Chapter One: Getting to Know You Let's Discover the Juicy Secrets About the Person Who Controls Your Health: You
Most people think they communicate with their doctors just fine. Better than fine, in fact. Fantastic. Given that most of the communication consists of nodding or a request for antibiotics, there's little to find fault with. That's the problem, of course. Most patients don't do a great job of communicating with their doctors because patients often give us too little pertinent information to go on (remember, just like the detective, we're looking for the facts). At the same time, they may also give us too many distracting or off-topic details. It reminds us a little bit of what a mechanic must think when we try to explain a noise in our car. We're not sure when it started, we're not sure what makes it worse, we think it's a whining sound but aren't sure...We bet this becomes a tedious monologue for those earnest professionals trying to help us.
An almost identical conversation goes on in doctors' offices every day. To be accurate, the parallel exchanges often concern befuddled male patients. There's a reason that women aged thirty to sixty are the prime decision makers about health care in the United States. Most of the guys they love either have no clue about their health needs or wouldn't see a doctor unless they had blood shooting out of both ears.
The goal of this chapter is to make sure you know the details and numbers in your health profile that you really need to know -- those stats and specifics that are crucial to you and your doctor. We always see health books and well-intentioned magazine articles that tell you to compile so much stuff, we get winded just reading the list. The average person would have to take a week off from work and probably hire a bounty hunter to get everything recommended. You don't need to do that, but you do need to assemble a thorough health history so that you'll have a body of evidence to use when working with your doctor. A big part of being a Smart Patient is knowing how to compare new evidence (such as new test results) against the old. Like Sherlock Holmes, even though something may seem elementary to everyone else and not worth asking about, you need to press on with your questions and your investigation.
We'll make compiling your health history simple enough to do, but we won't oversimplify the tasks so you lose accuracy. It's a small time investment that could save your life, so get started right away.
You Love Us? Ditto
The first sign of a Smart Patient is that telltale document they produce during their first visit, or even their fiftieth. It's a portent of a beautiful partnership -- that is, when it's not a form they need signed for their job, or a note asking one of our office assistants about their dinner plans. If we're lucky, it'll be their health profile. It's the sign of a patient who means business, one who will challenge us to be at our absolute best and who won't waste time and money on redundant and unnecessary efforts (which can lead to errors). To create the perfect health profile, circa early twenty-first century, flip ahead to appendix 2, Sample Forms, and find the forms labeled Your Health Journal. Make copies of them, or rip them out if that's handier. The forms are also online at www.jcrinc.com and www.realage.com.
Fill them out.
Finished? Everything? You're done. That is, if you don't have any questions, and you're sure it's all correct. Just bring those forms to your doctor along with a baggie filled with every medication, vitamin, herb, or whatever else you take regularly (in their original bottles). Store copies of the forms in a fireproof safe, and update them yearly or whenever a piece of key info changes. Everyone's happy.
What's that? It wasn't that simple? You don't know all the info by heart or have it filed neatly in your credenza? Now, that's woefully human of you. If you're like most of our patients, you've never compiled your important health info before, and you may not have the foggiest notion of where to find much of it -- or even if it exists at all. Even with using the forms as guides, your records may be so scattered that you don't know where to start.
Let's take it from the beginning.
Start in Top Form
Fill out all the easy stuff on the forms labeled Your Health Journal, such as your birth date, address, your doctor's contact info, your pharmacy, your insurance info, and everything else listed. As you may suspect, this will be your master form, the one you perhaps store on your computer, and give out whenever necessary, including when you visit a new medical professional or step foot in a hospital. (Take at least two copies, and always give one to the admitting nurse who welcomes you to your bed.)
This form won't just make your life easier, it'll prevent a severe case of hand cramps from rewriting half of this info dozens of times in the future. And bypassing twenty occasions that require you to blearily check boxes before you've had your morning coffee (and having another fallible person decipher that scrawl) is a no-brainer way of reducing errors.
Under the section entitled Your Health Now, write down every significant ailment or condition that you have right now. This would be the place to list ongoing conditions such as diabetes, hypertension, psoriasis, depression, back pain, and the like. Don't include anything you had years ago but don't have now; that goes in a different place. Be certain to include anything that you're taking medication for, even if the specific symptoms are gone; for example, if you're controlling your high blood pressure with medication, list high blood pressure. Next to each condition, list when you were diagnosed, what medication you're taking for it, if any, and any other relevant info. If you're not sure if it's relevant, jot it down. That's why your doctor's office assistant has Wite-Out.
In addition to those mentioned above, here are a few more examples of conditions that are significant:
- Heart disease
- Heart murmur, or any other
- heart irregularity
- Multiple sclerosis
- Nerve paralysis
- Cancer of any form
- Gingivitis (gum or periodontal disease)
- Kleptomania (just making sure you're paying attention)
- Gulf War syndrome
- Alcohol or other addictions
- Sexual dysfunction
- Paraplegia or quadriplegia
- Sleep apnea
- Vision or hearing loss
- Parkinson's disease
- Liver disease
- Post-traumatic stress disorder
- Dementia or frequent memory loss (for example, can't recall name of close friend or relative)
- Multicythemia veragis (just kidding)
- Here are some that are probably not significant:
- Dental cavities
- Sore lower back after shoveling heavy snow
- Varicose veins
- Toenail fungus infection or athlete's foot
- Forgetfulness (for example, can't remember where keys are, or where you were when Luke and Laura married on General Hospital)
- Sunburn prone or can't tan
- Insomnia before job interviews or court sentencings
- Cat allergy
- C-SPAN addiction
- Turkey neck
- Repeatedly date or marry losers
Now list your past significant ailments and conditions in the next section, noting when you were diagnosed and what happened. Then list all the details about the medications you're taking (all pills or tablets or anything that you regularly ingest, inject, insert, or otherwise consume regularly, whether it's prescription or over-the-counter (OTC) drugs, herbal supplements, vitamins, etc.). We'll say this again, but in addition to having this form handy when you see your doctor (in your pocket or the office file cabinet), always bring the actual bottles of all those medicinal consumables, too. It's important.
Checklist: We Ask, You Answer
For any condition or ailment you include on your list that you're still dealing with, write down and be prepared to tell the doc the following:
- What caused this?
- When was it diagnosed?
- How are you treating it?
- Has it gotten better or worse?
- When did it first begin to noticeably improve or worsen?
- What makes it better?
- What makes it worse?
Don't Know Much about Genealogy
On pages 52 and 53, you'll also find the Smart Patient Family Tree. Flip to it and sharpen a pencil. This Smart Patient Family Tree is designed to bring joy (and longevity) to your life. The solid lines sprouting outward from you to your siblings, and downward to your parents, aunts and uncles, and grandparents represent blood-relative connections (not by marriage). You'll notice a dashed line going to your spouse, which represents a non-blood relationship. The reason you need to include your spouse is that he or she lives with you (at least we hope so). That means you share the same environmental exposures and, likely, similar risks. You serve as each other's personal coal-mine canary. One of you may get nauseous from the toxic waste buried under your house years before the other one. (Just kidding! You'd likely be afflicted simultaneously.) Also, even though you don't share DNA (at least not on most school nights, anyway), your spouse influences your health far more than your aunt Sadie in Perth Amboy. Auntie may have a cholesterol count that would bring a Guinness World Records rep to her door, but she isn't filling your day-to-day life with cigarette smoke, bacon, Pabst Blue Ribbon, and lost-sock arguments. The only thing worse for your health and longevity than having a spouse is not having one, in fact. No one likes being nagged, but being nagged into eating broccoli pays dividends.
Start filling out the Smart Patient Family Tree by adding your spouse's info, if you have one. You'll notice that the tree reaches only to your grandparents, not back to your Viking ancestors like some other family trees you may have seen. Why? Of course you recall the genetic Mendel grid from biology class, and how a fruit fly's ability to pass his tiny wings to his great-grandson was so genetically diluted, it was practically nil. Alas, the apple never falls far from the tree, but the fruit fly must at least be in the orchard -- that is, at least as genetically close as a grandparent -- before you go blaming him for any shortcomings.
Are there any exceptions? Sure. It's biology. None of us would be our particularly unique and endearing selves if not for a whole gang of exceptions. Include great-gramps and any other distant forebear if they had a disease or condition that is especially rare and deadly (even a small risk may warrant vigilance or gene testing). For example, Baron von Munchausen VI is still at extreme risk, but he knows that.
Thicken your family tree with all the info you know offhand. You want to record each relative's birth date and (if applicable) death date, the jobs they performed (as certain occupations can strongly affect health), and -- most important -- any diseases they had that may have a genetic link. Your doctor can clarify this if you aren't certain about the disease or if it was never diagnosed. Just list the symptoms the person had (memory loss, for example). While you're at it, you might as well jot down any other interesting tidbits in case the kids get curious about their roots one day. If you're like most people, it'll be about 14 percent complete when your brain is tapped. You'll need to do some investigating, Columbo style (Remember? Smart cop?), so see the checklist (on page 54) for the family interrogation protocol.
Test: Just How Likely Are You to Inherit This Relative's Condition?
To better assess your risk, answer these questions for each relative who has (or had) a disease that might be genetically transmissible to you:
Y / N Is this an immediate, full-blood relative? Circle yes if it is your mother or father or a sibling (if a stepsibling, circle no)
Y / N Did this relative get the disease with a suspected genetic link before age sixty-five?
Y / N Did this relative die from this disease before age sixty-five?
Y / N Was this disease likely caused by a genetic link, and not caused by environmental or lifestyle factors? (If the relative was a heavy smoker, a heavy drinker, or had a toxic or hazardous exposure at work, and these likely caused or contributed to the disease, circle no)
Y / N Is there at least one other blood relative who also has or had any of these same diseases?
Y / N Do you look like this relative, either inside or out? Meaning, do you have the same body type, same cholesterol problem, same bad temper, etc.?
If you circled one or two Ys, you may be at risk for inheriting this condition, so monitor it with your doctor. You circled three or more Ys? You're likely at very high risk of inheriting the disease, so keep a watchful eye on it.
Hopefully, you won't have to interrogate more than a handful of relatives in the above manner. If you hail from a litter of fourteen and have more aunts than a cartoon picnic, however, just remember to keep your radar sharp for two factors: serious illness or death before age sixty-five, and potentially fatal conditions. Either can be more important than how close you and your relative are in the bloodline. For example, your uncle's pancreatic cancer at age fifty-three would likely be more alarming to us than your mother's heart fibrillations at age seventy. At a bare minimum, you need to know why your parents and grandparents died, if they're now gone. And your bottom-line question to your doctor is always the same: If there's a genetic link associated with this condition, how can I prevent it?
Checklist: Gastritis, Aunt Gertrude?
Shaking down family for health details needn't always be a horribly awkward task. Remember that half will always talk about the other half, so go the gossip route if easier. If you want to be direct, just grab your reporter's pad and pen, dial the phone or meet the relative at the early-bird diner, and repeat this checklist (feel free to ad-lib). You might consider an opener like this:
"Hello, [relative]. I know you haven't heard from me since [year], but I'm putting my family health history together to see if I'm at risk for anything genetic, and I thought you could tell me a few things I just can't find anywhere else. [Another relative he or she dislikes] said you probably wouldn't help me or wouldn't be able to remember, but I thought I'd try anyway."
- When were you born? (Or "Who was the first president you remember?" if the relative won't say. If it's Franklin Delano Roosevelt, ask if he or she voted for him.)
- Have you been diagnosed with any diseases? When?
- What kind of treatment did you get?
- Any cancers? Diabetes? Heart problems? High blood pressure? Do you take any drugs (not those kind) or supplements? If so, why?
- Any surgeries? When, and for what?
- Ever have a bout of depression, anxiety, or other emotional health problems? (Ask relative this family member dislikes for immediate answer.)
- Any miscarriages, stillbirths, or infant deaths?
- Any heart attacks or strokes? (Pretend you suddenly remember and ask if the flowers made it.)
- How's your hearing? (Whispered.)
- Do you or did you smoke or drink?
- What jobs did you have?
- Still lead in the pencil?
- Has your memory deteriorated? Do you still remember my name?
- So, that thing growing on [another relative] -- is that skin cancer or what?
A Day in Your Life
Woke up, fell out of bed...
Dragged a comb across your head. Then you found your way downstairs and dra...all right, you get it. One of the most time-intensive but valuable parts of your health profile is to get a detailed description of your typical day. We start by asking what time you generally wake up in the morning (and how, whether you're roused by dawn's gentle light, a rooster, an amorous mate, a lapping cat, morning smoker's cough, and so on) and how refreshed you typically feel. Next we ask about morning chores, the length and stress of the work commute, the first task (or taskmaster) to greet you at the office, and the sordid toils and pleasures of the entire A.M. journey. Then we discuss your typical lunch. You can see why this takes a while. But it's valuable in getting a full picture of your life and an accurate depiction of the suspects and scenes that affect your health, as demonstrated in these illustrations. Hopefully, this home setting won't look too much like yours.
We Double Trouble
We know you bend the truth a little when telling us the good and bad you do to yourself. That's why we at least double, up or down, the most fudged claims. For example:
Patient Says -- We Hear
I have two drinks a day. I might drink a case a week.
I exercise about twice a week. I rarely exercise.
I smoke a few cigarettes a day. I'm a pack-a-day-er.
I smoked for five years. I smoked for ten years and off and on for a few more.
My job is stressful. This job's going to give me a coronary if I don't quit or learn how to deal with it.
I hardly ever have unsafe sex. I use condoms about half the time.
I get short of breath if I run. Five porch steps leave me gasping.
I eat about two hamburgers a week. I eat cheeseburgers most of the other days.
I forget to take my medication about once a week. I remember to take my medication about twice a week.
I'll follow up with you; I won't forget. I'll stop back in when the kids are grown.
The Adopted Plan
Logging your genetic propensities is enough of a job when you have your blood relatives close at hand or accessible in your address book. But what if you're adopted? Or if you've adopted a child? Thousands face this hurdle each year in compiling a health history. Luckily, it's becoming a bit less difficult to get the information you need.
There's a trend in domestic adoptions toward openness -- in other words, the adoptee, birth parent (one or both), and adoptive family all have a degree of contact with one another and share relevant information, including health histories. Recent laws have helped unseal files too. Of course, there are still many adoptees and adoptive parents who have no such contact or any records whatsoever, for a host of different reasons, and have come up empty even after checking with the adoption agency (always the first place to contact on this mission). In this case, they should contact their state Department of Health and Human Services to see if any birth records exist, and also examine the various registries that attempt to link birth families and adopted persons. A great all-around source is the government's National Adoption Information Clearinghouse Web site at naic.acf.hhs.gov. You can search by state for info and availability of records. Remember that there's no need for a tearful, emotional reunion if that's not wanted: these registries often connect adoptees and birth parents for the sole purpose of gathering health information.
What about international adoptions? Some countries are just beginning to open their records, and the adoption agency and country consulate's office can be a starting point for investigation.
A Ghoulish Notion?
If your parents will consent to it, consider having an autopsy performed on them when they die. Few autopsies are done today as compared with decades ago, as it's rarely thought necessary when a cause of death is clear, such as a heart attack. But there's much value in knowing if your eighty-two-year-old father had undiagnosed prostate cancer that had been advancing since his fifties, or heart disease, even though it was a stroke that did him in. This is especially useful if the death was due to an accident, of course. Reassure your living parent that this doesn't mean foul play is suspected, or that the body will be shipped to a CSI soundstage, or that there can't be an open casket.
Tip: Have a Tattle Plan
Bring your spouse to your doctor's appointment when you're giving your health history; there are a lot of questions that only he or she can answer (how many times an hour do you stop breathing while asleep?). But, please, before coming in to the office together, make sure you discuss which fibs you're going to tell the doctor. Why? Because when you tell us that you rarely tear into the Pringles after 8:00 P.M. or that you've been taking your cholesterol-lowering drugs with the discipline of a marine, your spouse will shoot you -- or us -- an involuntary look that communicates something close to Are you kidding me? We never miss it. And, hey, sometimes your spouse wants to blow your cover. It's called love -- why do you think she booked the appointment?
If you try to snow us, remember that we might try to trip you up by asking about specific dates. As in when you last did something. For example, we'll ask you if you're fit enough to climb three flights of stairs. You'll say yes, unless you're older than eighty-five or bedbound. Then we'll ask, "When was the last time you climbed three flights of stairs?" You'll think, and start to say, "Maybe a month, or..." and your spouse will shoot that never-fails look. The one that says, You haven't climbed three flights of stairs since we voted for Ike.
So please, rehearse beforehand.
Click Access to Your Health Info
There are several Web sites that allow you to store your health records online, so you, your doctor, or any person given permission can tap them on the Internet, from any location. Some are free, and others have monthly fees that range from $30 to $80. To check out a few examples, click into the Web sites at www.ihealthrecord.org, www.personalhealthkey.com, healthmanager.webmd.com, and the Joint Commission Resources' own www.jcrinc.com. We'll update this list at the personal-health site at www.realage.com. Each site has security safeguards to protect the confidentiality of your info. Aside from the convenience factor, using these sites could make it easier to you keep your files current, because you'll have a one-stop, central place to update your info.
Copyright © 2006 by Michael F. Roizen, M.D., and Oz Works LLC, f/s/o Mehmet C. Oz, M.D., and Joint Commission Resources