for years to come.  Many people have told me that it was the birth of their child, a partner becoming healthier, or the realization that if they continued with their present lifestyle they would be reducing their own quality of life and potentially the years they have to be with those they love.  They want to see their children and grandchildren grow up.

 

My own motivation? A mix of fear and vanity. I have (for no particular reason other than knowing the statistics), a fear of breast cancer.  And I know that if I stay active my chances of developing cancer or of surviving a diagnosis both go down.

As for the vanity…..I do enjoy it when my clothes fit, and I’ve discovered that I also really like feeling strong.

So…..my love-hate relationship with my treadmill continues and I have given thought about how to keep from talking myself out of exercise.  Because really, I can always find an excuse not to do it!

To stay motivated I set goals for myself. They must be Achievable  in order to gain success.  And they must become more challenging over time. ie: Incremental. And since I hate the feeling of disappointing myself I usually work at reaching them.

Additionally, I have made an agreement with a friend involving regular exercise. It never hurts to have someone else to be accountable to….and someone to encourage you when you start coming up with creative excuses to not do it!

I would love to hear about what motivates you.