The Patient Speaks!

Here’s a headline that immediately caught my eye: USA Today Wednesday July 25, 2007 Communication now part of the cure - “Movement has begun to help doctors listen and patients understand” by Erin Donaghue.  My first thought was “well, duh”.  I mean, doesn’t everyone who sees the doctor communicate with him or her?  In a blink I answered my own question with a resounding “no”.  Thinking back to childhood (OK, way back), I can remember it took Mom or Dad to give their interpretation of what was ailing me to the doctor as I didn’t want to be there in the first place, never mind the medical dilemma.  Very little patient to doctor communication going on there and therefore I sometimes suffered just as much after the visit because I wasn’t being properly addressed.  After high school, I enlisted in the United States Air Force.  Only time I went to the doctor was when I was ordered to because, after all, I was an Airman and I can tough it out.  Therefore very little communication and a whole lot of flu.  Post military I met my true love and got married.  My outlook on life began transforming into an adult’s (very excruciatingly slow process according to some who knew me).  I started to open up to the doctors and explain just exactly what was ailing me.  Perhaps this happened as I was now responsible for the bill?  But I noticed a different phenomena happening.  Some doctors - not all - seemed to make a speed game out of the office visit.  The faster the doc could get into the examining room, scratch out a prescription and back out, the better.  I had a mental image that a nurse was just outside the door with a stopwatch.  Eventually, as I matured (again, questionable to some) in my medical travels, I began to understand that my physical - and mental - health was greatly enhanced by a good, solid line of communication between the medical professional and myself.  This includes the nurses, technicians, therapist’s and even the desk clerk.  I would leave the office satisfied that my questions were thoroughly answered instead of that nagging annoyance that I should have asked this/that.  Whenever I meet a medical professional that will not give my concerns the proper attention, I’m out of there and seek out one that will.  As I have written before, when seeing a new doctor, I come armed with a complete listing of my medications, who prescribed them, what the dosage is and what pharmacy I buy them from.  In my experience, the doctor takes me more seriously from the beginning.

As evidenced by the newspaper article, the medical community appears to be making communication more of a priority.  Faye Deich, chief nursing officer at Sacred Heart Hospital in Eau Claire, Wisconsin is quoted as saying “The main thing we’re trying to do is listen to our patients”.  Further, “We ask each patient what good care means to them, and that’s communicated to the staff” “If patients know you are there for them, they are more likely to tell you if something doesn’t seem right”.  For me, beyond the immediate care concerns, if I have a positive experience with the staff, I would be more likely to return if I have further need for their services.  In large cities, there are many choices for medical care.  Just as in taking my car in for repairs, I will go where I get the best attention and expertise.  That takes communication from both parties.  The mechanic can’t fix the car unless I tell him what’s wrong.

Just when I’m thinking my “headache life” has been fairly good for the past couple of weeks, I decided to clean my desk and came upon newspaper articles I had clipped and that dark cloud reappeared. Not a “pain” cloud, but an “annoyance” one. Examples:

November 03, 2006 Wall Street Journal
Front page, column #1 no less - Narcotic ‘Lollipop’ Becomes Big Seller Despite FDA Curbs by John Carreyrou. The article discusses how Cephalon Inc.’s Fentanyl containing lozenge Actiq® (oral transmucosal fentanyl citrate), originally developed to address cancer pain, is being used “off topic” more and more to address non-cancer pain. The first two paragraphs describe a pregnant woman who claimed “the strongest high she has ever experienced”. When her son was born, he was “cranky and wouldn’t sleep” and said “doctors told her he had become addicted to the drug and was in withdrawal”. Eventually, the woman ended up in jail for forging prescriptions as she was addicted to Actiq®. You can tell where this is going, right?

May 07, 2007 Newsweek Health
Lollipops & Lawsuits by Mary Carmichael & Samantha Henig. Words that jump out include “”…does not have cancer…” and “…in an average month he may suck on as many as 300… that its sugar content has corroded away all his teeth”. Now, here’s the biggie: “California Democrat Henry Waxman, chair of the House Oversight and Government Reform Committee, is looking into marketing at Cephalon and other companies.” To repeat, you can tell where this is going.

May 15, 2007 Wall Street Journal
Op/Ed page, Oxy Morons by Sally Satel. Ms. Satel is actually Dr. Satel, a psychiatrist specializing in addiction. The Opinion piece related the saga of charges brought by the attorney general of West Virginia for “misbranding”. The company, Purdue Frederick, paid $635 million to settle the charges. “Scores died as a result of OxyContin abuse and an even greater number of people became addicted” said Attorney General John Brownlee. However, in reading the piece, Dr. Satel believes (GASP!) that the people who abused the drug chose to do so. They, the abuser, had the responsibility. And who gets the short shrift? The legitimate pain patient, of course. Can you tell where this is going?

June 9, 2007 Chicago Tribune
Maddening movie migraines give experts real headache by Alexa Aguilar. While you don’t have to read the article to figure out that “movie migraines” do not reflect real life, I found the piece excellent. It has some interesting stats at the end. I highly recommend you read the article.

June 17, 2007 The New York Times
When Is a Pain Doctor a Drug Pusher? By Tina Rosenberg. Another good article that talks about addicts/abusers verses those of us with a medical need for responsible pain relief.

It seems that the “War On Drugs” is ever more targeting and restricting, in my opinion, the very people for whom the drugs can do the most good. As I’ve stated before in a previous posting, if a drug is developed for a specific use and later is found to address other issues, then amend the use and let people get relief. The classic example is anti-depression meds, widely used to treat consistent headaches. While I fully realize it is “not that simple”, I fail to understand why abusers and ner-do-wells can have an effect on available treatments for my ailments. Go after them, not us!

There, now my desk is momentarily clear. Makes me think something is terribly wrong as I can actually see the wood instead of stacks of paper. Wait! What’s that peeking out from under the keyboard? Drat! It’s a notice from my insurance company it’s denying payment for my last pain doctor visit. Everything is normal….

Thought I’d give you all a good belly laugh as sometimes that’s the best way to perk up and forget your troubles and pain for at least a moment or two.  There will be no comments about pain or preaching about your responsibility in this article.  Just good, clean laughter.  The following story is absolutely true.  Wife and I still chuckle about it and hopefully you will too!

On our recent vacation, we took a train from London to the Cotswold area of western England with a plan to enjoy some of the Public Footpaths the area is famous for.  Unlike the USA, the United Kingdom is peppered with trails throughout the countryside that the public, as long as they stick to the posted path, are allowed to use.  The trails, or Public Footpaths as the British say, many times cut right through private property.  Sheep, cow and horse pastures are common.  There are companies you can hire to transport your luggage from town to town while you walk across the countryside.  We chose to base ourselves at a specific Bed & Breakfast as we only had two days to walk.

We got out to Moreton-in-Marsh about 11:30am on a Tuesday, walked over to the B&B, got all settled and wouldn’t you know it - as soon as we turned the corner into the High Street, there was a street market. I cried with fear, wife cried with happiness.  As many times as we’ve been to Moreton, we’ve never encountered the market.  Apparently, it takes place every Tuesday of the year, Christmas & New Years the only non-weather exceptions. We ate our lunch by visiting the street vendors which, just like in the USA, normally have the best hot dogs, etc.  Next, visited the Town Council’s office of tourism and obtained the appropriate footpath maps and guides and set off.  Now the funny bit - feel free to laugh at any time.

Being city folk born and bred, imagine our trepidation when the marked path took us through an occupied cow pasture.  That would rarely, if ever, happen in the USA because the landowner would be terrified of liability and litigation.  Since the map was very clear, and the gate to the pasture was clearly marked with a specific placard, we knew we were in the right spot.  Plus we could see the gate at the opposite end of the pasture just where the map said it would be.  Oh, “occupied” as in a herd of cows. Anyway, we figured if we kept to ourselves with no sudden moves or outbursts, the cows would ignore us.  Wrong.

The herd of approximately 50 cows was all the way across the field.  Of course, as soon as we got to the middle - between the two gates and therefore past the point of no return - the cows all of a sudden decided watching us wasn’t enough and decided to investigate “up close and personal”.  My genteel and formal upbringing forbids me from telling you what both wife and I said out loud when the situation dawned on us.  The herd surrounded us in a tight circle and just stood there, looking (or glaring) at us. Amazing how large a cow is when you are not safe in your car whizzing by at 55mph.  It was like a cartoon.  When we took a step forward, the whole herd would move a step in unison forward, sideways or back depending upon their position in the circle.  Again, being city folk, we had no idea of what proper cow pasture etiquette was.  So we just kept walking toward the gate which looked ever so small on the horizon.  And the cows kept moving (or is that moo-ving?) in unison.  As we approached the gate, which was an elevated “V” in the fence and an amusing story in its own right, the cows directly in front of us parted just enough so we could access the crossing.  Apparently they had messed with tourists before!   When safely on the other side (we hadn’t realized we were in yet another occupied cow pasture), we turned to get a photograph and all the cows were pressed up against the fence with a look in their eyes such as “Hey! Where ya goin’?”

When we got back to Moreton-in-Marsh, we got a table in the local pub next to the fire and laughed and laughed.  Then I told wife that, as hard as we were laughing, imagine how hard the farmer and his wife were laughing as they watched the two city tourists from their kitchen with binoculars.  Wife snorted Diet Coke out her nose.  I managed to savor every last drop of my pint of Guinness.  The next day, we took the local bus to the picturesque town of Bourton-on-the-Water and did a five mile loop with much the same experience.

In all seriousness, we had such a good time walking the Public Footpaths, we plan on doing it again.  With all the guffawing and belly-laughs we did, we temporarily forgot all our 55+ years of aches and pains, all the worries at home, all the pressures of whatever and simply rejoiced in life.  Are you laughing at/with us?  GOOD!

So there I was, riding the Piccadilly branch of the London Undergound when I spotted a short article in the METRO newspaper entitled “Tune In”.  The first sentence is what caught my eye: “Listening to music can reduce chronic pain and depression by up to 25 percent, according to new research”.  It goes on to say there were tests done by having people listen to an hour’s worth of music every day and attributed the info to the Journal of Advanced Nursing.  The test subjects, as a whole, reported improved physical and psychological symptoms.  Amazing what you can learn on the Tube, or any other public transit system, eh?!

As I thought about my own experiences over the years - OK, decades - I half agreed and half disagreed with the article.  Then I narrowed it down further to what type of chronic pain I was challenged with at the moment.  For my headache, neither Bach, Strauss or Mozart would do any better for me than acid rock.  When it’s headache time it is “leave me alone” and turn out the lights.  Arthritis (primarily hands and neck) is a different story.  When I am sitting in my overstuffed leather chair listening to my favorite music of the moment, I get lost in the sounds and temporarily forget about my discomfort.  When the music is done, I may feel “better” enough to tackle the lawn mowing or my household chore of the week.

So there it is, then.  Next time your significant other glares at you with that “you’re lazy, bone-idle and a couch potato” accusatory laser stare, you can reply that you have engaged in a published method of physical recuperation that will allow you to actually “think” about doing the chores.  Nobody said it was scientifically proven, but it was published!