Can I just jump in again? I went to a "lunch and learn" program last month about diabetes. The Dr. stressed that he urged his patients to start taking medication right away. He said some would say that they wanted to give diet and exercise a try first. He said that 95 % of them came back 6 months later without having lost any weight or done any exercise. And they had gone for 6 months with no medication. Some people will make an effort, of course. And if you are really willing to make drastic changes, please just let the Dr. know that you are serious. Usually it's not that they want to push meds. it's just that they know that most people say they will take preventive measures and they really won't.

Not taking up for the Doc's here. Nurses are the most non-compliant people I know. But I usually know when to try to self medicate and when not to. I TELL my Dr. that i'm not going to take a medication, not leaving him thinking that I'm going to. He needs to know this.

I stress again, if your Dr. is not willing to talk to you and work with you, find one who will

This is, IMO, an excellent point. If you're a doctor, and you know that, really, less than 5% of your patients will actually follow through with lifestyle changes, wouldn't providing the majority of your patients the best care pretty much dictate that you medicate first, and allow individual exceptions to fight you on the meds if they so choose?

Thanks~ I've actually been reading quite a bit in preparation for my appointment this afternoon. I'm pretty sure my doctor will be on my side.

ETA: I should add that my "low fat" diet means I don't eat high levels of saturated fat. I've also come to the conclusion that eating a particularly fatty meal (like fried chicken) will cause me intestinal distress, so I don't eat fried foods either. I still eat 20-25% of fat per day, but from more healthy choices.

I think that at least in the US, there's often a tendency for all-or-nothing mentality. Either you trust everything your doctor says, or you reject the health care system entirely. I think both extremes are short-sighted.

As I said in the health care thread, I was raised in an era when you trusted your doctor completely and complied without question. I was put on 800 calorie diets several times before age 13, and at 13, given amphetemine diet pills. The doctor and my mother, were trying to help. The pills weren't the first thing the doctor tried, they'd been trying to help me get the weight off since I was 5 years old. I was in Weight Watcher's with my mom at 8.

I don't have any anger for the doctor. In fact, he was one of the best doctors on the planet. Once, after a car accident, in which my car was totalled, I was living with my parents, but no one was home to come and get me - my doctor drove me home (without asking directions) - he knew the way because he had made housecalls when family members were sick. This was around 1992, long after most doctors had given up the practice (or started charging an arm and a leg for it).

Health care is as much an art as a science. Doctors are working with people who aren't always open, honest, or skilled at communicating the problem (they forget or are embarassed to mention "some" symptoms, and may take vitamins, herbs and medications they aren't telling the doctor they are taking, and may be refusing to use medication they are prescribed - but not telling the doctor that). Doctors are also working under a health care system, especially if they're working under an HMO, in which they're allowed only a few minutes with each patient, they're also working with their own prejudices, and their own limited educations. They are taught a lot, but there's a lot that they're not taught as well. It's often been said that nutrition and dietetics are not required fields of study. I find that surprising, but if it's true, you can't expect a doctor to know what they haven't studied. If you need diet advice, you need a dietitian, but insurance generally doesn't cover it, which is probably one of the reasons most doctors often don't even recommend it.

They're also working with the limits of being taught to look for horses, not zebras (the common causes for symptoms, not the rarer ones). I suffered for over 10 years with severe sinus and lung problems, constant sinus infections, susceptible to every cold and flu that came around, and every one turned into months of bronchitis and often pneumonia, causing scarring on my lungs. Rather than the unusual "zebras" of autoimmunie disease, unusually structured sinuses, a fungal growth in those sinuses, and a reaction to NSAIDS, my sinus and lung problems were blamed on the "horse" of my obesity.

It took an unusual doctor who said, "I think more than just your weight is at work here," to do the tests that found the sinus "archetectural problem." That solved the sinus problems. And an accident (my running out of money before I could refil my NSAID) that I found they were causing my asthma symptoms.

By getting rid of relafen (a prescription NSAID like ibuprofen), I was able to also stop taking three other asthma medications, and reduce my allergy medication to as needed a couple times a year, instead of all-year round.

The difference was so dramatic without the relafen, that I started looking on-line and found that NSAIDs often cause asthma symptoms. I wasn't due to see my doctor for another six weeks, so I decided on a little experiement, and two weeks after I was off the NSAIDS, I stopped taking my asthma meds, except the rescue inhaler.

Without the relafen, my joints hurt really badly, so I looked online and found a few studies on fish oil supplements allowing some people with arthritis to reduce or even eliminate their NSAID use, so I figured if I couldn't use NSAIDs I'd add the fishoil.

By the time I'd seen the doctor 6 weeks later, I'd used the rescue inhaler twice (and have used it once since, shortly after). I told my doctor what I'd discovered. He wasn't surprised that the NSAID was causing the asthma (which did surprise me, why hadn't any doctor at least suggested the possibility?). My doctor told me that I could experience the same reaction with any NSAID or aspirin, so he didn't have anything better to recommend than the fish oil.

I can't condemn the health care system, because even though some important things were missed, without it, I wouldn't have been in any better shape. I wouldn't have gotten the surgery I needed, and I would have been taking an OTC NSAID, and probably wouldn't have discovered the NSAID/asthma connection, because ibuprofen and naproxen are cheap.

I think that to get the best care, a patient has to remember that they are shopping for a service. If they don't get the service they expect, they may need to shop around. If a doctor doesn't pay attention to what you say, or dismisses your concerns, or rubs you the wrong way in any respect, you need to find a doctor that you feel you can trust. Just like when you hire another professional, like a contractor - you don't need to know his job, but you do need to recognize the signs of a "bad one." If a doctor doesn't seem to be listening to what you say, find a new one.

Kaplods - I used to have a paramedic instrucdtor who was always telling us "when you hear hoofbeats, don't look for zebras" when assessing patients. Same thing. Look for the most obvious cause (which in emergency care, esp from trauma, is good advice)

Like you my DH had a lot of symptoms and spent about 4 months trying to find relief for his back pain. After he'd been through PT, massage therapy and some accupuncture, holistic and just-plain-strange alternative medicince places, he finally found an orthopedic guy who went beyond the normal x-ray (after of course, hearing about all the things DH had already tried) and an MRI showed huge amounts of damage which considering that DH had not suffered any recent trauma, led him to send DH to an oncologist, and from that point we were caught up in the cancer nightmare for the next 18 months. And that's an area where you want to read, and read, and talk to specialists, and support groups, and online chat groups, etc. We learned very quickly to be proactive and insistent on what we would do and what we would not. It all turned out well in the end - he's been in remission for 8 years after a stem-cell transplant - but it consumed our life for more than 2 years.

That being said, I have to say that there are some conditions that absolutely require medication. A person who was diagnosed with Type I diabetes would not get better with insulin. As someone who has high cholesterol, and who truly did try to lower it with diet/exercise, I found that while it went down some, it was still high, and medication is what keeps it low for me. I still use diet and exercise to keep the amount of meds I take low. (My sister, otoh figures the meds let her eat whatever she wants. She takes a higher dose.) I guess I'm a middle of the road person. I don't take antibiotics at the drop of a hat; I look for other solutions for problems before I jump at drugs. As with any issue, I have a problem with a total black/white approach. There are various shades of gray to most issues. :)

One of the reasons I love the show "House," is because although it's severely dramatized (don't count on all of the medical "stuff" they say to be true), it's pure fantasy, but shows doctors "thinking outside the box."

Of course, any doctor acting like House, would be fired, if not jailed. And none of the diseases treated on the show would be accurately diagnosed within a week.

I don't blame my doctors for "thinking horses, not zebras," because it makes sense. 99% of the symptoms they see are due to a very common cause. To order expensive tests to rule out the very rare possibilities, isn't usually the right thing to do either.

I think if I had to do it all over again, I would have trusted MY instincts better. I suspected all along, that my weight wasn't the "whole story," but I had a hard time communicating that well to doctors. Even when I tried, I knew I sounded more like a person in denial, than someone with information the doctor could use.

I'd suspected for years that changing my birth control to eliminate periods would help my monthy food binges. But, when I suggested it, and doctors said "well, you could try it, but I advise against it, or don't think it would help," I dropped the matter instead of pushing. I suspected that their was something unusual going on with my sinuses, but when doctors said "weight loss will fix it, here's some medication that might help in the mean time," I didn't push it either.

It was only an ENT finding a hole in my nose that could only be explained by cocaine or other inhaled drugs, a flesh eating bacteria, or autoimmune disease (the first two ruled out), that really started the ball rolling in terms of anyone suspecting "zebras." To prepare for the first sinus surgery, I had to see a cardiologist for a heart murmur (probably nothing serious, but had to be checked out). The cardiologist took one look at me and said that he suspected I had sleep apnea, and ordered a sleep study.

Suddenly the appearance of some of the "zebras," started adding up, and confirming that many of my "suspicions," had a basis in fact (and not just fat). So, I became a lot more active in my health care. A symptom diary was very helpful, and I took it to appointment and showed doctors the symptom diary. When I had questions, I wrote them down, and brought them to my doctor.

There were a few doctors who I could tell were rolling their eyes (oh no a patient who thinks she knows something about medicine), but most doctors were fairly open and even relieved to have a patient who had self-educated.

I did notice a regional difference (or I just had a tremendous bit of luck, or maybe just my being much more informed by the time we moved), but since moving to Wisconsin, I've had only one bad experience with a doctor - and he was one who had just moved to the area. The three doctors I have to see regularly (two specialists and my family doctor) are tremendous. They're not afraid to discuss my weight, but don't attribute everything sniffle to my weight either. They're willing to discuss what is helping and what isn't, and listen to my opinion and answer my questions, no matter how unrelated it might seem to them.

I think because of doctors having to deal with common ailments far more often than unusual ones, they're more likely to find the unusual ones when a patient speaks up. They may order the tests just to placate the patient, but as a result they find the right diagnoses. If a person never complains or never questions the advice, or stops complaining because it never gets any results, there's less likelihood for the "zebra" ever to be diagnosed.

Good medicine really only occurs when the doctor and the patient are doing their job.

I have had some very negative experiences with doctors in the past few years as I struggled to get a diagnosis of what was wrong with me. However, the doctor I have now is great, and 90% of the time I trust her and think her suggestions are good. Of course there are times we disagree, but overall I am far happier with her than I have been with my previous doctors.

Over the past four years, I have been to 4 GPs, 3 orthopedic surgeons, 5 occupational therapists, 3 physical therapists, 3 dermatologists, 1 rheumatologist, and 1 OB/GYN. The people I have been the LEAST satisfied with were the orthopedic surgeons and GP #2 and #3. Oh, and physical therapist #3. Not all of these were related to trying to solve my health problem, but I ended up having a frightening variety of treatments for conditions that I didn't really have. In the end I insisted on a thyroid test from a doctor and finally got my diagnosis, which none of them had even considered.

The worst part was doctors basically telling me that my condition was "minor" or otherwise implying that I was exaggerating my symptoms or making up symptoms. One orthopedic surgeon actually performed surgery on me, then when it didn't fix the problem threw up his hands and said, "What do you want me to do?" and when I got upset, responded with "It's not like you have metastatic breast cancer, this is such a minor thing." Arrrrgh.

Okay, enough complaining about my doctors. My point is that there are a lot of bad doctors out there -- it's the old joke: "What do you call the person who finished last in med school?" "Doctor." There are also a lot of great doctors out there, if you are lucky enough to find them. You can check your doctor's credentials often through your insurance company, and it is good to go and have a first appointment where you are basically interviewing your doctor. If you don't like the way they treat you, go to somebody else.

It's really frustrating to keep going to somebody else for years on end, but eventually you will find someone who is a good doctor for you.

Since I just moved and need to get a new doctor, I'm curious if anyone has interviewed a doctor before choosing him or her as a primary care physician? If so, how does that work? I don't know any of the doctors on the insurance list so I'd just be choosing by name and distance from my home, which is not the best way to choose a doctor. Any suggestions?

Oy, House is terrible. It's not just the bedside manner, it's the shotgun medicine. And it's not just the dollar cost of unreasonable tests (firing a shotgun of tests instead of taking the time to aim well), which are considerable. Those tests have all sorts of risks, both physical risks, and the risks of the paths they lead you down. Because medical tests are based on statistics. Therefore, the more you do, the more false positives you get. Which lead to more tests. Not to mention the stress and emotional cost to the patient.

I just picked a new GP through trial and error. We don't get any insurance lists or anything here in Ontario so we have to either just go to the phone book or get a referral from a friend, relative, colleague, etc.

I "interviewed" 3 doctors and picked the one who seemed to be competent, a good listener, and who had hours I could fit my work schedule around (if I'm not out there working I'm not earning and I have no unemployment insurance or the like). He was referred to me by my dog walker colleagues.

I really don't know what I'd do in a new city if I didn't know anyone. Probably just take a stab and ask some people at my new job who they go to and whether they like them. Of course we are not limited to those doctors on an insurers list, as the Ontario goverment is our insurer.

Dagmar

Me too. It isn't just me or isolated doctors. I watch this show called *mystery diagnosis* where over and over again people go with symptoms and the doctor does no more than a cursory inspection and tells them to leave. Some with serious problems. There was a girl throwing up over and over again and when they couldn't find they problem they told her to leave the hospital. It was in her head. Hey guys there is a whole show about this on TLC.

Honestly if the stories were that the doctors were trying and just couldn't find the problem I would see it being *mystery diagnosis* but almost EVERY story is the doctor trying one or two *duh* things like acid reflux and then giving up and moving you out of the office.

This has been my experience. Last month I broke my toe and my Er doctor told me I couldn't work for a month. When I told her that was insane she acted like I was a *problem* patient. She scared me with bizzare stories of losing my foot because of toe dislocation -- didn't give me the x-rays and sent me packing with tape (and no gauze). When I called my primary care PA she told me that was irrational, like I was making it up, and then kept putting the diagnosis off on me. Like -- does it hurt; do you feel you can work? Finally after e-mailing my actual doctor like 5 times... my actual doctor re did the x-ray and told me the real scoop... stay off as best as you can for first two weeks and then as you feel you can for the remainder. Call if seems to be getting more doesn't get better.

If it was that much of a problem for a broken toe, I fear something worse.

This has really started a discussion, hasn't it? So interesting.

HOUSE: If I had to work for him i'd quit tomorrow. And the hospital would not allow him to practice. For one thing, they wouldn't be able to afford the liability insurance for the things he does. And really, what DR. has one patient? They are over worked, have a full patient load or they couldn't exist.
The tests he runs are expensive and often unnecessary. Inusrance wouldn't cover them. And not only does he have one patient, he has a group of doctors at his disposal all the time. Let me tell you, I spend lot of time trying to round up a Dr.

In the real life series, I know that incidences like this happen, but they are not the norm. Most of the people that come into ER are there for normal illinesses. And yes, ER dcotors are like all the others, some good, some bad. And Iknow it's frustrating to get a wrong diagnosis. But Dr.'s go by S/S and tests. They can't see inside your body.

I guess we're back to the old "go with your gut". Take care of yourself, be informed, and ask questions. Find a Dr. that you trust and don't try to second guess him.

I got my cholesterol test results back. The news is mixed but mostly good. The normal tests (total cholesterol, LDL, HDL and triglycerides) are all within normal limits (although they could be better). The advanced cardiac markers are really mixed. Some are good, some are borderline and three are at risk. Of the three at risk markers, two are particularly bad--Lipoprotein(a) and Fibrinogen. Basically these are hereditary and are a good indication that I will suffer some sort of cardiac trouble in my lifetime unless I can get them down.

My doctor sat with me for 45 minutes explaining all the tests and markers and what he wants me to do about it. In a nutshell this is it:
1--lose 15 pounds
2--rethink Dr. Gundry's diet (basically low carb)
3--increase my Omega 3 from 1 to 3 pills per day
4--take a CoQ10 supplement starting with 50 mg per day and eventually increase to 150 if I see no side effects
5--take a niacin supplement (but don't start that until I've been on the CoQ10 for a few weeks--need to be aware of any possible side effects)
6--increase my B6, B12 and folic acid supplements
7--make sure my regular vitamin contains chromium, selenium and magnesium (it does)
8--continue with my exercise (of course!)

So, I bought the supplements and started the CoQ10 and will start the niacin in a few weeks. I brought the diet book to work with me to re-evaluate it and start planning my menu and shopping list for the next few weeks.

Allison. sounds like you have things well in control. Good luck.