23.5.05

the good idea

My father's hands began to shake a number of years ago. [He attributes it to CO poisoning from his VW Beetle, which could be true given what CO does to the basal ganglia.] At first it was just a little tremor, a minor shaking in his hands. Over the past handful of years, the tremor has become more severe and much more noticeable. He has difficulty writing, and it's not just his hands now- His arms tremble constantly, even when he is at rest. He worries quietly sometimes that it will go beyond his arms.

The only other health problem Dad has is mild hypertension. About a year ago, he became dissatisfied with the medication he was on to control his blood pressure... Knowing that he planned to see his rather uncreative physician about some alternatives, I armed myself with information and sprung an "attack" on Dad.

Me: So you're going to see Dr. Doe about your BP, huh?
Dad: Mm-hm.
Me: Have you ever talked to him about your tremor?
Dad: Oh, sort of. He doesn't have much to say.
Me: Welll, as long as you're going in maybe you could show him this article from the NEJM. It's about treating essential tremor with propranolol, which also happens to be a BP med. Maybe you could kill two birds with one stone? Wouldn't that be cool, to actually do something about the tremor? Since you need a BP med anyway?

Dad was intrigued and hopeful at the idea, took the article to his doctor, and started taking generic propranolol. It helped lower his BP and also significantly improved the tremor. After a while, though, he noted that the benefits of the propranolol began to wear off as the day went on. His doctor shrugged it off... So I suggested before his next appointment that he ask about taking Inderal LA, which is a sustained release form of propranolol. So he asked, and Dr. Doe wrote a new prescription for Inderal LA.

The tremor is still there, and still bothersome, but the propranolol makes a noticeable difference. You might say it "takes the edge off" the tremor. [Obviously a tremor is minor in comparison to, say, a ballooning aneurysm- But it is an embarassing and frustrating ailment, too often trivialized by those who don't take the time to consider its far-reaching ramifications...]

Cool story, right? I am telling it not for my role in it, however, but because of a bigger issue- I often wonder what would happen to someone else in the same situation. What if a poor immigrant who spoke little English and had little medical knowledge had gone to Dr. Doe with the same problems as my father? Would the immigrant have received treatment for his tremor? Would my father, even, have gotten treatment had I not been involved?

Why wasn't my father's MD coming up with this idea himself? Why was he so willing to ignore a tremor when there are fairly safe, inexpensive ways of treating it? And then so complacent about his failure later.

How many patients, every day, are losing out simply because they don't know what to ask for?(NOT as in asking for a pill just because they saw the TV ad... which is another rant all by itself) Of course, the patient bears a responsibility to participate in their care, insofar as they are capable. It is the physician's responsibility to make up for the gap created by the differing capabilities of patients to participate in their own care. Why do they so frequently, as in my father's case, fall short? [My intent is not at all to villainize physicians- I owe my life to the medical profession- These are merely my thoughts, raw. I hope they come across as intended.]

One would like to think that all patients are treated equally, but in reality my father's story illustrates what I see as a looming cloud over the medical profession; a lack of quality-control, if you will. How do we remedy such a situation? Where are the legions of patients and doctors who should be willing to improve the situation, at a time when physicians seem to be a threatened breed? Perhaps if we could recognize and respect each others' roles, our healthcare system would not be nearing (or already in) crisis in so many ways.

i'll have to edit later... you know it's time to quit staring at the computer when your eyes start crossing from exhaustion.

4 Comments:

Blogger Dreaming again said...

Glad you could help your dad.

The tremor's are not comfortable. I'm only 40 and already have them. I pointed them out to my neuro. He shrugged them off 6 months ago, then noticed them himself (which got a smartelic remark from me, good thing we've been doc/patient for 13 years!)

I'm not ready to treat it medically ... I know the drugs, they're not good for my other health issues ... but ...if I didn't have MG & allergies ... I'd be demanding treatments, it is frustrating and somewhat embarrasing, not to mention, uncomfortable.

The gist of this posting though ..you're right ... somehow that gap has to be filled!

2:27 PM  
Blogger Dreaming again said...

Shrinkette tagged Blondzila and she tagged me ...so I'm tagging you and Dr. Chalres ...

Your turn

10 things I've never done!

http://pearlsanddreams.blogspot.com/2005/05/ive-been-tagged-10-things-ive-never.html

1:09 PM  
Blogger Keith, RN said...

You bring up some interesting points that I think about alot. I work for a very cutting-edge care management program in which my job as a nurse is to make sure that my 80 patients receive the care that they need and deserve. Many of my patients speak little or no English (I am almost bilingual--English/Spanish) and many have varying degrees of mental illness, histories of trauma, or cognitive disturbances. Most of my charges are Puerto Rican, medically disabled, and unable to comfortably navigate the medical system. I can accompany them to appointments, grease the wheels between providers, and facilitate things happening which, for many patients, might just fall through the cracks. We now have a pilot doing the same for over-65's, something that is being floated by the Feds as a broader model of care for disabled seniors.

That said, what happens to the people who don't have such care? How many things fall through the cracks? How many people wish they had a nurse like me to go to bat for them? It is a sad state of affairs.

9:30 AM  
Anonymous Eliza said...

Such important points, and ones I think about a lot. As awful as many of my medical experiences have been, it scares me to think about how much worse it could have been if I *didn't* have the ability or means to research and advocate for myself.

At the same time, I often find that that requires some tightrope walking: I've also had way too many doctors who were dismissive of my own questions about potential medications or treatments that playing dumb often seems the easier route. It does make me wonder how all of these problems with patients' coming in and demanding meds they've seen advertised are coming about, when I often come up upon such resistance to a question about a medication that I've actually *researched* and read journal articles about and such.

Like, I come in, all, "So I read this article in Impressive Academic Smart Doctor Journal about how Special Magic Pill can help Big Bad Symptom. Is that something that might be helpful and appropriate for me?" And the doctor's all, "Ha ha ha. That's not what it's for. Don't believe everything you read on the Internet." Uh. And yet, Joe Public can be all, "On the teevee, Bob Dole told me this medicine will help me. Can I have some?" "Yup, sure, absolutely; I'd be happy to prescribe that. Here, have some samples. Oooh, look at my free pens that have the drug's name on them. Pretty." It is a strange, strange world.

I'm glad your dad is at least getting a little relief.

3:15 PM  

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